Trends In Adult Mortality Research Articles

Estimation of cause-specific mortality in Rakai, Uganda, using verbal autopsy 1999-2019

ABSTRACT Background There are scant data on the causes of adult deaths in sub-Saharan Africa. We estimated the level and trends in adult mortality, overall and by different causes, in rural Rakai, Uganda, by age, sex, and HIV status. Objectives To estimate and analyse adult cause-specific mortality trends in Rakai, Uganda. Methodology Mortality information by cause, age, sex, and HIV status was recorded in the Rakai Community Cohort study using verbal autopsy interviews, HIV serosurveys, and residency data. We estimated the average number of years lived in adulthood. Using demographic decomposition methods, we estimated the contribution of each cause of death to adult mortality based on the average number of years lived in adulthood. Results Between 1999 and 2019, 63082 adults (15–60 years) were censused, with 1670 deaths registered. Of these, 1656 (99.2%) had completed cause of death data from verbal autopsy. The crude adult death rate was 5.60 (95% confidence interval (CI): 5.33–5.87) per 1000 person-years of observation (pyo). The crude death rate decreased from 11.41 (95% CI: 10.61–12.28) to 3.27 (95% CI: 2.89–3.68) per 1000 pyo between 1999–2004 and 2015–2019. The average number of years lived in adulthood increased in people living with HIV and decreased in HIV-negative individuals between 2000 and 2019. Communicable diseases, primarily HIV and Malaria, had the biggest decreases, which improved the average number of years lived by approximately extra 12 years of life in females and 6 years in males. There were increases in deaths due to non-communicable diseases and external causes, which reduced the average number of years lived in adulthood by 2.0 years and 1.5 years in females and males, respectively. Conclusion There has been a significant decline in overall mortality from 1999 to 2019, with the greatest decline seen in people living with HIV since the availability of antiretroviral therapy in 2004. By 2020, the predominant causes of death among females were non-communicable diseases, with external causes of death dominating in males.

Unveiling Alarming Trends: Worsening All Cause Mortality in US Adults over 25 with Amyloid 1999-2020 Analysis

Introduction: Amyloidosis is a collective term for conditions with an abnormal extracellular deposition of amyloid protein. Amyloidosis can be classified based on the location of deposition (localized vs systemic) and by the different subtypes of proteins which are created as a result of a variety of diseases (plasma cell dyscrasias, chronic inflammation, nephrotic syndrome, genetic). Depending on the affected organs, amyloidosis can present with, not limited to, hepatomegaly, renal impairment, nerve conduction impairment, cardiac conduction abnormalities, restrictive cardiomyopathy, and multiorgan failure. In the last century there has been an increase in innovations leading to a better understanding of the pathology, diagnostic tests, staging, and treatment options for amyloidosis. Our study aims to compare all cause mortality trends in adults over 25 years old diagnosed with amyloidosis in the United States. Methods: The national mortality trends from 1999 to 2020 for all subtypes of amyloid were analyzed from the CDC WONDER database. The data was extracted using ICD codes E85 (Amyloidosis) with subgroups E85.0 (Non-neuropathic heredofamilial amyloidosis), E85.3 (Secondary systemic amyloidosis), E85.4 (Organ-limited amyloidosis), E85.8 (Other amyloidosis), and E85.9 (Amyloidosis, unspecified. Data was stratified for age groups above 25 years old. Age-adjusted mortality rates (AAMRs) were calculated per 100,000 people and death certificate data was stratified by reported sex, race/ethnicity, and US census region. Results: Between 1999 and 2020 there were 40,015 deaths from amyloid. Our analysis revealed that all-cause AAMR per 100,000 people with amyloid showed an increasing trend between 1999 to 2020 (Figure 1). Subgroup analysis on race/ethnicity revealed the AAMR for the Black population has been consistently higher to other groups (Table 1). On average, from 1999 to 2020, the Black population had the highest AAMR (1.52 AAMR) followed by the White population (0.78 AAMR), Hispanic (0.55 AAMR), and Asian (0.5 AAMR). Further subgroup analysis revealed men have a higher AAMR (1.9 AAMR, 2020) compared to women (0.8 AAMR, 2020). Overall there are similar census region trends of all mortality in Amyloid: North (1.5 AAMR, 2020), Midwest (1.5 AAMR, 2020), South (1.0, AAMR, 2020) and West (1.3 AAMR, 2020). Conclusion: Due to advancement in technology, amyloid diseases are becoming more widely recognized and increasingly diagnosed. Unfortunately, treatment of amyloidosis remains limited to early diagnosis and treatment of the underlying condition. This includes modalities such as chemotherapy and stem cell transplantation for plasma cell dysplasias and TTR stabilizers for hereditary amyloidosis. These trends in increase in AAMR likely reflect the increased awareness/diagnostics of amyloid disease and complications. The African American population may have higher AAMR due to socioeconomic and environmental factors, health disparities, and research bias. We also suspect men have a higher ATTR than women as it has been reported that ATTR and AL Amyloidosis tends to occur more frequently in men than women and is associated with more severe disease (Kroi et al., 2020, Desport et al., 2012). Further research is necessary to expand on the disparities seen with the ultimate goal of providing targeted therapies to reverse this downward trend.

