Spatial variations from causes amenable to medical care in Poland

Wiktoria Wroblewska, Warsaw School of Economics

The positive changes recorded in the avoidable mortality trends suggest that health care has made a substantial contribution to reducing mortality in Poland. Mortality from conditions which have become amenable to medical intervention remains an important contributor to premature mortality, accounting for 17% of deaths under age 75. This study aimed to investigate the spatial variations in amenable mortality in Poland and to analyze whether the medical care can explain regional variations in mortality from these causes of death. Age-standardized death rates (SDR) for each of 379 districts in Poland (NUTS-4 level) using unit–record mortality data was calculated. The list of causes of death considered amenable to health care is based on that developed by Nolte and McKee. Moran’s I statistics and spatial error models were used to measure the spatial autocorrelation (GeoDa). Two-level regression model with random intercepts was used to investigate the contribution of district’s characteristics to spatial variation in amenable mortality (MIXED procedure in SPSS). The results indicate that mortality from conditions which have become amenable to medical intervention has generally decreased in all districts of Poland in the past decades. At the same time, significant spatial autocorrelation was observed. We observed a weaker relationship between amenable mortality and medical care characteristics at districts level (NUTS-4. Geographical variation was mainly explained by socioeconomic indicators, such as education and low-income (social assistance users. The multi-level models revealed a substantial variation at the second level (voivodeship-NUTS 2), this imply that there are contextual influences on amenable mortality at this level.