The Measures of Mortality - PowerPoint Presentation

Slide1

The Measures of Mortality

9/19/2018

1

Slide2

Outline Components of Mortality

Mortality measures

Years of potential life

lostSources of statistics on mortality

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Slide3

Components of Mortality There are two biological aspects of mortality: 1. Lifespan:

refers to the oldest age to which human beings can survive (how long a person can possibly be alive). 2. longevity :

refers to the ability to remain alive from one year to the next.

The proportion of people who are actually able to approach that upper age limit is governed by a combination of biological (e.g. genetics, vital organs strength .. ) and Social ( e.g. lack of stress) factors.

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- Mortality is a term which means “death” or describes death and related issues.

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Why look at mortality rates?

1. Expressing

mortality in quantitative terms allow comparison of death:

A. Between people in different geographic areas or different countries.

B. Between

subgroups in the a population or country.

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2- Mortality rates can serve as a disease Severity, and can help to determine of whether the treatment for a disease has become more effective over time.

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Crude rates:

H

ow are

they calculated?

Crude rates are calculated for the entire population.

Refer to as crude because:

They ignore factors which may

affect

death rate such as: gender, age, race, economic status

….

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Slide8

Crude

Death rate (CDR):

Number of all deaths due to all causes in a certain year and within certain locality

Mid-year population for the same year and same locality

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8

x 1000

Example:

Suppose area X in

1438

H, we have:

1- 1200 deaths, all causes.

2- The area's mid year population was 150,000.

Slide9

3-

Find

crude death rate in

1438

H

?

Numerator: number of deaths all causes

= 1200

Denominator: Mid-year population =150,000

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CDR =

1200

x 1000 = 8/1000;

150,000

that is, 8 deaths per 1000 population.

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السنة

سعوديون

غير سعوديين

الجملة

SAUDI

NON-SAUDI

TOTAL

YEAR

ذكور

اناث

جملة

ذكور

اناث

جملة

ذكور

اناث

جملة

MALE

FEMALE

TOTAL

MALE

FEMALE

TOTAL

MALE

FEMALE

TOTAL

2004

4.7

3.9

4.3

3.4

3

3.3

4.3

3.8

4

2005

4.7

3.94.33.42.93.34.23.7420064.63.84.23.42.93.24.23.7420074.63.84.23.42.83.24.23.63.920084.53.74.13.52.83.34.23.63.920094.53.74.13.52.73.34.23.53.920104.43.74.13.62.73.34.23.53.9

CMR

By Sex And Nationality

In

The

KSA

(2004 to 2010)

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Country

Crude death rate

Crude birth rate

Infant mortality rate

Maternal mortality rate

 

Per 1000

Per 1000

Per 1000

Per 100,000

Saudi Arabia

3.8

22.1

18.5

16

Yemen

7.0

38.6

53.3

200

Palestine

3.6

35.9

22.2

32

 

Iraq

6.3

36.6

34.6

63

Bahrain

2.8

20.7

7.0

20

Emirates

1.4

14.010.912Oman3.822.218.511Qatar1.614.19.06Jordon26.44.121.063

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Why Mid-year population?

For example, for the crude death rate the number of persons exposed to the risk of dying (denominator): includes: Persons alive in Muharram 1 of the year previous year.

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plus

all persons born during year

minus

all persons who die during year,

adjustments made for persons who moved in or out.

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A common solution to this problem of determining the population at risk is to estimate the population at mid-year.

In our example (

1438H

):

T

he population at risk will be the population on Rajab1.

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Cause-specific Mortality Rate

• Is Mortality from a specified cause for a population during a specified time period.

• The numerator is the number of deaths from that cause.

The denominator remains the size of the population at the mid-point of the time period.

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Example: In the previous example: suppose the tuberculosis death in

1438H

was 5.

Calculate mortality rate due to TB.

Numerator: number of deaths due to TB = 5

Denominator: Mid-year population 150,000

Mortality rate due to TB =

(5/150,000) x 100,000 = 3.3/100,000

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The Age Specific Death Rate

Where:

ASDR

= The Age Specific Death Rate.

D

x

= Deaths for population at age x during

the

year.