COVID-19 Related Mortality Does Not Correlate with Vaccine Availability in Leukemia Patients: 2020-2023 Analysis in the United States

Introduction: Leukemia patients have abnormal immune function due to both the innate characteristics of their disease and the treatments, which are almost invariably immunosuppressive in nature. Treatment modalities may lead to both temporary and long term immunosuppression. For these reasons, the coronavirus disease 2019 (COVID-19) pandemic has posed challenges to the management of patients with leukemia.With the approval of several types of COVID-19 vaccines, the first of which became available in December 2020, there has been a significant decrease in morality from COVID-19 among vaccinated adults compared to unvaccinated adults. It is unclear if the same trend applies to adults with leukemia who may have an impaired immune response to vaccination. To further elucidate the efficacy of COVID-19 vaccination in this inherently immunocompromised group of patients, we performed a nationwide analysis of COVID-19 mortality trends in adults over 25 years old with leukemia. Methods: Using the CDC Wonder Database, we reviewed death certificates for COVID-19 related mortality trends from March 2020 to June 2023 for all subtypes of leukemia in the United States in adults above 25 years old. We included respective ICD codes: C91 lymphoid leukemia, C92 myeloid leukemia, C93 monocytic leukemia, C94 other leukemias of specified cell types, and C95 leukemia of unspecified cell types. Age-adjusted mortality rates (AAMRs) were calculated per 100,000 people. Data was stratified by reported sex, race/ethnicity, and census region. Results: Deaths from COVID-19 in people with leukemia were reported as 1800 in 2020, 2813 in 2021, 2445 in 2022, and 481 as of June 2023 (Figure 1). There were fluctuations of COVID-19 AAMR per 100,000 people with all subtypes of leukemia from 2020 to 2023 (Table 1). The provisional and incomplete data in 2023 showed a sudden decrease of AAMR within all groups. In 2020 the overall AAMR in all groups was 0.7 which increased to 1.1 in 2021, decreased to 0.9 in 2022, and 0.2 as of June 2023. There is a difference in mortality rates between sex with male AAMR being greater than female in all 3 years. For example in 2021 the AAMR for males was 1.4 while for females it was 0.6. Analysis of racial and ethnic groups showed Asians with the lowest AAMR (0.3 AAMR, 2020) compared to Whites (1.5 AAMR, 2020), Blacks (0.9 AAMR, 2020), and Hispanics (0.6 AAMR, 2020). The trends between the census regions were also comparable. Conclusion: The data demonstrates variations in AAMRs from each year to the next. These variations can be affected by infection rates, public health measures, healthcare access, and socioeconomic factors. The 2023 data is still provisional and incomplete, however, they do offer a glimpse of the 2023 trends. The multiple subtypes of leukemia have different degrees of immunosuppression, thus not all leukemia patients have the same risk profile. Despite the type of Leukemia, it is widely accepted that these patients are in an immunocompromised state and at a higher risk to develop complications from COVID-19. It is recommended for all patients with leukemia to receive non-live, attenuated viral vaccines. Although considered safe and recommended, there is very limited data regarding efficacy of the COVID-19 vaccine in immunocompromised patients. One study showed patients with CLL about 36% of patients were seronegative after vaccination (Chatzikonstantinou et al., 2021) and seronegativity rates may be even higher in patients with acute leukemias. Certainly the absence of steady downward trend in mortality following the availability of vaccination suggests either that leukemia patients are not complying with vaccination recommendations or that vaccination is often ineffective in the setting of their inherent immunocompromise. Certainly a limitation of this analysis is the lack of data regarding COVID-related mortality in vaccinated versus unvaccinated individuals. Given the lack of improvement in AAMR among leukemic patients following the availability of a COVID 19 vaccination, it seems appropriate that physicians still recommend using additional preventative measures from COVID-19 including social distancing and mask wearing. It is important to continue studying the relationship between serology positivity, immunity, and overall outcomes.

