Lecture Lecture 33

Natural movement of the population. Natural movement of the population. Death rate, its principal causes.Death rate, its principal causes.

Measurement of mortalityMeasurement of mortality• The elementary and absolute indicator of health is its The elementary and absolute indicator of health is its

full absence, or death. The primary document for full absence, or death. The primary document for death registration is «The Medical certificate of death registration is «The Medical certificate of death». The whole state statistics begins with this death». The whole state statistics begins with this document. The modern demography originates from document. The modern demography originates from the researches of English doctor J. Grount in 1662. He the researches of English doctor J. Grount in 1662. He analysed certificates of death and birth at various analysed certificates of death and birth at various areas of London with sex and age distribution of the areas of London with sex and age distribution of the dead.dead.

• In the majority of countries of the world the extract In the majority of countries of the world the extract from a death certificate is obligatory, it is made by the from a death certificate is obligatory, it is made by the doctor prior to a burial or cremation, with indication doctor prior to a burial or cremation, with indication of a cause of deathof 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 For the first time the International classification of

illnesses has been accepted to general use in 1910 in illnesses has been accepted to general use in 1910 in Paris. Then the decision was made to reconsider and Paris. Then the decision was made to reconsider and specify it every 10 years. specify it every 10 years.

• The last International classification of illnesses of the The last International classification of illnesses of the tenth revision, acting in the world since 1989, contains tenth revision, acting in the world since 1989, contains 21 class of illnesses. Each class describes a considerable 21 class of illnesses. Each class describes a considerable quantity of nosologic units and pathological conditions.quantity of nosologic units and pathological conditions.

• Classes are subdivided into three-value columns which Classes are subdivided into three-value columns which are in turn divided into four-unit columns, and in three are in turn divided into four-unit columns, and in three classes five-unit columns are introduced. As a matter of classes five-unit columns are introduced. As a matter of fact, the International classification of illnesses is the fact, the International classification of illnesses is the international standard ordered diagnostic classification, international standard ordered diagnostic classification, both for public health services system, and for the state both for public health services system, and for the state as a whole, but it works only in the countries which are as a whole, but it works only in the countries which are members of the World Health Organisation.members of the World Health Organisation.

International Death Certificate• The basis of mortality data is Death Certificate. So we The basis of mortality data is Death Certificate. So we

first look at death certification for ascertaining the first look at death certification for ascertaining the frequency of disease in a population. For ensuring frequency of disease in a population. For ensuring national and international comparability, it is very national and international comparability, it is very necessary to have a uniform and standardized system of necessary to have a uniform and standardized system of recording and classifying deaths.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 ratiosThe 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,The general indicator - death rate,•Special indicators of death rate Special indicators of death rate ((age and sex specific death age and sex specific death rates, monthly and weekly death raterates, monthly and weekly death rate).).

The crude death rate is calculated from the formula:

1000populationyear - Mid

year the during deaths ofNumber rate Death

Estimation of levels of death rate is made on the following scale

Death rate level Death rate per 1000 persons rate per 1000 persons

Low 10 ‰ and less

Average 11 - 15

High 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 Death rate

1970 2005

Angola, Zambia 29 24Bangladesh 21 8Pakistan 23 10Nepal 22 10Ethiopia, Ukraine 15 16Australia, Japan 10 7China 8 7Macedonia, Spain, India 11 9Russian Federation 8 16Italy, Greece, Portugal 11 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 The analysis of dynamics of death rate in Russia death rate in Russia population shows, that, population shows, that, beginning with the 1990th, beginning with the 1990th, the death rate has kept the the death rate has kept the tendency to growth up to tendency to growth up to 2005. Further the level of 2005. Further the level of the general death rate has the general death rate has decreased a little. decreased a little.

The leading causes of death in the world• The most typical feature of the twentieth century is sharp The most typical feature of the twentieth century is sharp

decrease of death rate due to infectious diseases and the decrease of death rate due to infectious diseases and the increasing part of chronic diseases in the structure of the increasing part of chronic diseases in the structure of the reasons of the general death rate. Thus, if at the beginning of reasons of the general death rate. Thus, if at the beginning of the twentieth century infectious diseases were one of leading the twentieth century infectious diseases were one of leading causes of death then the last decade their share has made less causes of death then the last decade their share has made less than 1%. than 1%.

