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February 2003, Vol 93, No. 2 | American Journal of Public Health 186
© 2003 American Public Health Association

LETTER

AVOIDABLE MORTALITY

David E. Clark, MD, MPH and Tomoko Shinoda-Tagawa, MD, MPH

The authors are with the Harvard Injury Control Research Center, Boston, Mass. David E. Clark is also with the Department of Surgery, Maine Medical Center, Portland.

Correspondence: Requests for reprints should be sent to David E. Clark, MD, Department of Surgery, Maine Medical Center, 887 Congress St, Portland, ME 04102 (e-mail: clarkd{at}mmc.org).

In a recent article, Manuel and Mao presented an interesting comparison of "avoidable mortality" rates in the United States and Canada,1 but we were surprised that the authors did not include mortality from injuries. They defined as avoidable those conditions for which "there must be identifiable, effective interventions and available health care providers"1(p1481) and considered deaths of persons younger than 65 years from these conditions to be potential evidence of inadequate health care. This approach was based on the proposal of Rutstein et al. in 1976 to focus attention on conditions for which "a single untimely death would justify asking, ‘Why did it happen?’"2(p582) Death following injury certainly meets these criteria.

As is true for several of the illnesses compared by Manuel and Mao, the mortality rate after injuries in the population aged younger than 65 years is lower in Canada than in the United States (Table 1Go).3,4 Furthermore, injury mortality rates (except for homicide) are even higher for persons older than 65 years in both countries.


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  		TABLE 1 —1997 Mortality Rates per 100 000 Population Younger Than 65 Years
 
While we share the authors’ concerns about "avoidable mortality," we believe it is important to include death after injuries, which is in fact the leading cause of mortality in the first 5 decades of life. Rutstein et al. did consider a category of "man-made" diseases, although they only briefly referred to "accidents" in this category.2 More than 25 years later, it is disappointing that injuries are still disregarded as a public health problem.

References

1. Manuel DG, Mao Y. Avoidable mortality in the United States and Canada, 1980–1996. Am J Public Health. 2002;92:1481–1484.[Free Full Text]

2. Rutstein DD, Berenberg W, Chalmers TC, Child CG 3rd, Fishman AP, Perrin EB. Measuring the quality of medical care: a clinical method. N Engl J Med. 1976;294:582–588.[Abstract]

3. Statistics Canada. Mortality—summary list of causes, 1997. Available at: http://www.statcan.ca/english/freepub/84F0209XIB/free.htm (PDF file). Accessed December 4, 2002.

4. National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System. Available at: http://www.cdc.gov/ncipc/wisqars/default.htm. Accessed December 4, 2002.




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Bro`aden the perspective of "avoidable mortality"
Daniel Leviton
AJPH Online, 28 Mar 2003 [Full text]
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