Adult mortality trends in Matlab, Bangladesh: an analysis of cause-specific risks

ObjectiveWith socioeconomic development, improvement in preventing and curing infectious diseases, and increased exposure to non-communicable diseases (NCDs) risk factors (eg, overweight/obesity, sedentary lifestyle), the majority of adult deaths in Bangladesh...

Causes and trends of adult mortality in southern Ethiopia: an eight-year follow up database study

BackgroundBroad and specific causes of adult mortalities are often neglected indicators of wellbeing in low-income countries like Ethiopia due to lack of strong vital statistics. Thus, this database study aimed to assess the causes of adult mortality using demographic surveillance data.MethodsAn 8-year (12 September 2009–11 September 2017) surveillance data from the Arba Minch Health and Demographic Surveillance Site was used for this study. Verbal autopsy methods and ICD codes were used to identify the causes of the adult deaths. The collected data were entered to the database by data clerks. We used Microsoft Excel and STATA version 16 software for data cleaning and analysis. Chi-squared test was used to see the significances of the trend analyses.ResultFrom the 943 adult deaths from 2009 to 2017 in the Health and Demographic Surveillance Site in southern Ethiopia, more than half of them were females. The specific leading cause of death in the adults were tuberculosis (16.8%), malaria (9.7%), and intestinal infectious diseases (9.6%).Communicable diseases (49.2%, 95% C.I 45.7, 52.7) accounted for about half of the deaths followed by non-communicable diseases (35%, 95% C.I 31.7, 38.4) where both categories showed an increasing trend.ConclusionAlthough pieces of evidences are showing the shift from communicable diseases to non-communicable diseases as the major causes of adult death in developing countries, this study showed that communicable diseases are still the major causes of adult deaths. Efforts and emphasis should be given to control infectious diseases such as tuberculosis and malaria.

Twenty-year trends in all-cause mortality of patients with systemic lupus erythematosus in Mexico: Results from a nationwide health registry.

Regional variations in systemic lupus erythematosus (SLE) mortality may be due to different spectra of local environmental factors. The aim of this study was to assess mortality trends in adults with SLE using a nationwide health registry. Data came from the Dynamic Cubes of the General Direction of Health Information for 1998-2017 for mortality. In patients aged ≥15years, SLE as the principal cause of death was defined according to ICD-10 code M32 and was classified by sex and age. Joinpoint trend analyses of annual age-standardized mortality rates (ASMR) for SLE patients and non-SLE people were made. We identified 11449 SLE deaths and 9,989,874 non-SLE deaths. The SLE ASMR increased more than the non-SLE ASMR, with a 98.2% cumulative increase in the ratio of SLE to non-SLE deaths. Whereas the non-SLE ASMR remained relatively stable throughout the study period (overall and by sex), the SLE ASMR significantly increased between 1998 and 2009, non-significantly decreased between 2009 and 2013 and non-significantly increased thereafter. Both women and men had a large cumulative increase in the SLE ASMR/non-SLE ASMR ratio (73.9 and 191.3%, respectively). The Southeast region had the largest cumulative increases in the ratio of SLE to non-SLE ASMR (108.8%). Of the 11,449deaths, 445 (3.8%) were in geographical areas where ≥40% of the population is indigenous. SLE mortality rates have increased since 1998 and remain high compared with non-SLE mortality: significant sex and regional disparities persist.

Emerging political and demographic divides: State politics, welfare generosity, and adult mortality in U.S. states 1977-2017.

Geographic disparities in adult mortality within the US have grown over the past several decades, but the reasons for these trends remain unclear. In this article, we examine trends in adult mortality (ages 55+) across US states from 1977 to 2017, paying close attention to the shifting geographic pattern of high- and low-mortality states. We find that states in the South tended to fall behind the rest of the country in the 1970s and 1980s, while states in the Great Plains and Mountain West tended to fall behind in the 1990s, 2000s, and 2010s. In contrast, states on the East and West Coasts have tended to see considerable improvement in mortality. We consider the role of state-level per-capita spending on public welfare programs in the mortality experience of states between 1977 and 2017. We use fixed effects models to show that greater state welfare generosity predicts greater yearly reductions in mortality. State shifts toward more generous welfare spending regimes may contribute to significant geographic divergences in adult mortality in the United States.

