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Original article

Vol. 147 No. 3132 (2017)

Trends and socioeconomic inequalities in amenable mortality in Switzerland with international comparisons

DOI
https://doi.org/10.4414/smw.2017.14478
Cite this as:
Swiss Med Wkly. 2017;147:w14478
Published
03.08.2017

Abstract

BACKGROUND

Amenable mortality is a composite measure of deaths from conditions that might be avoided by timely and effective healthcare. It was developed as an indicator to study health care quality.

METHODS

We calculated mortality rates for the population aged 0–74 years for the time-period 1996–2010 and the following groups of causes of death: amenable conditions, ischaemic heart diseases (IHD, defined as partly amenable) and remaining conditions. We compared the Swiss results with those published for 16 other high-income countries. To examine the association between amenable mortality and socioeconomic position, we calculated hazard ratios (HRs) by using Cox regression.

RESULTS

Amenable mortality fell from 49.5 (95% confidence interval [CI] 48.2–51.0) to 35.7 (34.6–36.9) in males and from 55.0 (53.6–56.4) to 43.4 (42.2–44.6) per 100 000 person-years in females, when 1996–1998 was compared with 2008–2010. IHD mortality declined from 64.7 (95% CI 63.1–66.3) to 33.8 (32.8–34.8) in males and from 18.0 (17.2–18.7) to 8.5 (8.0–9.0) in females. However, between 1996–1998 and 2008–2010 the proportion of all-cause mortality attributed to amenable causes remained stable in both sexes (around 12% in males and 26% in females). Compared with 16 other high-income countries, Switzerland had the lowest rates of amenable mortality and ranked among the top five with the lowest ischaemic heart disease mortality. HRs of amenable causes in the lowest socioeconomic position quintile were 1.77 (95% CI 1.66–1.90) for males and 1.78 (1.47–2.16) for females compared with 1.62 (1.58–1.66) and 1.38 (1.33–1.43) for unamenable mortality. For ischaemic heart disease, HRs in the lowest socioeconomic position quintile were 1.76 (95% CI 1.66–1.87) for males and 2.33 (2.07–2.62) for females.

CONCLUSIONS

Amenable mortality declined substantially in Switzerland with comparably low death rates for amenable causes. Similar to previous international studies, these Swiss results showed substantial socioeconomic inequalities in amenable mortality. Proportions of amenable mortality remained constant over time and patterns of inequalities observed for amenable causes in men did not substantially differ from those observed for non-amenable causes of death. Additional amenable mortality research is needed to better understand the factors contributing to mortality changes and social inequalities including information on disease characteristics and health care supply measures.

