Temporal trend analysis of avoidable mortality in Taiwan, 1971-2008: overall progress, with areas for further medical or public health investment

BMC Public Health

Chun-Yuh Yang²  Brian K Chen¹ 

[1] Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, 800 Sumter Street #116, Columbia, SC 29208, USA;Department of Public Health, College of Health Sciences, Kaohsiung Medical University, 100 Shih-Chuan 1st Road, Kaohsiung 807, Taiwan

关键词: Breast cancer;    Lung cancer;    Taiwan;    Standard estimated years of life lost;    Avoidable mortality;   

Others  :  1162130
DOI  :  10.1186/1471-2458-13-551

 received in 2012-10-19, accepted in 2013-04-17,  发布年份 2013

【 摘 要 】

Background

Avoidable mortality (AM), or “unnecessary untimely death,” is considered an indicator of health care quality. We investigated trends in the age-standardized mortality rates (ASMRs) and associated standard expected years of life lost (SEYLL) for deaths amenable to medical care or public health measures in Taiwan from 1971-2008, with an emphasis on identifying areas where additional medical or public health investment may help reduce the burden of AM.

Methods

Taiwan’s ASMRs per 100,000 for AM and other causes of death were calculated using data from the National Death Certificate Registry in five-year bins from 1971 to 2008. SEYLL rates per 100,000 were calculated annually from 1971 to 2008 using the same data source.

Results

ASMR for almost all AM and other causes of death declined dramatically from 1971 to 2008 except for lung cancer (16.6% and 7.4% increase among men and women, respectively) and breast cancer (109.8% increase among women). In the same period, SEYLL due to lung cancer increased from 269.2 to 555.7 for men and 249.7 to 342.5 for women. For women, SEYLL due to breast cancer increased from 263.5 in 1971 to 659.3 in 2008. There were gender-specific differences in the reduction (or increase) in AM rates, with women showing larger rates of reduction or smaller rates of increase. Among men, AM fell by 65.9% from 1971-1975 to 2006-2008, and deaths from other causes increased by 15.6%. Among women, AM and deaths from other causes fell by 80.8% and 59.8% respectively. SEYLL decreased, respectively among males and females, from 23,147.3 and 24,081.1 in 1971 to 11,261.8 and 5,929.6 in 2008.

Conclusion

From 1971 to 2008, Taiwan experienced a dramatic reduction in most AM and corresponding SEYLL except for lung cancer (for both males and females) and breast cancer (for females). Additional effort should be devoted to public health measures to combat the rising prevalence of smoking in Taiwan, which may be responsible for the increasing AM from lung cancer. If AM in breast cancer continues unabated in the future, greater policy emphasis on the early detection and treatment of breast cancer may also be warranted.

