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Nabukalu D, Yiannoutsos CT, Semeere A, Musick BS, Murungi T, Namulindwa JV, Waswa F, Nakigozi G, Sewankambo NK, Reynolds SJ, Lutalo T, Makumbi F, Kigozi G, Nalugoda F, Wools-Kaloustian K. Mortality Among HIV-Infected Adults on Antiretroviral Therapy in Southern Uganda. J Acquir Immune Defic Syndr 2024; 95:268-274. [PMID: 38408217 PMCID: PMC10898547 DOI: 10.1097/qai.0000000000003330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/24/2023] [Indexed: 02/28/2024]
Abstract
BACKGROUND Monitoring and evaluation of clinical programs requires assessing patient outcomes. Numerous challenges complicate these efforts, the most insidious of which is loss to follow-up (LTFU). LTFU is a composite outcome, including individuals out of care, undocumented transfers, and unreported deaths. Incorporation of vital status information from routine patient outreach may improve the mortality estimates for those LTFU. SETTINGS We analyzed routinely collected clinical and patient tracing data for individuals (15 years or older) initiating antiretroviral treatment between January 2014 and December 2018 at 2 public HIV care clinics in greater Rakai, Uganda. METHODS We derived unadjusted mortality estimates using Kaplan-Meier methods. Estimates, adjusted for unreported deaths, applied weighting through the Frangakis and Rubin method to represent outcomes among LTFU patients who were successfully traced and for whom vital status was ascertained. Confidence intervals were determined through bootstrap methods. RESULTS Of 1969 patients with median age at antiretroviral treatment initiation of 31 years (interquartile range: 25-38), 1126 (57.2%) were female patients and 808 (41%) were lost. Of the lost patients, 640 patient files (79.2%) were found and reviewed, of which 204 (31.8%) had a tracing attempt. Within the electronic health records of the program, 28 deaths were identified with an estimated unadjusted mortality 1 year after antiretroviral treatment initiation of 2.5% (95% CI: 1.8% to 3.3%). Using chart review and patient tracing data, an additional 24 deaths (total 52) were discovered with an adjusted 1-year mortality of 3.8% (95% CI: 2.6% to 5.0%). CONCLUSIONS Data from routine outreach efforts by HIV care and treatment programs can be used to support plausible adjustments to estimates of client mortality. Mortality estimates without active ascertainment of vital status of LTFU patients may significantly underestimate program mortality.
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Affiliation(s)
| | | | - Aggrey Semeere
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | | | | | | | | | | | - Nelson K. Sewankambo
- Makerere University College of Health Sciences, School of Medicine, Kampala, Uganda
| | - Steven J. Reynolds
- Division of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
- Johns Hopkins University School of Medicine, Baltimore, MD; and
| | - Tom Lutalo
- Rakai Health Sciences Program, Rakai, Uganda
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Tidière M, Colchero F, Staerk J, Adkesson MJ, Andersen DH, Bland L, Böye M, Brando S, Clegg I, Cubaynes S, Cutting A, De Man D, Derocher AE, Dorsey C, Elgar W, Gaglione E, Anderson Hansen K, Jungheim A, Kok J, Laule G, Goya AL, Miller L, Monreal-Pawlowsky T, Mucha K, Owen MA, Petersen SD, Pilfold N, Richardson D, Richardson ES, Sabo D, Sato N, Shellabarger W, Skovlund CR, Tomisawa K, Trautwein SE, Van Bonn W, Van Elk C, Von Fersen L, Wahlberg M, Zhang P, Zhang X, Conde DA. Survival improvements of marine mammals in zoological institutions mirror historical advances in human longevity. Proc Biol Sci 2023; 290:20231895. [PMID: 37848064 PMCID: PMC10581765 DOI: 10.1098/rspb.2023.1895] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 09/21/2023] [Indexed: 10/19/2023] Open
Abstract
An intense public debate has fuelled governmental bans on marine mammals held in zoological institutions. The debate rests on the assumption that survival in zoological institutions has been and remains lower than in the wild, albeit the scientific evidence in support of this notion is equivocal. Here, we used statistical methods previously applied to assess historical improvements in human lifespan and data on 8864 individuals of four marine mammal species (harbour seal, Phoca vitulina; California sea lion, Zalophus californianus; polar bear, Ursus maritimus; common bottlenose dolphin, Tursiops truncatus) held in zoos from 1829 to 2020. We found that life expectancy increased up to 3.40 times, and first-year mortality declined up to 31%, during the last century in zoos. Moreover, the life expectancy of animals in zoos is currently 1.65-3.55 times longer than their wild counterparts. Like humans, these improvements have occurred concurrently with advances in management practices, crucial for population welfare. Science-based decisions will help effective legislative changes and ensure better implementation of animal care.