P

x

= Mid year Population for the population

at

age x

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Deaths

Mid year Population

Age Group

4143

73795

19 – 15

4740

48764

24 – 20

4304

43635

29 – 25

3883

63337

34 – 30

4062

34423

39 – 35

4597

26983

44 – 40

5085

24548

49 - 45

Deaths

during the year and the population at the mid year for the different age groups

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ASDR

Death

Mid year Population

Age Group

56

4143

73795

19 – 15

97

4740

48764

24 – 20

99

4304

43635

29 – 25

61

3883

63337

34 – 30

118

4062

34423

39 – 35

170

4597

26983

44 – 40

207

5085

24548

49 - 45

The age Specific Death Rates

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Why Age Specific Death Rates

?

Can

compare mortality at different ages.

Can

compare mortality in the same age groups over time and/or between countries and areas

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3-

Infant mortality rates (IMR):

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Are

the most common used rates for measuring the risk of dying during the first year of life.

These

rates are

the

most frequently used measures for comparing health services among nations.

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Infant Mortality Rate , Saudi Arabia (2000-2011)

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High infant mortality rates are:

1- Reflection of poor economic conditions2- unmet health care needs and

3- other unfavorable environmental factors.

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IMR =

number of infant deaths

age 0-365 days

Number of live

births during year

1000

X

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Country

Infant mortality rate

 

Per 1000

Saudi Arabia

18.5

Yemen

53.3

Palestine

22.2

Iraq

34.6

Bahrain

7.0

Emirates

10.9

Oman

18.5

Qatar

9.0

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Suppose at KKU hospital, 20 infants died during

1438H

. The number of live births for the same year was 2600. Calculate IMR

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Numerator: number of infants died = 20

Denominator: Number of live births = 2600

IMR

=

20

x 1000

=

7.7

/

1000

2600

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That is; 7.7 infant deaths per 1,000 live births in

1438H

.

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Neonatal mortality rate

(NMR

)

:

Measures risk of dying among new born infants under the age 28 days.

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number of deaths for infants under 28 days of age

Number of live birth in the

same year

x 1,000

NMR

=

Example: In the previous example:

suppose out of the 20 who died, 12 died in the first 28 days. Calculate NMR for

1438H

.

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Numerator: number died in ( 0- 28) days = 12

Denominator: Number of live births = 2600

NMR =

12

x 1,000 = 4.6/1000

2600

4.6 deaths per 1,000 live births.

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Postneonatal

mortality rate (PNMR

):

Number who

died after 28 days of age.

For

the previous example:

T

he number of infants who died after 28 days of age is 8. (20 - 12 = 8).

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x 1,000 = 3.1/1000

3.1/1000 deaths per 1,000 live births.

PNMR =

12

2600

PNMR =

deaths for infants more than 28 days old through the age of 1 year

Number of live birth in the same year

x 1,000

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Maternal

Mortality

Definition

:‘Maternal death

’ is death of a woman

while

pregnant ,or

within

42 days of termination of

pregnancy.

Irrespective

of the duration or site of the

pregnancy.

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From any cause related to, or aggravated by the pregnancy or its management

Not

from accidental causes

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Maternal Mortality Indicators

Maternal

mortality

ratio

(per 100,000 live births -or per 1000 live births)

Maternal

mortality

rate

(

per 100,000 women of childbearing age)

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Maternal Mortality Ratio

Number

of women who die as a result of complications of pregnancy or childbearing in a given year per 100,000

live

births in

that

year

Represents

the risk associated with each pregnancy, i.e., the obstetric

risk

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The numerator is the number of deaths in a year from puerperal causes. (complications of pregnancy,

childbirth).

The denominator is the number of live births during the same year.

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MMRatio

=

T

otal maternal deaths for a period (year)

x 100,000

Number of live birth in the

same year

Example:

The year-end of

1438H

report from the obstetrical ward:

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1-

was 3 deaths (2 abortions, 1 pregnancy complications).

2-

The number of live born was as before (2600).

Numerator: number of mothers died = 3

Denominator: Number of live births = 2600

x 1,000 = 1.15/1000

MMRatio

=

3

2600

1.15/1000 maternal deaths per 1,000 live births

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Maternal

Mortality

Rate

Number of women who die as a result of complications of pregnancy or childbearing in a given year per 100,000

women of childbearing

age

in

the

population

Represents

both the obstetric risk and the frequency with which women are exposed to this

risk.

