Mortality

*How do you measure mortality & life expectancy?*Global patterns & how are they changing?*Effects of changes & management policies.

Key Definitions

Measurements of mortalityCrude Death Rate (CDR) The average annual

number of deaths during a year per 1,000 population.

Age-specific Death Rate This shows deaths rates per 1,000 population by sex for age groups 'Under 1', '1 to 4', '5 to 15', '16 to 24', '25 to 34', '35 to 44', '45 to 54', '55 to 64', '65 to 74', '75 to 84' and '85 and over'.

Life Expectancy The average number of years to be lived by a group of people born in the same year, if mortality at each age remains constant in the future.

How do we measure life expectancy?

http://www.ined.fr/en/everything_about_population/animations/life_expectancy/

Understanding length of life

How do we measure length of life? Reducing child mortality Longer & future length of life for

adults.

http://www.ined.fr/en/everything_about_population/animations/lifetime/

How long will you live?

Longevity Game

http://www.nmfn.com/tn/learnctr--lifeevents--longevity BMI Calculator

http://www.bbc.co.uk/health/healthy_living/your_weight/bmiimperial_index.shtml

Global Patterns – Death rates

Global Pattern of death rates

Global variations in DRs are smaller than in BRs. In 1995, crude BRs ranged from 8 (Bulgaria) to 54 (Niger) per

1,000, whereas crude DRs ranged only from 4 (Paraguay) to 25 (Malawi) per 1,000.

Divide between MEDCs & LEDCs is less clear cut. High rates prevail over Africa and some parts of SE Asia. But the lowest mortality rates do not include all advanced MEDCs.

The UK and Scandinavia have high mortality rates. These anomalies support the point made earlier that crude death rates are a poor measure of mortality, because they do not take age structure into account. The higher values for the UK and Scandinavia - their populations are relatively old. The existence of a large 'silvering' population will inflate the death rate.

Global Patterns – Life expectancy

Global Patterns of life expectancy The global pattern of life expectancy and gives a more

reliable picture of mortality. The inhabitants of the most advanced MEDCs (Western

Europe, North America, Australasia and Japan), have a life expectancy of + 75 years.

In stark contrast, life expectancy over much of Africa is less than 50 years. In Malawi it is only 35 years.

Afghanistan is the only country outside Africa to rank in the lowest category of life expectancy.

Remember, of course, that this map shows average life expectancy. Throughout most countries there will be marked contrasts. e.g. between rich and poor people, rural and urban areas.

Global pattern of Infant mortality

Global pattern of Infant mortality There are some basic similarities between

the distributions of life expectancy and infant mortality. Figure 3.23 shows that the lowest infant mortality rates are recorded in North America, Western Europe, Australasia and Japan. In these areas, the rate is less than one-tenth of what it is over much of Africa, the Middle East and SE Asia. In short, the overall pattern conforms with the broad distinction between MEDCs and LEDCs.

Why does mortality vary globally?

1st marked fall occurred during the later stages of the Industrial Revolution and was confined to the MEDCs of Europe, North America and Australasia. Major contributors to the decline were the advances in medical science, better housing and sanitation, together with improved food and water supplies.

A second marked fall occurred during the second half of the twentieth century, but this time it was mainly experienced by LEDCs. Here, a combination of economic development, aid from MEDCs and effective medical campaigns against infectious diseases led to a marked decline in mortality.

> Infant mortality is a prime indicator of socioeconomic development. It is the most sensitive of the age-specific rates. Sierra Leone has an infant mortality rate of 163 per 1,000 live births. Infant mortality is falling across the world, but there are still wide variations between nations - 142 infant deaths per 1,000 births in Liberia, but only 3 per 1,000 in Finland. Areas with high rates of infant mortality have high rates of mortality overall.

>Areas with high levels of medical infrastructure have low levels of mortality. A lack of prenatal and postnatal care, a shortage of medical facilities and trained professionals, and ignorance of the need for professional care are major contributors to high rates of mortality.

Life expectancy is higher in countries with higher levels of economic development. Poverty, poor nutrition, and a lack of clean water and sanitation (all associated with low levels of economic development) increase mortality rates. Worldwide, only 58% of the population has access to one of life's fundamental needs: adequate or improved sanitation facilities (Figure 5.3). There are, however, wide regional and rural/urban disparities. In developing countries, only one-quarter to one-half of all rural residents have access to improved sanitation. In many parts of the world, rural populations also lack access to safe drinking water .

Causes of death definitions

CATEGORY 1 - Endogenetic causes. This means that they are either congenital (such as deformities and diseases dating from birth) or degenerative (associated with ageing and the gradual wearing out of the mind and body).

CATEGORY 2 - Exogenetic causes that is those which result from environmental conditions. These include infectious, respiratory and digestive diseases which are linked with climate, diet, housing conditions, pollution, and social habits such as smoking drinking, drugs, promiscuity and urban living (stress) Also included are deaths caused by natural hazards, war, road accidents and so on.

Causes of mortality

In pairs predict the top 5 causes for MEDCs and the top 5 for LEDCs. If your lists vary, explain why.

High-income countries Deaths in millions % of deathsCoronary heart disease 1.38 16.9Stroke and other cerebrovascular diseases 0.77 9.5Trachea, bronchus, lung cancers 0.47 5.8Lower respiratory infections 0.34 4.2Chronic obstructive pulmonary disease 0.32 3.9Colon and rectal cancers 0.27 3.3Diabetes mellitus 0.24 2.9Alzheimer and other dementias 0.23 2.8Breast cancer 0.15 1.8Stomach cancer 0.15 1.8

Low-income countries Deaths in millions % of deathsCoronary heart disease 3.29 11.4Lower respiratory infections 2.72 9.5HIV/AIDS 2.06 7.2Stroke and other cerebrovascular diseases 1.83 6.4Perinatal conditions 1.78 6.2Diarrhoeal diseases 1.48 5.2Tuberculosis 1.01 3.5Chronic obstructive pulmonary disease 0.97 3.4Malaria 0.87 3.0

Q: What are the main differences between rich and poor countries with respect tocauses of death?

In high-income countries more than two-thirds of all people live beyond the age of 70 and die of chronic diseases: cardiovascular disease, chronic obstructive lung disease, cancers, diabetes or dementia. Lung infection remains the only leading infectious cause of death.

In low-income countries less than a quarter of all people reach the age of 70, and nearly a third of all deaths are among children under 14. Although cardiovascular diseases together represent the leading cause of death in these countries, infectious diseases (above all HIV/AIDS, lung infections,tuberculosis, diarrhoeal diseases and malaria) together claim more lives. Complications of pregnancy and childbirth together continue to be a leading cause of death, claiming the lives of both infants and mothers.

AIDS/HIV

In 1999 more than 33 million people around the world ' had been infected by Aids. China estimates that 400,000 of its population are now HIV positive. India, Russia and Nigeria have a rapidly rising number of HIV carriers. India accounts for 60 per cent of all Aids cases in Asia, and admits that 3.5 million people are carrying the virus. In Russia over 23,500 cases were reported in 1999 compared with 2,617 three years before. In Nigeria one person per minute is being infected, and by 2003, an estimated 4.3 million will be carrying the virus.