Résumé :
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[BDSP. Notice produite par INIST-CNRS A6R0xhdd. Diffusion soumise à autorisation]. Background : Recent avoidable mortality trends in Australia suggest that health care has made a substantial contribution to reducing mortality. This study investigates if the benefits of health care have been distributed equally by comparing declines in avoidable with non-avoidable mortality over time by socioeconomic status (SES). Methods : We calculated avoidable and non-avoidable mortality rates in Australia by small areas for 1986,1991,1997 and 2002. We performed pooled cross-sectional trend analysis of indirectly standardized mortality rates by SES and year, modelling using Poisson regression with over-dispersion. Socioeconomic inequalities were quantified using the relative (RII) and slope (SII) index of inequality. Results : The annual percentage decline in avoidable mortality at the higher end of the socioeconomic continuum (5.0% ; 95% CI : 4.7-5.4%) was larger than at the lower end (3.5% ; 3.2-3.8%), with increasing relative inequality between 1986 (RII=1.54 ; 1.46-1.63) and 2002 (RII=2.00 ; 1.95-2.06), greater than that in non-avoidable mortality (P=0.036). In absolute terms, avoidable deaths fell annually by 7.4 (6.9-7.8) and 8.4 (7.9-8.9) deaths per 100 000 at the higher and lower end of the spectrum, respectively, with absolute inequality decreasing between 1986 (SII=97.8 ; 87.6-107.9) and 2002 (SII=81.5 ; 74.6-88.5). Conclusions : Health care has contributed to decreasing the absolute SES mortality gap. However, advantaged people have obtained a disproportionate benefit of health care, contributing to widening relative health inequalities. A universal heath care system does not guarantee equality in health-care-related outcomes.
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