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Affiliation(s)
- Morgane Tidière
- Interdisciplinary Centre on Population Dynamics (CPop), University of Southern Denmark, Odense, Denmark
- Department of Biology, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark
- Conservation and Science Department, Species360, 7900 International Drive, Suite 300, Minneapolis, MN 55425, USA
| | - Fernando Colchero
- Interdisciplinary Centre on Population Dynamics (CPop), University of Southern Denmark, Odense, Denmark
- Department of Mathematics and Computer Science, University of Southern Denmark, Odense, Denmark
- Department of Primate Behavior and Evolution, Max Planck Institute for Evolutionary Anthropology, Deutscher Pl. 6, 04103 Leipzig, Germany
| | - Johanna Staerk
- Interdisciplinary Centre on Population Dynamics (CPop), University of Southern Denmark, Odense, Denmark
- Department of Biology, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark
- Conservation and Science Department, Species360, 7900 International Drive, Suite 300, Minneapolis, MN 55425, USA
| | | | - Ditte H. Andersen
- Department of Biology, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark
| | - Lucie Bland
- Conservation and Science Department, Species360, 7900 International Drive, Suite 300, Minneapolis, MN 55425, USA
- Eureka Publishing, Thornbury, Australia
| | - Martin Böye
- Centre de Recherche et d'Etude pour l'Animal Sauvage, Planète Sauvage, 44710 Port Saint Pere, France
| | - Sabrina Brando
- AnimalConcepts, PO Box 378, 03725 Teulada, Alicante, Spain
| | - Isabella Clegg
- Animal Welfare Expertise, The Knoll, Woodlands, Combe Martin, EX34 0ATLittleton Manor, Winchester SO22 6QU, UK
| | - Sarah Cubaynes
- CEFE, Univ Montpellier, CNRS, EPHE-PSL University, IRD, Montpellier, France
| | - Amy Cutting
- Polar Bear International, PO Box 3008, Bozeman, MT, USA
| | - Danny De Man
- European Association of Zoos and Aquaria (EAZA), Plantage Middelaan 45, 1018-DC Amsterdam, The Netherlands
| | - Andrew E. Derocher
- Department of Biological Sciences, University of Alberta; Edmonton, Alberta, Canada T6G 2E9
| | - Candice Dorsey
- Association of Zoos and Aquariums, 8403 Colesville Road Ste 710, Silver Spring, MD 20910, USA
| | - William Elgar
- Zoo Miami, 12400 SW 152 Street, Miami, FL 33177, USA
| | - Eric Gaglione
- Georgia Aquarium, 225 Baker Street, Atlanta, GA 30313, USA
| | - Kirstin Anderson Hansen
- Department of Biology, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark
- Marine Biological Research Center, University of Southern Denmark, Hindsholmvej 11, 5300 Kerteminde, Denmark
| | - Allison Jungheim
- Como Park Zoo and Conservatory, 1225 Estabrook Dr., Saint Paul, MN 55103, USA
| | - José Kok
- Ouwehands Zoo, Grebbeweg 111, 3911 AV Rhenen, The Netherlands
| | - Gail Laule
- Mandai Wildlife Group, 80 Mandai Lake Road, Singapore 729826
| | | | - Lance Miller
- Chicago Zoological Society, Brookfield Zoo, Brookfield, IL, USA
| | | | - Katelyn Mucha
- Conservation and Science Department, Species360, 7900 International Drive, Suite 300, Minneapolis, MN 55425, USA
| | - Megan A. Owen
- San Diego Zoo Wildlife Alliance, 15600 San Pasqual Valley Rd., Escondido, CA, USA
| | | | - Nicholas Pilfold
- San Diego Zoo Wildlife Alliance, 15600 San Pasqual Valley Rd., Escondido, CA, USA
| | - Douglas Richardson
- Zoological Consultancy Ltd, Columba Cottage, Mill Rd, Kingussie PH21 1LF, UK
- EAZA Polar Bear EEP, Amsterdam, Netherlands
