Changes in Socioeconomic Inequalities in Amenable Mortality after the Economic Crisis in Cities of the Spanish Mediterranean Coast

Abstract

Several studies have described a decreasing trend in amenable mortality, as well as the existence of socioeconomic inequalities that affect it. However, their evolution, particularly in small urban areas, has largely been overlooked. The aim of this study is to analyse the socioeconomic inequalities in amenable mortality in three cities of the Valencian Community, namely, Alicante, Castellon, and Valencia, as well as their evolution before and after the start of the economic crisis (2000–2007 and 2008–2015). The units of analysis have been the census tracts and a deprivation index has been calculated to classify them according to their level of socioeconomic deprivation. Deaths and population were also grouped by sex, age group, period, and five levels of deprivation. The specific rates by sex, age group, deprivation level, and period were calculated for the total number of deaths due to all causes and amenable mortality and Poisson regression models were adjusted in order to estimate the relative risk. This study confirms that the inequalities between areas of greater and lesser deprivation in both all-cause mortality and amenable mortality persisted along the two study periods in the three cities. It also shows that these inequalities appear with greater risk of death in the areas of greatest deprivation, although not uniformly. In general, the risks of death from all causes and amenable mortality have decreased significantly from one period to the other, although not in all the groups studied. The evolution of death risks from before the onset of the crisis to the period after presented, overall, a general pro-cyclical trend. However, there are population subgroups for which the trend was counter-cyclical. The use of the deprivation index has made it possible to identify specific geographical areas with vulnerable populations in all three cities and, at the same time, to identify the change in the level of deprivation (ascending or descending) of the geographical areas throughout the two periods. It is precisely these areas where more attention is needed in order to reduce inequalities.

Examining the Economic Perspective of Treatable Mortality: The Role of Health Care Financing and the Importance for Economic Prosperity

“…Differences in treatable mortality were also evident between population groups within one country, and in order to achieve comparable outcomes with other countries, an internal problem needs to be addressed first ( 60 ). It is very difficult to get closer to successful countries if there are obvious health disparities between geographical regions and provinces ( 61 , 62 ). Each country is specific and this fact should be taken into account when formulating health policies.…”

Assessing performance of the Healthcare Access and Quality Index, overall and by select age groups, for 204 countries and territories, 1990–2019: a systematic analysis from the Global Burden of Disease Study 2019

“…Amenable mortality, or deaths from causes that should not occur in the presence of high-quality health care, 15 , 16 has been used as a measure of the health-care dimension of health system performance for nearly 50 years. 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 The most widely used list of causes of mortality amenable to health care was developed by Nolte and McKee, and has since been used to compare high-income countries' performances at length. 10 , 18 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 A recent study by Kruk and colleagues 34 used case-fatality rates for causes included in the McKee and Nolte list and additional diseases to estimate the separate effects of utilisation versus quality for 137 countries.…”

“…A small number of existing studies have compared countries using amenable mortality across the life course, although these only focus on a subset of countries and territories. 15 , 22 , 32 , 40 , 41 , 42 Using amenable mortality, existing evidence suggests European countries improved health-care access and quality most for children and adolescents, with substantially bigger declines in amenable mortality estimated for these age groups as compared with older populations. 15 Past studies on amenable mortality by age have engaged the debate about the possibility of convergence in mortality and life expectancy.…”

Spatial and Temporal Evolutionary Characteristics and Its Influencing Factors of Economic Spatial Polarization in the Yangtze River Delta Region

“…Since more than 40 years of reform and opening up in China, after the transition from a planned economy to a market economy, the problem of unbalanced regional development has gradually emerged, and the imbalance of economic development has also transformed from a low level to a high level. Inequality has been widely studied in academia because of its important impact on social cohesion, medical service carrying capacity, and regional sustainable development [ 1 , 2 , 3 , 4 , 5 , 6 , 7 ]. The main contradiction in Chinese society has also been transformed into a contradiction between the people’s ever-growing needs for a better life and unbalanced and inadequate development.…”