In the Literature
Highlights from Commonwealth Fund-Supported Studies in Professional Journals
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Mortality Amenable to Health Care in the United States: The Roles of Demographics and Health Systems Performance ...........................................................................................................................................................................
August 29, 2011
Authors: Stephen C. Schoenbaum, M.D., Cathy Schoen, M.S., Jennifer L. Nicholson, M.P.H., and Joel C. Cantor, Sc.D.
Journal: Journal of Public Health Policy, published online Aug. 25, 2011
Contact: Stephen C. Schoenbaum, M.D., The Commonwealth Fund, [email protected], or Mary Mahon, Assistant Vice
President, Public Information, The Commonwealth Fund, [email protected]
Access to full article: http://www.palgrave-journals.com/jphp/journal/vaop/ncurrent/abs/jphp201142a.html
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Synopsis
A study of mortality amenable to health care in the United States shows a more than twofold variation in
rates across the country. There are strong associations between state-level amenable mortality rates and
demographic factors (e.g., poverty and race) and also to various health system-related indicators, like
hospital readmission rates and care for diabetics and asthmatics.
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The Issue
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The statistic known as “mortality
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amenable to health care” or “amenable
mortality” measures deaths from
certain causes before age 75 that are
potentially preventable with timely and
effective health care. Researchers have
used it to assess the performance of
health systems of industrialized nations
and to track changes over time.
Previous studies have shown that the
U.S. has failed to keep pace with rates
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of decline in amenable mortality in :)();"#*)6<'-'"21"=>>?@>4"A%*(%,'"12,":-'%)'%"A2*(,26")*+"B,%C%*D2*E'"F86DG6%"A)8'%&21&:%)(/"+)()"H6%'"8'-*$"5%(/2+262$<"1,25"I9"J26(%"
)*+"F9"F7K%%L"MF%)'8,-*$"(/%"N%)6(/"21"J)D2*';"#*)6<'-'"21"F2,()6-(<"#5%*)06%"(2"N%)6(/"A),%LO"!"#$"J2C9"P4L"=>>Q"Q=3R3?=?S;PP=T9"
U28,7%;"A2552*V%)6(/"W8*+"U()(%"U72,%7),+"2*"N%)6(/"U<'(%5"B%,12,5)*7%L"=>>T9"
other countries. As of 2002–2003, the
U.S. fell to last place out of 19 industrialized countries. In this study, authors led by former
Commonwealth Fund executive vice president Stephen Schoenbaum examined the variation of amenable
mortality across the U.S. and the extent to which this variation is associated with poverty and race, as well
as other health system indicators.
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Top quartile (63.9–76.8) Best: MN
Second quartile (77.2–89.9)
Third quartile (90.7–107.5)
Bottom quartile (108.0–158.3) Worst: DC
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Top quartile (56.4–72.6) Best: DC
Second quartile (73.4–82.0)
Third quartile (83.7–91.7)
Bottom quartile (91.8–110.6) Worst: WV
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Key Findings
•
In 2004–2005, amenable mortality in the United States ranged from a low of 63.9 deaths per 100,000
people under age 75 in Minnesota to highs of 142.0 in Mississippi and 158.3 in the District of
Columbia. Rates were highest in the southern states and in a band of states ranging from Texas to
New York. The North Central, Mountain, and Pacific regions had lower rates (see exhibit).
•
The variation in amenable mortality rates within the United States is more extensive than was
observed in 19 industrialized countries in 2002–2003. A study of these 19 Organization for Economic
Cooperation and Development (OECD) countries found a low of 65 in France and a high of 110 in the U.S.
•
There are strong associations between amenable mortality and several health care measures that
remain statistically significant after controlling for race and poverty. These indicators include:
percentage of adult diabetics who received recommended preventive care; adult asthmatics with an
emergency department or urgent care visit in the past year; hospital admissions of Medicare
beneficiaries for ambulatory care–sensitive conditions; hospital readmissions of Medicare patients and
of short-stay nursing home patients; and hospital admissions of long-stay nursing home patients.
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Addressing the Problem
Multiple health care indicators are associated with higher rates of
mortality amenable to health care. As such, improving performance
in these indicators (e.g., care for asthmatics or diabetics, hospital
readmission rates) could help to improve amenable mortality rates,
however the authors warn there is as yet no evidence. It is a
hypothesis worth testing, the authors state, adding that “improvement
in variables such as readmission rates or care for asthmatics or
diabetics are objectives worth attaining in their own right.” All
states—regardless of starting point—can work to improve their health
system performance and the health of their residents.
“Multiple health
carerelated variables
are associated
with amenable
mortality. These
indicators, selected
to broadly represent
important dimensions
of health system
performance, potentially
can be improved with
appropriate interventions.”
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About the Study
The authors calculated rates of mortality amenable to health care for each state and the District of
Columbia using Centers for Disease Control and Prevention data. Other variables, including the
percentage of each state population that is black, the percentage with household incomes under 200
percent of the federal poverty level, and 19 health care access and system performance indicators, were
originally compiled for The Commonwealth Fund’s 2009 state scorecard on health system performance.
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The Bottom Line
There is a more than twofold variation in rates of mortality amenable to health care across the United
States, with strong associations between state-level amenable mortality rates and poverty and race, and
with indicators including hospital readmission rates and care for diabetics and asthmatics.
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Citation
S. C. Schoenbaum, C. Schoen, J. L. Nicholson et al., “Mortality Amenable to Health Care in the United
States: The Roles of Demographics and Health Systems Performance,” Journal of Public Health Policy,
published online Aug. 25, 2011.
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This summary was prepared by Deborah Lorber.