| | - Evan S. Richardson
- Environment and Climate Change Canada, Unit 150–234 Donald Street, Winnipeg, Manitoba R3C 1M8, Canada
| | - Devon Sabo
- Columbus Zoo and Aquarium, 4850 W. Powell Road, PO Box 400, Powell, OH 43065-0400, USA
| | - Nobutaka Sato
- Asahiyama Zoological Park, Kuranuma, Higasiasahikawacho, Asahikawa city, Japan
| | | | - Cecilie R. Skovlund
- Conservation, Copenhagen Zoo, Roskildevej 38, 2000 Frederiksberg, Denmark
- Section of Animal Welfare and Disease Control, Department of Veterinary and Animal Sciences, University of Copenhagen, Grønnegårdsvej 8, 1870 Frederiksberg, Denmark
| | - Kanako Tomisawa
- Omuta City Zoo, 163 Showa-machi, Omuta, Fukuoka 836-0871, Japan
| | - Sandra E. Trautwein
- Conservation and Science Department, Species360, 7900 International Drive, Suite 300, Minneapolis, MN 55425, USA
| | - William Van Bonn
- A. Watson Armour III, Center for Animal Health and Welfare, Animal Care and Science Division, John G. Shedd Aquarium, Chicago, IL 60605, USA
| | - Cornelis Van Elk
- Independent practitioner, Arendsweg 98, Enschede 7544RM, The Netherlands
| | | | - Magnus Wahlberg
- Department of Biology, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark
- Marine Biological Research Center, University of Southern Denmark, Hindsholmvej 11, 5300 Kerteminde, Denmark
| | - Peijun Zhang
- Mammal and Marine Bioacoustics Laboratory Institute of Deep-sea Science and Engineering, Chinese Academy of Sciences, Sanya 572000, People's Republic of China
| | - Xianfeng Zhang
- Institute of Hydrobiology, Chinese Academy of Sciences, Wuhan 430072, People's Republic of China
| | - Dalia A. Conde
- Interdisciplinary Centre on Population Dynamics (CPop), University of Southern Denmark, Odense, Denmark
- Department of Biology, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark
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Manivannan S, Subramanyam B. Contact Efficacy of Two Amorphous Silica Powders against the Red Flour Beetle, Tribolium castaneum (Herbst) (Coleoptera: Tenebrionidae). Insects 2023; 14:833. [PMID: 37999032 PMCID: PMC10671609 DOI: 10.3390/insects14110833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/13/2023] [Accepted: 10/20/2023] [Indexed: 11/25/2023]
Abstract
The contact efficacy of two amorphous silica powders 1 and 2 procured from Imery's chemicals, Lompoc, CA, USA, were evaluated against the red flour beetle, Tribolium castaneum (Herbst). The efficacy of the silica two powders was evaluated by exposing 10 adults of T. castaneum to twelve different concentrations of silica powder 1 and 2 for 12, 24, 36, and 48 h. Mortality assessments were made after 14 d, and data on adult progeny production were recorded at 42 d. Complete mortality of T. castaneum was observed when adults were exposed for 36 h to concentrations of 1.5 to 5 g/m2 of silica powder 1. Conversely, in tests with silica powder 2, complete mortality was only achieved when adults were exposed for 48 h to concentrations ranging from 0.75 to 5 g/m2. Silica powder 1 exhibited greater efficacy in inhibiting adult progeny production in T. castaneum, particularly at a concentration of 2.0 g/m2 after 24 h exposure. Overall, silica powder 1 displayed superior performance in terms of adult mortality and the suppression of T. castaneum adult progeny production. This advantage can be attributed to the smaller particle size of silica powder 1 when compared to silica powder 2.
