Skip to main content

Research Repository

Advanced Search

Population characteristics, mechanisms of primary care and premature mortality in England: a cross-sectional study.

Population characteristics, mechanisms of primary care and premature mortality in England: a cross-sectional study. Thumbnail


Abstract

OBJECTIVES

Health systems with strong primary care tend to have better population outcomes, but in many countries demand for care is growing. We sought to identify mechanisms of primary care that influence premature mortality.

DESIGN

We developed a conceptual model of the mechanisms by which primary care influences premature mortality, and undertook a cross-sectional study in which population and primary care variables reflecting the model were used to explain variations in mortality of those aged under 75 years. The premature standardised mortality ratios (SMRs) for each practice, available from the Department of Health, had been calculated from numbers of deaths in the 5 years from 2006 to 2010. A regression model was undertaken with explanatory variables for the year 2009/2010, and repeated to check stability using data for 2008/2009 and 2010/2011.

SETTING

All general practices in England were eligible for inclusion and, of the total of 8290, complete data were available for 7858.

RESULTS

Population variables, particularly deprivation, were the most powerful predictors of premature mortality, but the mechanisms of primary care depicted in our model also affected mortality. The number of GPs/1000 population and detection of hypertension were negatively associated with mortality. In less deprived practices, continuity of care was also negatively associated with mortality.

CONCLUSIONS

Greater supply of primary care is associated with lower premature mortality even in a health system that has strong primary care (England). Health systems need to sustain the capacity of primary care to deliver effective care, and should assist primary care providers in identifying and meeting the needs of socioeconomically deprived groups.

Acceptance Date Dec 31, 2015
Publication Date Feb 1, 2016
Publicly Available Date Mar 29, 2024
Journal BMJ Open
Publisher BMJ Publishing Group
Pages e009981
DOI https://doi.org/10.1136/bmjopen-2015-009981
Keywords primary care, public health
Publisher URL http://dx.doi.org/10.1136/bmjopen-2015-009981

Files




Downloadable Citations