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Comparison of Amenable Mortality in the United States, France, Germany, and the United Kingdom

Comparison of Amenable Mortality in the United States, France, Germany, and the United Kingdom

In a comparison of amenable mortality among four high-income countries between 1999 and 2007, the United States had the lowest rate of improvement.

Amenable mortality means avoidable deaths or “deaths that should not occur in the presence of timely and effective health care.”1. Examples of avoidable deaths include those from measles (against which effective immunization is available), cervical cancer (for which early detection and proper management is possible and life-saving), appendicitis (for which the management is relatively straightforward). In a perfect world, people should not be dying from measles, cervical cancer or appendicitis.

Amenable mortality is an indicator of healthcare quality.

Following up on their earlier work in comparing trends in deaths considered amenable to healthcare in industrialized countries, Drs Nolte and McKee recently published their report of a comparative analysis of trends and patterns of amenable mortality in the US and three other developed countries—France, Germany, and the United Kingdom—between 1999 and 2007.2

Their primary sources of data were the World Health Organization mortality database and the Centers for Disease Control and Prevention. France, Germany, and the United Kingdom were selected for comparison to the United States because:

  • They are high-income countries;
  • Provide universal access to care (but have different mechanisms for doing this);
  • France has traditionally been lower end of the spectrum of amenable mortality rates, and the United Kingdom at the higher end; and
  • These countries have similar population sizes.

Results

  • Amenable mortality was an important contributor to premature mortality in all four countries.
  • Between 1999 and 2007, rates of amenable mortality fell in all countries but the rate of decline was lowest in the United States. In other words, the United States had the lowest rate of improvement.
  • The relative lack of progress in the US was mainly due to circulatory conditions other than heart disease, i.e. cerebrovascular disease and hypertension.
  • Relative lack of progress in the US was also seen in mortality rates due to surgical conditions and medical errors.
  • Mortality from treatable cancers fell at a similar pace in all four countries.

Why Does the US Lag Behind Other High-Income Countries in Healthcare Quality Indicators?

The evidence points to access to care (or the lack of it)—far too many Americans don’t receive the right (i.e. evidence-based) treatment for common chronic diseases (e.g. diabetes, hypertension, and asthma) and/or care that they can afford.3 This is regrettable. Americans who receive evidence-based care achieve outcomes similar to their European counterparts, e.g. in Minnesota.

Some people have suggested that different definitions, different methods of collecting data, and under-reporting are the main reasons why the US seems to always lag behind other countries in healthcare quality indicators. The literature does not support these suggestions.

Read the article by Nolte and McKee “In Amenable Mortality—Deaths Avoidable Through Health Care—Progress In The US Lags That Of Three European Countries.”

References

  1. Rutstein D, Berenberg W, Chalmers T, Child C, Fishman A, Perrin E. Measuring the quality of medical care. N Engl J Med. 1976;294:582–8.
  2. Nolte E, McKee M. In Amenable Mortality—Deaths Avoidable Through Health Care—Progress In The US Lags That Of Three European Countries. Health Aff August 2012 10.1377/hlthaff.2011.0851
  3. Desai M, Rachet B, Coleman M, McKee M. Two countries divided by a common language: health systems in the UK and USA. J R Soc Med. 2010;103:283–7.

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