Global Estimates and Projections of Mortality by Cause, 19702015

92 Pages·1992·3.8 MB·English

by  Rodolfo A. Bulatao

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October1992
WPS1007
Global Estimates
and Projections
of Mortality by Cause,
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RodolfoA. Bulatao
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PatienceW.Stephens
Globalestimatesandpr—ojectionsofdeath,bycause,for1970,
1985,2000,and2015 results,methods,tables,andexpert
assessmentsforselecteddiseasesandconditions.
PolicyReaeaichWoikinglepersdisiemmatethefindingsofworkinpruyesaandenooungeiheexchangeofideasamongBanksiafFand
lUolhcniiilensiedindeveli^mentissuca.Thesepapen,disuibutedbylhi:Rese^
andoyttbfeaeiimriviikuwt<e,diit)odtshheoWuolddbdeuBsaendk,anidtsdBioeadiadccoofrDdiinigmloyi.sT,heitfsimnadinnaggse,minetnetr,poreruaUnoynto,faintsdmceonnic^bercountries.
PolicyResearch
WORKINGPAPERS.
Population,Health,andNutrition
WPS1007
—
Thispaper —aproductofthePopulationPolicyandAdvisoryService,PopulationandHumanResources
Department waspreparedasbackgroundfortheHealthSectorPrioritiesReview.Copiesofthispaper
areavailablefreefromtheWorldBank,1818HStreetNW,Washington,DC20433.PleasecontactOtilia
Nadora,roomS6-065.extension31091(October1992,83pages).
BulataoandStephensreportestimatesand birthindevelopingcountriesisprojectedtorise
projectionsofdeathsbycauseformajorworld byfiveyears.
regions,basedondatafromcountryreportsto
theWorldHealthOrganizationandregression •Theleadingcausesofdeathfortheworldas
models.Theyreportmortalityratesforseven awholeforboth1970and1985wereinfectious
majorcauses:infectiousandparasiticdiseases, andparas—iticdiseasesandcirculatorysystem
neoplasms,circulatorysystemdiseases,compli- diseases withthefirstmoreimportantin
cationsofpregnancy,certainperinatalcondi- developingcountries,andthesecondmore
tions,injuryandpoisoning,andothercauses. importantindevelopedcountries.Certain
Somemorespecificcausesarereportedon.They perinatalconditionswerealsomoreimportant
giveestimatesforsixagegroupsbysexforfour fordevelopingcountries,butaccountedforonly
years(1970,1985,2000,and2015)andsix afourthorafifthasmanydeathsin1985.
countrygroups:industrialmariceteconomies, Neoplasmsweremoreimportantindeveloped
industrialnonmarketeconomies,LatinAmerica thanindevelopingcountries.
andtheCaribbean,Sub-SaharanAfrica,the
MiddleEastandNorthAfrica,andAsiaandthe •Deathsfrominfectiousdiseasesareex-
Pacific. pectedtodeclineasapercentageofdeaths;
proportionatedeathsfromdiseasesofthecircula-
Amongtheirfindings: torysystemareexpectedtorise.
•Thepopulationover45indeveloping •Thegreatestnumberofdeathswillcontinue
countriesisprojectedtomorethandouble tobeinAsia,wherealmosthalfofalldeathsin
between1985and2015,risingfrom17to24 theworldtakeplace.Thisproportionisnot
percentofthepopulation.Causesofdeath, projectedtochange.
whicharecloselyrelatedtoageatdeath,must
changeaccordingly. •Betterdataoncausesofdeathareessential.
TheWoridHealthOrganizationisworkingwith
•Infantmortalityindevelopingcountriesis countriestostrengthentheircause-of-death
projectedtofallfrom78perthousandin1985to informationsystemsasanessentialsupportfor
43perthousandin2015andlifeexpectancyat healthmonitoring.
ThePolicyResearchWorldngP^rSeriesdisseminatesthefindingsofworkunderwayintheBank.Anobjectiveoftheseries
istogetthesefindingsoutquickly,evenifpresentationsarelessthanfullypolished.Thefindings,interpretations,and
conclusionsinthesepapersdonotnecessarilyrepresentofficialBankpolicy.
