Avoidable Mortality in Paradise – a Benchmarking Descriptive Analysis of the UK Overseas Territory, Anguilla

Background: Avoidable mortality is widely recognized as an indicator of health systems performance, yet evidence from small island settings remains limited. This study was conducted to establish benchmarks in avoidable mortality and to elucidate areas for further investigation towards the improvement of health care services in Anguilla, a UK overseas territory (UKOT). Methods: The authors conducted a descriptive analysis of deaths in Anguilla, between 2010 and 2019. Using 2018 OECD/Eurostat definitions, deaths were considered avoidable if the underlying cause was preventable through public health intervention or amenable to optimal health care. Counts, proportions, and age-adjusted mortality rates were determined for avoidable, preventable and amenable deaths, disaggregated by age-group, gender and broad causal groups. Simple linear regression was conducted with year as the independent variable (x) and the raw (annual) counts as the dependent variable (y). Results: Almost 40% of deaths in Anguilla between 2010 and 2019 were avoidable. Cardiovascular diseases, external causes, cancers, diabetes, alcohol-related diseases collectively accounted for almost 80%. Seventy (70%) of avoidable deaths were males , mainly due to external causes, while neoplasms predominated among women. Avoidable deaths in children, mainly perinatal, averaged one per year and accounted for 7% of avoidable deaths. Age-standardized avoidable mortality was 310.5 per 100,000, exceeding UK (232.0) and OECD (255.0) rates. A significant increasing trend over time was observed (p=0.0005), with the sharpest rise following Hurricane Irma in 2017. The top five broad causal groups found in this study were the same as those of the Pan American Health Organization’s (PAHO) 2024 report on data from 2000 to 2019 for the Region of the Americas. The predominance of males in the avoidable mortality burden notably from preventable causes was also a similar finding. Conclusions: Avoidable deaths are high in Anguilla and males are more adversely affected. Gender disparities, gaps in the health system, and the other contributing factors need further study. Since data from this benchmarking analysis precedes the COVID-19 pandemic, it would be interesting to see the impact on avoidable deaths in future analyses and possible implications for investment in primary health care.