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Affiliation(s)
- Selladurai Manivannan
- Department of Grain Science and Industry, Kansas State University, Manhattan, KS 66506, USA;
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Abstract
The study aimed at finding the risk factors associated with adult mortality (15-59 years) due to external causes (accidents, suicide, poisoning, homicide, and violence). Using National Family Health Survey data-4 consisting of 1,756,867 sample, we applied a Robust Poisson Regression Model to determine the potential risk factors. Findings suggest that the highest proportion of deaths due to external causes was in the age group 20-24 years. The prevalence of these deaths was higher among older adults (age 50 years and above). The risk was more among males (Incident Rate Ratio (IRR) for females is: 0.29, p < 0.001), rural residents (IRR: 1.16, p < 0.001), exposed to mass-media (IRR: 1.08, p < 0.05), residing in female-headed households, in households having a member with higher education. This risk decreased for large families (IRR: 0.89, p < .001). A need to strengthen awareness and mentorship programs for young-adults and middle-aged people to control such avoidable deaths is recommended.
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Affiliation(s)
- Apyayee Sil
- Department of Mathematical Demography and Statistics, International Institute for Population Sciences, Mumbai, India
| | - Arpan Sil
- Symbiosis Statistical Institute, Symbiosis International University, Pune, India
| | - Preeti Dhillon
- Department of Mathematical Demography and Statistics, International Institute for Population Sciences, Mumbai, India
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Otiende M, Bauni E, Nyaguara A, Amadi D, Nyundo C, Tsory E, Walumbe D, Kinuthia M, Kihuha N, Kahindi M, Nyutu G, Moisi J, Deribew A, Agweyu A, Marsh K, Tsofa B, Bejon P, Bottomley C, Williams TN, Scott JAG. Mortality in rural coastal Kenya measured using the Kilifi Health and Demographic Surveillance System: a 16-year descriptive analysis. Wellcome Open Res 2023; 6:327. [PMID: 37416502 PMCID: PMC10320326 DOI: 10.12688/wellcomeopenres.17307.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 10/30/2023] Open
Abstract
Background: The Kilifi Health and Demographic Surveillance System (KHDSS) was established in 2000 to define the incidence and prevalence of local diseases and evaluate the impact of community-based interventions. KHDSS morbidity data have been reported comprehensively but mortality has not been described. This analysis describes mortality in the KHDSS over 16 years. Methods: We calculated mortality rates from 2003-2018 in four intervals of equal duration and assessed differences in mortality across these intervals by age and sex. We calculated the period survival function and median survival using the Kaplan-Meier method and mean life expectancies using abridged life tables. We estimated trend and seasonality by decomposing a time series of monthly mortality rates. We used choropleth maps and random-effects Poisson regression to investigate geographical heterogeneity. Results: Mortality declined by 36% overall between 2003-2018 and by 59% in children aged <5 years. Most of the decline occurred between 2003 and 2006. Among adults, the greatest decline (49%) was observed in those aged 15-54 years. Life expectancy at birth increased by 12 years. Females outlived males by 6 years. Seasonality was only evident in the 1-4 year age group in the first four years. Geographical variation in mortality was ±10% of the median value and did not change over time. Conclusions: Between 2003 and 2018, mortality among children and young adults has improved substantially. The steep decline in 2003-2006 followed by a much slower reduction thereafter suggests improvements in health and wellbeing have plateaued in the last 12 years. However, there is substantial inequality in mortality experience by geographical location.