【 授权许可】

   
2013 Chen and Yang; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Rutstein DD, Berenberg W, Chalmers TC, Child CG, Fishman AP, Perrin EB, Feldman JJ, Leaverton PE, Lane JM, Sencer DJ, et al.: Measuring the Quality of Medical Care. N Eng J Med 1976, 294(11):582-588.
• [2]Charlton JR, Velez R: Some international comparisons of mortality amenable to medical intervention. BMJ 1986, 292(6516):295-301.
• [3]Mackenbach JP, Looman CWN, Kunst AE, Habbema JDF, van der Maas PJ: Post-1950 mortality trends and medical care: Gains in life expectancy due to declines in mortality from conditions amenable to medical intervention in the Netherlands. Soc Sci; Med 1988, 27(9):889-894.
• [4]Poikolainen K, Eskola J: The effect of health services on mortality: decline in death rates from amenable and non-amenable causes in Finland, 1969-81. Lancet 1986, 327(8474):199-202.
• [5]Mackenbach JP, Bouvier-Colle MH, Jougla E: "Avoidable" mortality and health services: a review of aggregate data studies. J Epidemiol Community Health 1990, 44(2):106-111.
• [6]Kunst AE, Looman CWN, Mackenbach JP: Medical care and regional mortality differences within the countries of the European community. Eur J Pop/Revue européenne de Démographie 1988, 4(3):223-245.
• [7]Brandon JJ: 7 Billion and Counting. In In Asia. The Asia Foundation; available at http://asiafoundation.org/in-asia/2011/11/02/7-billion-and-counting/ webcite, accessed February 4, 2013; 2011
• [8]Beltrán-Sánchez H: Avoidable Mortality. In International Handbook of Adult Mortality. Volume 2 edition. Edited by Rogers RG, Crimmins EM. Netherlands: Springer; 2011:491-508.
• [9]Drumond E, Abreu DM, Machado C, Gomes F, Franca E: Racial disparities and avoidable infant mortality in a city of southeastern Brazil, 2001–09. J Trop Pediatr 2013, 59(1):23-28.
• [10]Ellis L, Coleman MP, Rachet B: How many deaths would be avoidable if socioeconomic inequalities in cancer survival in England were eliminated? A national population-based study, 1996–2006. Eur J Cancer 2012, 48(2):270-278.
• [11]Heijink R, Koolman X, Westert GP: Spending more money, saving more lives? The relationship between avoidable mortality and healthcare spending in 14 countries. Eur J Health Econ 2013, 14(3):527-538.
• [12]Klazinga N, Fischer C, ten Asbroek A: Health services research related to performance indicators and benchmarking in Europe. J Health Serv Res Policy 2011, 16(suppl 2):38-47.
• [13]Li SQ, Gray N, Guthridge S, Pircher S, Wang Z, Zhao Y: Avoidable mortality trends in Aboriginal and non-Aboriginal populations in the Northern Territory, 1985-2004. Aust N Z J Public Health 2009, 33(6):544-550.
• [14]Macinko J, Elo IT: Black–white differences in avoidable mortality in the USA, 1980–2005. J Epidemiol Community Health 2009, 63(9):715-721.
• [15]Nolasco A, Melchor I, Pina JA, Pereyra-Zamora P, Moncho J, Tamayo N, García-Senchermes C, Zurriaga O, Martínez-Beneito MA: Preventable avoidable mortality: Evolution of socioeconomic inequalities in urban areas in Spain, 1996–2003. Health Place 2009, 15(3):732-741.
• [16]Nolte E, McKee M: Variations in amenable mortality—trends in 16 high-income nations. Health Policy 2011, 103(1):47-52.
• [17]Schwierz C, Wübker A: Determinants of avoidable deaths from ischemic heart disease in East and West Germany. J Public Health 2010, 18(4):309-317.
• [18]Sundmacher L: Trends and levels of avoidable mortality among districts:“Healthy” benchmarking in Germany. Health Policy 2013, 109(3):281-289.
• [19]Sundmacher L, Busse R: The impact of physician supply on avoidable cancer deaths in Germany. A spatial analysis. Health Policy 2011, 103(1):53-62.
• [20]Weisz D, Gusmano MK, Rodwin VG, Neuberg LG: Population health and the health system: a comparative analysis of avoidable mortality in three nations and their world cities. Eur J Public Health 2008, 18(2):166-172.
• [21]Chung JI, Song YM, Choi JS, Kim BM: Trends in avoidable death over 20 years in Korea. J Korean Med Sci 2008, 23(6):975-981.
• [22]Chau PH, Woo J, Chan KC, Weisz D, Gusmano MK: Avoidable mortality pattern in a Chinese population—Hong Kong, China. Eur J Public Health 2011, 21(2):215-220.
