Mortality in the Islamic Republic of Iran, 1964-2004

OBJECTIVE: Reliable information on the pattern, level and trend of mortality is essential for evidence-based policy to improve health. Various sources of mortality data in the Islamic Republic of Iran have not been critically assessed. This paper aims to document and evaluate the completeness of the different data sources on mortality and to estimate the level and trends of mortality over the past 40 years according to various mortality indices such as child mortality, adult mortality and life expectancy. METHODS: We undertook a systematic review of all available studies on infant mortality from 1964 to 2004 and estimated the most probable trend in child mortality. Death registration data from between 1992 and 2004 were assessed for completeness to estimate the level of adult mortality. Life tables for 2004 were constructed for the Islamic Republic of Iran based on these data, corrected for under-registration of death. FINDINGS: Infant mortality decreased from an estimated 154 deaths per 1000 live births in 1964 to 26 in 2004. The risk of adult mortality in 2004 was estimated to be 0.124 and 0.175 for females and males respectively. According to adjusted death registration data, life expectancy at birth in 2004 was 71.2 for females and 68.7 for males. The average completeness of death registration for ages 5 years and older across all systems was 76% for the period 2001-2004. CONCLUSION: There has been a general decline in child mortality in the Islamic Republic of Iran over the past three decades. Adult mortality levels also have declined, but less substantially. Mortality information systems have improved, yet serious concerns remain regarding the completeness and quality of data.     

United States life tables, 2000.

This report presents period life tables for the United States based on age-specific death rates in 2000. Data used to prepare these life tables are 2000 final mortality statistics; July 1, 2000, population estimates based on the 1990 decennial census; and data from the Medicare program. Presented are complete life tables by age, race, and sex. In 2000 the overall expectation of life at birth was 76.9 years, representing an increase of 0.2 years from life expectancy in 1999. Between 1999 and 2000, life expectancy increased for both males and females and for both the white and black populations. Life expectancy increased by 0.4 years for black males (from 67.8 to 68.2) and by 0.2 years for white males (from 74.6 to 74.8). It increased by 0.2 years for black females (from 74.7 to 74.9) and by 0.1 year for white females (from 79.9 to 80.0).     

1996至2000年全国5岁以下儿童死亡监测主要结果分析

目的了解1996至2000年全国5岁以下儿童年龄别和主要死因别死亡率的变化趋势。方法采用全国5岁以下儿童死亡监测网收集的1996至2000年以人群为基础的监测资料,计算不同地区的新生儿、婴儿、5岁以下儿童死亡率及5岁以下儿童主要死因别死亡率。结果2000年全国新生儿、婴儿和5岁以下儿童死亡率分别为22．8‰、32．2‰和39．7‰,较1996年(24．0‰、36．0‰和45．0‰)分别下降了5．0％、10．6％和11．8％;2000年城市新生儿、婴儿和5岁以下儿童死亡率分别为9．5‰、11．8‰和13．8‰,较1996年(12．2‰、14．8‰和16.9‰)分别下降了22．1％、20．3％和18．3％;2000年农村新生儿、婴儿和5岁以下儿童死亡率分别为25．8‰、37．0‰和45．7‰,较1996年(26．7％0、40．9％0和51．4％0)分别下降了3．4％、9．5％和11．1％。1996至2000年,全国5岁以下儿童的痢疾、肺炎、腹泻、神经管缺陷和溺水死亡率有明显下降趋势。结论1996至2000年,我国城市和农村的新生儿、婴儿、5岁以下儿童死亡率有明显的下降趋势,且肺炎、腹泻等可避免死因的死亡率下降在农村地区尤为明显。     

云南5岁以下儿童死亡率趋势及千年发展目标分析

目的 分析2000-2014年云南省5岁以下儿童的死亡趋势,探讨千年发展目标的成效.方法 根据云南省5岁以下儿童死亡监测、常规报告、人口普查资料,采用时间序列曲线拟合方法,分析云南省5岁以下儿童死亡率的动态变化,计算出5岁以下儿童死亡率平均下降速度.结果 2000-2014年无论监测或常规资料,新生儿死亡率(NMR)、婴儿死亡率(IMR)、5岁以下儿童死亡率(U5MR)的平均下降速度均为92.00%;平均每年降低7.73%~7.77%,实现了千年发展目标之四(MDG4)"从1990-2015年间,将5岁以下儿童死亡率降低2/3"的计划.结论 云南省提前实现了千年发展目标中降低儿童死亡率的目标,但城乡和区域之间儿童死亡率仍存在显著差距.     

