Amenable Deaths Research Articles

Self-assessed survival probability and supply of medical doctors

ABSTRACT Self-assessed survival probability is a variable crucially affecting subjective wellbeing and individual (consumption, saving, retirement) economic choices. Bridging a gap in the literature we investigate its determinants, finding a positive and significant effect of the density of physicians at national level. The impact is stronger in the subsamples of individuals declaring low self-assessed health status, limitations in daily activities, and shortage of money. Our findings are robust when we instrument our main variable of interest with the parliaments’ political orientation and their dispersion. We show that our empirical results find correspondence in a negative link between the density of medical doctors and amenable deaths as an ‘objective’ health outcome. Our rationale for the emerging relationship is that individuals take physicians’ density as a proxy of the health system’s quality. Our results provide support for the relevance of public policies that address the shortage of medical doctors among those who improve the quality of national health systems.

Avoidable mortality contributes to the European Union’s life expectancy and lifespan dispersion gaps

Abstract Background Mortality differences between established (EMS) and post-2004 European Union member states (NMS) remain large. Contributing to this gap are deaths avoidable through prevention (preventable mortality) or adequate medical treatment (treatable mortality). This study examined the potential of reduced avoidable, preventable, and treatable mortality to close life expectancy and lifespan dispersion gaps between EMS and NMS. Methods Death and population counts were extracted from the WHO Mortality Database to calculate age and cause-specific mortality rates for each EU member state for 2005-2014. Causes of death were categorised as avoidable, amenable, and preventable based on the OECD/Eurostat lists of preventable and treatable causes of death. The gaps in life expectancy at birth and life span dispersion between EMS and NMS were estimated where: 1) all amenable, preventable, and avoidable deaths were averted across the EU, and 2) NMS achieved the same level of avoidable mortality as EMS. Results Averting all avoidable deaths throughout the EU would reduce the life expectancy gap between EMS and NMS from 4.4 to 2.4 years for women and 7.4 to 3.3 years for men. The difference in lifespan dispersion would be reduced from 0.9 (favouring EMS) to 0.1 years (favouring NMS) in women and from 1.5 years to 0.3 years (favouring EMS) in men. Were NMS to achieve the avoidable mortality observed in EMS, the life expectancy gap between EMS and NMS would fall from 4.4 to 2.5 years for women and from 7.4 to 3 years for men, while the difference in lifespan dispersion would be reduced from 0.9 to 0.3 years in women and from 1.5 years to 0.3 years in men. Conclusions NMS achieving the avoidable mortality observed in EMS would have halved the life expectancy gap and almost eliminated the life span dispersion gap between EMS and NMS during 2005-2014. Effective exchange of best practices in prevention and treatment could transform mortality differences across the EU. Key messages • This is the first study to examine the potential of reduced avoidable, preventable, and treatable mortality to close the life expectancy and lifespan dispersion gaps between EMS and NMS. • Achieving the avoidable mortality observed in established EU member states in post-2004 EU member states would greatly reduce mortality differences across the EU.

Supply-side health policy: The impact of scope-of-practice laws on mortality

The increased use of nurse practitioners (NPs) and physician assistants/associates (PAs) to provide healthcare represents an important supply-side policy option to expand access to care. However, restrictive scope-of-practice laws limit their ability to deliver care. I examine the effect of relaxing these scope-of-practice laws on healthcare amenable deaths, which are sensitive to access to care. Analyzing deaths in the United States between 2005 and 2019, I find that relaxing NP scope-of-practice laws reduces healthcare amenable deaths by 12 per 100,000 individuals and that relaxing PA scope-of-practice laws reduces these deaths by 10 per 100,000, with larger reductions in rural areas.

The social value of health: A frontier analysis of life expectancy gaps across 33 European countries

We estimate the life expectancy gaps that can be bridged by improving the quality of public health and health care policies at the country level. Our model calculates the net effect of amenable deaths on life expectancy after controlling for time effects and factors affecting amenable deaths related to education, health policies (health expenditure to GDP and waiting lists), and per capita income in a two equation system. We further estimate the life expectancy gap that countries with lower quality health systems can bridge by catching up and reaching the existing health quality frontier and compute the social value of that upside potential.

