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Related Experiment Videos

Variations in 'avoidable' mortality: a reflection of variations in incidence?

H F Treurniet1, C W Looman, P J van der Maas

  • 1Erasmus University, Department of Public Health, Rotterdam, The Netherlands.

International Journal of Epidemiology
|May 26, 1999
PubMed
Summary

Regional variations in avoidable mortality are partly explained by disease incidence. Incidence-adjusted mortality rates may better reflect healthcare quality variations, but individual-level research is needed to pinpoint care deficiencies.

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Area of Science:

  • Public Health
  • Epidemiology
  • Health Services Research

Background:

  • Avoidable mortality variations may stem from healthcare quality or disease incidence/severity.
  • This study investigates the link between regional 'avoidable' mortality and disease incidence variations.
  • The role of in-hospital deaths in explaining incidence-adjusted mortality variations was also analyzed.

Purpose of the Study:

  • To assess the association between regional variations in 'avoidable' mortality and disease incidence.
  • To determine if in-hospital death proportions explain incidence-adjusted mortality variations for selected conditions.

Main Methods:

  • Log-linear regression calculated relative risks for mortality, incidence, and in-hospital mortality (1984-1994).
  • Linear regression examined relationships between mortality and incidence, and incidence-adjusted mortality and in-hospital mortality.

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Main Results:

  • Significant regional mortality variations existed for cervical cancer, testicular cancer, cerebrovascular disease, and others.
  • Incidence variations partially explained overall mortality differences, except for cervical cancer.
  • In-hospital mortality explained a significant portion of variance for cerebrovascular accidents (60.1%) and appendicitis (29.2%).

Conclusions:

  • Disease incidence data enhance 'avoidable' mortality studies.
  • Incidence-adjusted mortality rates are more sensitive to healthcare quality variations than crude rates.
  • Further individual-level research is necessary to identify healthcare delivery deficiencies.