Temporal and spatial trends of adult mortality in small areas of Brazil, 1980\u20132010

To determine the variations and spatial patterns of adult mortality across regions, over time, and by sex for 137 small areas in Brazil, we first apply TOPALS to estimate and smooth mortality rates and then use death distribution methods to evaluate the quality of the mortality data. Lastly, we employ spatial autocorrelation statistics and cluster analysis to identify the adult mortality trends and variations in these areas between 1980 and 2010. We find not only that regions in Brazil’s South and Southeast already had complete death registration systems prior to the study period, but that the completeness of death count coverage improved over time across the entire nation—most especially in lesser developed regions—probably because of public investment in health data collection. By also comparing adult mortality by sex and by region, we document a mortality sex differential in favor of women that remains high over the entire study period, most probably as a result of increased morbidity from external causes, especially among males. This increase also explains the concentration of high male mortality levels in some areas.

Increasing Mortality in Adults With Diabetes and Low Estimated Glomerular Filtration Rate in the Absence of Albuminuria.

Improved blood pressure control and use of renin-angiotensin-aldosterone system blockers have altered the clinical presentation or phenotype of chronic kidney disease (CKD) in U.S. adults with diabetes. These changes may influence mortality. Data from the National Health and Nutrition Examination Surveys (NHANES) 1988-2006 were used to examine mortality trends in adults with diabetes, defined as physician diagnosis, fasting glucose ≥126 mg/dL, HbA1c >6.5% (48 mmol/mol), or use of glucose-lowering medications. Mortality trends by CKD phenotype (estimated glomerular filtration rate [eGFR] and urine albumin-to-creatinine ratio [ACR] level) were obtained via linkage with the National Death Index through 31 December 2011 while accounting for the complex survey design. From 1988 to 2006, adults with an eGFR <60 mL/min/1.73 m2 and an ACR <30 mg/g increased from ∼0.9 million (95% CI 0.7, 1.1) or 6.6% of the total population with diabetes during years 1988-1994 to 2.4 million (95% CI 1.9, 2.9) or 10.1% of the total population with diabetes during years 2007-2010. Mortality rates generally trended downward for adults with diabetes and an ACR ≥30 mg/g but increased in those with eGFR <60 mL/min/1.73 m2 and an ACR <30 mg/g from 35 deaths per 1,000 person-years (95% CI 22, 55) during years 1988-1994 to 51 deaths per 1,000 person-years (95% CI 33, 83) during years 2003-2006. ACR values are decreasing in U.S. adults with diabetes, but optimal management strategies are needed to reduce mortality in those with a low eGFR and an ACR <30 mg/g.

Estimating the impact of antiretroviral treatment on adult mortality trends in South Africa: A mathematical modelling study.

BackgroundSubstantial reductions in adult mortality have been observed in South Africa since the mid-2000s, but there has been no formal evaluation of how much of this decline is attributable to the scale-up of antiretroviral treatment (ART), as previous models have not been calibrated to vital registration data. We developed a deterministic mathematical model to simulate the mortality trends that would have been expected in the absence of ART, and with earlier introduction of ART.Methods and findingsModel estimates of mortality rates in ART patients were obtained from the International Epidemiology Databases to Evaluate AIDS–Southern Africa (IeDEA-SA) collaboration. The model was calibrated to HIV prevalence data (1997–2013) and mortality data from the South African vital registration system (1997–2014), using a Bayesian approach. In the 1985–2014 period, 2.70 million adult HIV-related deaths occurred in South Africa. Adult HIV deaths peaked at 231,000 per annum in 2006 and declined to 95,000 in 2014, a reduction of 74.7% (95% CI: 73.3%–76.1%) compared to the scenario without ART. However, HIV mortality in 2014 was estimated to be 69% (95% CI: 46%–97%) higher in 2014 (161,000) if the model was calibrated only to HIV prevalence data. In the 2000–2014 period, the South African ART programme is estimated to have reduced the cumulative number of HIV deaths in adults by 1.72 million (95% CI: 1.58 million–1.84 million) and to have saved 6.15 million life years in adults (95% CI: 5.52 million–6.69 million). This compares with a potential saving of 8.80 million (95% CI: 7.90 million–9.59 million) life years that might have been achieved if South Africa had moved swiftly to implement WHO guidelines (2004–2013) and had achieved high levels of ART uptake in HIV-diagnosed individuals from 2004 onwards. The model is limited by its reliance on all-cause mortality data, given the lack of reliable cause-of-death reporting, and also does not allow for changes over time in tuberculosis control programmes and ART effectiveness.ConclusionsART has had a dramatic impact on adult mortality in South Africa, but delays in the rollout of ART, especially in the early stages of the ART programme, have contributed to substantial loss of life. This is the first study to our knowledge to calibrate a model of ART impact to population-level recorded death data in Africa; models that are not calibrated to population-level death data may overestimate HIV-related mortality.