ProducedbythePolicyResearchDisseminationCenter
GLOBALESTIMATESANDPROJECTIONS
OFMORTALITYBYCAUSE,1970-2015
RodolfoA.BulataoandPatienceW.Stephens
Copynghloiimaterial
Contents
Acknowledgments iv
Background 1
Method 1
Groupingcausesold^tti 2
Dataoncausesofdeaft 3
Estimatingandprojectingmortali^.. 4
Predictingmortalityratesbycause 4
Results , 5
Thedemographicbadgground 5
Currentcausesofdeattt 6
Trendsinmajorcausesofdeath 13
Age-sexspedfispatterns 17
Discussion 18
AnnexA.Methodology 21
Dataoncausesofdeatti 23
Projectingmortality 23
Predictingdeathsbymajorcause 26
Bstimatmgdeathsbyspecificcause 27
Redassii^ingdeathsfromunqwdfiedcauses 28
AnnexB.SupplementaryTables 28
AnnexC.E?yertAssessments 68
Dianhea 69
Polio 76
YeMowfever^dengue,andencephalitis 77
Malaria 78
Sdustcwomiasisandfflarfarfg ,, 79
Gwnplicationsofpregnamy 80
Diabetes 81
References 81
CopynghlixJmale'ial
ListofTables
Table1. QassificationofcausesofdeathandcorrespondingInternational
ClassificationofDiseases, Injtiries,andCausesofDeath(ICD)
categories 2
Table2. Estimatedandprojectedmortalityrates(per100,000),bymajor
cause,sex,andregion,1970-2015 7
Table3. Deathsbymajorandspecificcause(inthousands), byregion,
1985 10
Table4. Age-standardized mortality rates (per 100,000) for major and
specificcauses,byregion,1985 11
Table5. Comparisonofregressionestimatesofmortalityratesanddeaths
fromparticularcausesandexpertassessments, alldeveloping
countries,1985 12
Table6. Ratioofdeathsfromcirculatorysystemdiseasestodeathsfrom
infectiousandparasiticdiseases,byregion,1970-2015 15
Table7. Percentagedistributionofdeathsbymajorcausein1985and
incremental changes expected by 2000 and 2015 from three
factors,worldanddevelopedanddevelopingcountries 16
Table8. Percentagedistributionbymajorcauseofalldeaths,deathsunder
65, andpotentialyeaxsoflifelost, worldanddevelopedand
Table9. dPeervceelnotpaignegocfournetgriioensa,l1p9o7p0u-l2a0t1i5oncoveredbyreportstoWHOor 18
samplesurveys,byyear 19
Table10. Predicted andreportedpercentage distributions of deathsby
causeforreportingcountriesgroupedbyregion,1985 20
TableAl. Regionalgroupingofcountriesandterritories 22
TableA2. Countriesorterritorieswithreliablereportsoncausesofdeath,
andyearofdataused,byregion 24
TableA3. Countriesorterritorieswithlessreliablereportsoncausesof
death, year of dataused, and indices of coverage and data
quality,byregion 25
TableBl. PopulationLimillionsbyageandsex,majorworldregions,1970-
2015 29
TableB2. Estimatesandprojectionsoffertility,mortality,andpopulation
growthformajorregionsinselectedquinqueiuiia 31
TableB3. Mortalityratesper1(K),000frommajorcatises,byage,sex,and
region,1970-2015 32
TableB4. Mortalityratesper100,000frommajorcauses,byage,sex,and
region,1970-2015 44
TableB5. Mortalityratesper100,000fromspecificcausesbyage,sex,and
region,1985 56
TableB6. Deathsinthousandsfromspecificcauseshyage,sex,andregion,
1985 62
ii
CofTynghlodmalB'ial
TableCI. Comparisonofestimateddeathsfromcertainspecificcausesin
developix\gcountriesaroimd1985withWalshassessment 68
TableC2. Expertassessmentsofmortalityrates(per100,000)anddeaths(in
thousands)forsomespecificcauses,byage, sex, andregion,
1985 70
ListofFigures
Figure1. Lifeexpectancybyregion 6
Figure2. Itifantmortality region 6
Figure3. Mortalitybycause,world,1970-85 9
Figure4. Deathsbycause,developedcountries,1970-2015 13
Figure5. Deathsbycause,developingcountries,1970-2015 14
iii
CopyriahloiJmatonal
Acknowledgments
Alan D. Lopez contributed tiiebase data andhis insists, critiquing the
azgumentandsuggestingimportantpoints.Expertassessmentsforspecificdiseasesor
commentsonthe regression estimates were providedhyDavid Dunlop, Richard
Feachem,E.RobertGreenberg,ScottB.Halstead,DeanT.Jamison,BemhardLiese,
JoseMartinez,AlbertoTorres,andPatridcVauj^uui,aswellasbyoUierparticipantsat
meetingsfortiieWorldBankhealthsectorprioritiesreview.However,theyarenot
respon^le for the specific figures reported here, wtdxh have been lev^d for
consistencywiththepresentfitame%voik.
br
Estimates andpn^ectionsofdeathsbycausefor majorworldregions are
reportedhere.ThesourcesfortheseestimatesarecountryreportstotheWorldHealth
Organization(WHO)andregressionmodels.
