Socioeconomic conditions, biological and psychosocial factors as well as health care service provision, prevention programs as well as individual lifestyles are major determinants for health and illness of women and men. Diseases causing a great number of deaths and prematurely occurring deaths in a particular population indicate a need for preventive interventions on all these determinants. The World Health Organization points out that setting-oriented interventions enhance the effectiveness and sustainability of such programs [19, 20]. In Austria, more than two thirds of deaths between 2010 and 2012 were caused either by diseases of the circulatory system or by cancer. Comparing those Austrian federal states with high death rates with those with low rates due to the two leading causes of death shows that up to one third of these deaths are potentially preventable. These results are consistent with the 20 % to 40 % of premature preventable deaths analysed by Yoon et al.  for the United States.
These findings suggest that the preventive potential for diseases of the circulatory system as well as for cancer needs to be realized. Particularly the eastern and southern federal states of Austria-Burgenland, Vienna, Styria and Carinthia -have a high potential for reducing premature mortality. In some federal states, the differences between women and men are particularly striking. The potentially preventable deaths due to circulatory diseases in Tyrol are 7.9 % for women and only 3.0 % for men, whereas for cancer the percentage in Burgenland is 15.6 % for women, and 24.2 % for men (see Tables 1 and 2). For circulatory diseases these differences are particularly high in Vorarlberg and Styria favouring women with lower preventive potentials for deaths in both federal states. Women in Salzburg had the highest rate of potentially preventable deaths from cancer. In Burgenland men had the highest rate of potentially preventable deaths from cancer. It is highly relevant to know about these sex-specific disparities in potentially preventable deaths in Austria to open the floor for further research on the causal effects, as their causes are not yet clear.
Economic data reveal disparities between the populations in south-eastern and western Austria. Median income from employment differs between women and men, and among the federal states . This gap is at least to some extent likely to explain the differences in mortality between the federal states. In addition, the distribution of unhealthy lifestyle factors varies between the states. Long-term trends show regional lifestyle-differences clearly, with healthier lifestyles in the west of Austria, both in women and men [22, 23]. In terms of health care services provision, women with cerebrovascular diseases in Styria, for example, attain insufficient therapeutic interventions which could also be a reason for premature deaths in women . Although such regional disparities are plausible co-factors for the differences assessed, analyses of aggregate-level data does not allow to distinguish between individual-level factors, composite measures of variables and context effects on regional mortality. A further limitation of the study is using the current national life expectancy as an age limit for preventable deaths. It could exclude some preventable deaths due to cardiovascular disease and cancer if life expectancy is reduced by higher mortality due to other causes. In addition, our analyses are based on single causes of death reported in death certificates. These might be affected by reporting bias. Biased regional differences, however, seem unlikely, as the autopsy rate, an indicator for confirmed causes of deaths, shows. The mean autopsy rate in Austria between 2010 and 2012 was on average 15.7 % of all deceased . In this period, Carinthia and Styria had rates below 10 %, Salzburg almost 12 %, Burgenland and Tyrol almost 15 %, and the other federal states were above the mean average. Quality checks for autopsies and for non-autopsy deaths are non-existent in Austria. Sex-specific numbers of autopsies are also not available in Austria, additionally limiting sex-specific analyses.
Finally, and in contrast to the study by Yoon et al.  on 50 states, our study encompasses the nine Austrian federal states. Therefore, just one federal state annually was taken as a benchmark for computing preventable deaths. The minimum death rates were averaged across the three years of study and stratified by age-group, sex, and cause of death and yielded robust results as 14 of the 16 computed minimum death rates were located in the three western states of Austria (Vorarlberg, Tyrol, Salzburg). Therefore, we consider this a reasonable procedure.