Различия в нивата на предотвратимата с медицински интервенции смъртност между градовете и селата в България за 10-годишен период (2005-2014 г.)

Introduction: Avoidable mortality is a valuable indicator of the health system performance. Urban and rural differences in it have not been examined in Bulgaria yet.AimThe present study aimed at analyzing the levels and trends of avoidable mortality in urban and rural areas of Bulgaria after the accession of the country to the European Union.Materials and Methods: We analyzed 20 amenable and preventable causes of death selected from the EUROSTAT list. Mortality and population data were provided by the National Statistical Institute. Standardized cause-specific death rates were calculated by applying the European standard population of 2013. We explored the dynamics of avoidable mortality in urban and rural areas over the period.Results: Avoidable mortality was higher in the rural areas and it increased insignificantly over the period. Urban avoidable mortality expressed a downward trend at a low pace of reduction (3-7% per year). Rural death rates of lung cancer, esophageal cancer, nephritis and nephrosis, certain conditions of the perinatal period, transport accidents and suicide outnumbered by 1.5-1.8 times the average urban death rates for the period. Mortality due to hypertension, ischemic heart disease and cerebrovascular disease remained higher in the villages even after controlling for the effect of age.Conclusion: Avoidable mortality in rural and in urban areas of Bulgaria still constitutes about a half of the total mortality. Rural population has higher risks of dying from conditions amenable by medical interventions.Effective health policies have to be enforced in order to reduce the urban and rural differences in the access, the scope and the quality of medical care