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Open Access Highly Accessed Research article

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

Iris Plug1, Rasmus Hoffmann1, Barbara Artnik2, Matthias Bopp3, Carme Borrell4, Giuseppe Costa56, Patrick Deboosere7, Santi Esnaola8, Ramune Kalediene9, Mall Leinsalu1011, Olle Lundberg12, Pekka Martikainen13, Enrique Regidor14, Jitka Rychtarikova15, Björn Heine Strand16, Bogdan Wojtyniak17 and Johan P Mackenbach118*

Author affiliations

1 Department of Public Health, Erasmus MC, Rotterdam, Netherlands

2 Department of Public Health, Faculty of Medicine, Ljubljana, Slovenia

3 Institute of Social and Preventive Medicine, University of Zurich, Zurich, Switzerland

4 Agència de Salut Pública de Barcelona, Barcelona, Spain

5 Regional Epidemiology Unit, ASL TO3 Piedmont Regio, Grugliasco, Italy

6 Department of Clinical and Biological Sciences, University of Turin, Turin, Italy

7 Department of Social Research, Vrije Universiteit, Brussel, Brussel, Belgium

8 Research Unit, Department of Health, Basque Government, Vittoria-Gasteiz, Spain

9 Lithuanian University of Health Sciences, Kaunas, Lithuania

10 Stockholm Centre on Health of Societies in Transition, Södertörn University College, Södertorn, Sweden

11 Department of Epidemiology and Biostatistics, National institute for Health Development, Talinn, Estonia

12 CHESS, Centre for Health Equity Studies, Stockholm, Sweden

13 Department of Sociology, University of Helsinki, Helsinki, Finland

14 Department of Preventive Medicine and Public Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain

15 Department of Demography and Geodemography, Faculty of Science, Charles University, Prague, the Czech Republic

16 Norwegian Institute of Public Health, Oslo, Norway

17 National institute of Public Health-National Institute of Hygiene, Warsaw, Poland

18 Department of Public Health, Erasmus MC, P.O. Box 2030, Rotterdam, CA, 3000, The Netherlands

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Citation and License

BMC Public Health 2012, 12:346  doi:10.1186/1471-2458-12-346

Published: 11 May 2012

Abstract

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 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.

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.