[Health system interventions assessment in Spain: an approach through the analysis of the time trends and the geographical variability of avoidable mortality between 1986 -2001].
BACKGROUND
Many studies have proposed Avoidable Mortality (ME) to monitor the performance of health services although its usefulness is limited by the multiplicity of the avoidable mortality lists being used. Time trends from 1986-2001 and the geographical distribution of avoidable mortality by provinces, are presented for Spain.


METHODS
An Avoidable Mortality consensus list is being used. It includes avoidable mortality through the intervention of health services (ISAS in Spanish) and through health policy interventions (IPSI in Spanish). Time trends are analyzed adjusting Poisson or Joinpoint regression models and the annual percentages of change (APC) are estimated. Changes in geographical distribution between the first half of the analysed period and the second are tested by means of standard mortality ratios (SMR) and comparative mortality rates (CMR) for each province.


RESULTS
Between 1986 and 2001 avoidable mortality decreased (APC: -1.68; CI: -1.99 and -1.38) slightly more than non-avoidable mortality (APC: -1.28; CI: -1.40 and -1.17). Higher reduction was observed for ISAS mortality (APC: -2.77; CI: -2.89 and -2.65) and an irregular trend for IPSI (between 1986-1990 increase APC: 4.86; CI: 3.32 and 6.41, between 1990-95 stabilization APC: -0.03; CI: -2.32 and 2.31 and finally 1995-2001 decrease APC: -3.57; CI: -4.72 and -2.40).


CONCLUSIONS
Avoidable mortality decreased more than non avoidable mortality and important geographical variability can be observed among provinces which should be monitored in order to identify the health services weaknesses. The higher ISAS mortality was observed in southern provinces and the higher IPSI mortality in some areas on the coast. The pattern is somewhat similar for both analyzed periods.
Gispert Magarolas
Rosa
R
Servei d'Informació i Estudis, Departament de Salut, Generalitat de Catalunya. rosa.gispert@gencat.net
Barés Marcano
Ma Arán
MA
Freitas Ramírez
Adriana
A
Torné Farré
Mar
M
Puigdefàbregas Serra
Anna
A
Alberquilla
Angel
A
Albert
Xavier
X
Luis Alfonso
Jose
J
Caminal
Josefina
J
Fernández-Cuenca
Rafael
R
García
Fernando
F
Gervas
Juan
J
Librero
Julián
J
Martos
Carmen
C
Medrano
Ma José
MJ
Ruiz
Miguel
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D010043:Outcome and Process Assessment, Health Care; D013030:Spain / Q000453:epidemiology; D013997:Time Factors