Trends In Adult Mortality Research Articles

Adult Male Mortality in India

This paper presents levels and trends of adult male mortality in India and its major states during the post-independence period applying the widowhood method on census data. It also estimates adult male mortality for all the districts from major states of India. We adjusted widowhood estimates for possible bias due to remarriages and examined the sensitivity of adjusted estimates to different scenarios of remarriage rates. Comparison of widowhood estimates with direct estimates from official sources supports the credibility of widowhood estimates. Information obtained from widows aged 40–44 and 45–49 provided the most convincing patterns of adult mortality. Trends in adult mortality suggest that maximum gain in 45q15 for India and its states occurred during 1949–1960. Adult male mortality varied substantially across the states of India. Although adult life expectancy has been rising in India, the rate of mortality reduction has been decreasing over the last few decades.

Measuring Adult Mortality Using Sibling Survival: A New Analytical Method and New Results for 44 Countries, 1974–2006

For several decades, global public health efforts have focused on the development and application of disease control programs to improve child survival in developing populations. The need to reliably monitor the impact of such intervention programs in countries has led to significant advances in demographic methods and data sources, particularly with large-scale, cross-national survey programs such as the Demographic and Health Surveys (DHS). Although no comparable effort has been undertaken for adult mortality, the availability of large datasets with information on adult survival from censuses and household surveys offers an important opportunity to dramatically improve our knowledge about levels and trends in adult mortality in countries without good vital registration. To date, attempts to measure adult mortality from questions in censuses and surveys have generally led to implausibly low levels of adult mortality owing to biases inherent in survey data such as survival and recall bias. Recent methodological developments and the increasing availability of large surveys with information on sibling survival suggest that it may well be timely to reassess the pessimism that has prevailed around the use of sibling histories to measure adult mortality. We present the Corrected Sibling Survival (CSS) method, which addresses both the survival and recall biases that have plagued the use of survey data to estimate adult mortality. Using logistic regression, our method directly estimates the probability of dying in a given country, by age, sex, and time period from sibling history data. The logistic regression framework borrows strength across surveys and time periods for the estimation of the age patterns of mortality, and facilitates the implementation of solutions for the underrepresentation of high-mortality families and recall bias. We apply the method to generate estimates of and trends in adult mortality, using the summary measure (45)q(15)-the probability of a 15-y old dying before his or her 60th birthday-for 44 countries with DHS sibling survival data. Our findings suggest that levels of adult mortality prevailing in many developing countries are substantially higher than previously suggested by other analyses of sibling history data. Generally, our estimates show the risk of adult death between ages 15 and 60 y to be about 20%-35% for females and 25%-45% for males in sub-Saharan African populations largely unaffected by HIV. In countries of Southern Africa, where the HIV epidemic has been most pronounced, as many as eight out of ten men alive at age 15 y will be dead by age 60, as will six out of ten women. Adult mortality levels in populations of Asia and Latin America are generally lower than in Africa, particularly for women. The exceptions are Haiti and Cambodia, where mortality risks are comparable to many countries in Africa. In all other countries with data, the probability of dying between ages 15 and 60 y was typically around 10% for women and 20% for men, not much higher than the levels prevailing in several more developed countries. Our results represent an expansion of direct knowledge of levels and trends in adult mortality in the developing world. The CSS method provides grounds for renewed optimism in collecting sibling survival data. We suggest that all nationally representative survey programs with adequate sample size ought to implement this critical module for tracking adult mortality in order to more reliably understand the levels and patterns of adult mortality, and how they are changing. Please see later in the article for the Editors' Summary.

'Mass Privatisation and the Post-Communist Mortality Crisis': Is There Really a Relationship?

We reexamine the well-publicized claim that rapid mass privatisation [of state-owned enterprises] . . . was a crucial determinant of differences in adult mortality trends in postcommunist countries (Stuckler, King and McKee, 2009). Our analysis shows that the estimated correlation of privatization and mortality in country-level data is not robust to recomputing the mass-privatization measure, to assuming a short lag for economic policies to affect mortality, and to controlling for country-specific mortality trends. Further, in an analysis of the determinants of mortality in Russian regions, we find no evidence that privatization increased mortality during the early 1990s. Finally, we reanalyze the relationship between privatization and unemployment in postcommunist countries, showing that there is little support for the proposed mechanism by which privatization might have increased mortality.

