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Data from May 2015. Most recent data: Further Eurostat information, Main tables and Database. Planned article update: May 2016

This article presents statistics on two different indicators of avoidable mortality, namely amenable and preventable deaths. The concept of amenable and preventable mortality is based on the idea that certain deaths (for specific age groups and according to specific diseases as defined by the ICD classification, see Data sources and availability) could be 'avoided', that means would not have occurred at this stage, if there had been effective public health and medical interventions in place. A death can be considered as amenable if it could have been avoided through good quality health care. The concept of preventable deaths is broader and includes deaths, which could have been avoided by public health interventions focusing on wider determinants of public health, such as behaviour and lifestyle factors, socioeconomic status and environmental factors.

In 2012, over 590 000 deaths in the EU could have potentially been avoided in the light of better healthcare systems and over 1 million deaths could have been prevented through better public health interventions. The number of potentially avoidable deaths - which accounts for the fact that certain diseases are both preventable and amenable[1] – reached over 1.2 million deaths in 2012. The main category contributing to avoidable mortality were ischaemic heart diseases.

Table 1: Amenable and preventable mortality, Standardized deaths rates (per 100 000 inhabitants)
Source: Eurostat (hlth_cd_apr)
Table 2: Avoidable, amenable and preventable mortality in the EU28, 2012 (absolute numbers)
Source: Eurostat (hlth_cd_apreu)
Figure 1: Sex differences in amenable mortality rates, 2012 (per 100 000 inhabitants)
Source: Eurostat (hlth_cd_apr)
Figure 2: Main contributors of amenable mortality in the EU, 2012 (1) (absolute numbers)
Source: Eurostat (hlth_cd_apreu)
Figure 3: Main contributors of preventable mortality in the EU (numbers)
Source: Eurostat (hlth_cd_apreu)
Figure 4: Different contributors of amenable mortality for men and women in the EU, 2012 (1) (percent)
Source: Eurostat (hlth_cd_apreu)
Figure 5: Different contributors of preventable mortality for men and women in the EU, 2012 (1) (percent)
Source: Eurostat (hlth_cd_apreu)

Main statistical findings

In 2012, over 590 000 deaths in the EU could have been avoided in the light of better healthcare systems….

In the European Union (EU), 1.7 million persons aged less than 75 years died in 2012. Among them, over 590 000 deaths could have been avoided in the light of better healthcare systems. The change compared to 2011 data is negligible, evidencing that these figures are stable in the short run. Across EU Member States a substantial amount of deaths can be considered as potentially avoidable and variations depend on Member States' population size. Table 1 shows data for standardized deaths rates of amenable mortality, which takes into account the population structure of countries. Among EU Member States, the lowest amenable mortality rates in 2012 are found for France (2011 data), Spain, Italy and the Netherlands. On the other side of the spectrum are Bulgaria, Lithuania, Romania and Latvia – evidencing high rates of potentially avoidable deaths. …and over 1 million deaths could have been prevented through better public health interventions.

The figures for preventable mortality are higher than the ones for amenable mortality, due to the broader definition of preventable deaths (Data sources and availability) (See Table 1). In 2012, over 1 million deaths could have been prevented through better public health interventions (See Table 2). These figures are again very similar to 2011 data. The Member States with the lowest preventable mortality rates in 2012 are Cyprus, Italy, Spain and Greece; while Member States evidencing highest levels of potentially preventable deaths are Romania, Hungary, Latvia and Lithuania.

The total number of deaths that could have potentially been avoided through effective public health and medical interventions reached over 1.2 million deaths in 2012 (Table 2). [2]

Amenable mortality rates are higher for men than for women in Europe

Consistently throughout Europe, amenable mortality rates for men are higher than those for women (see Figure 1). Lowest sex differences (compared to the total amenable mortality rate) are observed for the Netherlands, Denmark, Belgium, and the UK. Similar results are obtained when looking at the preventable mortality rates (not shown in this article). Heart diseases are the most important category of amenable and preventable deaths…

As shown in Figure 2, the six biggest contributors to amenable mortality are the following diseases or conditions (with decreasing importance): ischaemic heart diseases, cerebrovascular diseases, colorectal cancer, breast cancer, hypertensive diseases and pneumonia (A full overview over the diseases and conditions included in amenable mortality is presented in Table 2). In total, over 78 percent of all deaths classified as amenable in the EU were caused by the aforementioned diseases. Heart diseases alone accounted for over 32 percent of amenable deaths. As can be seen in Figure 2, the distribution over these diseases remained stable in the two periods studied. …while lung cancer, injuries, and alcohol related diseases are other major contributors to preventable deaths.

