Transcript `crude death rate`.

Lecture 3
Natural movement of the population.
Death rate, its principal causes.
Measurement of mortality
•
The elementary and absolute indicator of health is its
full absence, or death. The primary document for
death registration is «The Medical certificate of
death». The whole state statistics begins with this
document. The modern demography originates from
the researches of English doctor J. Grount in 1662. He
analysed certificates of death and birth at various
areas of London with sex and age distribution of the
dead.
• In the majority of countries of the world the extract
from a death certificate is obligatory, it is made by the
doctor prior to a burial or cremation, with indication
of a cause of death.
International classification of illnesses
• For ordering the supervision data at studying of
causes of death, disease and activity of public health
services the World Health Organization accepted the
International classification of illnesses.
• The purpose of the International classification of
illnesses is creation of uniform rules of registration,
the analysis and interpretation of data about
mortality and morbidity in the different countries
and world regions.
• The International classification of illnesses is used
for transformation of the verbal formulation of the
names of illnesses to alphanumeric codes. The
general principle of construction is based on decimal
system.
International classification of illnesses
• For the first time the International classification of
illnesses has been accepted to general use in 1910 in
Paris. Then the decision was made to reconsider and
specify it every 10 years.
• The last International classification of illnesses of the
tenth revision, acting in the world since 1989, contains
21 class of illnesses. Each class describes a considerable
quantity of nosologic units and pathological conditions.
• Classes are subdivided into three-value columns which
are in turn divided into four-unit columns, and in three
classes five-unit columns are introduced. As a matter of
fact, the International classification of illnesses is the
international standard ordered diagnostic classification,
both for public health services system, and for the state
as a whole, but it works only in the countries which are
members of the World Health Organisation.
International Death Certificate
• The basis of mortality data is Death Certificate. So we
first look at death certification for ascertaining the
frequency of disease in a population. For ensuring
national and international comparability, it is very
necessary to have a uniform and standardized system of
recording and classifying deaths.
• The international death certificate consist in two parts.
• Part I deals with the immediate cause, and the underlying
cause which started the whole trend of events leading to death.
The underlying cause of death is recorded on line (c). In the
example cited, the underlying cause of death is strangulated
hernia.
After
operation,
the
patient
developed
bronchopneumonia as a complication which ended in death.
The concept of "underlying cause" is the essence of the
international death certificate. It is defined as (a) the disease or
injury which initiated the train of morbid events leading
directly to death or (b) the circumstances of the accident or
violence which produced the fatal injury.
The Central Births and Deaths Registration Act
• In an effort to improve the civil registration system, the Govt. of
India promulgated the Central Births and Deaths Registration
Act in 1969. The Act came into force on 1 April 1970.
• The Act provides for compulsory registration of births and deaths
throughout the country, and compilation of vital statistics in the
States so as to ensure uniformity and comparability of data. The
implementation of the Act required adoption of rules for which
also, model guidelines have been provided. The Act also fixes the
responsibility for reporting births and deaths. While the public
(e.g., parents, relatives) are to report events occurring in their
households, the heads of hospitals, nursing homes, hotels, jails or
dharmashalas are to report events occurring in such institutions
to the concerning Registrar. The time limit for registering the
event of births is 14 days and that of deaths is 7 days. In case of
default a fine up to Rs.50 can be imposed. The Act makes the
beginning of a new era in the history of vital statistics registration
in India.
Mortality rates and ratios
The simplest measure of mortality is the 'crude death
rate'. It is defined as "the number of deaths (from all
causes) per 1000 estimated mid-year population in one
year, in a given place". It measures the rate at which
deaths are occurring from various causes in a given
population, during a specified period For the statistical
analysis of death rate a number of indicators are
applied:
•The general indicator - death rate,
•Special indicators of death rate (age and sex specific death rates,
monthly and weekly death rate).
The crude death rate is calculated from the formula:
Number of deaths during the year
Death rate 
 1000
Mid - year population
Estimation of levels of death rate is made on
the following scale
Death rate level
Low
Average
High
Death rate per 1000 persons
10 ‰ and less
11 - 15
more than 15
• The death rate, in many respects, is defined by age and sex structure
of the population, by educational level and well-beings of the
population. In days of economic crises, national disasters, and wars
the death rate raises considerably. The death rate fluctuates
considerably in the different countries of the world.