Association between enrolment with a Primary Health Care provider and amenable mortality: A national population-based analysis in Aotearoa New Zealand.

In Aotearoa New Zealand, being enrolled with a Primary Health Care (PHC) provider furnishes opportunities for lower cost access to PHC, preventative care and secondary health care services, and provides better continuity of care. We examine the characteristics of populations not enrolled, and whether enrolment is associated with amenable mortality. We retrieved records of all deaths registered 2008 to 2017 in Aotearoa New Zealand, which included demographic and primary cause of death information. Deaths were classified as premature (aged under 75 years) or not, and amenable to health care intervention or not. The Primary Health Organisation (PHO) Enrolment Collection dataset provided the PHC enrolment status. Logistic regression was used to estimate the risk of amenable deaths by PHO enrolment status, adjusted for the effects of age, sex, ethnicity and deprivation. A total of 308,628 mortality records were available. Of these, 38.2% were premature deaths, and among them 47.8% were amenable deaths. Cardiovascular diseases made up almost half of the amenable deaths. Males, youths aged 15-24 years, Pacific peoples, Māori and those living in the most socio-economically deprived areas demonstrated a higher risk of amenable mortality compared to their respective reference category. One in twenty (4.3%) people who had died had no active enrolment status in any of the calendar years in the study. The adjusted odds of amenable mortality among those not enrolled in a PHO was 39% higher than those enrolled [Odds Ratio = 1.39, 95% Confidence Interval 1.30-1.47]. Being enrolled in a PHC system is associated with a lower level of amenable mortality. Given demonstrated inequities in enrolment levels across age and ethnic groups, efforts to improve this could have significant benefits on health equity.

Amenable deaths among adults with intellectual and developmental disabilities including Down syndrome: An Ontario population-based cohort study.

Rates of death and avoidable deaths are reportedly higher among people with intellectual and developmental disabilities. This study contributes to our understanding of how mortality and intellectual and development disabilities are associated. General population and intellectual and developmental disabilities adult cohorts were defined using linked administrative data. All-cause and amenable deaths between 2010 and 2015 were reported for these cohorts and subcohorts with and without Down syndrome. Cox proportional hazards models evaluated the impact of potential contributors to amenable deaths. Adults with intellectual and developmental disabilities had higher all-cause (6.1 vs. 1.6%) and amenable death percentages (21.4 vs. 14.1%) than general population comparators. Within intellectual and developmental disabilities, those with Down syndrome had higher all-cause (12.0 vs. 6.0%) but lower amenable death percentages (19.2 vs. 21.8%) than those without. Results suggest that interventions to reduce amenable deaths target provider-care-recipient interactions and coordination across care and support sectors.

The Social Value of Health: Amenable Deaths and Estimated the Gap with the Life Expectancy Frontier

The Social Value of Health: Amenable Deaths and Estimated the Gap with the Life Expectancy Frontier

Trends of amenable deaths due to healthcare within the European Union countries. Exploring the association with the economic crisis and education

