What is avoidable mortality?
It is widely accepted that the contribution of healthcare to improvements in population health should be quantified. One indicator used to measure this contribution is avoidable mortality. The basic concept of avoidable mortality is that deaths caused by certain conditions, for which effective public health and medical interventions are available, should be rare and ideally should not occur.
For example, an untimely death from a heart attack would be considered avoidable if there were preventive public health measures in place to help reduce or eliminate behavioural risk factors such as tobacco smoking, unhealthy eating and physical inactivity which are associated with the development of heart disease. Similarly, where people have already developed heart disease, untimely death from it would be considered avoidable if access to adequate and equitable healthcare is available.
It is important to note that while a particular condition can be considered avoidable, this does not mean that every death from that condition could be prevented. This is because factors such as the age of the patient, the extent of disease progression at diagnosis or the existence of other medical conditions are not taken into account when compiling these statistics.
Change in leading cause of avoidable mortality
In 2001, deaths from potentially avoidable causes accounted for approximately 26% (140,820 out of 532,498) of all deaths registered in England and Wales. This proportion has since fallen, with avoidable deaths accounting for almost 24% (113,910 out of 484,367) of all deaths in 2011.
From 2001 to 2006, cardiovascular disease was the leading cause of avoidable mortality in England and Wales. Nevertheless, the death rate for this cause fell by 29% compared with only 8% for neoplasms (cancers and non-cancerous growths) during this period. This meant that in 2007, neoplasms became the leading cause of avoidable deaths and remained so until 2011, the latest year for which these statistics are available.
Although avoidable deaths from these two cause groups were more common among males than females, the percentage decreases in death rates over the period 2001 and 2011 varied by sex. While the percentage decrease in rates for neoplasms was greater for males than females (17% compared with 12% respectively) the reverse was true for cardiovascular diseases with decreases of 48% for males and 51% for females.
Factors associated with the rapid decline in avoidable cardiovascular disease mortality
The main factors associated with the sharp decline in avoidable deaths from cardiovascular disease in the last decade are advances in the field of medicine and improvements in lifestyle behaviours which increase the risk of developing or dying from cardiovascular disease.
Coronary heart disease is the major contributor to deaths from cardiovascular events. ONS data show that avoidable deaths from this cause have fallen since records began in 2001. This is consistent with findings in a recent study by Bajekal et al (2012) which reported that deaths from coronary heart disease fell by approximately 6% in each year between 2000 and 2007. Changes in lifestyle and behavioural risk factors such as physical inactivity and smoking were said to be partly responsible for this decrease.
Smoking has been shown to increase the risk of developing coronary heart disease and is a major cause of preventable death. It has also been shown to increase blood pressure, decrease exercise tolerance and increase the tendency for blood to clot. The risk of many cardiovascular diseases dramatically decreases the moment a person quits smoking and continues to decrease rapidly for the first year. After five years the risk returns to the level of that of a non-smoker (Glantz and Gonzalez, 2012).
There has been a general decline in the proportion of adults in Great Britain who smoke stretching back as far as 1974. Latest figures from ONS’s Opinions and Lifestyle Survey show that 45% of the adult population smoked in 1974 compared with 20% in 2012. This is likely to have contributed to the decline in smoking related heart disease and subsequent mortality. Since 2000, initiatives such as smoke free legislation and a ban on tobacco advertising have also been introduced to help reduce the prevalence of smoking.
In addition to these public health initiatives, medical intervention has also been shown to decrease cardiovascular mortality significantly. For example, Bajekal et al (2012) attributed half of the decrease in deaths from coronary heart disease in their study to surgical and medical treatments while Mills et al (2008) demonstrated the effectiveness of cholesterol lowering drugs known as statins in the prevention of cardiovascular events and in reducing subsequent mortality by up to 60%.
Furthermore, there is strong evidence of a link between high salt intake and high blood pressure (SACN, 2003). To mitigate the effect of excessive salt consumption on cardiovascular health, the Food Standards Agency and the Department of Health have targeted key players in the food industry to reduce the salt content in processed foods and embarked on an ongoing public awareness campaign to educate consumers on the dangers of excessive salt intake (FSA, 2009). These initiatives are also likely to have contributed to the decline in high blood pressure-related mortality.
Bajekal M, Scholes S, Love H, Hawkins N, O'Flaherty M, Raine R and Capewell S (2012) Analysing recent Socioeconomic Trends in Coronary Heart Disease Mortality in England, 2000–2007: A Population Modelling Study.
Scientific Advisory Committee in Nutrition (SACN). (2003). Salt and Health. The Stationery Office.
Mills E J, Rachlis B, Wu P, Devereaux P J, Arora P, Perri D. (2008). Primary prevention of cardiovascular mortality and events with statin treatments: a network meta-analysis involving more than 65,000 patients. Journal of the American College of Cardiology, 52(22):1769-1781.
Glantz, S and Gonzalez, M (2012) Effective tobacco control is key to rapid progress in reduction of non-communicable diseases. The Lancet, 379 (9822):1269-1271
Food Standards Agency (FSA). (2009). Salt reduction initiatives.
These statistics were compiled and analysed by the Mortality Analysis team in the Life Events and Population Sources Division. If you would like to find out more about our mortality statistics please go to the Health of the Population page on the ONS website and see further stories, for example on alcohol-related deaths. If you have any comments or suggestions, we would like to hear them. Please email us at firstname.lastname@example.org.