Mortality is closely linked with socioeconomic status. Healthcare needs and service use increase near the end of life. However, it is not well understood how age and socioeconomic status are related to patterns of illness and service use and access to potentially life-extending treatment near the end of life. We will use linked survey-mortality data from the Irish Longitudinal Study on Ageing (TILDA) and death certificates administered by the Central Statistics Office (CSO) to examine:
a) socioeconomic inequalities in mortality;
b) variations in amenable mortality; and
c) drivers of healthcare utilisation and costs at the end of life in the over 50s in Ireland.
While mortality rates have been improving steadily in most developed countries, socioeconomic inequalities in mortality persist, and the mechanisms underlying such inequalities are not well understood (e.g., health behaviours, access to healthcare, etc.). In addition, analyses of Irish mortality rates to date have been based on unlinked Census-mortality data, which have serious limitations for researchers.
As an indicator, mortality is also used to assess the contribution of health systems to population health. Amenable mortality is defined as premature deaths that should not occur in the presence of timely and effective healthcare. The Irish healthcare system, with variation in public healthcare entitlements across the population, and supply of services at a regional level, offers an ideal setting with which to examine the relative impact of age, socioeconomic status and healthcare accessibility on amenable mortality.
In the context of future pressures on public budgets from population ageing, examining the determinants of healthcare utilisation and costs at the end of life can assist policymakers in designing appropriate interventions (e.g., increasing use of primary prevention) to control expenditure, reduce health inequalities, improve population health and better project the effects of demographic and socioeconomic change on healthcare needs and use.