Contemporary patterns of Pacific Island mortality

BACKGROUND: The Pacific Island countries are at different stages of the demographic and epidemiological transitions. The availability of accurate and current mortality data is of vital importance for priority setting in health. Available mortality data generally underestimate death rates among both children and adults. In many Pacific Island populations, little is reliably known about levels and causes of death, particularly among adults. METHODS: The results of two comprehensive approaches to obtaining mortality estimates are reported. First, a systematic review of available life expectancy and infant mortality information reported by countries from 1990 onwards was undertaken and evaluated with respect to quality, and a final "best estimate" was established. Methods were based on registered deaths and indirect demographic methods. The second approach consisted of a demographic evaluation of vital registration data for completeness, with death rates adjusted accordingly, or where vital registration was not available, the application of new model life table methods to generate life tables from estimates of child mortality, as used by the World Health Organisation (WHO). RESULTS: This analysis reveals substantial uncertainty about mortality conditions in Pacific Island populations. In some countries, life expectancy variations of 10 years or more were recorded in the 1990s, depending on the source. Best approaches suggest that life expectancy (at birth) varied considerably, from levels of around 55-60 years in some Melanesian and Micronesian states to levels above 70 years in low-mortality countries. The principal issues with regard to uncertainty around mortality levels include underenumerated vital registration data; annual stochastic fluctuations in mortality in small populations; errors in the imputation of adult mortality from infant and childhood rates; implausible results from indirect demographic methods; use of possibly inappropriate model life tables to adjust death data or for indirect methods; and inadequately described and implausible projections. The WHO model life table method based on adjusted vital registration generally yielded results similar to those suggested by an evaluation of published data, with some exceptions, which are further discussed. CONCLUSIONS: This study indicates the urgent need to improve infrastructure, training, and resources for routine mortality estimation in many Pacific Island countries in order to better inform and evaluate health and public policy.     

Gender differences in quality-adjusted survival using a Health-Utilities Index

PURPOSE: Women live longer than men but experience high morbidity during later years. We attempt to represent life expectancy with adjustments for quality of life for men and women in the United States. DATA SOURCES: Survival estimates were obtained from Vital Statistics of the United States Life Tables. Quality-of-life data were obtained for 12,220 participants, aged 32-85 years, in the 1982-1984 National Health and Nutrition Examination Survey I Epidemiologic Follow-Up Study (NHEFS). METHOD: Using public data tapes, scores for the Health-Utilities Index (HUI) were imputed for NHEFS. These scores were calculated separately for men and women in the United States population and broken down by age. Using mortality data, the quality-adjusted life expectancy was calculated separately for men and women. RESULTS: The current life expectancy among men aged 32 years was 39.45 years. For women aged 32 years it was 44.83 years, suggesting a 5.38 female life-expectancy advantage. The life expectancy, adjusted for quality of life, was 31.8 years for men versus 33.1 years for women. Adjustment for quality of life reduced the 5.38-year female advantage to 1.3 years. CONCLUSIONS: Although women enjoy longer life expectancies than do men, this advantage is reduced when quality adjustments are used. The finding reflects high levels of morbidity among older women.     

