How to measure premature mortality? A proposal combining “relative” and “absolute” approaches

Population Health Metrics

Lucia Zanotto¹  Stefano Mazzuco²  Marc Suhrcke³ 

[1] Department of Economics, University of Venice, Fondamenta San Giobbe 873, 30100, Venice, Italy;Department of Statistical Sciences, University of Padova, Via Cesare Battisti 241, 35121, Padua, Italy;Luxembourg Institute of Socio-Economic Research, Maison des Sciences Humaines 11, 4366, Esch-sur-Alzette, Belval, Luxembourg;Centre for Health Economics, University of York, York, UK;

关键词: Premature mortality;    Mixture model;    Hierarchical model;   

DOI  :  10.1186/s12963-021-00267-y

来源: Springer

【 摘 要 】

BackgroundThe concept of “premature mortality” is at the heart of many national and global health measurement and benchmarking efforts. However, despite the intuitive appeal of its underlying concept, it is far from obvious how to best operationalise it. The previous work offers at least two basic approaches: an absolute and a relative one. The former—and far more widely used— approach sets a unique age threshold (e.g. 65 years), below which deaths are defined as premature. The relative approach derives the share of premature deaths from the country-specific age distribution of deaths in the country of interest. The biggest disadvantage of the absolute approach is that of using a unique, arbitrary threshold for different mortality patterns, while the main disadvantage of the relative approach is that its estimate of premature mortality strongly depends on how the senescent deaths distribution is defined in each country.MethodWe propose to overcome some of the downsides of the existing approaches, by combining features of both, using a hierarchical model, in which senescent deaths distribution is held constant for each country as a pivotal quantity and the premature mortality distribution is allowed to vary across countries. In this way, premature mortality estimates become more comparable across countries with similar characteristics.ResultsThe proposed hierarchical models provide results, which appear to align with related evidence from  specific countries. In particular, we find a relatively high premature mortality for the United States and Denmark.ConclusionsWhile our hybrid approach overcomes some of the problems of previous measures, some issues require further research, in particular the choice of the group of countries that a given country is assigned to and the choice of the benchmarks within the groups. Hence, our proposed method, combined with further study addressing these issues, could provide a valid alternative way to measure and compare premature mortality across countries.

【 授权许可】

CC BY