Tobias M, Jackson G
Ministry of Health, Wellington, New Zealand.
Aust N Z J Public Health. 2001;25(1):12-20. doi: 10.1111/j.1467-842x.2001.tb00543.x.
To describe avoidable mortality in New Zealand, including trends and variations between groups by age, gender, ethnicity and degree of deprivation.
New Zealand Health Information Service mortality unit records, 1981 to 1997, were classified as 'avoidable' or 'unavoidable' based on a reassessment of ICD9 codes and an upper age limit of 75 years. 'Avoidable' causes of death were further subcategorised according to the level of intervention involved (primary, secondary or tertiary). Deaths were assigned a deprivation score using a Census-based small area deprivation index, the NZDep96. Mortality rates were age standardised by the direct method, with Segi's world population as the reference.
Avoidable mortality declined 38% from 1981 to 1997; unavoidable mortality declined only 9%. In 1996-97 almost 70% of deaths in the 0-74 age range were still considered to be potentially avoidable. Almost 80% of avoidable deaths occur in the 45-74 age group. These deaths are dominated by the emergence of chronic diseases such as ischaemic heart disease, diabetes and smoking-related cancers. In younger age groups, injury (including suicide) dominates avoidable mortality. Males experience a greater burden of avoidable mortality than females--a relative excess of 54% (approximately 2,000) in 1996-97. The gender difference is largely attributable to diseases and injuries amenable to primary prevention, with the largest single contribution coming from ischaemic heart disease. The ethnic gap in avoidable mortality remains wide: rates for Mäori and Pacific people were 2-2 1/2 times higher than European rates in 1996-97. Similar gradients are seen with deprivation.
Avoidable mortality analysis provides a useful tool for evidence-based health needs assessment and health policy development.
描述新西兰可避免的死亡率，包括按年龄、性别、种族和贫困程度划分的群体间趋势及差异。
1981年至1997年新西兰健康信息服务部的死亡记录单位，基于对国际疾病分类第九版（ICD9）编码的重新评估以及75岁的年龄上限，被分类为“可避免的”或“不可避免的”。“可避免的”死亡原因根据所涉及的干预水平（初级、二级或三级）进一步细分。使用基于人口普查的小区域贫困指数NZDep96为死亡分配贫困分数。死亡率通过直接法进行年龄标准化，以塞吉世界人口作为参考。
1981年至1997年可避免的死亡率下降了38%；不可避免的死亡率仅下降了9%。在1996 - 1997年，0至74岁年龄范围内近70%的死亡仍被认为是潜在可避免的。近80%的可避免死亡发生在45至74岁年龄组。这些死亡主要由诸如缺血性心脏病、糖尿病和与吸烟相关的癌症等慢性病的出现所主导。在较年轻年龄组中，伤害（包括自杀）主导可避免的死亡率。男性比女性承受更大的可避免死亡负担——1996 - 1997年相对高出54%（约2000例）。性别差异在很大程度上归因于适合初级预防的疾病和伤害，其中最大的单一贡献来自缺血性心脏病。可避免死亡率方面的种族差距仍然很大：1996 - 1997年，毛利人和太平洋岛民的死亡率比欧洲人高出2至2.5倍。贫困程度也呈现类似的梯度差异。
可避免死亡率分析为基于证据的健康需求评估和健康政策制定提供了一个有用的工具。