Lack of improvement of life expectancy at advanced ages in The Netherlands

BACKGROUND: Several countries have reported an increase in life expectancy at advanced ages. This paper analyses recent changes in life expectancy at age 60 and 85 in The Netherlands, a low mortality country with reliable mortality data. METHODS: We used data on the population and the number of deaths by age, sex and underlying cause of death for 1970-1994. Life expectancy at age 60 and 85 was estimated using standard life-table techniques. The contribution of different ages and causes of death to the change in life expectancy during the 1970s (1970/74-1980/84) and the 1980s (1980/84-1990/94) were estimated with a decomposition technique developed by Arriaga. RESULTS: Life expectancy at age 60 increased in the 1970s and 1980s, whereas life expectancy at age 85 decreased (men) and stagnated (women) in the 1980s, and has decreased in both sexes since 1985/89. The decomposition by age showed that constant mortality rates in women aged 85-89, and increasing mortality rates at ages 85+ (men) and 90+ (women) have caused this lack of increase in life expectancy. The decomposition by cause of death showed that smaller mortality reductions from other cardiovascular and cerebrovascular diseases, which contributed most to the increase in life expectancy at age 85 in the 1970s, and mortality increases from, amongst others, chronic obstructive pulmonary disease (COPD), mental disorders and diabetes mellitus produced the decrease (men) and plateau (women) in life expectancy at age 85. CONCLUSIONS: Life expectancy at advanced ages stopped increasing during the 1980s in The Netherlands due to mortality increases at ages 85+ (men) and 90+ (women). Cause-specific trends suggest that, in addition to (past) smoking behaviour in men, changes in the distribution of morbidity and frailty in the population might have contributed to this stagnation.     

Estimating mortality and causes of death in Turkey: methods, results and policy implications

BACKGROUND: Cause-specific mortality statistics are primary evidence for health policy formulation, programme evaluation, and epidemiological research. In Turkey, a partially functioning vital registration system in urban areas yields fragmentary evidence on levels and causes of mortality. This article discusses the application of innovative methods to develop national mortality estimates in Turkey, and their implications for national health development policies. METHODS: Child mortality levels from the Demography and Health Survey (DHS) were applied to model life tables to estimate age-specific death rates. Reported causes of death from urban areas were adjusted using re-distribution algorithms from the Global Burden of Disease (GBD) Study. Rural cause structure was estimated from epidemiological models. Local epidemiological data was used to adjust model-based estimates. RESULTS: Life expectancy at birth in 2000 was estimated to be 67.7 years (males) and 71.9 years (females), about 8-10 years lower than in Western Europe. Leading causes of death include major vascular diseases (ischaemic heart disease, stroke) causing 35-38% of deaths, chronic obstructive lung disease and lung cancer in men, but also perinatal causes, lower respiratory infections and diarrhoeal diseases. Injuries cause about 6-8% of deaths, although this may be an underestimate. CONCLUSIONS: Mortality estimates are uncertain in Turkey, given the poor quality of death registration systems. Application of burden of disease methods suggests that there has been progress along the epidemiological transition. Key health development strategies for Turkey include improved access to communicable disease control technologies, and urgent attention to the development of a reliable, nationally representative health information system.     

The effect of structural adjustment on health conditions in Latin America and the Caribbean, 1980-2000]

OBJECTIVE: To assess the impact of structural adjustment on health indicators in Latin America and the Caribbean during 1980-2000. METHODS: This was an ecological study. Public spending and per capita gross domestic product (pcGDP) figures were obtained from the World Bank, and life expectancy (LE) and infant mortality (IM) figures were obtained from the World Health Organization. Structural adjustment (government downsizing) was assessed by looking at the change in the amount of spending taken up by the government (or the reduction in public spending) in Latin American and Caribbean countries during 1980-1990. Changes in health indicators were measured in terms of the percentage variation in LE and IM. The variations found in Latin America and the Caribbean were compared to those seen in different groups of countries in other parts of the world during 1980-2000. Pearson's chi squared test was used to explore the associations between the decrease in public spending and health indicators. In order to estimate the health effects of such changes, a multivariate linear regression model was created, with adjustments for pcGDP. RESULTS: A deceleration in the rise of LE and in the decline of IM in Latin America and the Caribbean was noted, especially over the period from 1980 through 1990. Significant associations were observed between health indicators and the change in public spending in all groups of countries included in the study. When adjustments were introduced into the multiple regression model, the only associations that remained were seen in Latin America and the Caribbean. CONCLUSIONS: In the decade of 1980, adjustments in macroeconomic policies had a negative effect on social indicators, specifically those that had to do with health conditions in Latin America and the Caribbean. Such an effect lasted throughout the following decade.     