The study of premature deaths from causes that are generally preventable given the current availability of healthcare – called amenable deaths due to healthcare – provides information on the quality of services. However, they are not only impacted by healthcare characteristics: other factors are also likely to influence. Therefore, identifying the association between amenable deaths due to healthcare and health determinants, such as education, might be the key to preventing these deaths in the future. Still unclear however, is how this works and how amenable deaths due to healthcare are distributed and evolve within the European Union (EU) below the national level. We therefore studied the geographical and temporal patterns of amenable deaths due to healthcare in the 259 EU regions from 1999 to 2016, including the 2007–2008 financial crisis and the post-2008 economic downturn, and identified whether any association with education exists.A cross-sectional ecological study was carried out. Using a hierarchical Bayesian model, we estimated the average smoothed Standardized Mortality Ratios (sSMR). A regression model was also applied to measure the relative risks (RR) at 95% credible intervals for cause-specific mortality association with education.Results show that amenable deaths due to healthcare decreased globally. Nevertheless, the decrease is not the same across all regions, and inequalities within countries do persist, with lower mortality ratios seen in regions from Central European countries and higher mortality ratios in regions from Eastern European countries. Also, the evolution trend reveals that after the financial crisis, the number of these deaths increased in regions across almost all EU countries. Moreover, educational disparities in mortality emerged, and a statistical association was found between amenable deaths due to healthcare and early exit from education and training.These results confirm that identifying and understanding the background of regional differences may lead to a better understanding of the amenable deaths due to healthcare and allow for the application of more effective policies.

Socio-economic inequalities in rates of amenable mortality in Scotland: Analyses of the fundamental causes using the Scottish Longitudinal Study, 1991-2010.

Socio-economic inequalities in amenable mortality rates are increasing across Europe, which is an affront to universal healthcare systems where the numbers of, and inequalities in, amenable deaths should be minimal and declining over time. However, the fundamental causes theory proposes that inequalities in health will be largest across preventable causes, where unequally distributed resources can be used to gain an advantage. Information on individual-level inequalities that may better reflect the fundamental causes remains limited. We used the Scottish Longitudinal Study, with follow-up to 2010 to examine trends in amenable mortality by a range of socioeconomic position measures. Large inequalities were found for all measures of socioeconomic position and were lowest for educational attainment, higher for social class and highest for social connection. To reduce inequalities, amenable mortality needs to be interpreted both as an indicator of healthcare quality and as a reflection of the unequal distribution of socio-economic resources.

The Contribution of Avoidable Mortality to the Life Expectancy Gains in Korea between 1998 and 2017.

This study evaluated the contribution of avoidable causes of death to gains in life expectancy between 1998 and 2017 in Korea. This is a multi-year, cross-sectional study using national data. Death certificate data from 1998 to 2017 were obtained from Statistics Korea. The difference in life expectancy between 1998 and 2017 by age and cause of death were decomposed using Arriaga’s method. Life expectancy rose 7.73 years over 20 years in Korea, which was largely (more than 50%) due to changes in avoidable causes of death. As age increased, the contribution to changes in life expectancy increased, and the gain in life expectancy due to avoidable causes also tended to increase. The major factors that drove that gain in life expectancy were avoidable causes such as cerebrovascular diseases and traffic accidents. The gain in life expectancy from preventable diseases was greater in men than in women. The results of this study indicate that active public health programs have been effective in improving life expectancy in Korea. Moreover, avoidable mortality could be further improved with good public health policy. Health policy aimed at reducing amenable and preventable deaths should be further implemented to promote population health.

Rates and causes of mortality among children and young people with and without intellectual disabilities in Scotland: a record linkage cohort study of 796 190 school children

ObjectivesTo investigate mortality rates and causes in children and young people with intellectual disabilities.DesignRetrospective cohort; individual record linkage between Scotland’s annual pupil census and National Records of Scotland death register.SettingGeneral...

The Opioid Epidemic Blunted the Mortality Benefit of Medicaid Expansion.

Although the Affordable Care Act's Medicaid expansion reduced uninsurance, less is known about its impact on mortality, especially in the context of the opioid epidemic. We conducted a difference-in-differences study comparing trends in mortality between expansion and nonexpansion states from 2011 to 2016 using the Centers for Disease Control and Prevention mortality data. We analyzed all-cause deaths, health care amenable deaths, drug overdose deaths, and deaths from causes other than drug overdose among adults aged 20 to 64 years. Medicaid expansion was associated with a 2.7% reduction (p = .020) in health care amenable mortality, and a 1.9% reduction (p = .042) in mortality not due to drug overdose. However, the expansion was not associated with any change in all-cause mortality (0.2% reduction, p = .84). In addition, drug overdose deaths rose more sharply in expansion versus nonexpansion states. The absence of all-cause mortality reduction until drug overdose deaths were excluded indicate that the opioid epidemic had a mitigating impact on any potential lives saved by Medicaid expansion.

