Using the diamond model to prioritize 30 causes of death by considering both the level of and inequality in mortality.

OBJECTIVES The diamond model considers two dimensions of criteria, i.e., the magnitudes of rates and the trends in rates, in order to prioritize different health issues for health policy decision-making. We aimed in this study to use the diamond model to prioritize 30 causes of death (COD) by considering both the level of and inequality in mortality for the setting of policy goals in Taiwan. METHODS In the level of mortality diamond, the mortality rates of 30 COD of 2006-2008 were classified into three groups by statistical examination to construct the magnitude dimension of the diamond. The 30 COD were then classified into three groups according to statistical examination of the slope of the mortality trend from 1991-1993 to 2006-2008 according to linear regression to construct the trend dimension of the diamond. By considering the two above-described dimensions, each COD can be classified into one of the nine (3 by 3) grid cells in the diamond model, resulting in five levels of priority. The same method was used to construct an inequality in mortality (mortality rate ratio between the city/county with the highest and the lowest rate) diamond. RESULTS In the level of mortality diamond, three COD were grouped in the first priority cell and seven in the second priority cell. However, only two COD were classified in the first priority cell and three in the second priority cell in the inequality in mortality diamond. Liver cirrhosis was the only COD in the first two priority cells in both diamonds. CONCLUSIONS The diamond model is a useful tool for initial prioritization of health issues by considering two dimensions of criteria at the same time using existing data. Furthermore, by using the diamond shape to graphically present the prioritized results, the diamond model efficiently conveys prioritization information to the general public and stakeholders during policy debates.