临朐县1980至2002年恶性肿瘤变化趋势分析

目的分析临朐县1980到2002年恶性肿瘤的变化趋势,以掌握其变化特点及规律。方法在我国北方胃癌高发区山东省临朐县分别进行1980-1982年、1990-1992年及2000-2002年3个时期的死亡回顾调查。结果临朐县恶性肿瘤死因顺位从1980-1982年的第3位上升到2000-2002年的第2位,仅次于循环系统疾病。3个时期恶性肿瘤死亡率（及标化率）分别为108．97／10万（111．48／10万）、132．38／10万（127.94／10万）和148．48／10万（105．53／10万）,死亡率呈上升趋势（Z=13,42,P〈0．0001）。去恶性肿瘤后增加的期望寿命在3个时期男性分别为：2．46岁、3．29岁和3．76岁（F=13．99,P〈0．0001）,女性分别为：1.67岁,2.30岁和2.33岁（F=13．61,P〈0．0001）。胃癌标化死亡率（及占恶性肿瘤的构成比）在3个时期分别为44．93／10万（40．29％）、41．37／10万（32．34％）和27．73／10万（26．90％）,胃癌标化死亡率呈下降趋势（Z=6.35,P〈0．01）。结论20多年来,临朐县恶性肿瘤死亡率逐渐上升,标化死亡率则无此趋势。胃癌一直是恶性肿瘤的首位死因,但其死亡构成比和标化死亡率不断下降。     

The new old epidemic of coronary heart disease

OBJECTIVES: This study quantified the consequences for prevalence of increased survival of coronary heart disease (CHD) in the Netherlands from 1980 to 1993. METHODS: A multistage life table fitted observed mortality and registration rates from the nationwide hospital register. The outcome was prevalence by age, sex, period, and disease state. RESULTS: The prevalence of CHD from 1980 to 1993 was 4.4% (men, aged 25 to 84 years) and 1.4% (women, aged 25 to 84 years). Between 1980-1983 and 1990-1993, the incidence changed little, but age-adjusted prevalence increased by 19% (men) and 59% (women). CONCLUSIONS: Sharply decreasing mortality but near-constant attack rates of CHD caused distinct increases in prevalence, particularly among the elderly.     

Child acute malnutrition and mortality in populations affected by displacement in the Horn of Africa, 1997-2009

Drought and conflict in the Horn of Africa are causing population displacement, increasing risks of child mortality and malnutrition. Humanitarian agencies are trying to mitigate the impact, with limited resources. Data from previous years may help guide decisions. Trends in different populations affected by displacement (1997-2009) were analyzed to investigate: (1) how elevated malnutrition and mortality were among displaced compared to host populations; (2) whether the mortality/malnutrition relation changed through time; and (3) how useful is malnutrition in identifying high mortality situations. Under-five mortality rates (usually from 90-day recall, as deaths/10,000/day: U5MR) and global acute malnutrition (wasting prevalences, < -2SDs of references plus edema: GAM) were extracted from reports of 1,175 surveys carried out between 1997-2009 in the Horn of Africa; these outcome indicators were analyzed by livelihood (pastoral, agricultural) and by displacement status (refugee/internally displaced, local resident/host population, mixed); associations between these indicators were examined, stratifying by status. Patterns of GAM and U5MR plotted over time by country and livelihood clarified trends and showed substantial correspondence. Over the period GAM was steady but U5MR generally fell by nearly half. Average U5MR was similar overall between displaced and local residents. GAM was double on average for pastoralists compared with agriculturalists (17% vs. 8%), but was not different between displaced and local populations. Agricultural populations showed increased U5MR when displaced, in contrast to pastoralist. U5MR rose sharply with increasing GAM, at different GAM thresholds depending on livelihood. Higher GAM cut-points for pastoralists than agriculturalists would better predict elevated U5MR (1/10,000/day) or emergency levels (2/10,000/day) in the Horn of Africa; cut-points of 20-25% GAM in pastoral populations and 10-15% GAM in agriculturalists are suggested. The GAM cut-points in current use do not vary by livelihood, and this needs to be changed, tailoring cut points to livelihood groups, to better identify priorities for intervention. This could help to prioritize limited resources in the current situation of food insecurity and save lives.     

