Amenable Mortality Among Older Brazilians: Evidence From the Brazilian Longitudinal Study of Aging (ELSI-Brazil)
James Macinko, Híram Beltrán-Sánchez, Flávia Cristina Drumond Andrade, Hisrael Passarelli-Araujo, Maria Fernanda Lima CostaBackground
Amenable mortality, deaths preventable through timely and effective healthcare, is a widely used indicator of health system performance, yet evidence is lacking on its individual-level determinants in Brazil.
Methods
We used data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil), a representative cohort of adults aged 50 and older. Deaths were classified as amenable using both the Brazilian and the Pan American Health Organization’s definitions. Semi-parametric competing risks regression modeled the hazard of amenable death while accounting for non-amenable death as a competing event and adjusting for covariates.
Results
Among 872 deaths during follow-up, 30% to 39% were classified as amenable, with rates ranging from 2.5 (50–59 yrs) to 32.3 (80+) per 1,000 person-years. Older age, male sex, unpartnered status, lower income, multi-morbidity, and tobacco use were associated with higher risk of amenable mortality.
Conclusions
Amenable mortality constitutes a substantial and inequitably distributed share of deaths among older Brazilians.