Avoidable mortality in Tuscany Region (Central Italy) from 1987 to 2008

OBJECTIVE: to evaluate the impact of avoidable mortality (AM) on the changes in life expectancy at birth (LE) in Tuscany Region (Central Italy) in two periods (1987-1989 and 2006-2008). SETTING AND PARTICIPANTS: a list of AM causes previously published was used. The AM were divided into two groups: AM by Health Policy Interventions (HPI), AM by Health System Interventions (HSI). MAIN OUTCOME MEASURES: years of potential life lost (PYLLs), rates of PYLL standardized on the European population (TSPYLLs), and LE were examined. RESULTS: in 2006-2008, LE increased with a gain of 5.2 in men and 3.8 in women in comparison to 1987-1989 LE (respectively 79 and 84,9 years). If AM did not have occurred, LE would have further increased of 2 years in men and 1.5 in women. AM recorded a 39% decrease: from 25.3% of overall mortality in men in 1987-1989 to 16.1% in 2006-2008; in women from 14.3% to 8.4%. Injury/poisoning and lung cancer are the most frequent IPP. The only increasing AM is lung cancer in women. Disentangling LE increases by group of causes, 25% of the increases in 2006-2008, compared to 1987-1989, was attributable to HSI reduction, and 4% in women and 16% in men to HPI reduction. CONCLUSIONS: AM recorded a 39% decrease from 1987-1989 to 2006-2008 in Tuscany. In 2006-2008, about one third of LE increase in women and 2/5 in men was attributable to AM decrease, while 2/3 in women and 3/5 in men to increased survival in eldest people.