title: Multiple social disadvantage does it have an effect on amenable mortality: a brief report.
abstract: BACKGROUND
  Most studies on inequalities in health and health-care focus on single indicators of social position, e.g. income or education. Recent research has suggested that multiple social circumstances need to be analysed simultaneously to disentangle their influence on health. In past decades mortality amenable to health-care, i.e. premature mortality that should not occur given timely and effective health-care, has increasingly been used to study the effect of health-care on health outcomes. This study elaborates the effect of social and regional deprivation and unemployment on the association between income and mortality amenable to health-care in Finland.
  
  
  METHODS
  Individual-level data for deaths were gathered by disease category between 1992 and 2008 for the resident Finnish population aged 25 to 59 years. Differences in amenable mortality and changes over time were assessed using individual-level linked register data. We used gender- and age-standardised rates and Poisson regression models to examine the simultaneous effect of these indicators on amenable mortality.
  
  
  RESULTS
  Altogether 22,663 persons aged 25-59 years died from causes amenable to health-care during the study period. An inverse pattern was found in amenable mortality for income. The mortality rate in the lowest income quintile was 98 (93-104) per 100,000 in the period 1991-1996 while in the highest group the figure was 40 (38-42) for the same period. Whereas the level of amenable mortality decreased, mortality differences between income groups steepened and amenable mortality increased in the lowest income group towards the end of the study period. Those in poor labour market position or living alone had significantly larger income differences in amenable mortality. Risk of regional deprivation was not associated with amenable mortality.
  
  
  CONCLUSIONS
  In order to prevent and treat at an early phase conditions that otherwise may lead to premature and unnecessary deaths more attention should be focused on groups with increased social and economic deprivation risk in municipal health centres with the aim at improving access to primary care. Our results also call for joint action by both health-care and social services, since health services alone cannot deal with the risks posed by accumulating social disadvantage.
authors.affiliation: National Institute for Health and Welfare, Service System Research Unit, Helsinki, FI-00271, Finland. kristiina.manderbacka@thl.fi.
authors.forename: Kristiina
authors.initials: K
authors.lastname: Manderbacka
authors.forename: Martti
authors.initials: M
authors.lastname: Arffman
authors.forename: Reijo
authors.initials: R
authors.lastname: Sund
authors.forename: Sakari
authors.initials: S
authors.lastname: Karvonen
mesh_terms: D000328:Adult; D005260:Female; D005387:Finland / Q000453:epidemiology; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D019984:Quality Indicators, Health Care; D012044:Regression Analysis; D012923:Social Class; D012959:Socioeconomic Factors
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