Health burden in the Netherlands due to infection with thermophilic Campylobacter spp

Infection with thermophilic Campylobacter spp. usually leads to an episode of acute gastroenteritis. Occasionally, more severe diseases may be induced, notably Guillain Barré syndrome and reactive arthritis. For some, the disease may be fatal. We have integrated available data in one public health measure, the Disability Adjusted Life Year (DALY). DALYs are the sum of Years of Life Lost by premature mortality and Years Lived with Disability, weighted with a factor between 0 and 1 for the severity of illness. The mean health burden of campylobacter-associated illness in the Dutch population in the period 1990-5 is estimated as 1400 (90% CI 900-2000) DALY per year. The main determinants of health burden are acute gastroenteritis (440 DALY), gastroenteritis related mortality (310 DALY) and residual symptoms of Guillain-Barré syndrome (340 DALY). Sensitivity analysis demonstrated that alternative model assumptions produced results in the above-mentioned range.     

United States Life Tables, 2001.

This report presents period life tables for the United States based on age-specific death rates in 2001. Data used to prepare these life tables are 2001 final mortality statistics; July 1, 2001, population estimates based on the 2000 decennial census; and data from the Medicare program. Presented are complete life tables by age, race, and sex. In 2001 the overall expectation of life at birth was 77.2 years, representing an increase of 0.2 years from life expectancy in 2000. Between 2000 and 2001, life expectancy increased for both males and females and for both the white and black populations. Life expectancy increased by 0.3 years for black males (from 68.3 to 68.6) and black females (from 75.2 to 75.5). It increased by 0.1 year for white males (from 74.9 to 75.0) and white females (from 80.1 to 80.2).     

铜陵市1996~2000年5岁以下儿童死因分析

目的　了解 5岁以下儿童死亡趋势。方法　对 1 9962 0 0 0年 5岁以下儿童死亡监测资料进行分析。结果　 5年来 5岁以下儿童死亡率维持在 1 0 %左右 ;新生儿死亡和婴儿死亡构成呈下降趋势 ,1 4岁儿童死亡构成有上升倾向 ;死因顺位显示 :肺炎死因在下降 ,意外死因在上升 ,窒息、早产、先天性心脏病、其他先天异常的死因顺位无明显变化。结论　窒息、早产、先天异常、意外是今后防治重点     

The effect of revised populations on mortality statistics for the United States, 2000.

OBJECTIVES: This report presents revised mortality statistics for the year 2000 based on April 1, 2000, population figures from the 2000 census. Death rates are presented by race, Hispanic origin, sex, age, and cause of death. Life expectancies are presented by race (white and black), sex, and age. The revised statistics are compared with previously published statistics that used July 1, 2000, postcensal population estimates based on the 1990 census. METHODS: Data in this report are based on information from all death certificates filed in the 50 States and the District of Columbia. The statistics presented in this report are computed on the basis of two sets of population figures provided by the U.S. Census Bureau. The first set includes July 1, 2000, postcensal population estimates based on the 1990 decennial census. The second set includes April 1, 2000, populations from the 2000 decennial census bridged to single race categories. RESULTS: Crude death rates were lower for all groups using the April 1, 2000, populations. Age-specific death rates were generally lower for most age groups, except for infants and the very old for which death rates were higher. Age-specific death rates for males were lower for most age groups, except infants and those 75 years and over. For females, with the exception of infants, age-specific death rates were lower. Race-specific pattems by age for the white and black populations were similar to all races combined. For the American Indian population, age-specific death rates were substantially lower for ages under 75 years. For ages 75 years and over, American Indian death rates were dramatically higher. Age-specific death rates for the Asian or Pacific Islander (API) population were higher for ages under 15 years; lower for ages 15-84 years, especially for the 15-34 year age group; and higher for those 85 years and over. For the Hispanic population, age-specific death rates were substantially lower for those age 15-34 years and higher for those age 55 years and over, especially for those age 85 years and over. For the total white and total black populations, the age-adjusted death rate was somewhat higher for males and lower for females. For API the pattern was reversed. For the American Indian and Hispanic populations, age-adjusted death rates were higher for both males and females. For the 15 leading causes of death, age-adjusted death rates based on the April 1, 2000, population figures were lower for heart disease, cancer, chronic liver disease, septicemia, diabetes, chronic lower respiratory diseases, unintentional injuries, homicide, suicide, and hypertension. Age-adjusted death rates were higher for pneumonitis, Alzheimer's disease, and stroke. Rates were unchanged for influenza and pneumonia and nephritis, nephrotic syndrome and nephrosis. Life expectancy at birth was higher for the entire population and both the white and black populations using the April 1, 2000, population figures. It was 0.1 year higher for the whole population as well as for the total white and total black populations. For the total male population, life expectancy at birth was 0.1 year higher while it was 0.2 years higher for the female population. The increase in life expectancy at birth was 0.1 year for both sexes within the white and black populations. This observed gain in life expectancy at birth based on the revised population figures is reversed for life expectancy at the oldest age groups for the whole population and for males. A similar pattern is observed for both white and black males; however, the magnitude of the decline in life expectancy at older ages is much greater among black males. Among females of both race groups and the total population, there is either no change or an increase in life expectancy in the oldest age groups. CONCLUSIONS: Revised death rates and life expectancies are, in many cases, significantly different from previously published mortality statistics calculated using 1990-based postcensal estimates for 2000. Thus, previously published mortality statistics for 2000 using the 1990-based populations will not be comparable to the corresponding statistics that will be published for 2001. The data in this report will provide comparable 2000 data. Efforts are also underway to revise previously published mortality tables for 2000 as well as previously published data for 1991-99.     

