Project Title:

Mortality amenable to health care intervention in Scotland

Project Number:

2015_001

Researchers:

Alastair Leyland (University of Glasgow)
Megan Yates (University of Glasgow)

Start Date:

6 July 2015

Summary:

Background

Premature deaths from selected causes which occur in the presence of timely and effective health care are considered to be amenable to medical intervention [1]. Rates of amenable deaths can be used to compare health systems within and between countries, as well as explore socio-economic gradients within selected populations over time.

A limited number of studies into amenable mortalities have focused on Scotland. In a comparison between the countries of the United Kingdom for 1990-1999 and 1999-2009, it was found that amenable mortality rates for both men and women in Scotland were the highest in 1990 (Men: Scotland: 238.6 per 100,000, Northern Ireland: 223/100,000, England and Wales: 187/100,000. Women: Scotland: 172.3/100,000, Northern Ireland: 165.5/100,000, England and Wales: 140/100,000). By 2009, rates in all countries, and for both sexes, had fallen, but Scotland remained the country with the largest rates (Men: 105.4/100,000, Women: 82.3/100,000) [2].

A similar project using SLS data found that between 1991 and 2008 43% of premature male deaths and 44% of premature female deaths were classed as being amenable to medical intervention. For this study, the follow-up period will increase to 2013.

A report detailing an initial analysis into the effect of deprivation of rates of amenable mortality in Scotland found that the rates were strongly correlated with deprivation; however, this relationship was not quantified [3]. Deprivation, in this case, was measured using area-based measures, rather than individual-level characteristics.

Various European studies into amenable mortality have made use of individual-level variables to investigate socio-economic gradients within the population. The variables include income [5], educational attainment [6], and living arrangement [7]. It is of interest to investigate whether similar relationships exist within a sample of the Scottish population.

Aims

This project aims to use all amenable deaths for SLS members enumerated at the 1991, 2001 and/or 2011 censuses as the study sample. Age standardised amenable mortality rates will be calculated using all SLS members as the population at risk, and the European Standard population. These will allow us to investigate the socio-economic patterning of amenable mortality in Scotland by individual characteristics such as education and occupational social class available from the SLS.

Specific questions of interest:

1. Do rates of amenable mortality vary over time by educational attainment?
2. Do rates of amenable mortality vary over time by occupational social class?
3. Do rates of amenable mortality vary over time by ethnicity?
4. Does living arrangement affect rates of amenable mortality?
5. How do each of these individual measures compare with an area based measure of deprivation (Carstairs score)?
6. Does the proportion of amenable deaths change over time?
7. Are gradients of amenable and non-amenable deaths similar over time?

References:

1. Nolte E, McKee M. Does health care save lives? Avoidable mortality revisited: The Nuffield Trust; 2004

2. Desai M, Nolte E, Karanikolos M, Khoshaba B, McKee M. Measuring NHS performance 1990-2009 using amenable mortality: Interpret with care. Journal of the Royal Society of Medicine. 2011;104(9):370-9

3. Grant I, Munoz-Arroyo R, Oduro S, Whyte B, Fischbacher C. Mortality amenable to health care in Scotland 1981-2004; 2006

4. Raab G, Boag C. P1-298 Trends in avoidable mortality in Scotland. Journal of Epidemiology and Community Health. 2011;65(Suppl 1):A149-A

5. McCallum AK, Manderbacka K, Arffman M, Leyland AH, Keskimäki I. Socioeconomic differences in mortality amenable to health care among Finnish adults 1992-2003: 12 year follow up using individual level linked population register data. BMC Health Services Research. 2013;13(1)

6. Stirbu I, Kunst AE, Bopp M, Leinsalu M, Regidor E, Esnaola S, et al. Educational inequalities in avoidable mortality in Europe. Journal of Epidemiology and Community Health. 2010;64(10):913-20

7. Manderbacka K, Peltonen R, Martikainen P. Amenable mortality by household income and living arrangements: A linked register-based study of Finnish men and women in 2000-2007. Journal of Epidemiology and Community Health. 2014

Related Outputs (viewable on CALLS Hub):

• 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 rates of amenable mortality in Scotland: Analyses of the fundamental causes using the Scottish Longitudinal Study, 1991–2010
• Inequalities in rates of amenable mortality by individual socioeconomic position in Scotland: analysis using Scottish Longitudinal Study 1991–2010
• Amenable mortality by individual measures of socioeconomic status
• Inequalities in rates of amenable mortality by individual socioeconomic position
• Inequalities in mortality amenable to healthcare intervention in Scotland