• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of jepicomhJournal of Epidemiology and Community HealthVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
J Epidemiol Community Health. Oct 1998; 52(10): 624–630.
PMCID: PMC1756619

Avoidable mortality in Europe 1955-1994: a plea for prevention


OBJECTIVE: To analyse trends of avoidable mortality in Europe, emphasising causes of death amenable to primary prevention through reduction of exposures, secondary prevention through early detection and treatment, and tertiary prevention through improved treatment and medical care. DESIGN: Descriptive study of mortality from avoidable causes for the years 1955 through 1994, for ages 5-64 at time of death. Using the World Health Organisation Mortality Database, five year death rates were standardised to the world population. SETTING: 21 countries of Europe in four regions (northern, central, and southern Europe, Nordic countries). PARTICIPANTS: All causes of deaths for men and women, aged 5-64, at time of death. MAIN RESULTS: Between 1955-59 and 1990-94, the reduction in mortality was somewhat greater for avoidable causes than for all causes: 45.8% v 45.1% (women) and 39.3% v 32.6% among men. Reductions in mortality were greater for causes amenable to improved medical care: 77.9% among women and 76.3% among men. The smallest reduction in mortality was seen in women for causes amenable to secondary prevention (11.0%), and in men for causes amendable to primary prevention including tobacco related conditions (16.6%). From a geographical point of view, there were slight differences in trends between European regions, but overall the patterns were similar. CONCLUSIONS: The greatest reduction of avoidable mortality in Europe from 1955-94 came from causes amenable to improved treatment and medical care for both sexes. Further reductions of avoidable mortality can be achieved through implementation of primary and secondary prevention activities, such as tobacco control, reduction of occupational exposures, and universal access to breast and cervical cancer screening programmes.


