Mortality amenable to health care services and health inequalities among Italian Regions

OBJECTIVES: to investigate differences in amenable mortality among Italian Regions using the lists of causes of death conceived by Nolte and McKee, and Tobias and Yeh, and assess whether these differences are in part attributable to the list used. We also estimated the contribution of amenable mortality to the gaps in all-cause mortality among North, Centre and South of Italy. DESIGN: cross-sectional study. SETTING AND PARTICIPANTS: Italian National Institute of Statistics (ISTAT) mortality data for the period 2006-2009. MAIN OUTCOME MEASURES: age- and gender-standardised amenable mortality rates. RESULTS: for the period 2006-2009, in Italy the Nolte and McKee mortality rate was 62.38 per 100,000 inhabitants, ranging from 54.92 in the Autonomous Province of Bolzano (Northern Italy) to 62.38 in Campania Region (Southern Italy). For the same period, the Tobias and Yeh mortality rate was 69.59 per 100,000, ranging from 60.06 in Marche Region (Central Italy) to 88.12 in Campania Region. Using Nolte and McKee's list, amenable mortality accounted for 40.65% of the differences in all-cause mortality between Northern and Southern Italy, and for 33.66% of the differences between Southern and Central Italy. Using Tobias and Yeh's list, amenable mortality accounted for 53.99% of the differences in all-cause mortality between Northern and Southern Italy, and for 42.62% of the differences between Southern and Central Italy. CONCLUSION: the findings here presented show that amenable mortality rates calculated using Tobias and Yeh's list were higher than rates calculated using Nolte and McKee's list. Geographical pattern of amenable mortality derived by the two lists were almost coincident. Moreover, amenable mortality makes a substantial contribution to inequalities in health among North, Centre and South of Italy.