• Death rates have declined worldwide over the last decades to 11 per
thousand population during 2002.
Redaction in the death rate in some countries
of the world, 1970 - 2005 (‰)
Country
Angola, Zambia
Bangladesh
Pakistan
Nepal
Ethiopia, Ukraine
Australia, Japan
China
Macedonia, Spain, India
Russian Federation
Italy, Greece, Portugal
Death rate
1970
2005
29
21
23
22
15
10
8
11
8
11
24
8
10
10
16
7
7
9
16
10
Dynamics of mortality rate in the
Russian Federation:
1940 - 17,4 ‰
1970 - 8,4 ‰
1980 - 11,0 ‰
1995 - 15,0 ‰
2003 - 16,4 ‰
2005 - 16,1 ‰
2006 - 15,3 ‰
2007 - 14,7 ‰
2010 – 13,5 ‰
• The analysis of dynamics of
death rate in Russia
population shows, that,
beginning with the 1990th,
the death rate has kept the
tendency to growth up to
2005. Further the level of
the general death rate has
decreased a little.
The leading causes of death in the world
• The most typical feature of the twentieth century is sharp
decrease of death rate due to infectious diseases and the
increasing part of chronic diseases in the structure of the
reasons of the general death rate. Thus, if at the beginning of
the twentieth century infectious diseases were one of leading
causes of death then the last decade their share has made less
than 1%.
• Cardiovascular diseases are the number one cause of death in
the world. An estimated 17.5 million people died from
cardiovascular disease in 2005, representing 30 % of all global
deaths. Second and third are cancer and traumas. Chronic
obstructive pulmonary diseases take now the fourth places of
the reasons of death rate.
• In short, the chronic noncommunicable diseases and conditions
have now supplanted acute infections as the major cause of
illness.
The leading causes of death in developing countries
• In developing countries infectious diseases also began
to play a smaller role in death rate structure, however
their share is still great – up to 30 %.
• In India, as in other developing countries, most deaths result
from infectious and parasitic diseases, abetted by
malnutrition. Diarrhoeal diseases are widespread. Cholera
has shown a declining trend. Malaria and kala-azar which
showed a decline in the 1960s have staged a comeback.
Japanese encephalitis and meningococcal meningitis have
shown an increasing trend. There is no appreciable change
in the prevalence of tuberculosis, viral hepatitis and
dysentery. On the other hand, an increase in the frequency
of “new” health problems such as coronary heart disease,
hypertension, cancer, diabetes and accidents has been noted.
• About 25 per cent of total deaths are attributed to infectious
and parasitic diseases in India.
Structure of the death
rate reasons in Russia
4% 4%
13%
14%
9%
56%
Blood circulation system diseases
malignant neoplasm’s
traumas
respiratory diseases
gastrointestinal diseases
Other
Blood circulation system
diseases take now the first
place in structure of the
reasons of death rate in
Russia, the second one –
malignant neoplasm’s, the
third place is taken by
traumas and poisonings, the
fourth and fifth places are
divided between respiratory
diseases and gastrointestinal
diseases. Only these classes
of diseases took more than
90% of all death rate
reasons.
In structure of death rate of
men, in comparison with
women, the larger part of
proportion
belongs
to
accidents,
traumas
and
poisonings,
respiratory
diseases.
The reserves of death rate decrease
• Among the unused reserves of death rate decrease
there are curable diseases, coronary heart disease,
tuberculosis and preventable diseases. From the point
of view of ability to influence on a death rate all causes
of death can be divided into groups: the reasons, death
rate from which to certain age can be prevented by the
system of public health services itself (curable
illnesses), and death rate from which can be prevented
on the basis of social policy measures with the
assistance of public health services system (the
preventable reasons). Coronary heart disease (CHD),
and tuberculosis, including its remote consequences,
singled out into independent groups are referred to
curable illnesses.
The reserves of death rate decrease
• Among curable diseases there are the majority of
children's infections and many acute infections, a
number of new growths, including leukemia,
diabetes and some other endocrine diseases, all
respiratory diseases, appendicitis, a hernia of
abdominal cavity and some other gastrointestinal
diseases, nephrite, congenital heart anomalies.
