How have ‘avoidable death’ indices for England and Wales changed? 1974–78 compared with 1979–83

Age standardized mortality ratios (SMRs) for selected disease groups that are amenable to medical treatment have been proposed as indicators of health care quality for primary prevention, secondary prevention and curative services. When variations in mortality from these conditions among the former Area Health Authorities of England and Wales were examined for the period 1974–78 considerable variation was found to exist; for most diseases this was greater than was likely to have occurred by chance. Data for the subsequent five-year period (1979–83) have now been assembled for the same areas and for District Health Authorities covering eight disease groups for which data were readily available. This paper examines how these indicators have changed nationally and locally, and compares the geographic distribution of these indicators in the two time periods. For each of the causes of death studied, except asthma, the death rates have declined substantially. The degree of geographic heterogeneity remains high, and for all disease groups apart from appendicitis and maternal deaths, is greater than is likely to have occurred by chance. Most of the increase in asthma deaths was in the age group 15 to 34 years. For hypertension and stroke, tuberculosis, chronic rheumatic heart disease and appendicitis the relative decline has been fairly uniform across age groups. For cervical cancer there has been a rise in mortality amongst women aged less than 44 years and a fall in the older age groups. Standardised mortality ratios for each time period, standardised to the prevailing national rates were compared for each AHA. The indicators for most AHAs were similar for the two time periods.