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An analysis of practice-level mortality data to inform a health needs assessment
1University of Manchester School of Primary Care, Rusholme Health Centre. roger.webb@man.ac.uk
Insights
Practice-level mortality analysis offers valuable health needs assessment insights. Maintaining accurate death registers is crucial, even with potential small number issues in smaller practices.
Area of Science:
- Public Health
- Health Services Research
- Mortality Analysis
Background:
- Practice death registers are useful but their individual analysis is questioned post-Shipman case.
- The study addresses the need to re-evaluate practice-level mortality data for health needs assessment.
Purpose of the Study:
- To assess the value of analyzing practice-level mortality data for informing health needs assessment.
- To compare mortality patterns between an inner-city practice and a reference practice.
Main Methods:
- Comparative analysis of premature deaths (aged 1-74) between two large practices (1994-1998).
- Calculation of cause-specific standardized mortality ratios (SMRs) and years of life lost (YLL) up to age 75.
- Standardized proportional mortality methods used to compare YLL associated with alcoholism, drug dependency, and severe mental illness.
Main Results:
- The study practice showed significantly raised SMRs for lung cancer (234), digestive diseases (362), and injuries (180).
- The study practice had nearly four times more YLLs due to alcoholism and over three times more due to drug dependency compared to the reference practice, after age standardization.
Conclusions:
- Mortality analyses provide useful insights for individual practice needs assessment.
- While small number issues exist for smaller practices, data collation at a higher level (PCG/T) is also valuable.
- Accurate and complete death registers are essential for practices.
Background:
The utility of practice death registers has been indicated but, in the wake of the recent Harold Shipman case in the United Kingdom, the value of individual practice-level analysis has been questioned.
Aim:
To assess the value of analysing practice-level mortality data to inform health needs assessment.
Design Of Study:
Comparative analyses of mortality.
Setting:
Two large practices, an inner-city study practice, and a reference practice in a medium-sized town.
Method:
All premature deaths (aged one to 74 years) during 1994-1998 at the study practice (n = 170), and reference practice (n = 340), were identified. Cause-specific standardised mortality ratios (SMRs) were calculated using national reference data. The proportions of the total number of years of life lost (YLL) up to age 75 years associated with alcoholism, drug dependency, and severe mental illness were calculated and a comparison between practices was made, using standardised proportional mortality methods.
Results:
Significantly raised SMRs for the study practice were lung cancer (SMR = 234), digestive system diseases (SMR = 362), and injuries and poisonings (SMR = 180). Having standardised for age, there were nearly four times as many YLLs in the study practice population associated with a history of alcoholism, and over three times as many associated with drug dependency, compared with the reference practice.
Conclusion:
Mortality analyses can provide useful insights for informing needs assessment in an individual practice. Small number problems may occur with smaller practice populations, but collation of data at PCG/T level also has potential utility. The study reinforces the argument that practices need to set up and maintain complete and accurate death registers.