Trend and causes of adult mortality in Kersa health and demographic surveillance system (Kersa HDSS), eastern Ethiopia: verbal autopsy method

BackgroundThe health problems of adults have been neglected in many developing countries, yet many studies in these countries show high rates of premature mortality in adults. Measuring adult mortality and its cause through verbal autopsy (VA) methods is becoming an important process for mortality estimates and is a good indicator of the overall mortality rates in resource-limited settings. The objective of this analysis is to describe the levels, distribution, and trends of adult mortality over time (2008-2013) and causes of adult deaths using VA in Kersa Health and Demographic Surveillance System (Kersa HDSS).MethodsKersa HDSS is a demographic and health surveillance and research center established in 2007 in the eastern part of Ethiopia. This is a community-based longitudinal study where VA methods were used to assign probable cause of death. Two or three physicians independently assigned cause of death based on the completed VA forms in accordance with the World Health Organization’s International Classification of Diseases. In this analysis, the VA data considered were of all deaths of adults age 15 years and above, over a period of six years (2008–2013). The mortality fractions were determined and the causes of death analyzed. Analysis was done using STATA and graphs were designed using Microsoft Excel.ResultsA total of 1535 adult deaths occurred in the surveillance site during the study period and VA was completed for all these deaths. In general, the adult mortality rate over the six-year period was 8.5 per 1000 adult population, higher for males (9.6) and rural residents (8.6) than females (7.5) and urban residents (8.2). There is a general decrease in the mortality rates over the study period from 9.4 in 2008–2009 to 8.1 in 2012–2013. Out of the total deaths, about one-third (32.4%) occurred due to infectious and parasitic causes, and the second leading cause of death was diseases of circulatory system (11.4%), followed by gastrointestinal disorders (9.2%). Tuberculosis (TB) showed an increasing trend over the years and has been the leading cause of death in 2012 and 2013 for all adult age categories (15–49, 50–64, and 65 years and over). Chronic liver disease (CLD) was indicated as leading cause of death among adults in the age group 15–49 years.ConclusionThe increasing TB-related mortality in the study years as well as the relative high mortality due to CLD among adults of age 15–49 years should be further investigated and triangulated with health service data to understand the root cause of death.

A Typology for Charting Socioeconomic Mortality Gradients

Holistic depiction of time-trends in average mortality rates, and absolute and relative inequalities, is challenging. We outline a typology for situations with falling average mortality rates (m↓; e.g., cardiovascular disease), rates stable over time (m-; e.g., some cancers), and increasing average mortality rates (m↑; e.g., suicide in some contexts). If we consider inequality trends on both the absolute (a) and relative (r) scales, there are 13 possible combination of m, a, and r trends over time. They can be mapped to graphs with relative inequality (log relative index of inequality [RII]; r) on the y axis, log average mortality rate on the x axis (m), and absolute inequality (slope index of inequality; SII; a) as contour lines. We illustrate this by plotting adult mortality trends: (1) by household income from 1981 to 2011 for New Zealand, and (2) by education for European countries. Types range from the "best" m↓a↓r↓ (average, absolute, and relative inequalities all decreasing; southwest movement in graphs) to the "worst" m↑a↑r↑ (northeast). Mortality typologies in New Zealand (all-cause, cardiovascular disease, nonlung cancer, and unintentional injury) were all m↓r↑ (northwest), but variable with respect to absolute inequality. Most European typologies were m↓r↑ types (northwest; e.g., Finland), but with notable exceptions of m-a↑r↑ (north; e.g., Hungary) and "best" or southwest m↓a↓r↓ for Spain (Barcelona) females. Our typology and corresponding graphs provide a convenient way to summarize and understand past trends in inequalities in mortality, and hold potential for projecting future trends and target setting.

