What, if anything, does amenable mortality tell us about regional health system Performance?

Objectives: Amenable mortality is proposed as a health system performance measure, and has been used in comparisons across countries and socio-economic strata. We assess its utility as a health region-level indicator in Canada. Approach: We classified all deaths in British Columbia from 2002 to 2009 using two common definitions of amenable mortality. Counts and standardized rates were calculated for 16 health regions. To assess reliability, sensitivity and validity, we compared rates across regions and over time, and examined correlations with premature and all-cause mortality. Results: Of the 238,849 deaths in the study period, 6.6% or 13.7% were classified as amenable (depending on the definition used). Rates were stable or falling in more populated regions, but unstable with large confidence intervals elsewhere. Correlation with overall mortality was strong. Conclusion: Though amenable mortality is appealing as a feasible, understandable indicator, we question whether it is appropriate for comparisons at a subprovincial level.