Socioeconomic inequalities in mortality from conditions amenable to medical interventions: Do they reflect inequalities in access or quality of health care?

Department of Public Health, Erasmus MC, Rotterdam, Netherlands.
BMC Public Health (Impact Factor: 2.26). 05/2012; 12(1):346. DOI: 10.1186/1471-2458-12-346
Source: PubMed


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.
Cause-specific mortality data for people aged 30-74 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 30-74 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.
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.
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.

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    • "On the one hand, the differences found might pertain to different access to and quality of healthcare according to SES, as suggested in various studies, so that higher income population segments are more likely to see a specialist [49,50]. However, other studies have not found any links between inequalities in the use of healthcare and amenable mortality [44]. On the other, the prevalence, incidence, and natural course of some diseases might have an effect on amenable mortality and differ between socioeconomic groups, since the exposure to its risk factors might also differ. "
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    • "Therefore the analysis of socioeconomic differences in avoidable causes of death can offer important lessons for tackling health inequalities. Following this reasoning, studies have looked at social differences in avoidable mortality [14] and whether access to medical care explains socioeconomic differences in avoidable mortality [15]. "
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