Temporal trend analysis of avoidable mortality in Taiwan, 1971-2008: Overall progress, but areas for additional public health investments

Avoidable mortality (AM), or “unnecessary untimely death,” is considered an indicator of health care quality. In this study, we investigated trends in the age-standardized mortality rates (ASMRs) of deaths amenable to public health measures or medical care in Taiwan from 1971-2008, with an emphasis on detecting areas where additional medical or public health investment may help reduce the Taiwanese burden in AM. Taiwan's age-standardized mortality rates (ASMRs) per 100,000 for AM and other causes of death were calculated using data from the National Death Certificate Registry in five-year bins from 1971 to 2008. Standard expected years of life lost (SEYLL) rates per 100,000 were calculated annually from 1971 to 2008 using the same data source. ASMR for almost all AM and other causes of death declined dramatically from 1971 to 2008 except for lung cancer (16.6% increase among men and 7.4% increase among women) and breast cancer (109.8% increase among women). SEYLL due to lung cancer likewise increased from 269.22 to 555.67 for men and 249.71 to 342.49 for women during the same period. For women, SEYLL due to breast cancer increased from 263.53 in 1971 to 659.31 in 2008. Additional effort should be devoted to public health measures to combat the rising prevalence of smoking in Taiwan, which may be at the root of the increasing AM from lung cancer. Greater policy emphasis on the early detection and treatment of breast cancer is also suggested.