Ros X A, Bayo Vila A, Alfonso Sánchez J L, Cortina Greus P, Chana González P, Sáiz Sánchez C
Unidad Docente de Medicina Familiar y Comunitaria, Valencia.
Med Clin (Barc). 1996 Apr 20;106(15):571-7.
Avoidable mortality (AM) has been proposed as the indicator of the quality and the efficacy of health care services and a parameter useful to distribute health care resources. The aim of this study was to analyze the size and geographic variability of AM in the Community of Valencia, Spain (1975-1990).
The causes of AM were analyzed by the classification of Holland divided into indicators of medical care (IMC) and indicators on national health care policy (INHCP) in addition to the causes of the Charlton classification. Standard rates for Spain and the European Community, the rate of masculinity and contribution to total mortality were calculated. Geographic distribution by areas and provinces was analyzed by the rate of standardized mortality.
According to the Holland classification AM was 30% of the deaths from 5 to 64 years of age. Out of these cases, 18.5% corresponded to INHCP and 11.1% to IMC. According to the Charlton classification, this percentage was 3.6%. A considerable variation was observed among the 20 areas analyzed due to many causes. The geographic distribution by groups (IMC, INHCP and the Charlton classification) is quite homogeneous. The worse results corresponded to the city of Valencia and to the area 21 (area of the city of Alicante).
A great variation was found in the results regarding geographic distribution for individual causes of death while the distribution was quite homogeneous for all of the groups of mortality with the worst results being observed in large urban centers.
可避免死亡率（AM）已被提议作为医疗服务质量和疗效的指标，以及用于分配医疗资源的一个有用参数。本研究的目的是分析西班牙巴伦西亚自治区（1975 - 1990年）可避免死亡率的规模和地理变异性。
除了查尔顿分类的病因外，还通过荷兰分类法分析可避免死亡的病因，该分类法分为医疗护理指标（IMC）和国家医疗政策指标（INHCP）。计算了西班牙和欧洲共同体的标准率、男性化率以及对总死亡率的贡献。通过标准化死亡率分析按地区和省份的地理分布。
根据荷兰分类法，可避免死亡率占5至64岁年龄段死亡人数的30%。在这些病例中，18.5%对应于国家医疗政策指标，11.1%对应于医疗护理指标。根据查尔顿分类法，这一百分比为3.6%。由于多种原因，在所分析的20个地区中观察到了相当大的差异。按组（医疗护理指标、国家医疗政策指标和查尔顿分类法）的地理分布相当均匀。最差的结果对应于巴伦西亚市和第21区（阿利坎特市所在地区）。
在个体死亡原因的地理分布结果中发现了很大差异，而所有死亡率组的分布相当均匀，最差的结果出现在大型城市中心。