Adult mortality and antiretroviral treatment roll-out in rural KwaZulu-Natal, South Africa.

To investigate trends in adult mortality in a population serviced by a public-sector antiretroviral therapy (ART) programme in rural South Africa using a demographic surveillance system. Verbal autopsies were conducted for all 7930 deaths observed between January 2000 and December 2006 in a demographic surveillance population of 74,500 in the Umkhanyakude district of northern KwaZulu-Natal province, South Africa. Age-standardized mortality rate ratios (SMRRs) were calculated for adults aged 25 to 49 years, the group most affected by HIV, for the 2 years before 2004 and the 3 subsequent years, during which ART had been available. Between 2002-2003 (the period before ART) and 2004-2006 (the period after ART), HIV-related age-standardized mortality declined significantly, from 22.52 to 17.58 per 1000 person-years in women 25-49 years of age (P < 0.001; SMRR: 0.780; 95% confidence interval, CI: 0.691-0.881), and from 26.46 to 18.68 per 1000 person-years in men 25-49 years of age (P < 0.001; SMRR: 0.706; 95% CI: 0.615-0.811). On sensitivity analysis the results were robust to the possible effect of misclassification of HIV-related deaths. Overall population mortality and HIV-related adult mortality declined significantly following ART roll-out in a community with a high prevalence of HIV infection. A clear public health message of the benefits of treatment, as revealed by these findings, should be part of a multi-faceted strategy to encourage people to find out their HIV serostatus and seek care.

ADULT MORTALITY IN MATLAB, BANGLADESH

This study examines adult mortality (15–59 years) in Matlab using data from the Health and Demographic Surveillance System (HDSS) of the International Centre for Diarrhoeal Disease Research, Bangladesh. Levels and trends of adult mortality were ascertained by life table techniques using HDSS reports, while detailed analyses were undertaken of two cohorts (a July 1982 cohort and a January 1996 cohort), each followed for three years. Over the study period, adult mortality declined significantly, but the decline was not homogenous across socio-demographic categories. Differences in mortality by education, ownership of household items and marital status changed little, but differences by religion and study area contracted. Elderly adult mortality remains higher for males than females, but the male–female mortality difference contracted for young adults. The proportion of adult deaths due to infectious diseases almost halved over the study period, while the proportion due to non-infectious diseases and injury more than doubled.

Mass privatisation and the post-communist mortality crisis: a cross-national analysis

During the early-1990s, adult mortality rates rose in most post-communist European countries. Substantial differences across countries and over time remain unexplained. Although previous studies have suggested that the pace of economic transition was a key driver of increased mortality rates, to our knowledge no study has empirically assessed the role of specific components of transition policies. We investigated whether mass privatisation can account for differences in adult mortality rates in such countries. We used multivariate longitudinal regression to analyse age-standardised mortality rates in working-age men (15-59 years) in post-communist countries of eastern Europe and the former Soviet Union from 1989 to 2002. We defined mass privatisation programmes as transferring at least 25% of large state-owned enterprises to the private sector within 2 years with the use of vouchers and give-aways to firm insiders. To isolate the effect of mass privatisation, we used models to control for price and trade liberalisation, income change, initial country conditions, structural predispositions to higher mortality, and other potential confounders. Mass privatisation programmes were associated with an increase in short-term adult male mortality rates of 12.8% (95% CI 7.9-17.7; p<0.0001), with similar results for the alternative privatisation indices from the European Bank for Reconstruction and Development (7.8% [95% CI 2.8-13.0]). One mediating factor could be male unemployment rates, which were increased substantially by mass privatisation (56.3% [28.3-84.3]; p<0.0001). Each 1% increase in the percentage of population who were members of at least one social organisation decreased the association of privatisation with mortality by 0.27%; when more than 45% of a population was a member of at least one social organisation, privatisation was no longer significantly associated with increased mortality rates (3.4% [95% CI -5.4 to 12.3]; p=0.44). Rapid mass privatisation as an economic transition strategy was a crucial determinant of differences in adult mortality trends in post-communist countries; the effect of privatisation was reduced if social capital was high. These findings might be relevant to other countries in which similar policies are being considered.

