Assessment of Avoidable Mortality Concepts in the European Union Countries, Their Benefits and Limitations

The concept of avoidable mortality is intended to assessing health care system performance. It is defined as premature deaths from selected disease groups that are considered either treatable through the timely and effective health care (amenable mortality), or preventable by public health interventions (preventable mortality). The purpose of study is to analyse the impact of four lists of causes of death created by researchers on amenable mortality by country, sex and cause of death. Data on deaths were obtained from the WHO database for 20 European Union countries in 2014. We applied the method of direct standardisation using the European Standard Population, Spearman rank-order correlation with statistical significance tests and confidence intervals. We found that the selection of diseases considered as amenable has not significantly impact on the cross-country comparison, but the weight of selected list of causes of death is significant at the national level. The concept has several limitations relating to selection of diseases and setting age threshold over time, availability of health care resources, prevalence of diseases or variation of causes of death coding among countries. However, indicator of avoidable mortality offers a way of the evaluating effectiveness of health systems in maintaining and improving population health.