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Country

Maternal mortality

rate

Per 100,000

Saudi Arabia

16

Yemen

200

Palestine

32

 

Iraq

63

Bahrain

20

Emirates

12

Oman

11

Qatar

6

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MMRate

=

T

otal maternal deaths for a period (year)

x 100,000

Number of women age 15 - 49

Example:

The year-end of

1438H

report from the obstetrical ward:

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1-

was 10 deaths (2 abortions, 8 pregnancy complications).

2-

The number of women aged 15-49 was: (250000).

MMRate

=

10

250000

x 100,000

= 4/100,000

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Case- fatality rate

(CFR):

(expressed usually as percent):

CFR =

x 100

Number of individuals with the specified disease

Number of deaths during a specified period of time after disease diagnosed

Slide43

Example 1: At X city:

1)

110 cases of cancer in 1433H

2) 29 died in 1433H.

Find CFR:

CFR = 29 x 100 = 26.4%

110

Numerator: # died of cancer = 29

Denominator: Number with cancer = 110

43

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Proportionate Mortality (PM):

T

he

proportionate of mortality from specified disease is defined as:

PM =

Number of deaths from a disease during a specified period of time

Total deaths in the same time period

x 100

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Example 1: At X city:

1)

10 deaths from cardiovascular disease in 1427

2) 500 deaths from all diseases in 1427

Find

PM

:

PM = 10 x 100 = 2%

500

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Years of potential life lost (YPLL)

Is a measure of early deaths.

Death occurring in the same person at a younger age involves a greater loss of future productive years than death occurring at an older age.

Steps in calculation of YPLL:

1- subtract each person’s death from predetermined age (differs according to country).

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The younger the age at which death occurs, the more years of potential life are lost.

2- ‘YPLL’ for each individual are then added together to yield the total YPLL.

For example a person died at age 32, and suppose the predetermined age is 65, then this person has lost (65 – 32) = 33 years of life.

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Example:

5 workers died because of exposure to toxic chemical.

The ages of death were 20, 25, 30, 35, and 40 years.

Use age 65 as the predetermined age.

Calculate the YPLL for these 5 workers. And so find the mean YPLL.

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YPLL = (65 – 20) + (65 – 25) + (65 – 30) + (65 – 35) + ( 65 – 40) = 175.

2- The mean YPLL = 175/5 = 35

On average, the number of years of premature death among those workers who died is 35 years.

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Country

Sex ratio

Life expectancy

Total fertility rate

 

 

Male

Female

 

Saudi Arabia

105 : 100

71

75

3.03

Yemen

105 : 100

61

60

5.48

Palestine

106 : 100

73

77

4.65

Iraq

105 : 100

70

73

4.86

Bahrain

103 : 100

76

81

2.63

Emirates

105 : 100

75

80

2.36Oman105 : 10075772.52Qatar102 : 10074771.92Jordon106 : 10079823.27

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Sex differentials:

The average life expectancy of females is greater than that of males, partly due to biological factors and partly because of behavioral differences.

Men smoke more tobacco, drink alcohol, have more motor vehicle accidents, engage in more

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dangerous occupation and are more prone to suicide.

There is an Excess male mortality in many countries.

Comparing the number of male deaths with the number of female deaths can be misleading due to sex ratio (more male babies being born and hence more deaths.

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To avoid the effect of sex ratio in mortality rate comparisons, the sex ratio of the age specific death rate, which is used to measure male excess mortality.

This is obtained as:

Male excess mortality =

Male death rate at age x

female death rate at age x

x 100

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For example, a male excess mortality of 150 would denote that the male death rate was 50% higher than the corresponding death rate for females.

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Male excess

 

mortality

Deaths

Mid year Population

 

females

Males

Females

Males

2.85

12

36

8651

9103

3.09

15

48

9345

9676

2.83

21

60

10617

10696

2.69

27

72

10986

10877

2.59

33

84

10061

9902

1.98

45

90

892486921.80579970626811

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Sources of statistics on mortality

1- Death certificate:

Specifies a number of demographic and social characteristics of the deceased and details about the cause of death.

Death certificate can also include:

birth place, marital status, education, residence, occupation

.

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2- Vital statistics:

Include mortality data on the number and causes of deaths, together with the age and sex of the deceased.

3- Cross-national data:

Comparative data on mortality are published in the United Nation Yearbook and WHO Health Statistics Annual.