Rates, causes, place and predictors of mortality in adults with intellectual disabilities with and without Down syndrome: cohort study with record linkage

ObjectivesTo investigate mortality in adults with intellectual disabilities: rates, causes, place, demographic and clinical predictors.DesignCohort study with record linkage to death data.SettingGeneral community.Participants961/1023 (94%) adults (16–83 years; mean=44.1 years; 54.6%...

Trends and inequities in amenable mortality between 1997 and 2012 in South Africa.

Amenable mortality comprises causes of death that should not occur with timely and effective healthcare. It is commonly used to assess healthcare performance. It could also be used to assess the effectiveness of the pending National Health Insurance (NHI) in South Africa (SA), but to do this, the level and distribution of amenable mortality are required using a local list of amenable causes. To establish an amenable cause-of-death list appropriate for SA and to determine the levels, trends, geographical distribution, population group differences and international comparisons of mortality amenable to healthcare. A local list of amenable causes of death was developed with input from public health and disease-specific medical experts. The Second SA National Burden of Disease estimates were reclassified into amenable mortality. Analyses of age-standardised death rates (ASDRs) and amenable mortality proportions were conducted by province and population group between 1997 and 2012. Excess mortality in relation to the best- performing province and population group was also analysed. ASDRs for SA were compared with those of European Union (EU) and Organisation for Economic Co-operation and Development (OECD) countries. The local list of amenable conditions contained 45 causes of death. There were large disparities in amenable mortality between provinces and population groups, which did not attenuate over time. There was an average annual percentage increase in amenable ASDRs, but when HIV/AIDS was excluded from the analysis there was an average annual decrease of 1.12%. In the post-peak HIV/AIDS period between 2008 and 2012, an annual average of 207 810 amenable deaths could have been saved if all provinces had the same ASDR as the Western Cape. SA's ASDR was 2.6 and 2.2 times higher than that of the worst-performing EU and OECD country, respectively. This is the first study known to the authors that has established a local amenable mortality list and described the epidemiology of amenable mortality in SA. Amenable mortality could be used as an indicator of the performance of the pending NHI over time and, in combination with other indicators, could identify areas of the health system that require improvement. Benchmarking could also quantify gaps in health system performance between geographical regions and indicate whether these are reduced with time.

Causes of death among homeless people: a population-based cross-sectional study of linked hospitalisation and mortality data in England.

Background: Homelessness has increased by 165% since 2010 in England, with evidence from many settings that those affected experience high levels of mortality. In this paper we examine the contribution of different causes of death to overall mortality in homeless people recently admitted to hospitals in England with specialist integrated homeless health and care (SIHHC) schemes. Methods: We undertook an analysis of linked hospital admission records and mortality data for people attending any one of 17 SIHHC schemes between 1st November 2013 and 30th November 2016. Our primary outcome was death, which we analysed in subgroups of 10th version international classification of disease (ICD-10) specific deaths; and deaths from amenable causes. We compared our results to a sample of people living in areas of high social deprivation (IMD5 group). Results: We collected data on 3,882 individual homeless hospital admissions that were linked to 600 deaths. The median age of death was 51.6 years (interquartile range 42.7-60.2) for SIHHC and 71.5 for the IMD5 (60.67-79.0). The top three underlying causes of death by ICD-10 chapter in the SIHHC group were external causes of death (21.7%; 130/600), cancer (19.0%; 114/600) and digestive disease (19.0%; 114/600). The percentage of deaths due to an amenable cause after age and sex weighting was 30.2% in the homeless SIHHC group (181/600) compared to 23.0% in the IMD5 group (578/2,512). Conclusion: Nearly one in three homeless deaths were due to causes amenable to timely and effective health care. The high burden of amenable deaths highlights the extreme health harms of homelessness and the need for greater emphasis on prevention of homelessness and early healthcare interventions.

