Avoidable mortality in Victoria between 1979 and 2001.

OBJECTIVE: To describe trends in avoidable mortality (AM) in Victoria by sex, degree of socio-economic disadvantage and remoteness. METHODS: The analysis is based on mortality and population data for 1979-2001 supplied by the Australian Bureau of Statistics (ABS) for Victoria. Total and disease-specific AM rates were age standardised using the direct method. For the period between 1997 and 2001, comparisons of total AM rates by sex were made between metropolitan and rural local government areas (LGAs), and between LGAs grouped into quintiles based on socio-economic disadvantage and categories of remoteness. RESULTS: Total AM rates declined significantly (p < 0.05) in both males and females between 1979 and 2001, but were significantly higher in males compared with females. Total AM rates were significantly higher in rural compared with metropolitan LGAs, from 1997 to 2001 in males and in 1998 in females. Total AM rates in the least disadvantaged quintile were significantly lower than those in the most disadvantaged quintile over the entire five-year period in males and in three years in females. Total AM rates were highest in remote LGAs and lowest in highly accessible LGAs. There were significant declines in ischaemic heart disease, stroke and road traffic accident AM rates among males. In females, IHD, stroke, breast and colon cancer AM rates declined significantly. CONCLUSIONS AND IMPLICATIONS: Despite large declines in AM in Victoria, there are significant differences in rates between the sexes and in the population based on socio-economic status or remoteness. These results provide opportunities for policy makers to prioritise public health and health services interventions, targeting population groups and specific disease conditions to reduce health inequalities.

The Victorian ambulatory care sensitive conditions study: rural and urban perspectives.

OBJECTIVES: Ambulatory Care Sensitive Conditions (ACSCs) are those for which hospitalisation is thought to be avoidable with the application of preventive care and early disease management, usually delivered in the ambulatory setting. This study presents detailed analyses of ACSCs as a measure of health outcome that might vary with access to primary health care in rural and urban regions of Victoria. METHOD: The Victorian Admitted Episodes Dataset (VAED), and data from the Health Insurance Commission, Medical Labour Force Annual Survey, socio-economic indexes for areas, and accessibility/remoteness index of Australia were merged to identify individual and aggregate level predictors of urban/rural differentials of ACSCs. Estimates of odds ratios and 95% confidence intervals were based on random effect multi-level generalised linear models. RESULTS: After adjustment for age, sex, and severity of illness, significant predictors of higher admission rates of ACSCs within rural areas include lack of insurance, emergency admissions, higher degree of remoteness, lower population density, lower number of general practitioners/10,000 population by local government area (LGA), lower number of general practitioner visits per person by LGA, and areas with lower socio-economic status, education and occupation, and economic resources. CONCLUSIONS: This study suggests that lack of timely and effective care may have a significant impact on rates of admissions for ACSCs in rural areas of Victoria especially in lower socio-economic groups.

A public health model of the social determinants of health.

As we move forward in the new century, epidemiologists and public health practitioners are faced with the challenge of reviewing the current direction of epidemiology and its links with public health. While the history of epidemiology has been a successful and productive one, there is a danger that modern epidemiology is becoming too narrow in its scope, concerned primarily with the analysis of risk factors in individuals, while ignoring sociological and ecological perspectives of health. We argue that a theoretical framework to guide the practice of epidemiology is needed which encompasses a role for social determinants of health while simultaneously also acknowledging the importance of behaviour and biology, and the inter-connectedness of all these factors. This paper presents a public health model of social determinants of health, which provides a framework for testing the causal pathways linking social determinant variables with health care system attributes, disease inducing behaviours and health outcomes. This approach provides an improved opportunity to identify and evaluate evidence-based public health interventions, and facilitates stronger links between modern epidemiology and public health practice.