Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy.
Unit of Data Analysis of NCD and Surveys, Centre for Disease Prevention and Control of Latvia, Riga, Latvia.
Int J Health Policy Manag. 2022 Jun 1;11(6):820-828. doi: 10.34172/ijhpm.2020.229.
Because quantifying the relative contributions of prevention and medical care to the decline in cardiovascular mortality is controversial, at present mortality indicators use a fifty-fifty allocation to fraction avoidable cardiovascular deaths as being partly preventable and partly amenable. The aim of this study was to develop a dynamic approach to estimate the contributions of preventable versus amenable mortality, and to estimate the proportion of amenable mortality due to non-utilisation of care versus suboptimal quality of care.
We calculated the contribution of primary prevention, healthcare utilisation and healthcare quality in Latvia by using Emilia-Romagna (ER) (Italy) as the best performer reference standard. In particular, we considered preventable mortality as the number of cardiovascular deaths that could be avoided if Latvia had the same incidence as ER, and then apportioned non-preventable mortality into the two components of non-utilisation versus suboptimal quality of hospital care based on the presence of hospital admissions in the days before death. This calculation was possible thanks to the availability of the unique patient identifier in the administrative databases of Latvia and ER.
41.5 people per 100 000 population died in Latvia in 2016 from cardiovascular causes amenable to healthcare; about half of these (21.4 per 100 000) had had no contact with acute care settings, while the other half (20.1 per 100 000) had accessed the hospital but received suboptimal-quality healthcare. Another estimated 26.8 deaths per 100 000 population were due to lack of primary prevention. Deaths attributable to suboptimal quality or non-utilisation of hospital care constituted 60.7% of all avoidable cardiovascular mortality.
If research is undertaken to understand the reasons for differences between territories and their possible relevance to lower performing countries, the dynamic assessment of country-specific contributions to avoidable mortality has considerable potential to stimulate cross-national learning and continuous improvement in population health outcomes.
由于量化预防和医疗对心血管死亡率下降的相对贡献存在争议，目前的死亡率指标采用对半分配的方法，将部分可预防的心血管死亡归因于部分可预防和部分可治疗。本研究旨在开发一种动态方法来估计可预防和可治疗死亡率的贡献，并估计由于未利用医疗保健和医疗保健质量差导致的可治疗死亡率的比例。
我们通过使用意大利艾米利亚-罗马涅（ER）作为最佳表现参考标准，计算了拉脱维亚的初级预防、医疗保健利用和医疗保健质量的贡献。具体而言，我们将可预防死亡率定义为如果拉脱维亚的发病率与 ER 相同，那么可以避免的心血管死亡人数，然后根据死亡前几天住院的情况，将不可预防死亡率分为未利用医疗保健和医院医疗保健质量差两个部分。由于拉脱维亚和 ER 的行政数据库中都有唯一的患者标识符，因此可以进行这种计算。
2016 年，拉脱维亚有 41.5 人/10 万人死于心血管疾病，这些疾病可通过医疗保健治疗；其中约一半（21.4 人/10 万人）没有接触过急性护理环境，而另一半（20.1 人/10 万人）曾去过医院，但接受的医疗保健质量不佳。另外估计有 26.8 人/10 万人的死亡归因于缺乏初级预防。由于医疗保健质量差或未利用导致的死亡占所有可预防心血管死亡率的 60.7%。
如果开展研究以了解各地区之间的差异原因及其对表现较差国家的可能相关性，那么对特定国家对可避免死亡率的贡献进行动态评估具有很大的潜力，可以促进跨国学习和改善人口健康结果。