Full Text

The Full Text of this article is available as a PDF (132K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Rutstein DD, Berenberg W, Chalmers TC, Child CG, 3rd, Fishman AP, Perrin EB. Measuring the quality of medical care. A clinical method. N Engl J Med. 1976 Mar 11;294(11):582–588. [PubMed]
  • Charlton JR, Hartley RM, Silver R, Holland WW. Geographical variation in mortality from conditions amenable to medical intervention in England and Wales. Lancet. 1983 Mar 26;1(8326 Pt 1):691–696. [PubMed]
  • Poikolainen K, Eskola J. The effect of health services on mortality: decline in death rates from amenable and non-amenable causes in Finland, 1969-81. Lancet. 1986 Jan 25;1(8474):199–202. [PubMed]
  • Holland WW. The "avoidable death" guide to Europe. Health Policy. 1986;6(2):115–117. [PubMed]
  • Mackenbach JP, Kunst AE, Looman CW, Habbema JD, van der Maas PJ. Regional differences in mortality from conditions amenable to medical intervention in The Netherlands: a comparison of four time periods. J Epidemiol Community Health. 1988 Dec;42(4):325–332. [PMC free article] [PubMed]
  • de Marco R, Zanolin ME. Mortalità per alcune cause riconducibili all'intervento medico nelle USL lombarde (1980-1985). Epidemiol Prev. 1990 Dec;12(45):24–32. [PubMed]
  • Westerling R, Smedby B. The European Community 'avoidable death indicators' in Sweden 1974-1985. Int J Epidemiol. 1992 Jun;21(3):502–510. [PubMed]
  • Marshall SW, Kawachi I, Pearce N, Borman B. Social class differences in mortality from diseases amenable to medical intervention in New Zealand. Int J Epidemiol. 1993 Apr;22(2):255–261. [PubMed]
  • Charlton JR, Velez R. Some international comparisons of mortality amenable to medical intervention. Br Med J (Clin Res Ed) 1986 Feb 1;292(6516):295–301. [PMC free article] [PubMed]
  • Mackenbach JP, Bouvier-Colle MH, Jougla E. "Avoidable" mortality and health services: a review of aggregate data studies. J Epidemiol Community Health. 1990 Jun;44(2):106–111. [PMC free article] [PubMed]
  • Ahrens W, Jöckel KH, Patzak W, Elsner G. Alcohol, smoking, and occupational factors in cancer of the larynx: a case-control study. Am J Ind Med. 1991;20(4):477–493. [PubMed]
  • Boffetta P, Kogevinas M, Simonato L, Wilbourn J, Saracci R. Current Perspectives on Occupational Cancer Risks. Int J Occup Environ Health. 1995 Oct;1(4):315–325. [PubMed]
  • Anttila A, Heikkilä P, Pukkala E, Nykyri E, Kauppinen T, Hernberg S, Hemminki K. Excess lung cancer among workers exposed to lead. Scand J Work Environ Health. 1995 Dec;21(6):460–469. [PubMed]
  • Simonato L, Boffetta P, Kogevinas M. Epidemiological aspects of cancer risk associated with exposure in the occupational environment. Med Lav. 1996 Jan-Feb;87(1):5–15. [PubMed]
  • Marks R. Prevention and control of melanoma: the public health approach. CA Cancer J Clin. 1996 Jul-Aug;46(4):199–216. [PubMed]
  • Mackenbach JP, Stronks K, Kunst AE. The contribution of medical care to inequalities in health: differences between socio-economic groups in decline of mortality from conditions amenable to medical intervention. Soc Sci Med. 1989;29(3):369–376. [PubMed]
  • Mackenbach JP, Looman CW, Kunst AE, Habbema JD, van der Maas PJ. Post-1950 mortality trends and medical care: gains in life expectancy due to declines in mortality from conditions amenable to medical intervention in The Netherlands. Soc Sci Med. 1988;27(9):889–894. [PubMed]
  • Gil LM, Rathwell T. The effect of health services on mortality: amenable and non-amenable causes in Spain. Int J Epidemiol. 1989 Sep;18(3):652–657. [PubMed]
  • Carr-Hill RA, Hardman GF, Russell IT. Variations in avoidable mortality and variations in health care resources. Lancet. 1987 Apr 4;1(8536):789–792. [PubMed]
  • Poikolainen K, Eskola J. Health services resources and their relation to mortality from causes amenable to health care intervention: a cross-national study. Int J Epidemiol. 1988 Mar;17(1):86–89. [PubMed]
  • Morosini PL, Lauriola P, Magliola E, Feola G, Paul EM. Le morti evitabili nella valutazione dell' attività del servizio sanitario. II. Atlante Europeo sulle morti evitabili: primi dati ed alcune riflessioni. Epidemiol Prev. 1990 Dec;12(45):48–58. [PubMed]
  • Gaizauskiené A, Westerling R. A comparison of avoidable mortality in Lithuania and Sweden 1971-1990. Int J Epidemiol. 1995 Dec;24(6):1124–1131. [PubMed]
  • Westerling R. Trends in "avoidable" mortality in Sweden, 1974-1985. J Epidemiol Community Health. 1992 Oct;46(5):489–493. [PMC free article] [PubMed]
  • Fletcher SW, Black W, Harris R, Rimer BK, Shapiro S. Report of the International Workshop on Screening for Breast Cancer. J Natl Cancer Inst. 1993 Oct 20;85(20):1644–1656. [PubMed]
  • Howson CP, Hiyama T, Wynder EL. The decline in gastric cancer: epidemiology of an unplanned triumph. Epidemiol Rev. 1986;8:1–27. [PubMed]
  • Beckett WS. Epidemiology and etiology of lung cancer. Clin Chest Med. 1993 Mar;14(1):1–15. [PubMed]
  • Peto R, Lopez AD, Boreham J, Thun M, Heath C., Jr Mortality from tobacco in developed countries: indirect estimation from national vital statistics. Lancet. 1992 May 23;339(8804):1268–1278. [PubMed]
  • Willett WC, Trichopoulos D. Nutrition and cancer: a summary of the evidence. Cancer Causes Control. 1996 Jan;7(1):178–180. [PubMed]
  • Miller AB, Anderson G, Brisson J, Laidlaw J, Le Pitre N, Malcolmson P, Mirwaldt P, Stuart G, Sullivan W. Report of a National Workshop on Screening for Cancer of the Cervix. CMAJ. 1991 Nov 15;145(10):1301–1325. [PMC free article] [PubMed]
  • Shapiro S. Periodic breast cancer screening in seven foreign countries. Cancer. 1992 Apr 1;69(7 Suppl):1919–1924. [PubMed]

Articles from Journal of Epidemiology and Community Health are provided here courtesy of BMJ Group


Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...


  • PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...