Citation

Lapostolle A, Lefranc A, Gremy I, Spira A. Rev. Epidemiol. Sante Publique 2008; 56(4): e1-e7.

Affiliation

Inserm U822, service de sante publique, hopital de Kremlin-Bicetre, 82, rue du General-Leclerc, 94276 le Kremlin-Bicetre cedex, France.

Copyright

(Copyright © 2008, Elsevier Publishing)

DOI

10.1016/j.respe.2008.07.001

PMID

18799277

Abstract

BACKGROUND: For many years in France, premature mortality (i.e., deaths before 65years of age) and avoidable deaths have routinely been used to monitor the health of the population and help to elaborate policies in this area. This paper aims, to account for, the utility of another indicator of premature mortality, which makes it possible to take into account the impact of deaths and the years of life lost (YLL). METHODS: Mortality data for France in the years 2000-2002 were obtained from the Center for Epidemiology of the Medical Causes of Death. Premature mortality was defined by death rates before 65. For the calculation of YLL, the mortality norm chosen was French life expectancy for the years 2001-2003. To study the spatial distribution of these indicators, standardized ratios were calculated for each department, taking France as the reference population. RESULTS: For all genders and indicators considered, ranking the causes emphasizes three main groups of diseases that are clearly distinguished from the others: cardiovascular diseases, malignant neoplasms, and injuries. The rank of causes varies appreciably depending on the indicator used. The spatial representation of standardized ratios of expected YLL and deaths before 65 shows a strong north-south trend. CONCLUSION: The concept of premature mortality is difficult to define and debate continues on the age limit to use for its quantification. The choice of an indicator depends to a large degree on how it is to be used. The simple analysis of deaths before 65years of age currently used to describe premature mortality in France describes its frequency. The use of a summary measure such as YLL allows us to quantify the impact of premature mortality by giving different weights to deaths depending on the age at death. YLL, therefore, seems to be an indicator that is particularly well adapted to decision-making in public health, depending on the preferred choices and values.

Language: en