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BMC Public Health. 2012; 12: 346.
Published online May 11, 2012. doi:  10.1186/1471-2458-12-346
PMCID: PMC3413570
Socioeconomic inequalities in mortality from conditions amenable to medical interventions: do they reflect inequalities in access or quality of health care?
Iris Plug,1 Rasmus Hoffmann,1 Barbara Artnik,2 Matthias Bopp,3 Carme Borrell,4 Giuseppe Costa,5,6 Patrick Deboosere,7 Santi Esnaola,8 Ramune Kalediene,9 Mall Leinsalu,10,11 Olle Lundberg,12 Pekka Martikainen,13 Enrique Regidor,14 Jitka Rychtarikova,15 Björn Heine Strand,16 Bogdan Wojtyniak,17 and Johan P Mackenbachcorresponding author1,18
1Department of Public Health, Erasmus MC, Rotterdam, Netherlands
2Department of Public Health, Faculty of Medicine, Ljubljana, Slovenia
3Institute of Social and Preventive Medicine, University of Zurich, Zurich, Switzerland
4Agència de Salut Pública de Barcelona, Barcelona, Spain
5Regional Epidemiology Unit, ASL TO3 Piedmont Regio, Grugliasco, Italy
6Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
7Department of Social Research, Vrije Universiteit, Brussel, Brussel, Belgium
8Research Unit, Department of Health, Basque Government, Vittoria-Gasteiz, Spain
9Lithuanian University of Health Sciences, Kaunas, Lithuania
10Stockholm Centre on Health of Societies in Transition, Södertörn University College, Södertorn, Sweden
11Department of Epidemiology and Biostatistics, National institute for Health Development, Talinn, Estonia
12CHESS, Centre for Health Equity Studies, Stockholm, Sweden
13Department of Sociology, University of Helsinki, Helsinki, Finland
14Department of Preventive Medicine and Public Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
15Department of Demography and Geodemography, Faculty of Science, Charles University, Prague, the Czech Republic
16Norwegian Institute of Public Health, Oslo, Norway
17National institute of Public Health-National Institute of Hygiene, Warsaw, Poland
18Department of Public Health, Erasmus MC, P.O. Box 2030, Rotterdam, CA, 3000, The Netherlands
corresponding authorCorresponding author.
Iris Plug: i.plug/at/erasmusmc.nl; Rasmus Hoffmann: r.hoffmann/at/erasmusmc.nl; Barbara Artnik: barbara.artnik/at/mf.uni-lj.si; Matthias Bopp: bopp/at/ifspm.unizh.ch; Carme Borrell: cborrell/at/aspb.es; Giuseppe Costa: giuseppe.costa/at/epi.piemonte.it; Patrick Deboosere: Patrick.Deboosere/at/vub.ac.be; Santi Esnaola: sesnaola/at/ej-gv.es; Ramune Kalediene: kaleda/at/kaunas.omnitel.net; Mall Leinsalu: mall.leinsalu/at/sh.se; Olle Lundberg: Olle.Lundberg/at/chess.su.se; Pekka Martikainen: pekka.martikainen/at/helsinki.fi; Enrique Regidor: enriqueregidor/at/hotmail.com; Jitka Rychtarikova: rychta/at/natur.cuni.cz; Björn Heine Strand: Bjorn.Heine.Strand/at/fhi.no; Bogdan Wojtyniak: bogdan/at/medstat.waw.pl; Johan P Mackenbach: j.mackenbach/at/erasmusmc.nl
Received December 21, 2011; Accepted May 11, 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.
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