Mortalityrateswillbereportedforsevenmajorcauses—infectiousandparasitic
diseases,neoplasnu,circulatorysystemdiseaaes,complicatioruofpregiumcy,certain
perinatalconditions,injuryandpoisoning,andothercauses—andformorespecific
causesundersomeheadings.Forthemajorcauses,predictiveequationsdependingon
tthheeospveecriaflilcmcoarutsaelsi,tyWlHevOelwdaetraeapnrdevsioomuedyneeswtuenqautaetdiotnosswuiplpllbeemetnhtebraespiosr.teddata;for
Estimatesweremadeforsueagegroups(0,1-4,5-14,15-44,45-64,and65and
older)bysexforfouryears(1970,1985,2000,and2015)andsbccountrygroups—
indtistrialmarketeconomies,industrialnorunarketeconomies,LatinAmericaandthe
Caribbean(LAC),Sub-SaharanAfrica,tiieMiddleEastandNorthAfrica(MENA),and
AsiaandthePadfic.Clas^cationofcountriesasindustrialordeveloping(AnnexA)
isasof1985.
Theobjective, approadi,andbackgroundoftheexercisearediscussed; the
methodologyisdesaibed;currentandprojecteddistributionsofdeathbycauseare
presentedandcontrastedamongregioits;aitdthereasonablenessofandpossiblebiases
intheestimatesareassessed.
Background
Themainobjectiveofthisexerciseistoprovideacomprehensivepictureofthe
distributionofdeathsbyunderlyingcausefor1985andagerteralperspectiveonhow
tiiedistributioncanbeexpectedtochange.Weattempttodassil^currentdeathsby
bothmajorandspecificcause,butprojectotifythemajorcausesintothefuture.
The approach is to summarize reports of causes of death to WHO and
supplementthesewithregressionestimatesforluxoreportingcountries.Analternative
wouldhavebeentoconsiderdiseasesordiseasegroupsonebyone,buildingupa
compositepicturefromtheepidemiologicalliterature.Thoughdiseaseexpertshavebeen
canvassedforinformationonthisliterature,wedonotrelyprimarilyonthisapproach
becauseitwouldleadtoinconsisterudesbetweenestimatesfordi^rentdiseasesand
wouldprovideoverallmortalityratesatoddswithotiiermortalitydata.
TheapproachtakenfollowsworkinitiatedbyPreston(1976)andcontinuedby
Hakulinenaiidothers(1986a,1986b),whoseage-sexspecificequationsformajorcauises
ofdeathareusedhere.Thisregression4>asedapproachhasalsobeenappliedto
particularareas,suchascancerdeattis(Paddnandothers1988).
Hakulinenandothersestimatedthedistributionofdeati\sbymajorcauseasof
1980.Weupdatetheirestimatesto1985,incorporatenewdatanotavailabletothem,
attemptamoredetaileddassificattcmofcauses,andprovideperspectivesonpossible
futuretrends.
1
Copyrightecmaerial
2 EstimatesandPivfediomofMortalitybyCause
Method
Thissectioncoverscategoriesofcausesofdeath;thenatureandqualityofthe
basedata;theestimationandprojectionofmortality;theequationsusedtodisaggregate
mortalitybymajorcause;andprocedur:"forsubdividii^majorcausesintospecific
categories.
Groupingcausesofdeath
ThecategoriesformajorcausesofdeathshowninTable1areidenticaltothose
usedbyHakulinenandotherstopermittheapplicationoftheirequations. These
categoriesrequiresomeexplanation.Bronchitis,emphysema,andasthmaareincluded
among the infectious and parasitic diseases because of the important infectious
bronchitiscomponent,whichwasnotseparablefromtheothersbecauseoftheway
Table1.QassificationofcausesofdeathandcoirespondingInteniationalaassificationof
Diseases,Injuries^andCausesofDeath(ICP)categories
ICiy-9(Basic
Cmsi,ofdeathcategory ICD-S(UstA) tabulationlist)
Majorcmms
1 Infectiousandparasiticdiseases Al-44,A99,A90-93 01-07,320-323
2 Neoplasms A45-61 08-17
3 Qiculatoiysystemandcertaindegenerative A80-88,A64,A98,A102, 25-30,181,341,
diseases A105-106 347,350
4 Complicationsofpregnancy A112-118 38-39,41
5 Perinatalconditions A131-135 45
6 Injutyandpoisoning AE138-150 E47-E56
7 Odtercauses Othercodes Othercodes
Spec^causes
1.1 Diarrhea Al-5 01
1.2 Tuberctilosis A6-10 02
1.3 Acuterespiratoryinfection A15-17,A89-92 033-035,320-322
1.4 Measles A25 042
1.5 Chronicobstructivepulmonarydisease(COPD) A93 323-325
1.6 PoUo A22-23 040,078
1.7 Yellowfever,dengue,andencephalitis A26-27 044-045
1.8 Malaria A31 052
1.9 Schistosomiasisandfilariasis A39,A41 072,074
1.10 Intestinalparasites A42-43 075-076
3.1 Ischemicheartdisease A83 27
3.2 Cerebrovasculardisease A85 29
3.3 Othercardiovasculardiseases A80,A82,A84,A86-88 25,26,28,30
3.4 Diabetes A64 181
3.5 Certaindegenerativediseases(nephritis,cirrhosisof A98,A102,A105,A106 341,347,350
theliver,ulcersofthestomachandduodenum)
7.1 Mentaldisorders A69 210^212
7.2 OralhealAdiseases A97 330
7.3 Mtcronutrientdisorders A62-63,A67 180,193,200
7.4 Malnutrition A65 190-192
Note:Ihespecificdiseaseslistedunderinfectiousandparasiticdiseases(1.1-1.10)andunderoti\er
causes(7.1-7.4)arenotmeanttobecomprehensive.