Letter to the editor

We examined the role of smoking in the two dimensions behind the time trends in adult mortality in European countries, that is, rectangularization of the survival curve (mortality compression) and longevity extension (increase in the age-at-death).Using data on national sex-specific populations aged 50 years and older from Denmark, Finland, France, West Germany, Italy, the Netherlands, Norway, Sweden, Switzerland, and the United Kingdom, we studied trends in life expectancy, rectangularity, and longevity from 1950 to 2009 for both all-cause and nonsmoking-related mortality and correlated them with trends in lifetime smoking prevalence.For all-cause mortality, rectangularization accelerated around 1980 among men in all the countries studied, and more recently among women in Denmark and the United Kingdom. Trends in lifetime smoking prevalence correlated negatively with both rectangularization and longevity extension, but more negatively with rectangularization. For nonsmoking-related mortality, rectangularization among men did not accelerate around 1980. Among women, the differences between all-cause mortality and nonsmoking-related mortality were small, but larger for rectangularization than for longevity extension. Rectangularization contributed less to the increase in life expectancy than longevity extension, especially for nonsmoking-related mortality among men.Smoking affects rectangularization more than longevity extension, both among men and women.

Levels and trends of demographic indices in southern rural Mozambique: evidence from demographic surveillance in Manhiça district.

BackgroundIn Mozambique most of demographic data are obtained using census or sample survey including indirect estimations. A method of collecting longitudinal demographic data was introduced in southern Mozambique since 1996 (DSS -Demographic Surveillance System in Manhiça district, Maputo province), but the extent to which it yields demographic measures that are typical of southern rural Mozambique has not been evaluated yet.MethodsData from the DSS were used to estimate the levels and trends of fertility, mortality and migration in Manhiça, between 1998 and 2005. The estimates from Manhiça were compared with estimates from Maputo province using the 1997 National census and 1997 Demographic and Health Survey (DHS). The DHS data were used to estimate levels and trends of adult mortality using the siblings' histories and the orphanhood methods.ResultsThe populations in Manhiça and in Maputo province are young (44% <15 years in Manhiça and 42% in Maputo); with reduced adult males when compared to females (all ages sex ratio of 78.7 in Manhiça and 89 in Maputo). Fertility in Manhiça is at a similar level as in Maputo province and has remained around 5 children per woman, during the eight years of surveillance in Manhiça. Although the infant mortality rate (IMR) in Mozambique has decreased during the last two decades (from 148 deaths per 1000 live births in 1980 to 101 in 2003), it has remained stable around 80 in Manhiça during the surveillance period. Adult mortality has increased both in Manhiça (probability of dying from ages 15 to 60 increased from 0.4 in 1998 to 0.6 in 2005 in Manhiça, from 0.3 in 1992 to 0.4 in 1997 in Maputo province and from 0.1 in 1980 to 0.6 in 2000 in Mozambique). Consequently, the life expectancy decreased from 53 to 46 in Manhiça and from 42 years in 1997 to 38 in 2004 in Mozambique. Migration is high in Manhiça but tends to stabilise after the movements of resettlement that followed the end of the civil war in 1992.ConclusionThe population under demographic surveillance in Manhiça district presents characteristics that are typical of southern rural Mozambique, with predominance of young people and reduction of adult males. Labour migration and excess adult male mortality are the major factors for the reduction of adult males. Mortality is high and only infant mortality has started to stabilise while adult mortality has increased, and as consequence, life expectancy has decreased. The Manhiça DSS is an adequate tool to report demographic measures for southern rural Mozambique.

Long-range trends in adult mortality: Models and projection methods

In the study reported here, I had two objectives: (1) to test a new version of the logistic model for the pattern of change over time in age-specific adult mortality rates and (2) to develop a new method for projecting future trends in adult mortality. A test of the goodness of fit of the logistic model for the force of mortality indicated that its slope parameter is nearly constant over time. This finding suggests a variant of the model that is called the shifting logistic model. A new projection method, based on the shifting mortality model, is proposed and compared with the widely used Lee-Carter procedure.

Commentary: On reappraisal of adult mortality.

