Inequalities in mortality amenable to healthcare intervention in Scotland
Yates, MA (2018) 18 October 2018. [SLS][CALLS]
Other information: Mortality amenable to health care intervention are premature deaths which, theoretically, should not occur in the presence of timely and effective health care. As Scotland has a universal health care system, where health care is freely provided at the point of access to all residents, there should be no socioeconomic inequalities in rates of amenable mortality (AM). However, gradients in rates of AM have been found in many countries, using various measures of socioeconomic position. The routine monitoring of rates of AM, and subgroups of amenable conditions, will contribute towards an indicator of health care performance. Records of all deaths occurring between 1980 and 2013, records of hospitalisations for amenable conditions, and mid-year population estimates were used to calculate rates of age standardised mortality and incident hospitalisations respectively. Absolute and relative inequalities in both rates for the total population were estimated using an area based measure of material deprivation, the Carstairs index. Individual level measurements of socioeconomic position, such as educational attainment, were used to measure inequalities in rates of deaths for a sample of the population, allowing for some comparison with European countries. Rates of AM in Scotland and England were compared in two natural experiments in the final two chapters, aiming to explore the direct and indirect effects of policy changes on health care systems abilities to effectively prevent amenable deaths. Rates of AM in Scotland have been found to be decreasing for both men and women. Mortality rates within two of the three subgroups of amenable conditions have also declined, with the third having too few deaths to comment on trends. The rates of incident hospitalisations of amenable conditions between 1996 and 2013 have remained relatively stable, suggesting that rates of AM may be reflecting improvements in the detection, treatment, and management of amenable conditions. Absolute and relative inequalities in mortality rates were largest when estimated using educational attainment, whilst occupational measures produced the smallest inequalities. The rate of decline in rates of AM slowed in Scotland, relative to England, following devolution, however the attempts to adequately control for differing levels of deprivation were unsuccessful. The final chapter saw step increase in rates of AM in England, compared to Scotland, following the publication of a White Paper for the Health and Social Care Act - however, this failed to reach statistical significance. This thesis concludes that the continued study of amenable mortality in Scotland is worthwhile, given that mortality rates continued to decline against stable rates of incident hospitalisations, and relative inequalities in mortality rates were found to be increasing, despite decreasing absolute inequalities. The monitoring of inequalities in rates of AM provides the potential for weaknesses in the provision and delivery of care to be identified and corrected.