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

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 under aged 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 five years 2006-10. A regression model was undertaken with explanatory variables for the year 2009/10, and repeated to check stability using data for 2008/09 and 2010/11. 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 socio-economically deprived groups.

研究目的：拥有完善基层医疗服务的卫生系统往往能获得更优的人群健康结局，但诸多国家的医疗服务需求仍在持续增长。本研究旨在明确影响过早死亡的基层医疗运作机制。
研究设计：本研究首先构建了基层医疗影响过早死亡的概念模型，并开展横断面研究，利用反映该模型的人群与基层医疗变量，解释75岁以下人群的死亡率差异。英国卫生部已公开各全科诊所的过早标准化死亡率（SMRs, standardised mortality ratios），该数据基于2006-2010年五年间的死亡人数计算所得。本研究以2009/10年度的变量作为解释变量构建回归模型，并分别采用2008/09与2010/11年度的数据重复开展分析，以验证结果稳定性。
研究场景与样本：英格兰境内所有全科诊所均符合纳入标准。初始总样本量为8290家，最终获取7858家诊所的完整有效数据。
研究结果：人群特征变量（尤其是社会剥夺程度）是过早死亡率最强的预测因子，但本研究模型所刻画的基层医疗运作机制同样对死亡率存在影响。每千人口全科医师数与高血压检出率均与死亡率呈负相关。在社会剥夺程度较低的诊所中，医疗服务连续性同样与死亡率呈负相关。
研究结论：即便是在基层医疗体系完善的英格兰卫生系统中，提升基层医疗供给量仍与更低的过早死亡率相关。卫生系统需要维持基层医疗提供有效服务的能力，并应协助基层医疗服务机构识别并满足社会经济弱势人群的健康需求。