European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK.
J R Soc Med. 2011 Sep;104(9):370-9. doi: 10.1258/jrsm.2011.110120.
The new performance framework for the NHS in England will assess how well health services are preventing people from dying prematurely, based on the concept of mortality amenable to healthcare. We ask how the different parts of the UK would be assessed had this measure been in use over the past two decades, a period that began with somewhat lower levels of health expenditure in England and Wales than in Scotland and Northern Ireland but which, after 1999, saw the gap closing.
We assessed the change in age-standardized death rates in England and Wales, Northern Ireland and Scotland in two time periods: 1990-1999 and 1999-2009. Mortality data by five-year age group, sex and cause of death for the years 1990 to 2009 were analysed using age-standardized death rates from causes considered amenable to healthcare. The absolute change was assessed by fitting linear regression and the relative change was estimated as the average annual percent decline for the two periods.
United Kingdom.
Not applicable.
Mortality from causes amenable to healthcare.
Between 1990 and 1999 deaths amenable to medical care had been falling more slowly in England and Wales than in Scotland and Northern Ireland. However the rate of decline in England and Wales increased after 1999 when funding of the NHS there increased. Examination of individual causes of death reveals a complex picture, with some improvements, such as in breast cancer deaths, occurring simultaneously across the UK, reflecting changes in diagnosis and treatment that took place in each nation at the same time, while others varied.
Amenable mortality is a useful indicator of health system performance but there are many methodological issues that must be taken into account when interpreting it once it is adopted for routine use in England.
英格兰国民保健署（NHS）的新绩效框架将根据医疗保健可改善的死亡率这一概念，评估卫生服务在多大程度上防止人们过早死亡。我们想知道，如果在过去二十年中使用这一衡量标准，英国各地将如何进行评估，这一时期始于英格兰和威尔士的医疗支出水平略低于苏格兰和北爱尔兰，但在 1999 年之后，差距开始缩小。
我们评估了英格兰、威尔士、北爱尔兰和苏格兰在两个时间段内的年龄标准化死亡率变化：1990-1999 年和 1999-2009 年。使用考虑到医疗保健可改善的死因的年龄标准化死亡率，分析了 1990 年至 2009 年每五年一个年龄组、性别和死因的死亡率数据。通过拟合线性回归评估绝对变化，用两个时期的平均年百分率下降来估计相对变化。
英国。
不适用。
医疗保健可改善的死因死亡率。
1990 年至 1999 年期间，英格兰和威尔士医疗保健可改善的死亡人数下降速度比苏格兰和北爱尔兰慢。然而，1999 年之后，随着那里国民保健署资金的增加，英格兰和威尔士的下降速度加快。对个别死因的检查显示出一幅复杂的画面，一些改善，如乳腺癌死亡率的改善，在整个英国同时发生，反映了每个国家在同一时间发生的诊断和治疗变化，而其他情况则有所不同。
可改善的死亡率是评估卫生系统绩效的有用指标，但在英格兰将其用于常规使用时，必须考虑到许多方法学问题。
