Avoidable mortality: Approaches to estimation

Strategic documents issued in the Russian Federation are now giving higher priority to health and life expectancy of the country population. Given that, special attention should be paid to monitoring and assessment of avoidable mortality as an indicator describing effectiveness of the healthcare system in Russia. This review covers evolution of approaches to defining avoidable mortality, considers its basic methodological components as well as highlights key differences between the existing criteria of avoidable mortality.

We performed an analytical review of research literature as well as approaches to defining avoidable mortality created by national or international organizations. Overall, 37 literature sources were examined; of them, five were methodologies developed by national and international organizations. At the same time, we examined studies focusing on avoidable mortality in Russia with relation to approaches to defining avoidable mortality, which were used in them. At present, there is no unified universal criterion of avoidable mortality. Instead, different approaches are being used, which differ from each other per three basic aspects: a way to group avoidable death causes (which interventions could have led to a death being avoided); the list of causes of death which are considered avoidable; and age limits, within which deaths due to a specific cause are considered avoidable. These criteria vary between scientific studies and official methodologies accepted in some countries. A trend can be traced involving wider age limits of avoidable mortality.

Avoidable mortality is therefore a dynamic concept reflecting both public health challenges and advances in healthcare. Flexibility of the concept makes it possible to further develop a national criterion for avoidable mortality based on both international practice and the specifics of the Russian population and the healthcare system in Russian Federation.