Causes of death among homeless people: a population-based cross-sectional study of linked hospitalisation and mortality data in England.

Background: Homelessness has increased by 165% since 2010 in England, with evidence from many settings that those affected experience high levels of mortality. In this paper we examine the contribution of different causes of death to overall mortality in homeless people recently admitted to hospitals in England with specialist integrated homeless health and care (SIHHC) schemes. Methods: We undertook an analysis of linked hospital admission records and mortality data for people attending any one of 17 SIHHC schemes between 1st November 2013 and 30th November 2016. Our primary outcome was death, which we analysed in subgroups of 10th version international classification of disease (ICD-10) specific deaths; and deaths from amenable causes. We compared our results to a sample of people living in areas of high social deprivation (IMD5 group). Results: We collected data on 3,882 individual homeless hospital admissions that were linked to 600 deaths. The median age of death was 51.6 years (interquartile range 42.7-60.2) for SIHHC and 71.5 for the IMD5 (60.67-79.0). The top three underlying causes of death by ICD-10 chapter in the SIHHC group were external causes of death (21.7%; 130/600), cancer (19.0%; 114/600) and digestive disease (19.0%; 114/600). The percentage of deaths due to an amenable cause after age and sex weighting was 30.2% in the homeless SIHHC group (181/600) compared to 23.0% in the IMD5 group (578/2,512). Conclusion: Nearly one in three homeless deaths were due to causes amenable to timely and effective health care. The high burden of amenable deaths highlights the extreme health harms of homelessness and the need for greater emphasis on prevention of homelessness and early healthcare interventions.

Population risk and burden of health behavioral–related all-cause, premature, and amenable deaths in Ontario, Canada: Canadian Community Health Survey–linked mortality files

PurposeTo examine the association of all-cause and premature mortality with four modifiable lifestyle behaviors and quantify the burden of behavioral-related premature death in Ontario, Canada. MethodsWe analyzed a cohort of 149,262 adults in the 2000–2010 Canadian Community Health Surveys, linked to vital statistics data to ascertain deaths until December 31, 2015. The strength of the association between behaviors (smoking, body mass index, physical inactivity, and alcohol consumption) and all-cause and premature mortality was estimated using sex-specific Cox proportional hazards models. We estimated the proportion of deaths from causes amenable to the health system by behavior. ResultsAfter full adjustment, hazard ratios (95% confidence interval) for premature mortality were significantly increased for heavy smokers versus nonsmokers [males: 5.48 (4.55–6.60); females 4.45 (3.49–5.66)]; obese class III versus normal weight [males: 2.47 (1.76–3.48); females: 1.73 (1.29–2.31)]; and physically inactive versus active [males: 1.25 (1.07–1.45); females: 1.70 (1.41–2.04)]. In both sexes, a disproportionate burden of amenable deaths were experienced by heavy smokers, severely obese, physically inactive, and heavy drinkers. ConclusionsThe findings emphasize the importance of prevention to reduce the prevalence of risk behaviors that contribute to a large burden of premature deaths that are amenable to the health system.

Mortality due to low-quality health systems in the universal health coverage era: a systematic analysis of amenable deaths in 137 countries

SummaryBackgroundUniversal health coverage has been proposed as a strategy to improve health in low-income and middle-income countries (LMICs). However, this is contingent on the provision of good-quality health care. We estimate the excess mortality for conditions targeted in the Sustainable Development Goals (SDG) that are amenable to health care and the portion of this excess mortality due to poor-quality care in 137 LMICs, in which excess mortality refers to deaths that could have been averted in settings with strong health systems.MethodsUsing data from the 2016 Global Burden of Disease study, we calculated mortality amenable to personal health care for 61 SDG conditions by comparing case fatality between each LMIC with corresponding numbers from 23 high-income reference countries with strong health systems. We used data on health-care utilisation from population surveys to separately estimate the portion of amenable mortality attributable to non-utilisation of health care versus that attributable to receipt of poor-quality care.Findings15·6 million excess deaths from 61 conditions occurred in LMICs in 2016. After excluding deaths that could be prevented through public health measures, 8·6 million excess deaths were amenable to health care of which 5·0 million were estimated to be due to receipt of poor-quality care and 3·6 million were due to non-utilisation of health care. Poor quality of health care was a major driver of excess mortality across conditions, from cardiovascular disease and injuries to neonatal and communicable disorders.InterpretationUniversal health coverage for SDG conditions could avert 8·6 million deaths per year but only if expansion of service coverage is accompanied by investments into high-quality health systems.FundingBill & Melinda Gates Foundation.

