Inequalities in treatable mortality across microregions of Hungary

Absztrakt

A good measurement of the contribution of health care to lowering death rates (or improving life expectancy) and its geographical differences would be a useful tool for planning improvement of health care provision. This study examines the indicator of treatable mortality, which can hopefully indicate the localities most in need of more extensive or better-quality health care.
Treatable mortality was calculated for 197 geographical units (174 LAU1 level units and the 23 districts of Budapest) of Hungary for the period between 2008 and 2022. We used Nolte and McKee’s (2004) definition of treatable mortality.
We compared the trends and inequalities of treatable mortality to trends and inequalities of all-cause premature (0–74 years) mortality.
As country-level trends, premature mortality slowly decreased until 2020. Treatable mortality also decreased in the first part of the period, but from 2014 it has rather stagnated. During the first three years of the period, treatable mortality decreased more dynamically than overall (premature) mortality, but from 2014, the contribution of treatable mortality to the (rather moderate) overall mortality reduction has been constantly lessening. In the pandemic period, treatable mortality increased by 4%. In the same period, total mortality among those aged 0–74 increased by 10%.
We grouped LAU1 units into deciles according to their treatable mortality level. In 2008–2010 the most disadvantaged geographic units had 94% higher treatable mortality than those in the best-performing decile. This measure lowered in the coming period and increased to 87% only in 2020–2022. In contrast, overall mortality was higher for the worst-performing 20 geographical units by 62%, which value did not change considerably in the coming period, but increased to 70% in 2020–2022.
The contribution of treatable causes to lowering death rates among the most disadvantaged was significant only between the periods 2008–2010 and 2011–2013. For other periods, this contribution was negligible or negative. We found a negative contribution in the pandemic period, when treatable causes made up a significant share of the experienced large mortality increase among the most disadvantaged units, while it had close to zero effect on the mortality increase in areas with initially low mortality.