Does avoidable mortality validly reflect health system quality? Avoidable deaths in West-Europe 2019
S Stolpe, K Kunde, HC Vollmar, B KowallAbstract
Background
Avoidable mortality is used to indicate health system quality. It relates to preventable or treatable causes of death (CoD) in people <75 years. In West-Europe, avoidable mortality differs strongly. In 2019, it was 149 per 100.000 inhabitants in the Netherlands (NL), 161 in Ireland (IR) and 188 in Germany (DE). As EU reports do not find greater shortcomings in health system performance in Germany, we explored whether other factors have impact on avoidable mortality. From the national mortality registries, we retrieved all underlying CoD (3-digit ICD10) by sex for deaths in ages 60-<75 years for 2019. We categorized CoD as preventable or treatable with the joint OECD/Eurostat list. We identified the most frequent CoDs responsible for 60% of all deaths. Prevalence trends for smoking, alcohol intake, hypertension and obesity by sex were retrieved from OECD for 2000-2019.
Results
In 2019, in ages 60-<74 years, 7499 deaths were registered in Ireland, 35,556 in the Netherlands, and 184,915 deaths in Germany. Among all deaths, 58% (NL), 64% (DE) and 67% (IR) were avoidable in men, and 62% (NL), 63% (DE) and 66% (IR) in women. Proportion of avoidable cardiovascular deaths differed: it was 14% (NL) compared to 21% (DE) and 23% (IR) in men, and 10% (NL) compared to 15% (DE, IR) in women. In men, in Germany, 5% of deaths were attributed to alcohol-related avoidable causes, compared to 1.6% in IR reporting similar alcohol consumption. Trends and risk factor burden could not fully explain the differences. Unknown causes -categorized as non-avoidable- accounted for 7% (women) and 9% (men) of all deaths in NL and DE but were rarely used in IR.
Conclusions
Avoidable mortality is based on death certificate information that is affected by national differences in certifying. Cross-country comparisons of avoidable mortality should be interpreted with caution. They are influenced not only by risk factor patterns and health care performance, but also by differences in CoD certification.