Prime-age adult mortality in sub-Saharan Africa: examining trends in Demographic and Health Surveys conducted between 1990 and 2014

Adult mortality rate is a critical indicator used to assess the level of national development in most sub-Saharan African countries. However, estimation of adult mortality rates requires comprehensive and accurate reporting of adult deaths, which is one of the challenges faced by most sub-Saharan African countries. Using data from Demographic and Health Surveys conducted between 1990 and 2014 in 25 countries in sub-Saharan Africa, we examine trends in all-cause prime adult mortality (measured by the probability of dying between exact ages 15 and 50) and sex differences in adult mortality by region. Our paper provides a basis for tracking progress in reducing adult mortality and improving overall health. The median probability of dying was 173 per 1000 for women in the latest surveys, an increase from 166 per 1000 during the initial surveys. The median value for men was 177 per 1000; a decrease from the initial surveys which was 202 per 1000. Across all countries, the average annual increase in the probability of dying was higher for women (1.08%) than men (0.49%). Intensive efforts are needed to improve adult survival and ensure that sub-Saharan Africa achieves the Sustainable Development Goals by 2030. In particular, efforts to mitigate the premature risk of dying among women need to be intensified.     

Regional trends in fertility and mortality in Brazil

Abstract Questions asked in the 1970 Brazilian census allow the application of fertility and childhood mortality techniques developed by W. Brass. Using some propositions based on fertility estimates from the 1970 census data it was possible to extend the analysis to the 1940, 1950 and 1960 censuses. Estimates are also provided for ten Brazilian regions, for 1940, 1950 and 1970. These estimates show a slight decrease in the fertility level for the country as a whole, but two different trends at regional levels. Between 1940-50 and 1960-70 the poorer regions experienced constant or increasing fertility levels while developed regions experienced declining ones, with only one exception. The mortality estimates indicate a consistent decline in the mortality level of all regions, but also a divergent trend between poor and developed regions, in life expectancies at birth. This work is a summarized version of Chapters II, III and IV of my Ph.D. thesis written under the supervision of Professor D. V. Glass and Mr J. Hobcraft at the University of London. I am most grateful to my supervisors as well as to Professor W. Brass for valuable comments on several aspects of the thesis. While carrying out this study, the author was supported by grants from the Federal University of Minas Gerais, Brazil, and the Ford Foundation.     

A century of international mortality trends: I

An attempt is made to summarize the chief generalizations that can be drawn from available evidence on world mortality developments during the last hundred years. Past and prospective trends are compared for three broad groups of populations or approximately those in the West, Eastern and Southern Europe, and Latin America, Africa, and Asia. Two major points of emphasis are that the usual methods of comparing regional changes can usefully be supplemented by other approaches, and that the mortality history of Western nations may prove a highly unsatisfactory guide to future trends elsewhere. The study is based on a nearly complete compilation of the national life tables on record.     

Infant mortality trends in rural East Pakistan

Infant mortality trends in a rural area of East Pakistan are analyzed utilizing the Bogue pregnancy history technique. The findings indicate that infant mortality has declined slightly over 20 percent between 1958 and 1967. The existence of development programs in women’s education and family planning since 1961 are proposed as possible reasons for this finding. A convergence in infant mortality rates to mothers in the age range 15–39 years was found in the final year under analysis, while the standard U shaped pattern of infant mortality with age structure was exhibited in the previous years. One possible explanation for the convergence is that the development programs are reaching women within this age range more equally than in the past. An alternative explanation relating to the problems of recall of mortality events was discussed.     

Infant and child mortality in India: trends in inequalities across economic groups

This paper examines the trends in economic inequalities with respect to infant and child mortality in India using three rounds of the Indian National Family Health Survey conducted in 1992–1993, 1998–1999, and 2005–2006. The paper uses concentration index, and pooled discrete-time survival regression model to examine the aforementioned trends and regional patterns. The findings suggest a decreasing trend in economic inequality in infant mortality but an upward trend in economic inequality in child mortality in India. Economic inequalities in infant mortality have narrowed in the southern region, whereas they have widened in the western region and risen in the northern region. However, mixed trends in concentration indices were found in the different regions of India in the case of child mortality.     

