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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

  1. 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.

  2. 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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