Trends in Belgian premature avoidable deaths over a 20 year period

Study objectives-To analyse over a 20 year period the level and trends in t he " EC avoidable death indicators " Design-The Years of Potential Life Lost (YPLL) method applied to curative a nd preventive avoidable mortality indicators in Belgium for four successive five year periods, countrywide as well as by district, separately for wome n and men. Ratios of YPLL rates (age standardised) describe changes between 1974-78 and 1990-94. Setting-Belgium for the periods 1974-78, 1980-84, 1985-89, 1990-94. Participants-All avoidable death cases aged 1-64. Main results-Ratio of YPLL rates indicated a more favourable development be tween 1974-78 and 1990-94 in the EC avoidable indicators than in all causes premature mortality. The EC avoidable mortality indicators have been assig ned to two categories, curative indicators and preventive indicators. The b est ratio of YPLL rates was found in curative indicators for men but the la rgest gains in YPLL rates over the periods come from the "preventive indica tors " in men. For women, malignant neoplasm of the breast rose to the firs t ranked in 1985-1989 and 1990-1994, where it contributed to more years of YPLL loss than motor vehicle accidents, and malignant neoplasm of the trach ea, bronchus and lung had risen to the fifth ranked since 1985-89. The orde r of the top causes for men did not change between 1974 and 1994, except fo r cirrhosis of liver, which rose from the fifth to the fourth rank. In the particular case of one "preventive indicator", malignant neoplasm of the tr achea, bronchus and lung, the regional analysis of time trend between 1974- 78 and 1990-94 showed more districts with a favourable development for both men and women in the Flemish region than in Wallonia. Conclusion-the YPLL method combined with the avoidable mortality indicators enabled us to compare the changes of curative and preventive EC avoidable indicators between 1974-78 and 1990-94. In the case of malignant neoplasm o f the trachea, bronchus and lung, which is of major concern to the health p romotion policies, changes over the periods have widened a " north/south" h ealth contrast.