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Affiliation(s)
- Mark Otiende
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Evasius Bauni
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Amek Nyaguara
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - David Amadi
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Christopher Nyundo
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Emmanuel Tsory
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - David Walumbe
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Michael Kinuthia
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Norbert Kihuha
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Michael Kahindi
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Gideon Nyutu
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Jennifer Moisi
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Amare Deribew
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Ambrose Agweyu
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Kevin Marsh
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Benjamin Tsofa
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Philip Bejon
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Christian Bottomley
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Thomas N. Williams
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - J. Anthony G. Scott
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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Palloni A, Beltrán-Sánchez H, Pinto G. Estimation of older- adult mortality from information distorted by systematic age misreporting. Popul Stud (Camb) 2021; 75:403-420. [PMID: 34002662 DOI: 10.1080/00324728.2021.1918752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Testing theories about human senescence and longevity demands accurate information on older-adult mortality; this is rare in low- to middle-income countries where raw data may be distorted by defective completeness and systematic age misreporting. For this reason, such populations are frequently excluded from empirical tests of mortality and longevity theories, thus limiting their reach, as they reflect only a small and selected human mortality experience. In this paper we formulate an integrated method to compute estimates of older-adult mortality when vital registration and population counts are defective due to inaccurate coverage and/or systematic age misreporting. The procedure is validated with a simulation study that identifies a strategy to compute adjustments, which, under some assumptions, performs quite well. While the paper focuses on Latin American and Caribbean countries, the method is quite general and, with additional information and some model reformulation, could be applied to other populations with similar problems.
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Masquelier B, Kanyangarara M, Pison G, Kanté AM, Ndiaye CT, Douillot L, Duthé G, Sokhna C, Delaunay V, Helleringer S. Errors in reported ages and dates in surveys of adult mortality: A record linkage study in Niakhar (Senegal). Popul Stud (Camb) 2021; 75:269-287. [PMID: 33390060 DOI: 10.1080/00324728.2020.1854332] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Sibling survival histories are a major source of adult mortality estimates in countries with incomplete death registration. We evaluate age and date reporting errors in sibling histories collected during a validation study in the Niakhar Health and Demographic Surveillance System (Senegal). Participants were randomly assigned to either the Demographic and Health Survey questionnaire or a questionnaire incorporating an event history calendar, recall cues, and increased probing strategies. We linked 60-62 per cent of survey reports of siblings to the reference database using manual and probabilistic approaches. Both questionnaires showed high sensitivity (>96 per cent) and specificity (>97 per cent) in recording siblings' vital status. Respondents underestimated the age of living siblings, and age at and time since death of deceased siblings. These reporting errors introduced downward biases in mortality estimates. The revised questionnaire improved reporting of age of living siblings but not of age at or timing of deaths.