Matiod 3
datawerereported.Diabetes^nephritis,cirrhosisoftheliver,andtilcersofthestomach
andduodenumhavebeenincludedamongdrcuiatorysystemdiseasesnotbecauseof
anypresumedsimilarityinetiology orpathogenesisbut tokeepthenvonberof
categoriesmanageablebycombiningthedegenerativediseasesotherthancancer.
Hakulinenandothersalsoincludedintheiranalysistwosubcategoriesfor
infectious andparasitic diseases: diarrhea, gastritis, andenteritis; andinflueiiza,
pnexunonia,andbronchitis.Onlythediarrheasubcategoryismaintainedasaspecific
cause. The second subcategory is further refined into infectious and chronic
components.Othersubcategoriesforspecificcausesofdeath(Table1)werechosento
breakupthethreelargestofthemajorcategories—iiifectiousandparasiticdiseases,
drcuiatorysystemdiseases,andothercauses.Subcategorieswerechosenmainlyfor
substantiveinterest.Thediarrheasubcategoryisduplicatedamongthesespecificcauses,
but the influenza, pneumonia, andbronchitis subcategory is replacedby otheis
somewhatmorespedfic.Thesebreakdownsalsoallowdistinctionofthespecificcauses
justnotedthatfitawkwardlyintothemajorcategories.
Among the specific causes, not all could be defined with precision. For
micronutrientdisorders,forinstance,thecodesselectedfromtherevisioncurrentlyin
uCsaeus(etsheonfiDnteha)thof(tIhCeD-I9n;teWrnHatOion1a9l77S)tawtiesrtiecatlhColsaessfiofricdaitsioonrdoefrsDiosfeatshees,diIynfjouiridesg,laannd,d
anaemias,andavitaminosis.Thisgroupofcausesmaybebothtoobroadandtoonarrow
indifferentways,butfurtherspecificationwasnotpossible.
Dataoncausesofdeath
Gass^'IcSatattiiosnticosfoDinsecaasuessesaroefpdreoavtihd,edbyannsueaxllayndtoagWe,HObasbeydsoonmeth7e0Icnotuenmtartiieositoarl
territories.Inprindple,thecauseofdeathretvimsshouldbecomparablebetween
countriessincetheyarebasedonacommonsetofproceduresforcodingandcertifying
thecauseofdeath.Inpractice,however,thecomparabilityofdataacrosscountriesis
affectedbyvariationsindiagnosticpreferences,culturalfactors,medicaltraining,the
availabilityofdiagnosticaids,andotherfactors.
Inaddition,thereliabilityofnationalcauseofdeathstatisticsisamatterof
concern.Broadlyspeaking,reliabilitydependsoncoverageandquality.Deathsnot
coveredbythevitalregistrationsystemaremostlikelythoseinmoreremoteareaswith
acauseofdeathstructuretypic^ofhighmortalitypopulations.Thuscountrieswith
incompletecoveragearelikelytoreportacauseofdeadistructurebiasedtowardsthe
chronic diseases pattern morecommonly found inurban areas; the greaterthe
incompleteness,themorebiasedthedataarelikelytobe.However,ofevengreater
significancewiUirespecttoreliabilityistheextentofmedicalcertificationofthecause
ofdeath,whichensuresdataquauty.Inremoteareaswithfewifanyphysidaits,cause
ofdeathisfrequentlycertifiedbylaypersonnelwhohavelittleornomedicaltraining.
Diagnosisisuncertainandmanydeathsmaybecodedtos}miptomsandill-defined
conditions.