Temporal trends and ethnic variations in amenable mortality in Singapore 1965-1994: the impact of health care in transition

Background Amenable mortality is used to assess the effects of health care services on gains in mortality outcomes. Possibly differing patterns of tre nds in amenable mortality may be expected in economically less developed co untries, which have undergone rapid epidemiological transition and recent r eforms in health care systems, but such studies are scarce. This study was set up to examine the trends in amenable mortality in Singapore from 1965 t o 1994; to estimate the relative impact of medical care and primary prevent ive policy measures in terms of gains in mortality outcomes; to examine eth nic differences in amenable mortality among Chinese, Malays and Indians. Methods Age-standardized mortality rates were calculated for 16 amenable ca uses of death in Singapore for six 5-year periods (1965-1969,.., 1990-1994) , and for each of the three main ethnic groups for three periods (1989-1991 , 1992-1994, 1995-1997). Amenable mortality rates were divided into those w hich can be reduced by timely therapeutic care for 'treatable' conditions ( e.g. asthma and appendicitis), or by primary preventive measures for 'preve ntable' conditions (e.g. lung cancer and motor vehicle injury). Results Amenable mortality was higher in males (age-standardized rate 109.7 per 100 000 population) than in females (age-standardized rate 60.7 per 10 0 000 population). Amenable mortality declined by 1.77% a year in males and 1.72% a year in females. By comparison, the average yearly decline in non- amenable mortality was 0.91% in males and 1.17% in females. The decline in amenable mortality was largely due to 'treatable' causes rather than a decl ine in mortality due to 'preventable' causes of death. Amenable mortality w as lowest for Chinese and highest for Malays. Over the recent 9-year period from 1989 to 1997, amenable mortality declined more in Chinese than in Mal ays and Indians, However, Indian females showed by far the sharpest decline , whereas Indian males, by contrast, showed an increase in amenable mortali ty, due to both treatable and preventable causes. Conclusions In line with findings from European countries, amenable mortali ty in Singapore declined more than non-amenable mortality. There were more significant gains in mortality outcomes from medical care interventions tha n from primary preventive policy measures. Gender and ethnic differences in amenable mortality were also observed, highlighting issues of socioeconomi c equities to be addressed in the financing and delivery of health care.