Regional and gender variation in mortality amenable to health care services in Italy
Authors: Lenzi Jacopo , Rucci Paola , Franchino Giuseppe , Domenighetti Gianfranco , Damiani Gianfranco , Fantini Maria Pia 
Published: February 2013

Background: Mortality amenable to health care services (“amenable mortality”) has been defined as “premature deaths that should not occur in the presence of timely and effective health care” and as “conditions for which effective clinical interventions exist”. Although it proved to be a reliable indicator of performance of health care services in the European countries at national level, evidence about its regional variation is limited. We analyzed the regional and gender variability in the performance of health care services using the amenable mortality rate and its contribution to all-cause mortality under age 75 for the period 2006–2009. Methods: The national amenable mortality rate was calculated as the average annual number of deaths for specific causes defined according to the list of Nolte and McKee over the average population aged 0–74 years per 100,000 inhabitants in Italy. The contribution of amenable mortality to all-cause mortality (%AM) was calculated as the ratio of amenable mortality rate to all-cause mortality rate. Results were then stratified by gender, region, and year. Data were drawn from national mortality statistics for the period 2006–2009 provided by the Italian Institute of Statistics (ISTAT). Results: During the index period, in Italy the age and sex-standardized death rate amenable to health care services (SDR) was 62.4 per 100,000 inhabitants: 65.8 per 100,000 for males and 59.0 for females. Amenable mortality accounted for about one-quarter (25.3%) of total mortality under age 75: one-fifth (20.1%) for males and one-third (32.9%) for females. Southern Italy generally had higher levels of amenable mortality, both in terms of SDR and %AM, except for Puglia. However, SDRs and %AM had a different geographical pattern, which was consistent for men and women. Examination of temporal trends revealed that SDR linearly declined between 2006 and 2009 (63.9 to 61.7 per 100,000; % change = –3.4%; p = 0.021), while %AM was almost stable (25.1% to 25.7%; % change = +2.4%; p = 0.120). Piedmont, Lombardy, the autonomous province of Trento, Veneto and Campania had a linear decrease in SDR, while Abruzzo had a linear increase in SDR. Puglia had a linear increase in %AM. Conclusions: The present study contributes additional evidence on the role of amenable mortality as a synthetic indicator of the effectiveness of health care services. We argue that, in a decentralized health care system such as the Italian one, regional stratification is needed to put amenable mortality into the context of the regional specificities of health care provision. We also demonstrated that it is important to consider both SDRs and %AM, because this latter measure can give an insight on the extent to which health services can contribute to ameliorating the health of a population. Thus, consideration of both SDRs and %AM can be useful for national and regional comparisons, and can constitute the basis for evidence-based policy decision making.