Mortality rates (the number of people who die in a given year per 100,000 population) give a general measure of the health of a population. They are affected by the quality of healthcare, but also by a range of wider social, economic and environmental factors.
Measures of amenable mortality look at premature deaths for conditions where effective and timely healthcare can reduce the chances of death. They can provide a starting point to assess the quality and effectiveness of healthcare systems in reducing premature deaths.
The mortality rate from all causes of death in England and Wales fell steadily between 1995 and 2011, from 1,392 deaths per 100,000 population to 979 deaths per 100,000 population. Since then, progress has stalled to 965 deaths per 100,000 population in 2018.
Male mortality rates are consistently higher than female mortality rates; however, the gap has been narrowing over time. In 1994, the mortality rate for males was 1.5 times higher than for females, while in 2018 it was 1.3 times higher. This is associated with improvements in mortality from cardiovascular disease, which has historically been higher in men, as well as a greater reduction in risk factors such as smoking among men than women.
In 2019, the OECD developed an internationally recognised definition of avoidable mortality, which can be split into preventable mortality and amenable mortality. Preventable mortality is defined as deaths that can be mainly avoided through effective public health and primary prevention interventions. Amenable (or treatable) mortality is defined as deaths that can be mainly avoided through timely and effective healthcare interventions, including secondary prevention and treatment.
In 2018, approximately 22% of deaths in the UK were considered avoidable. Of these, 64% were preventable and the remaining 36% were considered amenable to healthcare. As with all cause mortality rates, avoidable mortality rates decreased steadily until 2011, after which improvements have stalled. The same trend is seen for both amenable and preventable mortality rates.
Avoidable mortality rates vary across the four countries of the UK. In 2018, Scotland had the highest avoidable mortality rate at 310 deaths per 100,000 population, and England had the lowest rate at 227 deaths per 100,000 population (data not shown). However, it is worth noting that the data for Scotland includes deaths of non-residents, which are excluded for England, Wales and Northern Ireland.
There is a strong relationship between amenable mortality and deprivation. Amenable mortality rates are consistently higher in more deprived areas and higher for men than women. In 2017, the amenable mortality rate was 3.8 times higher for men in the most deprived areas of England (279 deaths per 100,000 men) than in the least deprived areas (74 deaths per 100,000 men). For women, amenable mortality was 3.3 times higher in the most deprived areas (183 deaths per 100,000 women) than in the least deprived areas (55 deaths per 100,000 women).
Between 2001 and 2013, the amenable mortality rate decreased for both men and women in all deprivation deciles. However, the decreases were greater in the least deprived areas, causing the gap in amenable mortality between the most and least deprived areas to increase. Since 2014, amenable mortality has continued to decrease in the least deprived decile, but at a slower rate. In the most deprived decile, the amenable mortality rate has increased slightly.
The conditions considered to be amenable are regularly updated, to account for advances in treatment and medical technology. In 2014, the definition of amenable mortality was updated, so data prior to this is not comparable. The increases seen after this definition change are largely due to the reclassification of chronic obstructive pulmonary disorder (COPD) as both amenable and preventable.
Amenable mortality rates can be used to compare health care access and quality across countries. They represent deaths that could have been avoided in the presence of optimal quality health care. Risk- and age-adjusted amenable mortality rates have been decreasing over time in all of the comparator countries. Although the UK does well by global standards (in 2015 the global average was 228 deaths per 100,000), it performs poorly compared with the other developed countries in our comparison group. In 2015, the UK’s amenable mortality rate was 69.7 per 100,000 which is higher than 12 of the comparator countries. Spain had the lowest amenable mortality rate in 2015 at 50.8 per 100,000, while the United States had the highest at 99 per 100,000.
About this data
Mortality rates are calculated as the total number of deaths registered in a calendar year divided by the mid-year population estimate for the respective year. Rates are calculated based on where the death was registered, rather than where the deceased was resident. For more information, see the Office for National Statistics (ONS) Quality and methodology information.
In 2019, the Organisation for Economic Co-operation and Development (OECD) developed an internationally recognised definition of avoidable mortality. When discussing avoidable deaths, the following terms are used:
- preventable mortality – deaths that can be mainly avoided through effective public health and primary prevention interventions
- treatable (or amenable) mortality – deaths that can be mainly avoided through timely and effective health care interventions, including secondary prevention and treatment
- avoidable mortality – deaths defined as either preventable or treatable
The attribution of causes of death to the preventable or treatable category is based on whether it is predominantly prevention or health care interventions that can reduce deaths. For those causes of death that can be both largely prevented and also treated once they have occurred, the cause of death is considered to be preventable on the rationale that if these diseases are prevented, there would be no need for treatment.
In the UK, this definition was implemented by the ONS in 2020 and updated avoidable mortality rates were published for 2001 to 2018 to allow comparisons over time. For detailed definitions of the causes of death considered to be preventable or amenable, see the OECD’s Avoidable mortality: OECD/Eurostat lists of preventable and treatable causes of death.
Global Burden of Disease Study data
Global Burden of Disease Study (2015) estimates were used to calculate age-standardised risk-standardised death rates for 32 causes of disease and injury considered to be amenable to healthcare. For more information, see the Global Burden of Disease Study website.