References

  1. Murray CJ, Frenk J. A framework for assessing the performance of health systems. Bull World Health Organ. 2000;78(6):717–31.
  2. Rutstein DD, Berenberg W, Chalmers TC, Child CG, 3rd, Fishman AP, Perrin EB, et al. Measuring the quality of medical care. A clinical method. N Engl J Med. 1976;294(11):582–8. doi:.https://doi.org/10.1056/NEJM197603112941104
  3. Castelli A, Nizalova O. Avoidable mortality: What it means and how it is measured. Center for Health Economics, 2011.
  4. Nolte E, McKee M. Does Health Care Save Lives? Avoidable Mortality Revisited. Research Report. Nuffield Trust; 2004.
  5. Korda RJ, Butler JR, Clements MS, Kunitz SJ. Differential impacts of health care in Australia: trend analysis of socioeconomic inequalities in avoidable mortality. Int J Epidemiol. 2007;36(1):157–65. doi:.https://doi.org/10.1093/ije/dyl282
  6. 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. J Epidemiol Community Health. 2014;68(10):965–70. doi:.https://doi.org/10.1136/jech-2014-204272
  7. Plug I, Hoffmann R, Artnik B, Bopp M, Borrell C, Costa G, et al. Socioeconomic inequalities in mortality from conditions amenable to medical interventions: do they reflect inequalities in access or quality of health care? BMC Public Health. 2012;12(1):346. doi:.https://doi.org/10.1186/1471-2458-12-346
  8. Stirbu I, Kunst AE, Bopp M, Leinsalu M, Regidor E, Esnaola S, et al. Educational inequalities in avoidable mortality in Europe. J Epidemiol Community Health. 2010;64(10):913–20. doi:.https://doi.org/10.1136/jech.2008.081737
  9. Yates M, Dundas R, Katikireddi S, McKee M, Pell J, Stuckler D, et al. Trends in inequalities in amenable mortality in England: 1990–2010. European Journal of Public Health. 2015;25(suppl 3):ckv170.049.
  10. Brandmeir K, Grimm M, Heise M, Holzhausen A. Global Wealth Report. Munich: 2015.
  11. Biller-Andorno N, Zeltner T. Individual Responsibility and Community Solidarity--The Swiss Health Care System. N Engl J Med. 2015;373(23):2193–7. doi:.https://doi.org/10.1056/NEJMp1508256
  12. Daley C, Gubb J, Clarke E, Bidgood E. Healthcare Systems: Switzerland. Available from The Institute for the Study of Civil Society, London, UK website: http://www civitas org uk/nhs/download/switzerland pdf. 2007.
  13. van Ginneken E, Swartz K, Van der Wees P. Health insurance exchanges in Switzerland and the Netherlands offer five key lessons for the operations of US exchanges. Health Aff (Millwood). 2013;32(4):744–52. doi:.https://doi.org/10.1377/hlthaff.2012.0948
  14. Davis K, Stremikis K, Squires D, Schoen C. Mirror, mirror on the wall- 2014 Update. How the performance of the US Health care system compares internationally, New York: Common Wealth Fund, 2014.
  15. Cayotte E, Buchow H. Who dies of what in Europe before the age of 65. Eurostat Statistics in Focus. 2009;67
  16. Lutz JM, Pury P, Fioretta G, Raymond L. The impact of coding process on observed cancer mortality trends in Switzerland. Eur J Cancer Prev. 2004;13(1):77–81. doi:.https://doi.org/10.1097/00008469-200402000-00012
  17. Schmidlin K, Clough-Gorr KM, Spoerri A, Egger M, Zwahlen M ; Swiss National Cohort. Impact of unlinked deaths and coding changes on mortality trends in the Swiss National Cohort. BMC Med Inform Decis Mak. 2013;13(1):1. doi:.https://doi.org/10.1186/1472-6947-13-1
  18. Nolte E, McKee M. Variations in amenable mortality--trends in 16 high-income nations. Health Policy. 2011;103(1):47–52. doi:.https://doi.org/10.1016/j.healthpol.2011.08.002
  19. Bopp M, Spoerri A, Zwahlen M, Gutzwiller F, Paccaud F, Braun-Fahrländer C, et al. Cohort Profile: the Swiss National Cohort--a longitudinal study of 6.8 million people. Int J Epidemiol. 2009;38(2):379–84. doi:.https://doi.org/10.1093/ije/dyn042
  20. Spoerri A, Zwahlen M, Egger M, Bopp M. The Swiss National Cohort: a unique database for national and international researchers. Int J Public Health. 2010;55(4):239–42. doi:.https://doi.org/10.1007/s00038-010-0160-5
  21. Panczak R, Galobardes B, Voorpostel M, Spoerri A, Zwahlen M, Egger M ; Swiss National Cohort and Swiss Household Panel. A Swiss neighbourhood index of socioeconomic position: development and association with mortality. J Epidemiol Community Health. 2012;66(12):1129–36. doi:.https://doi.org/10.1136/jech-2011-200699