Due to the development of indirect estimation methods for estimating infant and child mortality from some simple questions asked routinely in censuses and surveys, and collection of detailed birth histories in some sample surveys, there has been marked improvement in the information on levels and trends in child mortality in the developing world. 1 But unfortunately, the same cannot be said about levels and trends in adult mortality. In recent years, the spread of the human immunodeficiency virus (HIV)/AIDS epidemic has brought the paucity of data on adult mortality into sharp focus. Although the United Nations does provide estimates of adult mortality for all the developing countries, in only about onethird of the countries is such information based on vital registration. 2 The estimates derived from indirect information, such as on orphanhood, have been found useable in only 4% of the countries. For about one-third of developing countries the adult mortality levels are arrived at from the estimates of child mortality by assuming age patterns of mortality contained in ‘model’ life tables. The model life tables synthesize the relationship between mortality rates at different ages observed in countries that had reliable data on age- and sex-specific mortality rates. Although they may be useful in approximating the level of adult mortality for the time periods for which estimates of child mortality are available, the assumed high correlation between the levels of adult and child mortality could become too restrictive when ascertaining trends, especially in populations affected by the HIV/AIDS epidemic. It is in this context that Gakidou and colleagues recommend collection and analysis of sibling survival data. 3 It should be noted that there are two alternative methods of estimating adult mortality from this information. The ‘indirect’ method, developed originally by Hill and Trussell 4 and revised subsequently by Timaeus and others, 5 uses data only on the proportion of surviving siblings by respondent’s age. The data collected in the maternal mortality module of the Demographic and Health Surveys (DHS) had additionally included data on current age of surviving siblings, age at death, and time period of those who have died. Data of this type permit the direct estimation of mortality rates by age for any time period in the past, and it is this data and the method that Gakidou and others discuss in their paper. The advantage of the direct method is that it is not affected by assumptions about the age patterns of fertility and mortality made in the indirect method, but could be sensitive to errors in the detailed data used in the estimation. Neither of these methods has been extensively used and hence there is scant information on how well they perform in practice. An issue of particular concern is that as respondents cannot be expected to report on siblings who died before they were born or when they were very young, the method would invariably lead to underestimation of adult mortality. Gakidou and others provide estimates of probability of survival between age 15 and 59 ( 59 q 15 ) derived from the DHS data for 29 populations. Apparently the estimates are for the 5-year period before the survey (the paper is not very clear on this issue). The comparison with the estimates provided by the United Nations for the corresponding period show that sibling survival estimates are lower (the extent of underestimation is difficult to gauge from the data presented by the authors) which appears to confirm the suspicion about the sensitivity of the estimates to selective omission of non-surviving siblings. However, the UN estimates are also not above criticism, as the adult mortality estimates for many of the countries in the data set were probably inferred from the estimates of child mortality using model life tables. Nonetheless, the estimates presented for four countries at two points in time raise doubts about the usefulness of sibling-survival data for monitoring adult mortality trends. Of the four countries, the survey estimates suggest unbelievably large increases in adult mortality in a span of 3‐4 years in the case of two (Indonesia and Malawi), and large declines in one (Peru).

The impact of AIDS on adult mortality: evidence from national and regional statistics.

To measure trends in adult mortality in countries with significant levels of HIV prevalence using data sources other than those that collect information on HIV status. Data sources consisted of national population censuses and sample surveys, Demographic and Health Surveys (DHS), vital registration, and longitudinal surveillance systems. Estimates of adult mortality were derived from censuses using intercensal survival and questions on deaths of household members and orphanhood. From DHS adult mortality was measured from data on survival of siblings and orphanhood. Death registration should be tested for changes in the level of coverage before drawing conclusions on mortality trends. Demographic surveillance systems record trends and age patterns of mortality, but are not nationally representative. Census and survey data from Kenya, Malawi and Zimbabwe showed increasing adult mortality in the 1990s, reversing previous downward trends. DHS data for over 20 sub-Saharan countries showed that most had increasing mortality, which was steepest in eastern and southern Africa, with high HIV prevalences. Death registration in Zimbabwe and South Africa showed increasing adult mortality, as in Thailand and Trinidad, both countries with appreciable levels of HIV. Surveillance systems in Tanzania and South Africa showed radically different age patterns of mortality, with relatively high rates among younger adults compared with data from countries with lower HIV prevalences. Adult mortality is increasing in countries with high HIV/AIDS prevalences, although the contribution of the epidemic to this increase is difficult to measure. More data and improved methods of analysis are needed before firm conclusions can be drawn.

Demographic and socioeconomic impact of AIDS: taking stock of the empirical evidence.

