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February 2003, Vol 93, No. 2 | American Journal of Public Health 186-187
© 2003 American Public Health Association

LETTER

MANUEL AND MAO

Douglas G. Manuel, MD, MSc, FRCPC and Yang Mao, PhD

Douglas G. Manuel is with the Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada, and the Department of Public Health Sciences, University of Toronto. Yang Mao is with the Laboratory Centre for Disease Control, Health Canada, Ottawa, Ontario.

Correspondence: Requests for reprints should be sent to Douglas G. Manuel, MD, MSc, FRCPC, Institute for Clinical Evaluative Sciences G-119, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada (e-mail: doug.manuel{at}ices.on.ca).

We wholeheartedly agree with Clark and Shinoda-Tagawa that injuries are an important source of "avoidable mortality." Injuries, along with tobacco-related causes of death, are arguably the most important source of deaths that could be avoided by the public health care system. Injury and lung cancer death rates, like death rates for most other avoidable causes, have been decreasing in both Canada and the United States, but the rates are lower in Canada (Figure 1Go). For injuries, not only is the Canadian death rate much lower than that of the United States, but—again like death rates due to most other avoidable diseases—it is also decreasing faster. There are many other causes of death that could be avoided by the health care system that we did not include in our study.



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  		FIGURE 1 —Rates of avoidable deaths from injuries and lung cancer in Canada and the United States, 1980–1996.

Note. ASDR = age-standardized death rate (direct method; deaths per 100 000 population younger than 65 years for injuries, aged 35 to 65 years for lung cancer).

Source. Data are from the US Centers for Disease Control and Prevention and Statistics Canada.1,2

 
Since the study objective was to examine avoidable mortality as a potential performance measure of national health care systems, we felt it was important to select an unbiased group of avoidable deaths to ensure that disease groups were not specifically chosen to favor one country over another. We chose the same disease groups as the European Community Concerted Action Project on Health Services and Avoidable Mortality because this was the most established and widely disseminated evaluation of avoidable mortality.3 An additional benefit of using the European standard population is the ready comparison to the European Community and 13 member countries.

Future studies should include injuries and other disease groups based on the principles of "avoidable mortality"3,4 where there is reliable ascertainment of cause of deaths.

References

1. CDC WONDER [data extraction program]. Available at: http://wonder.cdc.gov/#aboutWonder. Accessed December 26, 2002.

2. Health Indicators [program]. Cat No. 82-221-XDE version. Ottawa, Canada: Statistics Canada; 1996.

3. Holland WW, ed. European Community Atlas of Avoidable Death 1985–89. 3rd ed. Oxford, England: Oxford University Press; 1997.

4. 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]





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Right arrow Mortality
Right arrow Surveillance

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