(404) - National Heart Failure Admissions and Associated Mortality Trends in Adults With Congenital Heart Disease in the United States, 1998-2011

(404) - National Heart Failure Admissions and Associated Mortality Trends in Adults With Congenital Heart Disease in the United States, 1998-2011

The role of smoking in changes in the survival curve: an empirical study in 10 European countries

PurposeWe 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). MethodsUsing 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. ResultsFor 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. ConclusionsSmoking affects rectangularization more than longevity extension, both among men and women.

Long-term trends in adult mortality for U.S. Blacks and Whites: an examination of period- and cohort-based changes.

Black-white differences in U.S. adult mortality have narrowed over the past five decades, but whether this narrowing unfolded on a period or cohort basis is unclear. The distinction has important implications for understanding the socioeconomic, public health, lifestyle, and medical mechanisms responsible for this narrowing. We use data from 1959 to 2009 and age-period-cohort (APC) models to examine period- and cohort-based changes in adult mortality for U.S. blacks and whites. We do so for all-cause mortality among persons aged 15-74 as well as for several underlying causes of death more pertinent for specific age groups. We find clear patterns of cohort-based reductions in mortality for both black men and women and white men and women. Recent cohort-based reductions in heart disease, stroke, lung cancer, female breast cancer, and other cancer mortality have been substantial and, save for breast cancer, have been especially pronounced for blacks. Period-based changes have also occurred and are especially pronounced for some causes of death. Period-based reductions in blacks' and whites' heart disease and stroke mortality are particularly impressive, as are recent period-based reductions in young men's and women's mortality from infectious diseases and homicide. These recent period changes are more pronounced among blacks. The substantial cohort-based trends in chronic disease mortality and recent period-based reductions for some causes of death suggest a continuing slow closure of the black-white mortality gap. However, we also uncover troubling signs of recent cohort-based increases in heart disease mortality for both blacks and whites.

Corrigendum

This article refers to:Does the Spectrum model accurately predict trends in adult mortality? Evaluation of model estimates using empirical data from a rural HIV community cohort study in north-western Tanzania

Does the Spectrum model accurately predict trends in adult mortality? Evaluation of model estimates using empirical data from a rural HIV community cohort study in north-western Tanzania

Introduction Spectrum epidemiological models are used by UNAIDS to provide global, regional and national HIV estimates and projections, which are then used for evidence-based health planning for HIV services. However, there are no validations of the Spectrum model against empirical serological and mortality data from populations in sub-Saharan Africa. Methods Serologic, demographic and verbal autopsy data have been regularly collected among over 30,000 residents in north-western Tanzania since 1994. Five-year age-specific mortality rates (ASMRs) per 1,000 person years and the probability of dying between 15 and 60 years of age (45Q15,) were calculated and compared with the Spectrum model outputs. Mortality trends by HIV status are shown for periods before the introduction of antiretroviral therapy (1994–1999, 2000–2005) and the first 5 years afterwards (2005–2009). Results Among 30–34 year olds of both sexes, observed ASMRs per 1,000 person years were 13.33 (95% CI: 10.75–16.52) in the period 1994–1999, 11.03 (95% CI: 8.84–13.77) in 2000–2004, and 6.22 (95% CI; 4.75–8.15) in 2005–2009. Among the same age group, the ASMRs estimated by the Spectrum model were 10.55, 11.13 and 8.15 for the periods 1994–1999, 2000–2004 and 2005–2009, respectively. The cohort data, for both sexes combined, showed that the 45Q15 declined from 39% (95% CI: 27–55%) in 1994 to 22% (95% CI: 17–29%) in 2009, whereas the Spectrum model predicted a decline from 43% in 1994 to 37% in 2009. Conclusion From 1994 to 2009, the observed decrease in ASMRs was steeper in younger age groups than that predicted by the Spectrum model, perhaps because the Spectrum model under-estimated the ASMRs in 30–34 year olds in 1994–99. However, the Spectrum model predicted a greater decrease in 45Q15 mortality than observed in the cohort, although the reasons for this over-estimate are unclear.