• CCardiovascular diseases are the number one cause of deathardiovascular diseases are the number one cause of death in in the world.the world. An estimated 17.5 million people died from An estimated 17.5 million people died from cardiovascular disease in 2005, representing 30 % of all global cardiovascular disease in 2005, representing 30 % of all global deaths. deaths. Second and third are cancer and traumas. Chronic Second and third are cancer and traumas. Chronic obstructive pulmonary diseases take now the fourth places of obstructive pulmonary diseases take now the fourth places of the reasons of death rate.the reasons of death rate.

• In short, the chronic noncommunicable diseases and conditions In short, the chronic noncommunicable diseases and conditions have now supplanted acute infections as the major cause of have now supplanted acute infections as the major cause of illness. illness.

The leading causes of death in developing countriesThe 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 About 25 per cent of total deaths are attributed to infectious and parasitic diseases in India.and parasitic diseases in India.

Structure of the death

rate reasons in Russia 9%

56%14%

13%

4%4%

Blood circulation system diseases malignant neoplasm’s traumasrespiratory 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 Among the unused reserves of death rate decrease

there are curable diseases, coronary heart disease, there are curable diseases, coronary heart disease, tuberculosis and preventable diseases. From the point tuberculosis and preventable diseases. From the point of view of ability to influence on a death rate all causes of view of ability to influence on a death rate all causes of death can be divided into groups: the reasons, death of death can be divided into groups: the reasons, death rate from which to certain age can be prevented by the rate from which to certain age can be prevented by the system of public health services itself (curable system of public health services itself (curable illnesses), and death rate from which can be prevented illnesses), and death rate from which can be prevented on the basis of social policy measures with the on the basis of social policy measures with the assistance of public health services system (the assistance of public health services system (the preventable reasons). Coronary heart disease (CHD), preventable reasons). Coronary heart disease (CHD), and tuberculosis, including its remote consequences, and tuberculosis, including its remote consequences, singled out into independent groups are referred to singled out into independent groups are referred to curable illnesses. curable illnesses.

The reserves of death rate decrease• Among curable diseases there are the majority of Among curable diseases there are the majority of

children's infections and many acute infections, a children's infections and many acute infections, a number of new growths, including leukemia, number of new growths, including leukemia, diabetes and some other endocrine diseases, all diabetes and some other endocrine diseases, all respiratory diseases, appendicitis, a hernia of respiratory diseases, appendicitis, a hernia of abdominal cavity and some other gastrointestinal abdominal cavity and some other gastrointestinal diseases, nephrite, congenital heart anomalies.diseases, nephrite, congenital heart anomalies.

• Malignant neoplasms of a trachea, bronchial tubes Malignant neoplasms of a trachea, bronchial tubes and lungs (they do not occur up to 15 years of age), and lungs (they do not occur up to 15 years of age), accidental alcoholic poisonings, a road and transport accidental alcoholic poisonings, a road and transport traumatism, and AIDS form the number of traumatism, and AIDS form the number of preventable reasons of death rate. 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) × 1000Average 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

20,4

3,1 510,2

22,9

36,8

56,2

78,6

103,2

16,32,61,2

73,82,91,91,80

20

40

60

80

100

120

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 The leading reason of death rate of able-bodied population is traumas and poisonings which push aside population is traumas and poisonings which push aside cardiovascular diseases and neoplasm’s to the second cardiovascular diseases and neoplasm’s to the second and third place. and third place.

• When analyzing the death rate of able-bodied When analyzing the death rate of able-bodied population of Russia special alarm is caused by the population of Russia special alarm is caused by the frequency increase of fatal outcomes due to such classes frequency increase of fatal outcomes due to such classes of preventable reasons, as gastrointestinal diseases, some of preventable reasons, as gastrointestinal diseases, some infectious and parasitic diseases, respiratory diseases.infectious and parasitic diseases, respiratory diseases.

Age-specific death rate indicators at infancy, adolescence, Age-specific death rate indicators at infancy, adolescence, and youthful ageand 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 Age (years)

1-4 5-9 10-14 15-19

Infectious diseases 8.0 0.7 0.8 1.9

Neoplasm 8.7 6.56.5 6.06.0 8.28.2

Blood circulation diseases 1.1 0.8 1.2 5.05.0

Respiratory diseases 15.415.4 2.0 1.8 2.8

Gastrointestinal diseases 1.4 0.5 0.6 1.6

Traumas and poisoningsTraumas and poisonings 44,944,9 33.833.8 32.832.8 109.6109.6

Total 108.0 57.0 49.7 114.0

Reproduction of the population in the countryReproduction 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 Natality = the general indicator of birth rate – the general

indicator of death rateindicator 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.