Since 1998, a large amount of new evidence has become available from specialist community-based studies, national surveys and censuses. Various analytical techniques have been developed that allow us to use these data in new ways. In addition to demographers and epidemiologists, social scientists and economists are now starting to look at empirical evidence on the effects of HIV, at the family, community and national level. Although modelling was the primary basis for an assessment of the size and future of the epidemic in the past, increasingly use is made of real data to inform policy and to evaluate national responses to the epidemic. In this context it is timely and appropriate to re-visit this problem area, to summarize our wider knowledge of the demographic and social impacts of the epidemic, and to broaden the range of effects that we scrutinize critically to include macro and microeconomic impacts. These impacts of AIDS are having an increased impact on policy making: the health services are stretched; the education system is losing teachers; and numbers of orphans are growing. Policy needs to be advised by good data and rigorous analysis. A scientific meeting on the Demographic and Socioeconomic Impact of AIDS was held in Durban, South

Vietnamese Casualties During the American War: A New Estimate

Retrospective reports of the birth and death dates of 5562 kin from the 1991 Vietnam Life History Survey (VLHS) a sample survey of 403 households and 921 adults in four areas of Vietnam provide plausible estimates of adult mortality trends and patterns in that country. The VLHS mortality estimates are consistent with estimates from independent sources for recent periods and when war deaths are excluded are in broad agreement with expected patterns from model life tables. After analyzing the quality of the VLHS mortality data the authors estimate the costs in Vietnamese lives of the `American war from 1965 to 1975. Death rates of young men age 15-29 during the peak war years were more than seven times higher than `normal (nonwar) death rates. Applying the VLHS estimated age-specific death rates for war-related deaths to population estimates for the period the authors estimate that approximately one million (plus or minus 175000) Vietnamese died either as military or civilian casualties on both sides from 1965 to 1975. (SUMMARY IN FRE AND SPA) (EXCERPT)

History of Black Mortality and Health before 1940

This article documents the history of black mortality between 1850 and 1940 and begins the process of placing that history into the context of the more general history of mortality decline in the United States. One aspect of this process has been to discuss the trends in mortality among blacks and whites living in the same general geographic areas--for example, comparing southern rural blacks with southern rural whites. A second part has been to relate black mortality to many of the factors that have been discussed as determinants of general mortality trends--such as water and sanitation, the urban disadvantage in mortality, and child care and feeding practices. During the second half of the nineteenth century, black mortality declined only slightly or not at all. Between 1850 and 1880 there may have been some decline in child mortality, but the trends in adult mortality are indeterminate. Between 1880 and 1900 both child and adult mortality rates were constant. Sometime between 1900 and 1910 mortality rates among blacks began to decline at all ages, especially in urban areas. During the first four decades of this century mortality rates among American blacks declined substantially. Expectation of life at birth increased from about 35 years to about 54 years, which represents a significant improvement in health and living standards. The life expectancy among blacks in 1940, however, was still two years below the value for whites in the death registration area in 1920. (This may exaggerate the difference slightly since the mortality rates for 1919 and 1920 were artificially low following the pandemic of influenza in 1918. In addition, the mortality rates in the DRA may not have been representative of the whole white population.) Throughout the period studied, blacks had substantially higher mortality rates than whites living in the same area. Although the amount of excessive mortality among blacks differed from place to place and period to period, we did not find a single area or time when black mortality rates were close to those of whites. The examination of causes of death among whites and blacks in 1920 showed that racial differences in the amount of tuberculosis explained a substantial part of the mortality differences in New York and North Carolina, but blacks probably had excessive mortality due to all causes.(ABSTRACT TRUNCATED AT 400 WORDS)

Estimation of adult mortality in Korea: levels, trends, and socioeconomic differentials.

SummaryData from the 1974 Korean National Fertility Survey indicate levels, trends, and socioeconomic differentials in adult mortality in the Republic of Korea. The indirect techniques of parental survival and the time location of mortality are used to estimate mortality levels and to discern time trends in adult mortality. Socioeconomic variables are considered for their relationship with levels of adult mortality. The index of household wealth (based on the ownership of modern goods, size and space of household) and education stand out as the most important differentials in adult mortality. The trend in mortality decline is most pronounced for the subgroups representing higher levels of educational attainment and greater ownership of modern goods even after adjusting for the interrelationship between these two variables.