Recent trends in multiple-caused mortality 1968 to 1982: Age and cohort components

Declines in mortality at advanced ages have been observed recently in the United States. These declines have been related to a reduction in the risk of major circulatory diseases, such as stroke and heart disease. In this paper we examine the contribution of two additional major factors in those declines. The first is the effect of conditions associated with circulatory diseases. This effect can be examined by using multiple-cause mortality data in which all conditions reported by the physician on the death certificates are recorded. The second is the contribution of cohort mortality differentials to temporal changes. If major cohort differentials are identified, we may be able to determine if recent declines in mortality are likely to continue-and to what levels. Such insights would be useful both in improving projections of the size and age structure of the U.S. elderly population and its entitlement groups and in helping to identify future patterns of needs for preventive and other health services.     

Paradox lost: Explaining the hispanic adult mortality advantage

We tested three competing hypotheses regarding the adult "Hispanic mortality paradox": data artifact, migration, and cultural or social buffering effects. On the basis of a series of parametric hazard models estimated on nine years of mortality follow-up data, our results suggest that the "Hispanic" mortality advantage is a feature found only among foreign-born Mexicans and foreign-born Hispanics other than Cubans or Puerto Ricans. Our analysis suggests that the foreign-born Mexican advantage can be attributed to return migration, or the "salmon-bias" effect. However, we were unable to account for the mortality advantage observed among other foreign-born Hispanics.     

The measurement of historical trends in fetal mortality in England and Wales

This paper critically discusses recent attempts to estimate long-term trends in the stillbirth rate for England and Wales. It assesses the available historical evidence for the level of late-fetal mortality, drawing especially on examples from Norway, Sweden, and Denmark. A theoretical fetal-infant life table for a high-mortality population is also outlined as a means of analysing the relationship between segments of the conception-to-first-birthday mortality curve. Finally, new estimates of the stillbirth rate for England and Wales are proposed, based on variations in the early neonatal and maternal mortality rates during the 1930s. These estimates are substantially lower than the earlier estimates and are more in keeping with the available evidence from northern Europe. The implications of the revised estimates for interpretations of historical changes in mortality patterns are also considered.     

The measurement of historical trends in fetal mortality in England and Wales

This paper critically discusses recent attempts to estimate long-term trends in the stillbirth rate for England and Wales. It assesses the available historical evidence for the level of late-fetal mortality, drawing especially on examples from Norway, Sweden, and Denmark. A theoretical fetal–infant life table for a high-mortality population is also outlined as a means of analysing the relationship between segments of the conception-to-first-birthday mortality curve. Finally, new estimates of the stillbirth rate for England and Wales are proposed, based on variations in the early neonatal and maternal mortality rates during the 1930s. These estimates are substantially lower than the earlier estimates and are more in keeping with the available evidence from northern Europe. The implications of the revised estimates for interpretations of historical changes in mortality patterns are also considered.     

An assessment of methods for estimating adult mortality from two sets of data on maternal orphanhood

Survey and census data about the survival of respondents’ mothers have been used widely for the estimation of adult mortality. Four methods are described that combine two sets of orphanhood data and yield estimates for the intersurvey period. They are applied to enquiries conducted in Peru, Kenya, and Malawi. This provides improved estimates of recent mortality and also clarifies the nature of the errors that affect the basic data. Age misreporting and other errors affect the information about older respondents and orphanhood of children is sometimes underreported. In contrast, data supplied by young adults seem plausible.     

The influence of cohort effects on mortality trends in India

The inferences drawn from this study are as follows: The stagnation/ increase in mortality rates of adult ages in the recent years in India as well as for the major states may be attributed to food shortages and price hikes experienced in the country during 1960–74. In other words, all those who were adults during 1980s had experienced the crisis of hunger due to nonavailability of food as well as entitlement failure during their childhood. These persons would have had higher risk of dying in their life time and that may be one of the main reasons for the stagnation or increase in adult mortality in India and in most of the states. The findings of the study suggest that, the economic crisis experienced in India during the late eighties, may decrease the survival chances of those born during this period in their future life time. However, successful containment of increase in food prices during the period of crisis would be helpful in protecting the entitlement of vulnerable groups. The policy implication of the study is that it is essential to control the prices of food during the time of food shortages and or economic crisis and even in the period when food is available, measures should be undertaken to evolve efficient distribution system ensuring the supply of food to those vulnerable groups, who were unlucky to be born or were in infancy during the period of economic crisis. Thus, essentially this is a study in interaction of economic factors and demographic trends in an economy where large segments of the population are periodically subject to heightened food insecurities, compression of real wages and entitlement failures.     