  22. Renaud A. Methodology Report–Coverage Estimation for the Swiss Population Census 2000. Neuchâtel: Swiss Federal Statistical Office. 2004.
  23. Bollini P, Wanner P, Pampallona S. Trends in maternal mortality in Switzerland among Swiss and foreign nationals, 1969-2006. Int J Public Health. 2011;56(5):515–21. doi:.https://doi.org/10.1007/s00038-010-0213-9
  24. Feller A, Mark MT, Steiner A, Clough-Gorr KM. Time trends in avoidable cancer mortality in Switzerland and neighbouring European countries 1996-2010. Swiss Med Wkly. 2015;145:w14184.
  25. Ess S, Savidan A, Frick H, Rageth Ch, Vlastos G, Lütolf U, et al. Geographic variation in breast cancer care in Switzerland. Cancer Epidemiol. 2010;34(2):116–21. doi:.https://doi.org/10.1016/j.canep.2010.01.008
  26. Marques-Vidal P, Paccaud F. Regional differences in self-reported screening, prevalence and management of cardiovascular risk factors in Switzerland. BMC Public Health. 2012;12(1):246. doi:.https://doi.org/10.1186/1471-2458-12-246
  27. Feng X, Liu Y, Astell-Burt T, Yin P, Page A, Liu S, et al. Analysis of health service amenable and non-amenable mortality before and since China’s expansion of health coverage in 2009. BMJ Open. 2016;6(1):e009370. doi:.https://doi.org/10.1136/bmjopen-2015-009370
  28. Gusmano MK, Rodwin VG, Wang C, Weisz D, Luo L, Hua F. Shanghai rising: health improvements as measured by avoidable mortality since 2000. Int J Health Policy Manag. 2014;4(1):7–12. doi:.https://doi.org/10.15171/ijhpm.2015.07
  29. Kamarudeen S. Amenable mortality as an indicator of healthcare quality - a literature review. Health Stat Q. 2010;47:66–80. doi:.https://doi.org/10.1057/hsq.2010.16
  30. 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 Serv Res. 2013;13(1):3. doi:.https://doi.org/10.1186/1472-6963-13-3
  31. Nolte E, McKee CM. Measuring the health of nations: updating an earlier analysis. Health Aff (Millwood). 2008;27(1):58–71. doi:.https://doi.org/10.1377/hlthaff.27.1.58
  32. Doll R. Comparison between Registries. Age-Standardized Rates. In: Waterhouse J, Muir C, Correa P, Powell J, editors. Cancer incidence in five continents. Lyon: International Agency for Research on Cancer; 1976. p. 453–9.
  33. Korm EL, Graubard BI, Midthune D. Time-to-event analysis of longitudinal follow-up of a survey: choice of the time-scale. Am J Epidemiol. 1997;145(1):72–80. doi:.https://doi.org/10.1093/oxfordjournals.aje.a009034
  34. Thiébaut AC, Bénichou J. Choice of time-scale in Cox’s model analysis of epidemiologic cohort data: a simulation study. Stat Med. 2004;23(24):3803–20. doi:.https://doi.org/10.1002/sim.2098
  35. Garne E. Perinatal mortality rates can no longer be used for comparing quality of perinatal health services between countries. Paediatr Perinat Epidemiol. 2001;15(3):315–6. doi:.https://doi.org/10.1046/j.1365-3016.2001.00356.x
  36. Fedewa SA, Cullati S, Bouchardy C, Welle I, Burton-Jeangros C, Manor O, et al. Colorectal Cancer Screening in Switzerland: Cross-Sectional Trends (2007-2012) in Socioeconomic Disparities. PLoS One. 2015;10(7):e0131205. doi:.https://doi.org/10.1371/journal.pone.0131205
  37. Bouchardy C, Verkooijen HM, Fioretta G. Social class is an important and independent prognostic factor of breast cancer mortality. Int J Cancer. 2006;119(5):1145–51. doi:.https://doi.org/10.1002/ijc.21889
  38. Rapiti E, Blanc A, Benhamou S, Schubert H, Vlastos G, Schaffar R, et al. Strong Socioeconomic Disparities in Breast Cancer Quality of Care in Switzerland. Cancer Res. 2011;71(24 Suppl.):abstract no. P1-11-01.
  39. Ford ES, Ajani UA, Croft JB, Critchley JA, Labarthe DR, Kottke TE, et al. Explaining the decrease in U.S. deaths from coronary disease, 1980-2000. N Engl J Med. 2007;356(23):2388–98. doi:.https://doi.org/10.1056/NEJMsa053935
  40. World Population Prospects. The 2015 revision. New York: United Nations, Department of Economic and Social Affairs, Population Division, 2015.
  41. Salomon JA, Wang H, Freeman MK, Vos T, Flaxman AD, Lopez AD, et al. Healthy life expectancy for 187 countries, 1990-2010: a systematic analysis for the Global Burden Disease Study 2010. Lancet. 2012;380(9859):2144–62. doi:.https://doi.org/10.1016/S0140-6736(12)61690-0
  42. Frei A, Hunsche E. The Swiss health care system. Eur J Health Econ. 2001;2(2):76–8. doi:.https://doi.org/10.1007/PL00012220