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Affiliation(s)
- Bruno Masquelier
- Université catholique de Louvain.,Institut national d'études démographiques
| | | | - Gilles Pison
- Institut national d'études démographiques.,French Museum of Natural History
| | | | | | | | | | - Cheikh Sokhna
- VITROME, Institut de recherche pour le développement
| | - Valérie Delaunay
- LPED, Institut de recherche pour le développement, Aix Marseille Univ
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Abstract
OBJECTIVES To assess disparities in mortality by socioeconomic status in Germany. DESIGN AND PARTICIPANTS We analyse a large administrative dataset of the German Pension Fund (DRV), including 27 million person-years of exposure and 42 000 deaths in 2013. The data cover the economically active population, stratified by sex and by East and West. OUTCOME MEASURES Age-standardised mortality rates and Poisson regression mortality rate ratios (MRRs). RESULTS The risk of dying increases with decreasing income: the MRRs of the lowest to the highest income quintile are 4.66 (95% CI 4.48 to 4.85) among men and 3.06 (95% CI 2.90 to 3.23) among women. The impact of income attenuates after controlling for education and other explanatory variables, especially for females. In the fully controlled model for females, individual income is a weaker predictor of mortality, but there is a clear educational mortality gradient. In the fully controlled model, the MRRs of the unemployed to the employed are 2.09 (95% CI 2.03 to 2.15) among men and 2.01 (95% CI 1.92 to 2.10) among women. The risk of dying is around half as high among foreigners as among German citizens. The socioeconomic disparities are greater among East than West German men. CONCLUSIONS Low socioeconomic status is a major determinant of excess adult mortality in Germany. The persisting East-West differences in male adult mortality can be explained by the higher socioeconomic status of men living in the West, rather than by contextual differences between East and West. These differences can be further monitored using DRV data.
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Affiliation(s)
- Pavel Grigoriev
- Max Planck Institute for Demographic Research, Rostock, Germany
| | | | - Vladimir M Shkolnikov
- Max Planck Institute for Demographic Research, Rostock, Germany
- National Research University Higher School of Economics, Moscow, Russian Federation
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Chisumpa VH, Odimegwu CO, Saikia N. Adult mortality in sub-Saharan Africa: cross-sectional study of causes of death in Zambia. Trop Med Int Health 2019; 24:1208-1220. [PMID: 31420929 DOI: 10.1111/tmi.13302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To describe the age-sex pattern and socio-economic differentials in causes of death among adults between the ages of 15 and 59 years in Zambia. METHODS Using data from the 2010-2012 Zambia sample vital registration with verbal autopsy survey, we calculated the percentage share of causes of death, the age-/sex cause-specific death ratio and cause-eliminated life expectancy at age 15. RESULTS HIV/AIDS was the leading cause of death across all socio-economic subgroups contributing 40.7% of total deaths during the study period. This was followed by deaths due to injury and accidents (11.2%). Cause-specific death ratios due to HIV/AIDS increased by age and peaked in the 35-39 age group and were higher among females than males. The second-leading cause of death was injuries and accidents for males and tuberculosis for females. The third-leading cause of death was cardiovascular diseases for females and tuberculosis for males. Cause of death patterns varied notably by socio-economic characteristics. Deaths attributable to non-communicable diseases were more evident in adults aged 45-59 years. Eliminating HIV/AIDS in Zambia as a cause of death could raise life expectancy at age 15 by 5.7 years for males and by 6.4 years for females. CONCLUSION HIV/AIDS-related health programmes and interventions should be further supported and strengthened, as they would significantly contribute to the reduction in adult mortality in Zambia.
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Affiliation(s)
- Vesper H Chisumpa
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Population Studies, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia
| | - Clifford O Odimegwu
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nandita Saikia
- School of Social Sciences, Centre for the Study of Regional Development, Jawaharlal Nehru University, New Delhi, India.,International Institute for Applied Systems Analysis, Laxenburg, Austria
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Abstract
Existing estimates of mortality for Papua New Guinea (PNG) have primarily been based on models using little empirical data, and without estimation of life expectancy at subnational level. We used data on deaths from the 2000 and 2011 censuses and indirect demographic methods to estimate under-5 mortality (5q0), adult mortality (45q15), and life expectancy by province and sex. A Socioeconomic Composite Index was constructed to assess the plausibility of life expectancy estimates. We generated 5q0 estimates (68 per 1000 live births for males and 58 for females), 45q15 (269 per 1000 for males and 237 for females), and life expectancy (62.0 years for males and 64.3 for females) in PNG in 2011. Provinces with low life expectancy had correspondingly low levels of development as measured by the Composite Index, and vice versa. These subnational estimates of mortality levels and patterns maybe useful at the provincial level to improve population health in PNG.