The Economic Consequences Of Mortality Amenable To High-Quality Health Care In Low- And Middle-Income Countries.

We estimated deaths amenable to high-quality health care globally and then modeled the macroeconomic impact in low- and middle-income countries using two macroeconomic perspectives: a value-of-lost-output approach to project gross domestic product (GDP) losses annually for the period 2015-30, and a value-of-lost-welfare approach to estimate the present value of total economic welfare losses in 2015. We estimated that eight million amenable deaths occurred in 2015, 96percent of them in low- and middle-income countries. The value of lost output resulted in a projected cumulative loss of $11.2trillion in these countries during 2015-30, with a potential economic output loss of up to 2.6percent of GDP in low-income countries by 2030, compared to 0.9percent in upper-middle-income countries. The value-of-lost-welfare approach estimated welfare losses of $6.0trillion in 2015. Inadequate access to high-quality health care results in significant mortality and imposes a macroeconomic burden that is inequitably distributed, with the largest relative burden falling on low-income countries. Given that these deaths are unnecessary and the projected GDP losses are avoidable, there is a strong ethical and economic case for promoting high-quality health care as an essential component of universal health coverage.

Assessment of health care, hospital admissions, and mortality by ethnicity: population-based cohort study of health-system performance in Scotland

SummaryBackgroundEthnic minorities often experience barriers to health care. We studied six established quality indicators of health-system performance across ethnic groups in Scotland.MethodsIn this population-based cohort study, we linked ethnicity from Scotland's Census 2001 (April 29, 2001) to hospital admissions and mortality records, with follow-up until April 30, 2013. Indicators of health-system performance included amenable deaths (ie, deaths avertable by effective treatment), preventable deaths (ie, deaths avertable by public health policy), avoidable deaths (combined amenable and preventable deaths), avoidable hospital admissions, unplanned readmissions, and length of stay. We calculated rate ratios and odds ratios (with 95% CIs) using Poisson and logistic regression, which we multiplied by 100, adjusting first for age-related covariates and then for socioeconomic-related and birthplace-related covariates. The white Scottish population was the reference (rate ratio [RR] 100).FindingsThe results are based on 4·61 million people. During the 50·5 million person-years of study, 1·17 million avoidable hospital admissions, 587 740 unplanned readmissions, and 166 245 avoidable deaths occurred. South Asian groups had higher avoidable hospital admissions than the white Scottish group, with the highest reported RRs in Pakistani groups (RR 140·6 [95% CI 131·9–150·0] in men; RR 141·0 [129·0–154·1] in women). There was little variation between ethnic groups in length of stay or unplanned readmission. Preventable and amenable mortality were higher in the white Scottish group than several ethnic minorities including other white British, other white, Indian, and Chinese groups. Such differences were partly diminished by adjustment for socioeconomic status, whereas adjustment for country of birth had little additional effect.InterpretationThese data suggest concerns about the access to and quality of primary care to prevent avoidable hospital admissions, especially for south Asians. Relatively high preventable and amenable deaths in white Scottish people, compared with several ethnic minority populations, were unexpected. Future studies should both corroborate and examine explanations for these patterns. Studies using several indicators simultaneously are also required internationally.FundingChief Scientist's Office, Medical Research Council, NHS Research Scotland, Farr Institute.