21世纪西班牙各地区可避免的过早死亡和卫生系统减少过早死亡的有效性

Marta Donat , Gregorio Barrio , Juan Miguel Guerras , Almudena Moreno , Elena Ronda , Julieta Politi , María José Belza
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摘要

目的评估2001 - 2022年间西班牙可避免死亡率的区域间不平等以及卫生系统降低可避免死亡率的有效性。材料与方法对观测时间趋势进行了研究,得到了按区域划分的测量结果:年龄和性别标准化的每10万人年可避免、可预防、可治疗和不可避免的死亡率,这些死亡率的年际差异(ARDs),可避免和不可避免死亡率的年度百分比变化(APCs)之间的差异(卫生系统有效性与可避免死亡率),国家死亡率的标准差和变异系数(CV)(分别为绝对和相对区域间不平等),以及可避免和不可避免死亡率cv之间的差异(卫生系统对可避免死亡率不平等的贡献)。结果2022年可避免死亡率最高的是阿斯图里亚斯(218)、加那利群岛(208)和安达卢西亚(200),最低的是马德里(142)、纳瓦拉(161)和拉里奥哈(165)。2001年至2022年期间,所有社区的可避免死亡率均有所下降,最不利的ARDs发生在阿拉贡(- 2.8)、卡斯蒂利亚和莱昂(- 3.1)以及阿斯图里亚斯(- 3.2),卫生系统效率最低的是卡斯蒂利亚-拉曼查、马德里、阿斯图里亚斯和阿拉贡。可避免死亡率的标准差也有所下降(从2001年的29.4下降到2022年的20.2),卫生系统对这种不平等的影响也有所下降。结论在西班牙,可避免死亡率的重要区域间不平等仍然存在,尽管2001 - 2022年期间其绝对不平等有所下降。在此期间,所有区域卫生系统都有效地降低了可避免的死亡率,它们对这种死亡率的区域间不平等的贡献减少了。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Avoidable premature mortality and effectiveness of the health system to reduce it during the 21st century in Spain by region

Objectives

To assess inter-regional inequalities in avoidable mortality and in the effectiveness of the health system to reduce it during 2001−2022 in Spain.

Materials and method

An observational time trends study was performed, obtaining the following measures by region: age- and sex-standardized avoidable, preventable, treatable and non-avoidable mortality rates per 100,000 person-years, inter-annual rate differences (ARDs) in these mortalities, differences between the annual percentage changes (APCs) of avoidable and non-avoidable mortality (health system effectiveness against avoidable mortality), standard deviation and coefficient of variation (CV) of national mortality rates (absolute and relative inter-regional inequality, respectively), and difference between CVs in avoidable and non-avoidable mortality (health system contribution to inequality in avoidable mortality).

Results

In 2022, the highest avoidable mortality rates were observed in Asturias (218), the Canary Islands (208) and Andalusia (200), and the lowest in Madrid (142), Navarra (161) and La Rioja (165). During 2001−2022, avoidable mortality decreased in all communities, with the most unfavourable ARDs in Aragon (−2.8), Castile and Leon (−3.1), and Asturias (−3.2), and the lowest health system effectiveness in Castile-La Mancha, Madrid, Asturias and Aragon. The standard deviation of avoidable mortality also decreased (from 29.4 in 2001 to 20.2 in 2022), as well as the health system contribution to this inequality.

Conclusions

In Spain, important inter-regional inequalities in avoidable mortality persist, although during 2001−2022 its absolute inequality decreased. During this period, all regional health systems were effective in reducing avoidable mortality, and their contribution to inter-regional inequalities in such mortality decreased.
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