The composite rate of mortality amenable to health care per 100 000
consists of age-standardized rates of deaths that occur before age 75
from causes considered at least partially treatable or preventable with
timely and appropriate health care.1 The developers designed it to be
‘conservative’, excluding deaths due to lung cancer and including only
50 per cent of the deaths from ischemic heart disease. Deaths counted
in the measure comprise approximately 27 per cent of deaths from all
causes among persons under age 75 (see Appendix, Table A1).
We followed Nolte and McKee’s methodology1,3 to calculate rates
for each US state and the District of Columbia using the 2004–2005
CDC Multiple Cause-of-Death data files. For each state, we pooled
deaths for 2 years to allow for greater stability in those states with small
populations. We age-standardized state rates using US Census Bureau
population data. The median amenable mortality rate for all states in
2004–2005 was 89.9 deaths per 100 000 (range 63.9–158.3).
The variables in the analyses included each of the state-based rates of
mortality amenable to health care; two socio-demographic measures –
the per cent of each state population that is black and the per cent that is
under 200 per cent of the federal poverty level; and 19 health care access
and system performance indicators. The access and system performance
indicators include measures of the non-elderly uninsured population,
delays in care, routine physician visits among at-risk patients, having
a usual source of care, use of recommended primary and secondary
clinical preventive services, hospital delivery of recommended care, andmeasures of preventable hospitalizations. The data were originally
compiled for the Commonwealth Fund’s 2009 state scorecard on health
system performance6 (see Appendix, Table A2).