title: Socioeconomic inequalities in mortality from conditions amenable to medical interventions: do they reflect inequalities in access or quality of health care?
abstract: BACKGROUND
  Previous studies have reported large socioeconomic inequalities in mortality from conditions amenable to medical intervention, but it is unclear whether these can be attributed to inequalities in access or quality of health care, or to confounding influences such as inequalities in background risk of diseases. We therefore studied whether inequalities in mortality from conditions amenable to medical intervention vary between countries in patterns which differ from those observed for other (non-amenable) causes of death. More specifically, we hypothesized that, as compared to non-amenable causes, inequalities in mortality from amenable causes are more strongly associated with inequalities in health care use and less strongly with inequalities in common risk factors for disease such as smoking.
  
  
  METHODS
  Cause-specific mortality data for people aged 30-74 years were obtained for 14 countries, and were analysed by calculating age-standardized mortality rates and relative risks comparing a lower with a higher educational group. Survey data on health care use and behavioural risk factors for people aged 30-74 years were obtained for 12 countries, and were analysed by calculating age-and sex-adjusted odds ratios comparing a low with a higher educational group. Patterns of association were explored by calculating correlation coefficients.
  
  
  RESULTS
  In most countries and for most amenable causes of death substantial inequalities in mortality were observed, but inequalities in mortality from amenable causes did not vary between countries in patterns that are different from those seen for inequalities in non-amenable mortality. As compared to non-amenable causes, inequalities in mortality from amenable causes are not more strongly associated with inequalities in health care use. Inequalities in mortality from amenable causes are also not less strongly associated with common risk factors such as smoking.
  
  
  CONCLUSIONS
  We did not find evidence that inequalities in mortality from amenable conditions are related to inequalities in access or quality of health care. Further research is needed to find the causes of socio-economic inequalities in mortality from amenable conditions, and caution should be exercised in interpreting these inequalities as indicating health care deficiencies.
authors.affiliation: Department of Public Health, Erasmus MC, Rotterdam, Netherlands.
authors.forename: Iris
authors.initials: I
authors.lastname: Plug
authors.forename: Rasmus
authors.initials: R
authors.lastname: Hoffmann
authors.forename: Barbara
authors.initials: B
authors.lastname: Artnik
authors.forename: Matthias
authors.initials: M
authors.lastname: Bopp
authors.forename: Carme
authors.initials: C
authors.lastname: Borrell
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Costa
authors.forename: Patrick
authors.initials: P
authors.lastname: Deboosere
authors.forename: Santi
authors.initials: S
authors.lastname: Esnaola
authors.forename: Ramune
authors.initials: R
authors.lastname: Kalediene
authors.forename: Mall
authors.initials: M
authors.lastname: Leinsalu
authors.forename: Olle
authors.initials: O
authors.lastname: Lundberg
authors.forename: Pekka
authors.initials: P
authors.lastname: Martikainen
authors.forename: Enrique
authors.initials: E
authors.lastname: Regidor
authors.forename: Jitka
authors.initials: J
authors.lastname: Rychtarikova
authors.forename: Björn Heine
authors.initials: BH
authors.lastname: Strand
authors.forename: Bogdan
authors.initials: B
authors.lastname: Wojtyniak
authors.forename: Johan P
authors.initials: JP
authors.lastname: Mackenbach
mesh_terms: D000328:Adult; D000368:Aged; D016208:Databases, Factual; D004522:Educational Status; D005060:Europe / Q000453:epidemiology; D005500:Follow-Up Studies; D054625:Healthcare Disparities; D006801:Humans; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D011787:Quality of Health Care; D012307:Risk Factors; D012959:Socioeconomic Factors