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Affiliation(s)
- Urarang Kitur
- 1 University of Melbourne, Carlton, Victoria, Australia
| | - Tim Adair
- 1 University of Melbourne, Carlton, Victoria, Australia
| | - Alan D Lopez
- 1 University of Melbourne, Carlton, Victoria, Australia
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11
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Todd N, Valleron AJ, Bougnères P. Prenatal loss of father during World War One is predictive of a reduced lifespan in adulthood. Proc Natl Acad Sci U S A 2017; 114:4201-6. [PMID: 28377521 DOI: 10.1073/pnas.1617911114] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Although early-life stress is known to alter health, its long-term consequences on mortality remain largely unknown. Thanks to unique French legislation established in 1917 for war orphans and children of disabled soldiers, we were able to study the adult mortality of individuals born in 1914-1916 whose fathers were killed during World War 1. Vital information and socio-demographic characteristics were extracted manually from historical civil registers for 5,671 children born between 1 August 1914 and 31 December 1916 who were granted the status of "pupille de la Nation" (orphan of the Nation). We used a database comprising 1.4 million deceased soldiers to identify war orphans and collect information on their fathers and then paired each orphan with a nonorphan from the same birth register matched for date of birth, sex, and mother's age at the infant's birth. Mortality between ages 31 and 99 y was analyzed for 2,365 orphan/nonorphan pairs. The mean loss of adult lifespan of orphans who had lost their father before birth was 2.4 y (95% CI: 0.7, 3.9 y) and was the result of increased mortality before age 65 y. Adult lifespan was not reduced when the father's death occurred after the infant's birth. These results support the notion that intrauterine exposure to a major psychological maternal stress can affect human longevity.
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12
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Abstract
Mounting evidence suggests that early-life conditions have an enduring effect on an individual's mortality risks as an adult. The contribution of improvements in early-life conditions to the overall decline in adult mortality, however, remains a debated issue. We provide an estimate of the contribution of improvements in early-life conditions to mortality decline after age 30 in Dutch cohorts born between 1812 and 1921. We used two proxies for early-life conditions: median height and early-childhood mortality. We estimate that improvements in early-life conditions contributed more than five years or about a third to the rise in women's life expectancy at age 30. Improvements in early-life conditions contributed almost three years or more than a quarter to the rise in men's life expectancy at age 30. Height appears to be the more important of the two proxies for early-life conditions.
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13
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Abstract
The last century in Brazil was witness to profound changes. Female life expectancy at birth increased from 34.6 years in 1910 to 77.26 years in 2010. At the same time, the educational composition of the population has changed dramatically. In the 1940s, only 25% of the children aged 5-14 years old were enrolled in school. Currently, nearly all children attend school. We examine the extent to which changes in the age-specific distribution of education have contributed to the decline in adult mortality among women in Brazil. Our analysis follows other applications in the literature to measure the mortality reduction that would occur if exposure to specific risk factors was changed at the counterfactual level. The effects are not trivial: Between 1960 and 2010, about 38% of the increase in life expectancy at age 30 can be attributed to changes in the educational composition of women. An additional 22% increase is expected until 2040.