• [23]Lee YC, Huang YT, Tsai YW, Huang SM, Kuo KN, McKee M, Nolte E: The impact of universal National Health Insurance on population health: the experience of Taiwan. BMC Health Serv Res 2010, 10:225. BioMed Central Full Text
• [24]Lu T-H, Lee M-C, Chou M-C: Accuracy of cause-of-death coding in Taiwan: types of miscoding and effects on mortality statistics. Int J Epidemiol 2000, 29(2):336-343.
• [25]Holland W: Measuring the quality of medical care. J Health Serv Res Policy 2009, 14(3):183-185.
• [26]Kossarova L, Holland W, Nolte E, McKee M: Measuring "avoidable" mortality: methodological note. Edited by Directorate-General. Brussels, Belgium: Employment, Social Affairs and Equal Opportunities; 2009.
• [27]James PD, Manuel DG, Mao Y: Avoidable mortality across Canada from 1975 to 1999. BMC Public Health 2006, 6(1):137. BioMed Central Full Text
• [28]Gerald R, Fowkes F, Housley E, Riemersma RA, Macintyre CCA, Cawood EHH, Prescott RJ, Ruckley CV: Smoking, Lipids, Glucose Intolerance, and Blood Pressure as Risk Factors for Peripheral Atherosclerosis Compared with Ischemic Heart Disease in the Edinburgh Artery Study. Am J Epidemiol 1992, 135(4):331-340.
• [29]Goldman L, Cook EF: The decline in ischemic heart disease mortality rates, An analysis of the comparative effects of medical interventions and changes in lifestyle. Ann Intern Med 1984, 101(6):825-836.
• [30]Courville KA, Lavie CJ, Milani RV: Lipid-Lowering Therapy for Elderly Patients at Risk for Coronary Events and Stroke. Am Heart Hosp J 2005, 3(4):256-262.
• [31]Boodhwani M, Rubens FD, Sellke FW, Mesana TG, Ruel M: Mortality and myocardial infarction following surgical versus percutaneous revascularization of isolated left anterior descending artery disease: a meta-analysis. Eur J Cardiothorac Surg 2006, 29(1):65-70.
• [32]Ringash J: Care tCTFoPH: Preventive health care, 2001 update: screening mammography among women aged 40–49 years at average risk of breast cancer. Can Med Assoc J 2001, 164(4):469-476.
• [33]Sigurdsson K, Sigvaldason H: Effectiveness of cervical cancer screening in Iceland, 1964–2002: a study on trends in incidence and mortality and the effect of risk factors. Acta Obstet Gynecol Scand 2006, 85(3):343-349.
• [34]Lăără E, Day N, Hakama M: Trends in mortality from cervical cancer in the Nordic countries: association with organised screening programmes. Lancet 1987, 329(8544):1247-1249.
• [35]Anthonisen NR, Skeans MA, Wise RA, Manfreda J, Kanner RE, Connett JE: The effects of a smoking cessation intervention on 14.5-year mortality: a randomized clinical trial. Ann Intern Med 2005, 142(4):233-239.
• [36]Chiu WT, Kuo CY, Hung CC, Chen M: The effect of the Taiwan motorcycle helmet use law on head injuries. Am J Public Health 2000, 90(5):793-796.
• [37]Nolte E, McKee M: Measuring the health of nations: analysis of mortality amenable to health care. J Epidemiol Community Health 2004, 58(4):326-326.
• [38]Oh MS, Yu KH, Roh JK, Lee BC: Gender Differences in the Mortality and Outcome of Stroke Patients in Korea. Cerebrovasc Dis 2009, 28(5):427-434.
• [39]Massie DL, Campbell KL, Williams AF: Traffic Accident involvement rates by driver age and gender. Accident Anal; Prev 1995, 27(1):73-87.
• [40]Ahmad OE, Boschi-Pinto C, Lopez AD, Lozano R, Inoue M: Age standardization of rates: A new WHO standard. GPE Discussion Paper, Series No. 31: Geneva, Switzerland; 2010.
• [41]Lai CC, Tan CK, Huang YT, Chou CH, Hung CC, Yang PC, Luh KT, Hsueh PR: Extensively drug-resistant Mycobacterium tuberculosis during a trend of decreasing drug resistance from 2000 through 2006 at a medical center in Taiwan. Clin Infect Dis 2008, 47(7):e57-e63.
• [42]Yeh Y, Luh D, Chang S, Suo J, Chang H, Chen T: Tuberculin reactivity in adults after 50 years of universal bacille Calmette-Guerin vaccination in Taiwan. Trans R Soc Trop Med Hyg 2005, 99(7):509.
• [43]Hung TP: Changes in mortality from cerebrovascular disease and clinical pattern of stroke in Taiwan. Journal of the Formosan Medical Association =. Taiwan yi zhi 1993, 92(8):687-696.
