Avoidable mortality: a consensus list of causes to update the indicator in Spain

Mortality indicators could reflect the effect of health services interventions on the population's health, although there is no agreement about which indicator would be the most appropriate. The objective of this study was to obtain a consensus list of causes of avoidable mortality that could be used as a reference in Spain. Based on existing publications and participants' knowledge, a process of consensus among medical practitioners, producers and users of health indicators was carried out. The degree of agreement on the different items was assessed. Agreement was reached on a final list of 34 causes of avoidable mortality as well as on the interventions that could avoid death. The level of consensus was high or intermediate in most categories (consensus was low in only 4 categories) and was high for the list and sublists (medical care or health policy interventions) as a whole. Agreement was higher on the avoidable causes of death than on the kind of interventions that can avoid it. Discrepancy was greater for the kind of medical interventions than for intersectorial policy measures. The reflection and discussion involved in reaching a consensus on the avoidable mortality list, as well as the dissemination of the criteria and the procedures followed, provide added value. The list will improve data comparisons and facilitate benchmarking among the various regional health systems. We recommend its use in the Spanish context.