Background : the concept of "premature mortality" is at the heart of many national and global health measurement and benchmarking efforts. However, despite the intuitive appeal of its underlying concept, it is far from obvious how to best operationalise it. The previous work offers at least two basic approaches: an absolute and a relative one. The former -- and far more widely used -- sets a unique age threshold (e.g. 65 years), below which deaths are defined as premature. The relative approach derives the share of premature deaths from the country--specific age distribution of deaths in the country of interest. The biggest disadvantage of the absolute approach is that of using a unique, arbitrary threshold for different mortality patterns, while the main disadvantage of the relative approach is that its estimate of premature mortality strongly depends on how the senescent deaths distribution is defined in each country.\
Method : we propose to overcome some of the downsides of the existing approaches, by combining features of both, using a hierarchical model, in which senescent deaths distribution is held constant for each country as a pivotal quantity and the premature mortality distribution is allowed to vary across countries. In this way, premature mortality estimates become more comparable across countries with similar characteristics.\
Results : the proposed hierarchical models provides results which lead to shared conclusions researchers developed analyzing the specific countries. In particular, we find a relatively high premature mortality for United States and Denmark.
Conclusions : while our hybrid approach overcomes some of the problems of the previous measures, some issues needs further work. In particular the choice of the group of countries a given country is assigned to and the choice of the benchmarks within the groups. Hence our proposed method, combined with further study addressing the clustering issue, could provide a valid alternative way to measure and compare premature mortality across countries.