A comprehensive population health index based on mortality and disability data

Two versions of a new population health index based on the mortality and disability experiences of nations or communities are proposed for comparing their overal health status. One version is the ratio of the mean mortality rate of selected population groups to the mean disability free rate of survivors. The other version is a composite of these variables, transformed to stabilize their variances, that are so weighted as to maximize the probability of correctly differentiating ‘healthy’ and ‘unhealthy’ nations. Problems with application of the index are briefly discussed.     

Mortality and Metropolis: The Case of London 1675–1825

Recent work in population history emphasizes that demographic phenomena should be seen in a wider social and economic context. This perspective is, however, more easily achieved in the case of fertility than of mortality, which is widely treated as a variable ‘exogenous’ to economy and society. In the present paper it is argued that the inclusion of spatial structure and migration in accounts of historical demographic regimes can restore long-term variations in mortality to an ‘endogenous’ position. Within such a model a central role is played by large metropolitan populations, which act as endemic reservoirs of infection, with high but relatively stable levels of mortality. Data from the annual London Bills of Mortality allow empirical testing for the period 1675–1825, with results which generally conform to theoretical expectations, although a substantial reduction in mortality occurs during the latter part of the period.     

Does Weighting Capture What’s Important? Revisiting Subjective Importance Weighting with a Quality of Life Measure

The present study evaluated subjective importance weighting using data collected with the Injection Drug User Quality of Life Scale (IDUQOL). Weighted and unweighted IDUQOL scores from 241 adults were correlated with convergent, discriminant, and criterion measures. Regression analysis was used to examine the contribution of importance ratings to scores on a global measure of life satisfaction and the corrected weighted IDUQOL total scores. Overall, the results showed that weighted scores did not perform better than unweighted scores in measuring quality of life. However, the mean satisfaction ratings for important domains correlated significantly higher with convergent measures than did the mean satisfaction ratings for unimportant domains. This finding suggests further attention needs to be paid to the meaning and measurement of subjective importance and how it may be incorporated more effectively into measures of quality of life.     

The momentum of mortality change

Mortality change is not usually assigned much importance as a source of population growth when future population trends are discussed. Yet it can make a significant contribution to population momentum. In populations that have experienced mortality change, cohort survivorship will continue varying for some time even if period mortality rates become constant. This continuing change in cohort survivorship can create a significant degree of mortality-induced population change, a process we call the ‘momentum of mortality change’. The momentum of mortality change can be estimated by taking the ratio of e ₀ (the period life expectancy at birth) to CAL (the cross-sectional average length of life) for a given year. In industrialized nations, the momentum of mortality change can attenuate the negative effect on population growth of declining fertility or sustained below-replacement fertility. In India, where population momentum has a value of 1.436, the momentum of mortality change is the greatest contributor to its value.     

Socioeconomic Inequalities in Infant Mortality in Egypt: Analyzing Trends Between 1995 and 2014

This paper analyses the trend of the socioeconomic inequalities in infant mortality rates in Egypt over the period 1995–2014, using repeated cross-sectional data from the National Demographic and Health Survey. A multivariate logistic regression and concentration indices are used to examine the demographic and socioeconomic correlates of infant mortality, and how the degree of socioeconomic disparities in child mortality rates has evolved over time. We find a significant drop in infant mortality rates from 63 deaths per 1000 live births in 1995 to 22 deaths per 1000 live births in 2014. However, analyzing trends over the study period reveals no corresponding progress in narrowing the socioeconomic disparities in childhood mortality. Infant mortality rates remain higher in rural areas and among low-income families than the national average. Results show an inverse association between infant mortality rates and living standard measures, with the poor bearing the largest burden of early child mortality. Though the estimated concentration indices show a decline in the degree of socioeconomic inequality in child mortality rates over time, infant mortality rate among the poor remains twice the rate of the richest wealth quintile. Nonetheless, this decline in the degree of socioeconomic inequality in child mortality is not supported by the results of the multivariate logistic regression model. Results of the logistic model show higher odds of infant mortality among rural households, children who are twins, households with risky birth intervals. We find no statistically significant association between infant mortality and child’s sex, access to safe water, mothers’ work, and mothers’ nutritional status. Infant mortality is negatively associated with household wealth and regular health care during pregnancy. Concerted effort and targeting intervention measures are still needed to reduce the degree of socioeconomic and regional inequalities in child health, including infant mortality, in Egypt.     

