Marta Donat , Gregorio Barrio , Juan Miguel Guerras , Almudena Moreno , Elena Ronda , Julieta Politi , María José Belza
{"title":"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","authors":"Marta Donat , Gregorio Barrio , Juan Miguel Guerras , Almudena Moreno , Elena Ronda , Julieta Politi , María José Belza","doi":"10.1016/j.medcle.2025.107053","DOIUrl":null,"url":null,"abstract":"<div><h3>Objectives</h3><div>To assess inter-regional inequalities in avoidable mortality and in the effectiveness of the health system to reduce it during 2001−2022 in Spain.</div></div><div><h3>Materials and method</h3><div>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).</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":74154,"journal":{"name":"Medicina clinica (English ed.)","volume":"165 3","pages":"Article 107053"},"PeriodicalIF":0.0000,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Avoidable premature mortality and effectiveness of the health system to reduce it during the 21st century in Spain by region\",\"authors\":\"Marta Donat , Gregorio Barrio , Juan Miguel Guerras , Almudena Moreno , Elena Ronda , Julieta Politi , María José Belza\",\"doi\":\"10.1016/j.medcle.2025.107053\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objectives</h3><div>To assess inter-regional inequalities in avoidable mortality and in the effectiveness of the health system to reduce it during 2001−2022 in Spain.</div></div><div><h3>Materials and method</h3><div>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).</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>\",\"PeriodicalId\":74154,\"journal\":{\"name\":\"Medicina clinica (English ed.)\",\"volume\":\"165 3\",\"pages\":\"Article 107053\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Medicina clinica (English ed.)\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2387020625004085\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Medicina clinica (English ed.)","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2387020625004085","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
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.