Impact of Baby Boomers on hospitalizations for coronary heart disease and stroke in the United States

OBJECTIVE: Comparison of hospitalizations for coronary heart disease and stroke in older Baby Boomers, aged 45-54 years (the 1946-1955 birth cohort) in 2000 with that of the 1936-1945 birth cohort in 1990 and the 1926-1935 birth cohort in 1980. METHOD AND DATA SOURCE: Analysis of the annual National Hospital Discharge Survey that collects data on discharges from non-federal short-stay hospitals. RESULTS: Among hospitalizations for coronary heart disease, 294,000 (15.4%) in 1980, 289,000 (14.7%) in 1990, and 329,000 (15.2%) in 2000 occurred among adults aged 45-54 years. However, the age-specific hospitalization rate (per 100,000) for coronary heart disease was lower in 2000 than in 1990 or 1980 (p<0.05). Among hospitalizations for stroke, 37,000 (6.0%) in 1980, 42,000 (6.5%) in 1990, and 64,000 (8.5%) in 2000 were observed in this age group. The age-specific hospitalization rate (per 100,000) for stroke in 2000 compared to that in 1990 or 1980 was higher among women (p<0.05) but lower among men (p<0.05). The proportion of transfers to another care facility after discharge in 2000, 1990, and 1980 increased for coronary heart disease and stroke in successive decades of middle-aged adults. CONCLUSION: Baby Boomers made a greater impact on absolute numbers of coronary heart disease and stroke hospitalizations in 2000 relative to that of 45-54-year-olds in 1990 and 1980.     

Disaggregating proportional multistate lifetables by population heterogeneity to estimate intervention impacts on inequalities

The mortality pattern from birth to age five is known to vary by underlying cause of mortality, which has been documented in multiple instances. Many countries without high functioning vital registration systems could benefit from estimates of age- and cause-specific mortality to inform health programming, however, to date the causes of under-five death have only been described for broad age categories such as for neonates (0–27 days), infants (0–11 months), and children age 12–59 months. We adapt the log quadratic model to mortality patterns for children under five to all-cause child mortality and then to age- and cause-specific mortality (U5ACSM). We apply these methods to empirical sample registration system mortality data in China from 1996 to 2015. Based on these empirical data, we simulate probabilities of mortality in the case when the true relationships between age and mortality by cause are known. We estimate U5ACSM within 0.1–0.7 deaths per 1000 livebirths in hold out strata for life tables constructed from the China sample registration system, representing considerable improvement compared to an error of 1.2 per 1000 livebirths using a standard approach. This improved prediction error for U5ACSM is consistently demonstrated for all-cause as well as pneumonia- and injury-specific mortality. We also consistently identified cause-specific mortality patterns in simulated mortality scenarios. The log quadratic model is a significant improvement over the standard approach for deriving U5ACSM based on both simulation and empirical results.