Cohort Quantum as a Function of Time-dependent Period Quantum for Non-repeatable Events

The paper discusses translation formulae for time-dependent cohort and period quantum for non-repeatable events. Cohort quantum expressions are investigated for two cases: one in which period quantum, and another in which the sum of the period rates decreases linearly with time. In both cases the assumption is that period tempo does not change. Sufficient conditions are given for the situation in which the cohort quantum simply equals the period quantum measured at the time when the cohort reaches the mean age of the period schedule of age-specific rates, given that the period rate sum is a polynomial function of time. The paper takes up an issue which was unresolved in the article ‘Translation formulae for non-repeatable events’, which appeared in the July 1994 issue of Population Studies.     

Famine Mortality in Nineteenth-Century Japan: The Evidence from a Temple Death Register

Economic and demographic historians who have studied Japan's early modern period argue that preventive checks to fertility were the primary cause of Japan's stationary population in the eighteenth and early nineteenth centuries, and that the role of ‘positive’ checks was negligible. This paper presents evidence and a claim that mortality crises – famines in particular – also played an important role in checking population growth during this period. It analyses data from the death register of Ogen-ji, a Buddhist temple in the Hida region of central Japan. These data provide a remarkably detailed picture of the short-term demographic consequences of Japan's last great famine, the Tenpō famine of the 1830s. ‘Normal’ mortality patterns, by age and sex, are compared with patterns of mortality during the famine. Mortality of males rose considerably more than that of females, with the greatest rise occurring among young boys aged 5–14 and adult men aged 30–59. A surprising finding was that mortality at ages 0–4 rose relatively little, in part a consequence of a marked fall in the number of births during the famine. The Tenpō subsistence crisis was not the sole cause of population stagnation in the Ogen-ji population, but it was a prominent feature of the ‘high mortality regime’ that this population experienced during the eighteenth and nineteenth centuries.     

On the nature of errors involved in estimating stage-specific survival rates by Southwood's method for a population with overlapping stages

Summary This paper has examined the effect of within-stage mortality on the estimation of stage-specific survival rates bySouthwood's (1978, p. 358) method. As pointed out bySouthwood, both the severity and timing of mortality affect the mean duration of a life stage, and consequently the estimate of the number of individuals entering that stage. Knowledge of the form of the survivorship curve permits correction of the estimate under certain circumstances. The use ofSouthwood's method with two overlapping stages having different rates and patterns of mortality leads to complex errors in the estimation of survival for the first stage. The nature of these errors is examined analytically and via a simulation model.Southwood's method is fairly robust, with moderate differences in mortality rates leading to acceptable errors in estimating survival for the first stage. When both the rate and pattern of mortality in both life stages are the same, then the survival estimate is made without error. Precise estimates of stage-specific survival will not usually be possible withSouthwood's method because of the errors introduced by the very parameters being measured. Direct measurement of mortality rates and survivorship patterns (seeSouthwood, 1978, p. 309) is strongly advised, at least in preliminary work.     

Effects of changes in rainfall and temperature on age- and sex-specific patterns of rural-urban migration in sub-Saharan Africa

We evaluate how changes in weather patterns affected rural-urban migration across 41 sub-Saharan African countries, by age and sex, over the 1980–2015 period. We combine recent age- and sex-specific estimates of net rural-urban migration with historical data on rainfall and temperature from the Climate Research Unit (CRU). We also compare standard unweighted estimates of rainfall and temperature to estimates weighted by the proportion of the country’s total rural population in the CRU grid. Results show that rural out-migration of young adults is the most sensitive to shifts in weather patterns, with lower rainfall, lower variability in rainfall, and higher temperatures increasing subsequent rural out-migration—though the last of these is not observed in weighted models. The strength of these effects has grown stronger over time for 20–24 year olds, though weaker above age 30. In contrast, increasing temperature variability is associated with a higher rural in-migration of children (0–9) and older adults (55–64). Gender differences in these effects are minimal and concentrated in areas which experienced heavy reductions in rainfall.

     

The effects of ethnicity and educational attainment on Jewish marriage patterns: Changes in Israel, 1957–1995

Abstract. This paper presents a study of changes in marriage patterns among the Jewish population of Israel over nearly 40 years. Using data from four Israeli Censuses spanning experience from the late 1950s to the mid 1990s, we employ Schoen's harmonic mean model in a multivariate framework to consider, simultaneously, changes over time in age-specific marriage rates by ethnicity and educational attainment. Our analyses point to a number of clear and interesting findings: (1) an increasingly positive association between marriage and educational attainment, especially for women; (2) the continuing central role of ethnicity in mate selection, despite important declines in ethnic endogamy over the period; (3) a decrease in the prominence of unions of ‘exchange’; (4) some evidence of increasing ‘block’ endogamy among Jews of Asian and African origin; and (5) a small increase in educational homogamy over the period. Interpretations and implications of these findings are discussed.     

