The current trends of avoidable mortality, which is an integral indicator of
health system performance, were analyzed. The paper discusses the regional
heterogeneity of levels and trends in avoidable mortality in the Russian
Federation. Also, it contains the analysis of impact of the financial costs
of public health on avoidable mortality in regions with different levels of
economic development. The last 20-years period was studied, which includes a
stage of crisis as well as a social recovery phase. The official data of the
State Statistics Committee were analyzed. In Russia, all death cases are
registered in accordance to the international classification ICD-10. Special
computer program summarizes death cases from preventable causes, and
calculates the standardized rates for the population aged from 5 to 64 years.
The old European standard of population age structure is used. Estimates of
avoidable mortality were made in accordance with the European approach, under
which avoidable mortality accumulates deaths of persons aged from 5 to 64
years due to 34 causes and 4 classes of causes. These 38 causes are divided
into 3 groups according to three levels of diseases prevention. The level of
avoidable mortality in the different regions varies up to 8 times. That is
comparable to the difference between Russia and the countries of European
Union in 1994. This gap is due to the coexistence of different stages of
epidemiological development among the regions in Russia. When death rates
increased, it is shown that mortality from causes which are preventable by
measures of primary and tertiary prevention increased to a greater extent
than mortality from the causes which depend from measures of secondary
prevention. Therein, the largest growth of observed mortality was due to low
quality of medical care in case of males (group 3), and due to causes which
are preventable by measures of primary prevention in case of females (group
1). When mortality was reduced, the rates of change for causes in groups 1
and 3 were approximately the same for both sexes. Avoidable mortality due to
late detection of malignant tumors (group 2) has been changed the least.
Preventable component defines over 80% of the regional differences in death
rates. In 2009, the level of avoidable mortality differed more than fourfold
among different regions of the Russia. Similarly, the difference in the level
of unavoidable mortality was 1.3-fold and 1.7-fold, for males and females
respectively. Proportion of deaths from preventable causes in the total sum
of death cases varies from 40% till 75%. Funding for comprehensive programs
of public health to a greater extent stimulates the reduction in mortality
from preventable causes of the first group. Mortality connected with quality
of medical care is more determined by socio-political situation in the
country than by regional health care expenses. Based on these results, it is
concluded that the action plans to reduce mortality in Russia must have a
strong regional specificity, different targets and indicators. Using the
proportion of preventable causes, it is possible to separate the regions into
groups with different ratios of death determinants, which, therefore, require
different approaches to reduce mortality.
The Quality of Medical Care as a Challenge to Public Health. The Fourth Annual Bronfman Lecture