  43. Wegmüller B, Bienlein M. The Swiss health care system. World Hosp Health Serv. 2007;43(1):10–1.
  44. Bulliard JL, Ducros C, Jemelin C, Arzel B, Fioretta G, Levi F. Effectiveness of organised versus opportunistic mammography screening. Ann Oncol. 2009;20(7):1199–202. doi:.https://doi.org/10.1093/annonc/mdn770
  45. Vassilakos P, Catarino R, Boulvain M, Petignat P. Controversies in the mammography screening programme in Switzerland. Swiss Med Wkly. 2014;144:w13969.
  46. Marques-Vidal P, Ferrières J, Metzger MH, Cambou JP, Filipiak B, Löwel H, et al. Trends in coronary heart disease morbidity and mortality and acute coronary care and case fatality from 1985-1989 in southern Germany and south-western France. Eur Heart J. 1997;18(5):816–21. doi:.https://doi.org/10.1093/oxfordjournals.eurheartj.a015347
  47. Nichols M, Townsend N, Scarborough P, Rayner M. Cardiovascular disease in Europe 2014: epidemiological update. Eur Heart J. 2014;35(42):2950. doi:.https://doi.org/10.1093/eurheartj/ehu299
  48. Egger M, Minder CE, Smith GD. Health inequalities and migrant workers in Switzerland. Lancet. 1990;336(8718):816. doi:.https://doi.org/10.1016/0140-6736(90)93284-V
  49. Carr-Hill RA, Hardman GF, Russell IT. Variations in avoidable mortality and variations in health care resources. Lancet. 1987;329(8536):789–92. doi:.https://doi.org/10.1016/S0140-6736(87)92810-8
  50. Kunst AE, Looman CW, Mackenbach JP. Medical care and regional mortality differences within the countries of the European community. Eur J Popul. 1988;4(3):223–45. doi:.https://doi.org/10.1007/BF01796895
  51. Mackenbach JP, Hoffmann R, Khoshaba B, Plug I, Rey G, Westerling R, et al. Using ‘amenable mortality’ as indicator of healthcare effectiveness in international comparisons: results of a validation study. J Epidemiol Community Health. 2013;67(2):139–46. doi:.https://doi.org/10.1136/jech-2012-201471
  52. Bauer RL, Charlton JR. Area variation in mortality from diseases amenable to medical intervention: the contribution of differences in morbidity. Int J Epidemiol. 1986;15(3):408–12. doi:.https://doi.org/10.1093/ije/15.3.408
  53. Treurniet HF, Looman CW, van der Maas PJ, Mackenbach JP. Variations in ‘avoidable’ mortality: a reflection of variations in incidence? Int J Epidemiol. 1999;28(2):225–32. doi:.https://doi.org/10.1093/ije/28.2.225
  54. Charlton JR, Hartley RM, Silver R, Holland WW. Geographical variation in mortality from conditions amenable to medical intervention in England and Wales. Lancet. 1983;321(8326):691–6. doi:.https://doi.org/10.1016/S0140-6736(83)91981-5
  55. Charlton JR, Holland WW, Lakhani A, Paul EA. Variations in avoidable mortality and variations in health care. Lancet. 1987;329(8537):858. doi:.https://doi.org/10.1016/S0140-6736(87)91630-8
  56. Holland WW, Fitzgerald AP, Hildrey SJ, Phillips SJ. Heaven can wait. J Public Health Med. 1994;16(3):321–30.
  57. Manuel DG, Mao Y. Avoidable mortality in the United States and Canada, 1980-1996. Am J Public Health. 2002;92(9):1481–4. doi:.https://doi.org/10.2105/AJPH.92.9.1481
  58. Lumme S, Sund R, Leyland AH, Keskimäki I. Socioeconomic equity in amenable mortality in Finland 1992-2008. Soc Sci Med. 2012;75(5):905–13. doi:.https://doi.org/10.1016/j.socscimed.2012.04.007
  59. Nolasco A, Quesada JA, Moncho J, Melchor I, Pereyra-Zamora P, Tamayo-Fonseca N, et al. Trends in socioeconomic inequalities in amenable mortality in urban areas of Spanish cities, 1996-2007. BMC Public Health. 2014;14(1):299. doi:.https://doi.org/10.1186/1471-2458-14-299
  60. Schoenbaum SC, Schoen C, Nicholson JL, Cantor JC. Mortality amenable to health care in the United States: the roles of demographics and health systems performance. J Public Health Policy. 2011;32(4):407–29. doi:.https://doi.org/10.1057/jphp.2011.42
  61. Janssen F, Kunst AE. ICD coding changes and discontinuities in trends in cause-specific mortality in six European countries, 1950-99. Bull World Health Organ. 2004;82(12):904–13.
  62. Mathers CD, Fat DM, Inoue M, Rao C, Lopez AD. Counting the dead and what they died from: an assessment of the global status of cause of death data. Bull World Health Organ. 2005;83(3):171–7.

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