The role of a provincial hospital: The Norfolk and Norwich hospital, 1771–1880

Up to the mid-1950's most economic and social historians accepted that improved medical measures, notably the expansion of hospital facilities, made a significant contribution to population growth in the late eighteenth and early nineteenth centuries by helping to reduce mortality rates. In an article which first appeared in 1955, T. McKeown and R. G. Brown criticized what had become the ‘traditional’ view. Though the number of hospitals increased, and though there were advances in medical education and knowledge, such developments, McKeown and Brown suggested, were of little value to the population until reflected in improvements in the standards of treatment available. ‘In assessing the contribution of hospitals to the reduction of mortality’, they argued, ‘we are less concerned with the number of beds than with the results of treatment of the patients who occupied them’.     

Midwives’ job satisfaction and intention to leave their current position in developing regions of Ethiopia

BackgroundThe aim of this research was to analyze midwives’ job satisfaction and intention to leave in developing regions of Ethiopia.MethodsA facility-based cross-sectional study was conducted amongst 107 midwives in four developing regions of Ethiopia. All midwives who were working in 26 health facilities participated in the study. A structured self-administered questionnaire, and in depth key informant interview guides, were used to collect data. Job satisfaction was measured by nine dimensions and intention to leave their current position was measured using three questions.ResultsMore than two-thirds (67%) of the midwives were female, with a mean age of 26.1 (sd ± 4.2) years old. Less than half (45%) of the midwives were satisfied with their job, less than half (42%) were satisfied with ‘work environment’ and less than half (45%) were satisfied with ‘relationship with management’ and ‘job requirements’. Relatively better satisfaction rates were reported regarding ‘professional status’, of which more than half (56%) of midwives were satisfied, followed by more than half (54%) of midwives being satisfied with ‘staff interaction’. Almost two-fifths (39%) of midwives intended to leave their current position.ConclusionJob dissatisfaction and intention to leave rates amongst midwives in developing regions in Ethiopia are a source of concern. The majority of midwives were most dissatisfied with their working environment and issues related to payment. Their intention to leave their current position was inversely influenced by job satisfaction. The introduction of both financial and nonfinancial mechanisms could improve midwives’ job satisfaction, and improve retention rates within the profession.     

Can We Weight Satisfaction Score with Importance Ranks Across Life Domains?

The main purpose of this study was to investigate the utility of importance weighting when importance ranks were considered as the weighting values by (1) examining the range-of-affect hypothesis in the within-subject context and (2) comparing performances of weighted and unweighted satisfaction scores in predicting overall judgment of subjective well-being. Participants were 167 undergraduates at National Taiwan University. The mean age was 19.80 years (SD = 1.98). They were first asked to complete the measurements for global life satisfaction and overall QOL and then completed a QOL questionnaire for rating satisfaction, perceived have–want discrepancy on 12 life domains and ranking importance on these domains. Hierarchical linear modeling with a random-coefficients regression model was applied to examine the range-of-affect hypothesis in the within-subject context. Correlation analysis was applied to evaluate performances of weighted and unweighted satisfaction scores in predicting overall judgment of subjective well-being. Results of this study supported the range-of-affect hypothesis, showing that the relationship between item have–want discrepancy and item satisfaction is stronger for high importance items than low importance items for a given individual. Correlation analysis found that the four weighted satisfaction scores computed from the algorithms proposed by Hsieh (Social Indicators Research 61:227–240, 2003) were not superior to unweighted satisfaction score in predicting overall QOL and global life satisfaction. All these findings suggested that weighting satisfaction scores with importance ranks may not have theoretical basis and empirical contribution.     

Age-parity-specific birth rates and birth probabilities from census or survey data on own children

The ‘own-children’ method is a census- or survey-based reverse-survival technique for estimating age-specific birth rates for years previous to enumeration. In this paper it is extended to estimate birth rates and birth probabilities by parity as well as by age. The refined method is tested for accuracy by comparing ‘own-children’ estimates of age-parity-specific birth probabilities for the United States in 1969 with parallel estimates obtained by the method used in Vital Statistics of the United States. The ‘own-children’ estimates give relatively lower values at ages 15-19 and higher values at ages above 40, but compare well in between. The discrepancies are probably due mainly to adoption of illegitimate children of young mothers by older women. The ‘own-children’ estimate of the total fertility rate is very close to the published vital statistics estimate.     