Over 70 percent of preventable deaths in the EU are attributable to the following diseases and conditions (with decreasing importance): ischaemic heart diseases, lung cancer, accidental injuries, alcohol related diseases, suicides and self-inflicted injuries, colorectal cancer, and breast cancer (A full overview over the diseases and conditions included in preventable mortality is presented in Table 2). Again, the allocation of deaths over these diseases remained stable in the two periods studied (see Figure 3). Similar contributors to amenable mortality for men and women, with the exception of breast and cervical cancer concerning women

The distribution of diseases and conditions contributing to both amenable and preventable deaths varies slightly for men and women. While for men the biggest contributor in percentage terms were ischaemic heart diseases, the number one contributor for amenable deaths for women was breast cancer (Figure 4). For preventable mortality, the biggest contributor for men is again ischaemic heart diseases, while accidental injuries and female breast cancer are equally important contributors to preventable deaths for women (Figure 5).

Data sources and availability

Amenable and preventable mortality indicators are calculated from the data on causes of death, which provide information on mortality patterns, supplying information on developments over time in the underlying causes of death. The causes of death data collection is documented in more detail in this background article which provides information on the scope of the data, its legal basis, the methodology employed, as well as related concepts and definitions.

The definitions of amenable and preventable death are as follows[3]:

  • A death is amenable if, in the light of medical knowledge and technology at the time of deaths, all or most deaths from that cause could be avoided through good quality health care.
  • A death is preventable if, in the light of understanding of the determinants of health at the time of death, all or most deaths from that cause could be avoided by public health interventions in the broadest sense.

In order to define a precise list of diseases and conditions and age boundaries (based on the ICD classification), Eurostat set up a Task Force composed of health experts. The list of diseases and conditions was approved by the Members of Eurostat's Working Group of Public Health Statistics.

Some diseases and conditions are included in both amenable and preventable death, since certain conditions are considered as both treatable and preventable (examples are ischaemic heart diseases and diabetes). In addition to the specific diseases and conditions, the Task Force specified the age up to which a death can be considered as either amenable or preventable. Age limits are necessary because the quality of deaths registration data is sensitive to the age of the deceased.

Both, the list of diseases and conditions, as well as the age limits reflect the current health expectations, medical technology and knowledge, and developments in healthcare public policy, and hence might be subject to change in the future.

Annual data on amenable and preventable deaths are provided in absolute numbers and as standardised death rates. Since most causes of death vary significantly by age and according to sex, the use of standardised death rates improves comparability over time and between countries as death rates can be measured independently of a population’s age structure.

Context

Assessing the performance of health care systems is of increasing importance in the EU. While amenable and preventable mortality indicators are not meant to be a definite measurement of the quality of the health care in Member States, they provide some indication for the quality and performance of healthcare and (wider) public health policies in a country. Improvements in health policies should translate into lower values for amenable and preventable deaths. However, there is likely to be a long time lag between implementation of health (care) policies and changes in the mortality rates, and hence conclusions need to be drawn with caution.

See also

Further Eurostat information

Publications

Main tables

Database

Dedicated section

Methodology / Metadata

Source data for tables and figures (MS Excel)

External links

Notes

  1. ↑ Without double counting.
  2. ↑ Note that the total avoidable number of deaths does not equal the sum of amenable and preventable. See Table 2.
  3. ↑ See Office for National Statistics (ONS), UK, 2011: http://www.ons.gov.uk/ons/about-ons/get-involved/consultations/archived-consultations/2011/definitions-of-avoidable-mortality/definition-of-avoidable-mortality.pdf


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