Surenjav Enkhjin, Sovd Tugsdelger, Yoshida Yoshitoku, Yamamoto Eiko, Reyer Joshua A, Hamajima Nobuyuki
Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Swiss Tropical and Public Health Institute, University of Basel, Switzerland.
Nagoya J Med Sci. 2016 Feb;78(1):55-68.
Amenable mortality (AM) is an indicator of medical care quality. This study aimed to assess the trend and magnitude of AM in Mongolia, with the purpose of providing evidence for decisions on resource allocation. This is the first study on AM trends in Mongolia. Retrospective analysis was done on mortality statistics for the period 2007-2014. Causes of death were coded according to the 10th revision of the International Classification of Diseases (ICD-10). Nolte & McKee's classification of AM was used for the estimation of amenable mortality rates (AMRs) in Mongolia. During the study period, a total of 130,402 deaths were registered in Mongolia, of which 44,800 (34.4%) deaths were classified as being amenable. The age-standardized AMR per 100,000 population was highest in 2007 (226.6), and declined continuously until the level of 169.2 in 2014. The rate remained consistently higher in males than in females. Cerebrovascular diseases, ischemic heart diseases, perinatal deaths, influenza/pneumonia/asthma and tuberculosis were the leading causes of AM in the past eight years in Mongolia. The AMR was higher in remote western provinces with harsh weather conditions, high poverty rates, lack of human resources for health, and poor infrastructure. In addition, the provinces where Mongolia's ethnic minorities live tended to have a higher AMR. The government of Mongolia needs to critically look at the regional differences in AM in order to allocate health resources, including human resources, effectively. Further studies are needed to look into the causes of regional disparities in AM, individual-level risk factors to amenable deaths, and validity of death coding in health sector.
可避免死亡（AM）是医疗质量的一个指标。本研究旨在评估蒙古国可避免死亡的趋势和程度，为资源分配决策提供依据。这是蒙古国关于可避免死亡趋势的首次研究。对2007 - 2014年期间的死亡率统计数据进行了回顾性分析。死亡原因按照《国际疾病分类》第十版（ICD - 10）进行编码。采用诺尔特和麦基的可避免死亡分类法来估算蒙古国的可避免死亡率（AMRs）。在研究期间，蒙古国共登记了130,402例死亡病例，其中44,800例（34.4%）被归类为可避免死亡。每10万人口的年龄标准化可避免死亡率在2007年最高（226.6），并持续下降至2014年的169.2。男性的该比率一直高于女性。脑血管疾病、缺血性心脏病、围产期死亡、流感/肺炎/哮喘和结核病是蒙古国过去八年可避免死亡的主要原因。在气候恶劣、贫困率高、卫生人力资源匮乏且基础设施差的西部偏远省份，可避免死亡率较高。此外，蒙古国少数民族聚居的省份往往可避免死亡率也较高。蒙古国政府需要审慎看待可避免死亡在地区上的差异，以便有效分配包括人力资源在内的卫生资源。需要进一步研究可避免死亡地区差异的原因、可避免死亡的个体层面风险因素以及卫生部门死亡编码的有效性。