Coherent Mortality Forecasting: The Product-Ratio Method With Functional Time Series Models

When independence is assumed, forecasts of mortality for subpopulations are almost always divergent in the long term. We propose a method for coherent forecasting of mortality rates for two or more subpopulations, based on functional principal components models of simple and interpretable functions of rates. The product-ratio functional forecasting method models and forecasts the geometric mean of subpopulation rates and the ratio of subpopulation rates to product rates. Coherence is imposed by constraining the forecast ratio function through stationary time series models. The method is applied to sex-specific data for Sweden and state-specific data for Australia. Based on out-of-sample forecasts, the coherent forecasts are at least as accurate in overall terms as comparable independent forecasts, and forecast accuracy is homogenized across subpopulations.     

General growth balance method: A reformulation for populations open to migration

This paper proposes a reformulation of the general growth balance method for estimating census and registration completeness so as to make it applicable even to populations that are affected by migration. It also discusses a new procedure of line fitting that could be useful in countries where the input data are severely affected by age misreporting. The method is applicable to countries where data on age distribution of the population are available for two points in time from either censuses or surveys. Following closely the original proposal of Brass, it involves adjusting the ‘partial’ birth rates for age-specific disturbances from growth and migration rates. Beyond correcting the death rates, the method is useful in inferring the relative completeness of the censuses, and in deriving a robust estimate of birth rate under certain conditions. The application of the method is illustrated using the example of the male population of the Indian state of Uttar Pradesh for the period 1981 to 1991.     

Books and Publications Received

Mexican fertility has remained at a high level (a crude birth rate of 42–46) in spite of rapid economic development and its concomitants: rising levels of urbanization, education, income, and female labour force participation, and falling levels of infant mortality and agricultural population, combined with rural-urban migration.

Data on child-woman ratios and children-ever-born statistics, for Mexico and each state, suggest that the constant crude birth rate is not masking age or region-specific declines in fertility.

Cross-section regressions are employed in an attempt to explain Mexico’s paradoxical fertility behaviour. Using measures of income, education, urbanization, occupational status, industrial composition, labour force participation, and the sex ratio, in a weighted log-linear form, a large portion of the variation in state adjusted child-woman ratios is explained by the ‘demographic transition’ variables. The only two which might possibly explain the trend in Mexican fertility are the income variable and the sex ratio, which have positive influences on Mexican fertility in 1960 and 1970.     

Investigating Importance Weighting of Satisfaction Scores from a Formative Model with Partial Least Squares Analysis

This study introduced a formative model to investigate the utility of importance weighting on satisfaction scores with partial least squares analysis. Based on the bottom-up theory of satisfaction evaluations, the measurement structure for weighted/unweighted domain satisfaction scores was modeled as a formative model, whereas the measurement structure for global satisfaction scores was modeled as a reflective model according to top-down theory. The purpose was to see if the predictive effect of importance-weighted domain satisfaction scores is stronger than unweighted domain satisfaction scores in predicting global satisfaction scores. Three datasets in life, self, and job satisfaction were analyzed. In the life satisfaction dataset, 237 undergraduates at Central Taiwan University of Science and Technology voluntarily provided their responses. The mean age of respondents was 20.80 years (SD = 1.05). In the self-satisfaction dataset, 269 undergraduates at National Taiwan University provided their responses. The mean age of respondents was 19.78 years (SD = 1.44). Finally, in the job satisfaction dataset, 557 staff members in seven Taiwan provincial hospitals provided their responses. The mean age of respondents was 35.87 years (range from 21 to 65, SD = 8.60). Three measures of domain satisfaction, domain importance, and global satisfaction were collected in each dataset. Partial least squares analysis was used in model estimation. All the results revealed that unweighted domain satisfaction scores have a stronger predictive effect for global satisfaction measures than importance-weighted domain satisfaction scores, indicating that importance weighting on satisfaction scores did not have an empirical benefit.     

There is no low-level fertility and development trap

The theory of the low-level equilibrium trap asserts that an increase in income stimulates population growth sufficiently so that the additional people ‘eat up’ the ‘surplus’ over subsistence, and hence drive the level of income back to subsistence. Originally the theory referred primarily to mortality, but nowadays its application is to fertility. In the long-run equilibrium context in which the theory is ordinarily presented, the fact that the long-run elasticity of fertility with respect to income is negative in less developed countries fatally contradicts the accepted version of the trap. But to give every chance for trap theory to be meaningful, the paper presents a period-by-period analysis, embodying larger-than-observed positive elasticities during the early years and the logically necessary counterbalancing negative elasticities during the later years. These elasticities are combined with consumption and production figures for various age groups to estimate the effect in each year after the windfall, and altogether. The results show that even under assumptions not charitable to the conclusion of this paper, additional children do not even come close to ‘eating up’ the increase in income which induced their births, so that the trap theory is falsified.