Differential impacts of health care in Australia: trend analysis of socioeconomic inequalities in avoidable mortality.
BACKGROUND
Recent avoidable mortality trends in Australia suggest that health care has made a substantial contribution to reducing mortality. This study investigates if the benefits of health care have been distributed equally by comparing declines in avoidable with non-avoidable mortality over time by socioeconomic status (SES).


METHODS
We calculated avoidable and non-avoidable mortality rates in Australia by small areas for 1986, 1991, 1997 and 2002. We performed pooled cross-sectional trend analysis of indirectly standardized mortality rates by SES and year, modelling using Poisson regression with over-dispersion. Socioeconomic inequalities were quantified using the relative (RII) and slope (SII) index of inequality.


RESULTS
The annual percentage decline in avoidable mortality at the higher end of the socioeconomic continuum (5.0%; 95% CI: 4.7-5.4%) was larger than at the lower end (3.5%; 3.2-3.8%), with increasing relative inequality between 1986 (RII = 1.54; 1.46-1.63) and 2002 (RII = 2.00; 1.95-2.06), greater than that in non-avoidable mortality (P = 0.036). In absolute terms, avoidable deaths fell annually by 7.4 (6.9-7.8) and 8.4 (7.9-8.9) deaths per 100 000 at the higher and lower end of the spectrum, respectively, with absolute inequality decreasing between 1986 (SII = 97.8; 87.6-107.9) and 2002 (SII = 81.5; 74.6-88.5).


CONCLUSIONS
Health care has contributed to decreasing the absolute SES mortality gap. However, advantaged people have obtained a disproportionate benefit of health care, contributing to widening relative health inequalities. A universal heath care system does not guarantee equality in health-care-related outcomes.
Korda
Rosemary J
RJ
National Centre for Epidemiology and Population Health, Australian National University, Canberra ACT 0200, Australia. rosemary.korda@anu.edu.au
Butler
James R G
JR
Clements
Mark S
MS
Kunitz
Stephen J
SJ
D001315:Australia / Q000453:epidemiology; D002423:Cause of Death / Q000639:trends; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000639:trends*; D005260:Female; D006297:Health Services Accessibility / Q000639:trends; D006801:Humans; D008297:Male; D015233:Models, Statistical; D009026:Mortality / Q000639:trends*; D017202:Myocardial Ischemia / Q000401:mortality; D017678:Sex Distribution; D012959:Socioeconomic Factors; D014504:Urban Health / Q000639:trends