Divergent mortality trends by ethnicity in Fiji.

To examine trends in infant mortality rate (IMR), adult mortality and life expectancy (LE) in the two major Fijian ethnic groups since 1975. Estimates of IMR, adult mortality (15-59 years) and LE by ethnicity are calculated from previously unreported Fiji Ministry of Health data and extracted from published sources. Over 1975-2008: IMR decreased from 33 to 20 deaths/1,000 live births in i-Taukei (Fiji Melanesians); and 38 to 18 in Fijians of Indian descent. Increased adult male mortality among i-Taukei and decline among Fijians of Indian descent led to an equal probability of dying in 2007 of 29%; while in female adults the probability trended upwards in i-Taukei to 25%, and declined in Fijians of Indian descent to 17%. Life expectancy in both ethnicities increased until 1985 (to 64 years for males; 68 for females) then forming a plateau in males of both ethnicities, and Fijian females of Indian descent, but declining in i-Taukei females to 66 years in 2007. Despite IMR declines over 1975-2008, LE for i-Taukei and Fijians of Indian descent has not increased since 1985, and has actually decreased in i-Taukei women, consistent with trends in adult mortality (15-59 years). Mortality analyses in Fiji that consider the entire population mask divergent trends in the major ethnic groups. This situation is most likely a consequence of non-communicable disease mortality, requiring further assessment and a strengthened response.

Estimating Adult Mortality in Cameroon from Census Data on Household Deaths: 1976-1987

Many African countries lack conventional data sources for systematic assessment of adult mortality. Studies of mortality in Cameroon have mainly been concerned with infant and child survival, while levels and structure of adult mortality have rarely been investigated. This paper employs the Generalized Growth Balance method to estimate adult mortality in Cameroon using data from 1976 and 1987 censuses. More specifically, we use data on household deaths during the 12 months preceding the 1976 and 1987 censuses to assess the adult mortality situation in Cameroon prior to the onset of HIV/AIDS pandemic. Results suggest that overall adult mortality in Cameroon prior to the HIV/AIDS era was high even by African standards. Ignoring potential methodological and data differences, a comparison of age-specific death rates from the two censuses to those from the recent DHS results portray a recent increase in mortality during the peak productive and reproductive years. However, a complete and reliably operational vital registration system remains the ultimate solution to estimating and fully understanding the trends in adult mortality. In the meantime, consistently collecting census data on household deaths can enhance knowledge and inform policy intervention.

Adult mortality estimates for small areas in Brazil, 1980–2010: a methodological approach

BackgroundIn recent decades, life expectancy and health status have improved considerably in Brazil. Life expectancy at birth has risen from 48 years in 1960 to over 73 years in 2010. However, the country is marked by large regional and socioeconomic inequality. Due to data limitations, incomplete coverage of vital registration systems, and errors in age declaration for both population and death counts, little is known about the level and trends in adult mortality for sub-national areas. This study aimed to study the evolution of adult mortality in small areas in Brazil from 1980 to 2010, using 45q15 as a summary measure of adult mortality across small areas in Brazil. MethodsData were obtained from the mortality database available from Datasus, a vital statistics database organised by the Brazilian Ministry of Health that contains information on deaths by age, sex, and cause from 1979 to 2010. Population censuses were used to acquire the population by age and sex for 137 comparable small areas in Brazil, as defined by the National Statistics Office, for the years 1980 to 2010. We combined traditional formal demography methods, called death distribution methods, with indirect standardisation and Bayesian statistics to produce more reliable estimates of adult mortality for the 137 small areas. FindingsThe results show that data quality has improved considerably across Brazil during the period of analysis, but regional variation persists. On average, completeness of death counts increased from 80% (range 50–100) in 1980–91, to 95% (73–100) in 2000–10. Estimates of adult mortality show that more developed regions in the south and southeast parts of the country have lower mortality levels than the northeast, but there is a clear convergence process. InterpretationThis study indicates that the combination of traditional demographic methods to Bayesian statistics is a successful alternative to produce mortality estimates for small areas in Brazil. We also found a large improvement in the quality of mortality data in Brazil since 1980. Finally, we observe a convergence process on health status. FundingBrazilian National Counsel of Technological and Scientific Development (CNPq) and Minas Gerais Research Foundation (Fapemig).