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Amenable mortality

Amenable mortality is mortality that can theoretically be averted by good health care. The concept of amenable mortality first appeared in the 1970s and a substantial amount of work in this area was undertaken in the 1980s (Ruststein et al 1976, Charlton et al 1983, Mackenbach et al 1988, Holland 1988). More recently a comprehensive review was published which evaluated the conditions considered amenable to medical intervention (Nolte & McKee 2003, 2004). 

The work reported here, which was carried out by the ScotPHO team at ISD, was initiated in response to a request from the Chief Medical Officer for Scotland. The analyses (based on methodology outlined in the aforementioned review) was developed into a short report.  This report, Mortality amenable to health care in Scotland 1981-2004 PDF Button(588kb), provides estimates of amenable mortality by NHS board in Scotland and an assessment of its potential contribution to understanding health system performance in Scotland.

A summary of the key findings are provided below:

  • During 2000-2004, there were 34,000 deaths in Scotland (around 6,800 per annum) categorised as amenable to health care, representing approximately 10% of all deaths annually.
  • Ischaemic heart disease, cerebrovascular disease, malignant neoplasm of colon and rectum, malignant neoplasm of breast, and pneumonia accounted for the largest numbers of amenable deaths, and caused 82% of all amenable deaths in Scotland during the 5-year period.
  • Greater Glasgow NHS Board has the highest age and sex standardised amenable mortality rates for both males and females, with significantly high standardised rates also observed for Argyll and Clyde and Lanarkshire.
  • The overall standardised death rate for amenable mortality in Scotland was 123.6 per 100,000 population compared to 130.0 for the UK.

In 2005, the Office for National Statistics (ONS) undertook a consultation exercise on the development of indicators of avoidable mortality for use in National Statistics in England and Wales. A paper summarising responses to the consultation was published in September 2006. These papers can be downloaded from the ONS website.

The ScotPHO team at ISD is developing plans for further work on this topic and we hope to be able to report progress on this in later in 2007.  

Key references:

Charlton J.R.H., Hartley R.M., Silver R. and Holland W.W. (1983), Geographical variation in mortality from conditions amenable to medical intervention in England and Wales, Lancet 691-696.

Holland W.W. (1988), The 'avoidable death' guide to Europe. Health Policy, 6:115-117.

Mackenbach J.P., Looman C.W.N., Kunst A.E., Habbema J.F.D. and van der Mass P.J. (1988), Post 1950 mortality trends and medical care: gains in life expectancy due to declines in mortality from conditions amenable to medical care interventions in the Netherlands, Social Science and Medicine, 27:889--894.

Nolte E. and McKee M. (2003), Measuring the health of nations: an analysis of mortality amenable to health care, British Medical Journal 327:1129-1134. 

Nolte E. and McKee M. (2004) (851kb). Does Health Care Save Lives? Avoidable Mortality revisitedPDF Button(851Kb). The Nuffield Trust, London.

Rutstein D.D., Berenberg W., Chalmers T.C., Child C.G., Fishman A.P. and Perrrin E.B. (1976), Measuring the quality of medical care. New England Journal of Medicine 294:582-588.