• Malignant neoplasms of a trachea, bronchial tubes
and lungs (they do not occur up to 15 years of age),
accidental alcoholic poisonings, a road and transport
traumatism, and AIDS form the number of
preventable reasons of death rate.
Age specific death rate indicators
Alongside with the general mortality coefficient age
specific factors are calculated. A technique of
calculation of age specific death rate indicators:
Number of dead in a certain age group (18 years) × 1000
Average annual population of the same age group
•Age specific rates can be presented graphically as a
curve. High enough death rates fall to the immediate
postnatal period and in age groups older 60 years. The
least death rate is marked in age group of 10 – 14
years old and during this period of time death rate
does not exceed 1 ‰. One of prominent features of
death rate indicator is its higher level almost in all age
groups at males and at countrymen.
Estimated Age-Specific Death Rate in India per 1000
population
120
103,2
100
78,6
80
56,2
60
36,8
40
22,9
16,3
10,2
20,4
20
1,2
0
1,9
5
3,1
2,9
3,8
7
10
-1
4
20
-2
4
30
-3
4
40
-4
4
50
-5
4
60
-6
4
70
-7
4
80
-8
4
0-
4
1,8
2,6
Urban
Rural
Combined
Age specific death rates
• Early mortality of men at able-bodied age, by its level
exceeding the death rate of women of the same age
almost by 4 times is especially great. This law explains
distinctions in a way of life, labour and professional
work (the great physical and nervous-emotional intensity
of work), and biological features.
• The leading reason of death rate of able-bodied
population is traumas and poisonings which push aside
cardiovascular diseases and neoplasm’s to the second
and third place.
• When analyzing the death rate of able-bodied population
of Russia special alarm is caused by the frequency
increase of fatal outcomes due to such classes of
preventable reasons, as gastrointestinal diseases, some
infectious and parasitic diseases, respiratory diseases.
Age-specific death rate indicators at infancy, adolescence,
and youthful age
• For the second half of the 20th century reduction of age-specific
death rate indicators at infancy, adolescence, and youthful age is
characteristic. A death rate principal cause in these age groups
are traumas and poisonings, the share of this class in relation to
all causes of death fluctuates from 41 % at the age of 1 – 4 years
to 96 % at the age of 15 – 19 years. The second place in structure
of causes of death at children at the age of 1 – 4 years is occupied
with respiratory diseases and at children above five years and
teenagers – neoplasms. The third place in structure of causes of
death of teenagers is occupied with illnesses of blood circulation
system, and with age group increase the importance of this class
of illnesses increases many times.
• Indicators of infant and teenage death rate characterize not only a
state of health of the children's population, but also level of social
and economic well-being of a society as a whole. The correct and
timely analysis of children's death rate allows developing a
number of concrete measures of improvement of health of
pregnant women and children, to estimate the efficiency of
preventive actions, work of public health establishments.
The reasons of death rate of children and teenagers
in Russia (by 10 thousand children of corresponding age)
Principal causes
Infectious diseases
1-4
8.0
Neoplasm
Age (years)
5-9
10-14
0.7
0.8
15-19
1.9
8.7
6.5
6.0
8.2
Blood circulation diseases
1.1
0.8
1.2
5.0
Respiratory diseases
15.4
2.0
1.8
2.8
Gastrointestinal diseases
1.4
0.5
0.6
1.6
Traumas and poisonings
44,9
33.8
32.8
109.6
Total
108.0
57.0
49.7
114.0
Reproduction of the population in the country
• The most informative indicator characterizing a condition and
prospects of reproduction of the population in the country is the
factor of natality which is calculated as a difference between the
general indicator of birth rate and the general indicator of death rate
and does not depend on a tendency and intensity of a migratory
exchange.
Natality = the general indicator of birth rate – the general
indicator of death rate
• The positive factor of natality means that the population of the
studied territory increases, and negative one – that the territory
population decreases. The negative natality always gives
evidence to obvious trouble in a society. The negative tendencies
of reproduction remaining long enough usually lead to
depopulation, i. e. to reduction of a population of the country
and its separate territories; now it is an undesirable reality for
Russia. Natural decline in population of Russia has begun in
1992 and for the period between censuses of 1989 and 2002 has
made about 7,4 million persons; depopulation of the basic ethnos
of the country – Russians is observed, that is not only ethnic, but
also a nation-wide political, social and economic problem.