Socioeconomic inequalities in mortality from conditions amenable to medical interventions : Do they reflect inequalities in access or quality of health care?
Plug, Iris (Erasmus Medical Center (Països Baixos))
Hoffmann, Rasmus (Erasmus Medical Center (Països Baixos))
Artnik, Barbara (Faculty of Medicine (Ljubljana, Eslovènia). Department of Public Health)
Bopp, Matthias (University of Zurich)
Borrell i Thió, Carme (Institut d'Investigació Biomèdica Sant Pau)
Costa, Giuseppe (University of Turin)
Deboosere, Patrick (Vrije Universiteit Brussel)
Esnaola, Santi (Gobierno del País Vasco. Departamento de Salud)
Kalediene, Ramune (Lithuanian University of Health Sciences)
Leinsalu, Mall (National Institute for Health Development (Estònia))
Lundberg, Olle (Centre for Health Equity Studies (Suècia))
Martikainen, Pekka (University of Helsinki (Finlàndia))
Regidor, Enrique (Universidad Complutense de Madrid)
Rychtarikova, Jitka (Charles University (Txèquia))
Strand, Björn Heine (Norwegian Institute of Public Health (Noruega))
Wojtyniak, Bogdan (National Institute of Public Health (Polònia))
Mackenbach, J.P (Erasmus Medical Center (Països Baixos))
Universitat Autònoma de Barcelona

Data:	2012
Resum:	Background: Previous studies have reported large socioeconomic inequalities in mortality from conditions amenable to medical intervention, but it is unclear whether these can be attributed to inequalities in access or quality of health care, or to confounding influences such as inequalities in background risk of diseases. We therefore studied whether inequalities in mortality from conditions amenable to medical intervention vary between countries in patterns which differ from those observed for other (non-amenable) causes of death. More specifically, we hypothesized that, as compared to non-amenable causes, inequalities in mortality from amenable causes are more strongly associated with inequalities in health care use and less strongly with inequalities in common risk factors for disease such as smoking. Methods: Cause-specific mortality data for people aged 3074 years were obtained for 14 countries, and were analysed by calculating age-standardized mortality rates and relative risks comparing a lower with a higher educational group. Survey data on health care use and behavioural risk factors for people aged 3074 years were obtained for 12 countries, and were analysed by calculating age-and sex-adjusted odds ratios comparing a low with a higher educational group. Patterns of association were explored by calculating correlation coefficients. Results: In most countries and for most amenable causes of death substantial inequalities in mortality were observed, but inequalities in mortality from amenable causes did not vary between countries in patterns that are different from those seen for inequalities in non-amenable mortality. As compared to non-amenable causes, inequalities in mortality from amenable causes are not more strongly associated with inequalities in health care use. Inequalities in mortality from amenable causes are also not less strongly associated with common risk factors such as smoking. Conclusions: We did not find evidence that inequalities in mortality from amenable conditions are related to inequalities in access or quality of health care. Further research is needed to find the causes of socio-economic inequalities in mortality from amenable conditions, and caution should be exercised in interpreting these inequalities as indicating health care deficiencies. © 2012 Plug et al. ; licensee BioMed Central Ltd.
Ajuts:	European Commission 2003125
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Publicat a:	BMC public health, Vol. 12 Núm. 1 (2012) , p. 346, ISSN 1471-2458

DOI: 10.1186/1471-2458-12-346
PMID: 22578154

13 p, 308.7 KB

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