Article
Introduction of a new normalised mortality measure to ensure more valid comparisons of cardiovascular mortality in Western Europe
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Authors
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Susanne Stolpe
- Universitätsklinikum Essen, Essen, Germany
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Bernd Kowall
- Institut für Medizinische Informatik, Biometrie und Epidemiologie; Universitätsklinikum Essen, Essen, Germany
| Published: | September 6, 2024 |
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Outline
Text
Background: The quality and efficacy of health systems is assessed by comparing age-standardised mortality (ASM) from cardiovascular diseases (CVD) [1], as they are regarded avoidable by health care. Differences in CVD mortality in West-Europe are surprising and hard to explain: in 2018, ASM for CVD in Germany was much higher (women: 102, men: 155/100,000) than in the Netherlands (65 and 97). Yet, these differences do not root in health system quality, but in different shares of CVD deaths among all deaths (DE: 39%, NL: 25%), which strongly effect CVD mortality [2].
Aim: We developed a mortality measure less sensible to differences in shares of CVD deaths to increase plausibility of comparisons and validity of conclusions.
Methods: WHO data on sex-specific all and CVD deaths, ASM for CVD and all-causes for 2000-2018 for Western-European countries was used to calculate the share of CVD deaths among all deaths. ASM for CVD was divided by the share of CVD deaths resulting in a mortality measure normalized for 1% of CVD deaths. ASM and normalized mortality for CVD were used in comparative analyses. Strength of linear association between total and (normalized) ASM for CVD was estimated (adj. R²).
Results: Normalised CVD mortality ranked from 2.0 (CHE in women) to 4.9 (SVN in men) in 2018. While ASM for CVD was lowest in Danish women and Dutch men, Switzerland leads both rankings using the normalised CVD mortality. While ASM for CVD was much higher in Germany than in the Netherlands, the countries had the same normalized CVD mortality (2.6).
ASM for CVD was moderately associated with all-cause mortality only in men (adj. R² 0.33; in women: -0.06). Using the normalized CVD mortality yielded an adj R² of 0.66 in women and 0.94 in men.
Conclusion: The normalised CVD mortality ensures reliable comparisons of CVD mortality eliminating the effect of different shares of CVD deaths. It gives more plausible results when comparing age-standardised mortality rates for CVD and enables valid conclusions about health system quality and better decisions for public health.
The authors declare that they have no competing interests.
The authors declare that an ethics committee vote is not required.
References
- 1.
- Busse R, Blümel M, Knieps F, Bärninghausen T. Statutory health insurance in Germany: a health system shaped by 135 years of solidarity, self-governance and competition. Lancet. 2017;390(10097):882-897.
- 2.
- Stolpe S, Kowall B, Stang A. Decline of coronary heart disease mortality is strongly effected by changing patterns of underlying causes of death: an analysis of mortality data from 27 countries of the WHO European region 2000 and 2013. Eur J Epidemiol. 2021;36(1):57-68.