• [44]Chang Y-H, Li C-Y, Tung T-H, Tsai J-J, Lu T-H: Age–period–cohort analysis of mortality from epilepsy in Taiwan, 1971–2005. Seizure 2011, 20(3):240-243.
• [45]Tsai MC, Hemenway D: Effect of the mandatory helmet law in Taiwan. Inj Prev 1999, 5(4):290-291.
• [46]Doll R, Hill AB: Lung Cancer and Other Causes of Death in Relation to Smoking. BMJ 1956, 2(5001):1071-1081.
• [47]Hecht SS: Tobacco Smoke Carcinogens and Lung Cancer. J Natl Cancer Inst 1999, 91(14):1194-1210.
• [48]Zhong L, Goldberg MS, Parent ME, Hanley JA: Exposure to environmental tobacco smoke and the risk of lung cancer: a meta-analysis. Lung cancer (Amsterdam, Netherlands) 2000, 27(1):3-18.
• [49]Hecht SS: Cigarette smoking and lung cancer: chemical mechanisms and approaches to prevention. Lancet Oncol 2002, 3(8):461-469.
• [50]Cornfield J, Haenszel W, Hammond EC, Lilienfeld AM, Shimkin MB, Wynder EL: Smoking and lung cancer: recent evidence and a discussion of some questions. Int J Epidemiol 2009, 38(5):1175-1191.
• [51]Alberg A, JM S: Epidemiology of Lung Cancer. Chest 2003, 123:21-49.
• [52]U.S. National Institutes of Health: SEER Cancer Statistics Review. In Edited by National Cancer Institute. 1973-2008.
• [53]Chiang T-A, Chen P-H, Wu P-F, Wang T-N, Chang P-Y, Ko A, Huang M-S, Ko Y-C: Important prognostic factors for the long-term survival of lung cancer subjects in Taiwan. BMC Cancer 2008, 8(1):324. BioMed Central Full Text
• [54]Liaw K, Chen C: Mortality attributable to cigarette smoking in Taiwan: a 12-year follow-up study. Tob Control 1998, 7(2):141-148.
• [55]Wen CP, Levy DT, Cheng TY, Hsu C-C, Tsai SP: Smoking behaviour in Taiwan, 2001. Tob Control 2005, 14(suppl 1):i51-i55.
• [56]Chen CJ, Wu HY, Chuang YC, Chang AS, Luh KT, Chao HH, Chen KY, Chen SG, Lai GM, Huang HH: Epidemiologic characteristics and multiple risk factors of lung cancer in Taiwan. Anticancer Res 1990, 10(4):971-976.
• [57]Parkin DM, Pisani P, Ferlay J: Estimates of the worldwide incidence of eighteen major cancers in 1985. Int J Cancer Journal international du cancer 1993, 54(4):594-606.
• [58]Commission on Cancer: National Cancer Database. 2001-2002.
• [59]Cheng SH, Tsou M-H, Liu M-C, Jian JJ, Cheng JC-H, Leu S-Y, Hsieh C-Y, Huang AT: Unique features of breast cancer in Taiwan. Breast Cancer Res Treat 2000, 63(3):213-223.
• [60]Morrison AS, Black MM, Lowe CR, Macmahon B, Yuasa S: Some international differences in histology and survival in breast cancer. Int J Cancer 1973, 11(2):261-267.
• [61]Hsu JL, Glaser SL, West DW: Racial/Ethnic Differences in Breast Cancer Survival Among San Francisco Bay Area Women. J Natl Cancer Inst 1997, 89(17):1311-1312.
• [62]Yang PS, Yang TL, Liu CL, Wu CW, Shen CY: A case-control study of breast cancer in Taiwan - a low-incidence area. Br J Cancer 1997, 75(5):752-756.
• [63]Surveillance Epidemiology and End Results Program: SEER Incidence Database. National Cancer Institute, DCCPS, Surveillance Research Program, Surveillance Systems Branch 2005-2009.
• [64]Eheman C, Henley SJ, Ballard-Barbash R, Jacobs EJ, Schymura MJ, Noone AM, Pan L, Anderson RN, Fulton JE, Kohler BA, et al.: Annual Report to the Nation on the status of cancer, 1975-2008, featuring cancers associated with excess weight and lack of sufficient physical activity. Cancer 2012, 118(9):2338-2366.
• [65]Jatoi I, Miller AB: Why is breast-cancer mortality declining? Lancet Oncol 2003, 4(4):251-254.
• [66]Nathanson CA: Sex Differences in Mortality. Annu Rev Sociol 1984, 10:191-213. ArticleType: research-article / Full publication date: 1984 / Copyright © 1984 Annual Reviews
• [67]Reeves MJ, Bushnell CD, Howard G, Gargano JW, Duncan PW, Lynch G, Khatiwoda A, Lisabeth L: Sex differences in stroke: epidemiology, clinical presentation, medical care, and outcomes. Lancet Neurol 2008, 7(10):915-926.
• [68]Ayala C, Croft JB, Greenlund KJ, Keenan NL, Donehoo RS, Malarcher AM, Mensah GA: Sex Differences in US Mortality Rates for Stroke and Stroke Subtypes by Race/Ethnicity and Age, 1995–1998. Stroke 2002, 33(5):1197-1201.
• [69]Lu T-H, Shau W-Y, Shih T-P, Lee M-C, Chou M-C, Lin C-K: Factors associated with errors in death certificate completion: a national study in Taiwan. J Clin Epidemiol 2001, 54(3):232-238.