Effects of early-life conditions on adult mortality: a review

"This paper considers the effects of health conditions in childhood on an individual's mortality risks as an adult. It examines epidemiologic evidence on some of the major mechanisms expected to create a linkage between childhood and adult mortality and reviews demographic and epidemiologic studies for evidence of the hypothesized linkages....Many empirical studies support the notion that childhood conditions play a major role in adult mortality, but only in the case of respiratory tuberculosis has the demographic importance of a specific mechanism been established by cohort studies. One's date and place of birth also appear to be persistently associated with risks of adult death in a wide variety of circumstances. An individual's height, perhaps the single best indicator of nutritional and disease environment in childhood, has recently been linked to adult mortality, especially from cardiovascular diseases. Further research is needed, however, before causal mechanisms can be identified."     

Male and female components of perinatal mortality: International trends, 1901–63

Analysis of vital data from five West European countries indicates that there has been a decline in the relative male risk and the sex ratio of late fetal mortality during the period 1901–1963. However, this decline is largely compensated for by an increase in the relative male risk and sex ratio of early neonatal mortality. As a result, no clear and consistent trend in the relative male risk or sex ratio of perinatal mortality can be detected. It is suggested that improvements in obstetric practice or in registration effectiveness may be responsible for the phenomena noted. Whatever the explanation, the findings illustrate the dangers of reifying registration definitions in the analysis of vital events.     

Measurement of adult mortality in less developed countries: a comparative review

"This paper compares the direct and indirect methods used to measure adult mortality in the developing world. No other approach can substitute fully for accurate and complete vital registration, but in many countries it is unrealistic to expect the registration system to cover the majority of the population in the foreseeable future.... The difficulties involved in measuring adult mortality using surveys and other ad hoc inquiries are discussed.... While the choice of methods must depend on each country's situation, direct questions require very large samples and are unreliable in single-round inquiries. On the other hand, although indirect methods provide less detailed and up-to-date information than is ideal, they are adequate for many practical purposes. In particular, the experience of the 1980s suggests that questions about orphanhood perform better than earlier assessments indicated, and recent methodological developments have circumvented some of the limitations of the indirect approach."     

The use of mortality time series data to produce hypothetical morbidity distributions and project mortality trends

It is difficult to obtain direct empirical estimates of chronic disease prevalence in the U.S. population. The available estimates are usually derived from epidemiological studies of selected populations. In this paper we present strategies for estimating morbidity distributions in the national population using auxiliary biomedical evidence and theory to estimate transitions to morbidity states from a cohort mortality time series. We present computational methods which employ these estimates of morbid state transitions to produce life table functions for both primary (morbidity) and secondary (mortality) decrements. These methods are illustrated using data on stomach cancer mortality for nine white male cohorts, aged 30 to 70 in 1950, observed for a 28-year period (1950 to 1977).     

The choice among past trends as a basis for the prediction of future trends in old-age mortality

We explored the extent to which projections of future old-age mortality trends differ when different projection bases are used. For seven European countries, four alternative sets of annual rates of mortality change were estimated with age-period log-linear regression models, and subsequently applied to age-specific all-cause mortality rates (80+) in 1999 to predict mortality levels up to 2050. On average, up to 2050, e80 is predicted to increase further by 2.33 years among men and 4.03 years among women. Choosing a historical period of 25 instead of 50 years results in higher predicted gains in e80 for men but lower gains for women. Choosing non-smoking-related mortality instead of all-cause mortality leads to higher gains for women and mixed results for men. In all alternatives there is a strong divergence of predicted mortality levels between the countries. Future projections should be preceded by a thorough study of past trends and their determinants.