AVOIDABLE MORTALITY IN QUEBEC AND ITS REGIONS

Avoidable mortality has been proposed as an outcome measure of health services and our aim, in this study, is to trace its general features and regional variations in Quebec. For that purpose, comparisons are e stablished between two time periods (1969-73 and 1982-90) and with sev eral countries. Furthermore, regional SMRs (for the period 1982-90) ar e submitted to the Gail heterogeneity test and introduced in a stepwis e regression with variables describing health services, socio-economic context and prevalence or incidence of related diseases. An analysis of proportional mortality is carried out in the two northern regions o f Kativik and Baie-James. Avoidable mortality has dropped substantiall y in Quebec, except in the case of asthma, and now displays excellent scores at the international level. Only three causes of death show sig nificant regional variations: tuberculosis, hypertensive and cerebrova scular diseases and perinatal mortality. These variations are mainly a ssociated with socio-economic factors but also with health services. F urthermore, the highest rates of avoidable death have been observed in Gaspesie, Saguenay/Lac St-Jean and in the two northern regions. These results are discussed through information already available on health services in Quebec.