Avoidable deaths in Sweden, 1997–2018: temporal trend and the contribution to the gender gap in life expectancy

Abstract

Background Avoidable mortality is considered as a potential indicator of the influences of public health policies and healthcare quality on population health. This study aimed to examine the trend in avoidable mortality and its influence on rising life expectancy (LE) and declining gender gap in LE (GGLE) in Sweden. Methods We extracted data on causes of death by age, sex, and year from national registry from 1997 to 2018. The UK Office for National Statistics definition was used to divide causes of death into five mutually exclusive categories: amenable, preventable, amenable & preventable, ischemic heart disease (IHD), and non-avoidable causes. We applied Joinpoint regression to analyse temporal trends in age-standardized mortality rates. The Arriaga method was applied to decompose changes in LE and GGLE by age group and causes of death. Results Average annual reductions in avoidable vs. non-avoidable mortality were 2.6% (95% CI:2.5, 2.7) vs. 1.4% (95% CI:1.3, 1.5) in men, and 1.6% (95% CI:1.4, 1.9) vs. 0.9% (95% CI:0.7, 1.0) in women over the study period. LE in men rose by 4.1 years between 1997 and 2018 (from 72.8 to 76.9 years), of which 2.4 years (59.3%) were attributable to reductions in avoidable mortality. Corresponding LE gain was 2.3 years in women (from 78.0 in 1997 to 80.3 in 2018) and avoidable mortality accounted for 1.0 year (45.6%) of this gain. Between 1997 and 2018, the GGLE narrowed by 1.9 years, of which 1.4 years (77.7%) were attributable to avoidable causes. Among avoidable causes, while preventable causes had the largest contribution to the GGLE, IHD had the greatest contributions to LE gains and the narrowing GGLE. Conclusions Our findings showed that avoidable causes had a substantial contribution to gain in LE with more profound gain in men than in women, resulting in narrowing the GGLE. Lower pace of reductions in preventable than amenable mortality highlights the need for improving the effectiveness of inter-sectoral health policies aimed at behavioural changes.

The contributions of public health policies and healthcare quality to gender gap and country differences in life expectancy in the UK

“…Our results are in line with the previous findings in the UK and other locations [ 5 – 7 , 15 , 16 , 21 , 33 , 34 ]. We observed significant gain in LE in the UK over the study period largely due to reduction in deaths from avoidable causes such as IHD, lung cancer, injuries, and lifestyle diseases (e.g.…”

“…smoking, alcohol consumption). These declines in avoidable mortality resulted in a decrease over the decade in the contribution of avoidable deaths to the GGLE (from 2.9 years to 2.0 years) which is consistent with previous literature [ 7 , 15 – 20 ]. These improvements can partially be attributed to public health policies, such as those mentioned below, implemented during the period observed [ 35 ].…”

“…The observed decline in the GGLE in our study, particularly large contributions from preventable causes and IHD, possibly imply declining the gender gap in behavioural risk factors such as smoking, alcohol use, and obesity [ 5 , 7 , 15 , 16 , 33 , 34 ]. For example, in recent years women smoked at the same rate as men [ 8 , 11 ] and the gender gap in alcohol consumption has been narrowed considerably [ 49 , 50 ].…”

“…A number of studies have shown a greater decline in the number of avoidable deaths over time than non-avoidable deaths globally [ 7 , 15 – 20 ] which translated into significant contribution of avoidable death into gain in LE. Moreover, the decreases in avoidable deaths were generally larger in men than women leading to meaningful contributions of avoidable causes in reducing GGLE.…”

“…Moreover, the decreases in avoidable deaths were generally larger in men than women leading to meaningful contributions of avoidable causes in reducing GGLE. For instance, avoidable causes of death were responsible for 1.4 years (78%) of reduction in the GGLE in Sweden between 1997 and 2018 [ 15 ]. Previous studies on the GGLE have shown that male LE is increasing in the UK while female LE remains constant and at lower levels than many comparable countries [ 5 , 21 – 23 ].…”