Perspectives in Disease Prevention and Health Promotion
Mortality Due to Conditions Preventable by Medical Intervention --
New Hampshire, 1970-1985
Epidemiologic surveillance, which serves to identify areas
requiring prevention and control efforts, is most effective when
accurate and complete population-based data are available. In New
Hampshire, population-based incidence data are available for only a
limited number of conditions; therefore, mortality data from death
certificates have been used as an indicator of health status. The
following analysis examines the distribution of deaths in New
Hampshire due to 14 specific conditions during the period
1970-1985.
These particular conditions were studied because they generally do
not
lead to death if appropriate medical intervention is provided (1).
For this analysis, deaths were tabulated by year and county of
residence. To increase the likelihood that mortality from the
given
conditions was preventable, only deaths occurring among specific
age
groups were included. Age-adjusted rates were derived by the
direct
method using the 1970 U.S. population as the standard. To estimate
the years of potential life lost (YPLL) before age 65, each death
was
considered to have occurred during the mid-year of the individual
age
stratum.
During this 16-year period, 870 deaths were attributable to
these
14 selected causes. Cervical cancer, hypertensive heart disease,
and
pneumonia accounted for 69% of these deaths and for 60% of the
resulting YPLL (Table 2). The greatest number of deaths occurred
among persons 45-54 years of age, followed by those aged 55-64.
The
overall age-adjusted county death rates ranged from 84.6 to
152.7/100,000 population during this period. The statewide
age-adjusted mortality rate for these conditions declined from 97
in
1970 to 51 in 1985.
Reported by: E Schwartz, MD, MPH, State Epidemiologist, New
Hampshire
State Dept of Health and Human Services. Div of Surveillance and
Epidemiologic Studies, Epidemiology Program Office, CDC.
Editorial Note
Editorial Note: The above analysis provides a means for
evaluating
screening and treatment services and may be useful for health
planning
and for monitoring the impact of health care delivery on mortality.
The occurrence of even a single sentinel health event* represents a
possible deficiency in the health care system. Thus, surveillance
of
case counts rather than comparison of rates is important.
Calculation
of YPLL before age 65 emphasizes the loss in productive years of
life.
The annual averages of 14 deaths from cervical cancer and 12
deaths from hypertensive heart disease suggest the need to evaluate
screening and treatment services. The small but persistent number
of
deaths due to appendicitis, cholecystitis, and abdominal hernias,
all
of which are surgically correctable, implies a need to evaluate the
accessibility of health care. Additionally, an average 12
pneumonia
and bronchitis deaths each year in the 15- to 54-year age group
suggests possible shortcomings in the health care system.
Data from death certificates do not provide sufficient detail
to
determine the underlying circumstances that may have led to these
deaths. Various factors, including the presence of coexisting
diseases and other predisposing conditions that may complicate
treatment, might explain their occurrence. Socioeconomic
conditions
such as financial constraints, lack of education, and
unavailability
of transportation as well as the quality of medical care may also
be
important.
The almost 50% decline in the statewide age-adjusted mortality
rate from these 14 conditions over the 16-year period indicates an
improvement in health care. Continued efforts to prevent
unnecessary
or untimely deaths will require evaluating both the social
conditions
that may cause diseases and the factors influencing the efficacy of
medical services. Monitoring sentinel deaths and the subsequent
search for their causes may provide new opportunities for
preventing
needless mortality.
References
Charlton JRH, Hartley RM, Silver R, Holland WW. Geographical
variation in mortality from conditions amenable to medical
intervention in England and Wales. Lancet 1983;1:691-6.
Rutstein DD, Berenberg W, Chalmers TC, Child CG 3rd, Fishman
AP,
Perrin EB. Measuring the quality of medical care: a clinical
method. N Engl J Med 1976;294:582-8.
*Unnecessary or untimely death (2).
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