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Affiliation(s)
- Cassio M Turra
- Department of Demography, Cedeplar, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | - Raquel Guimarães
- Economics Department, Federal University of Paraná, Curitiba, Brazil
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14
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Abstract
Mortality in the United States is 18% higher than in Costa Rica among adult men and 10% higher among middle-aged women, despite the several times higher income and health expenditures of the United States. This comparison simultaneously shows the potential for substantially lowering mortality in other middle-income countries and highlights the United States' poor health performance. The United States' underperformance is strongly linked to its much steeper socioeconomic (SES) gradients in health. Although the highest SES quartile in the United States has better mortality than the highest quartile in Costa Rica, US mortality in its lowest quartile is markedly worse than in Costa Rica's lowest quartile, providing powerful evidence that the US health inequality patterns are not inevitable. High SES-mortality gradients in the United States are apparent in all broad cause-of-death groups, but Costa Rica's overall mortality advantage can be explained largely by two causes of death: lung cancer and heart disease. Lung cancer mortality in the United States is four times higher among men and six times higher among women compared with Costa Rica. Mortality by heart disease is 54% and 12% higher in the United States than in Costa Rica for men and women, respectively. SES gradients for heart disease and diabetes mortality are also much steeper in the United States. These patterns may be partly explained by much steeper SES gradients in the United States compared with Costa Rica for behavioral and medical risk factors such as smoking, obesity, lack of health insurance, and uncontrolled dysglycemia and hypertension.
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Affiliation(s)
- Luis Rosero-Bixby
- Centro Centroamericano de Población, Universidad de Costa Rica, San José 2060, Costa Rica;
| | - William H Dow
- Centro Centroamericano de Población, Universidad de Costa Rica, San José 2060, Costa Rica; Department of Demography, University of California, Berkeley, CA 94720-2120
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15
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Abstract
Hispanics make up a rapidly growing proportion of the U.S. older adult population, so a firm grasp of their mortality patterns is paramount for identifying racial/ethnic differences in life chances in the population as a whole. Documentation of Hispanic mortality is also essential for assessing whether the Hispanic paradox--the similarity in death rates between Hispanics and non-Hispanic whites despite Hispanics' socioeconomic disadvantage--characterizes all adult Hispanics or just some age, gender, nativity, or national-origin subgroups. We estimate age-/sex- and cause-specific mortality rate ratios and life expectancy for foreign-born and U.S.-born Hispanics, foreign-born and U.S.-born Mexican Americans, non-Hispanic blacks, and non-Hispanic whites ages 65 and older using the 1989-2006 National Health Interview Survey Linked Mortality Files. Results affirm that Hispanic mortality estimates are favorable relative to those of blacks and whites, but particularly so for foreign-born Hispanics and smoking-related causes. However, if not for Hispanics' socioeconomic disadvantage, their mortality levels would be even more favorable.
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Affiliation(s)
- Joseph T. Lariscy
- Population Research Institute and Department of Sociology, Duke University, 271 Soc-Psyc Building, Campus Box 90088, Durham, NC 27708, USA,
| | - Robert A. Hummer
- Population Research Center and Department of Sociology, University of Texas at Austin, 305 E. 23rd Street, G1800, Austin, TX 78712, USA,
| | - Mark D. Hayward
- Population Research Center and Department of Sociology, University of Texas at Austin, 305 E. 23rd Street, G1800, Austin, TX 78712, USA,
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16
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Abstract
Lifespans are both shorter and more variable for blacks than for whites in the United States. Because their lifespans are more variable, there is greater inequality in length of life-and thus greater uncertainty about the future-among blacks. This study is the first to decompose the black-white difference in lifespan variability in America. Are lifespans more variable for blacks because they are more likely to die of causes that disproportionately strike the young and middle-aged, or because age at death varies more for blacks than for whites among those who succumb to the same cause? We find that it is primarily the latter. For almost all causes of death, age at death is more variable for blacks than it is for whites, especially among women. Although some youthful causes of death, such as homicide and HIV/AIDS, contribute to the black-white disparity in variance, those contributions are largely offset by the higher rates of suicide and drug poisoning deaths for whites. As a result, differences in the causes of death for blacks and whites account, on net, for only about one-eighth of the difference in lifespan variance.
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17
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Michael D, Kanjala C, Calvert C, Pretorius C, Wringe A, Todd J, Mtenga B, Isingo R, Zaba B, Urassa M. Does the Spectrum model accurately predict trends in adult mortality? Evaluation of model estimates using empirical data from a rural HIV community cohort study in North-Western Tanzania. Glob Health Action 2014; 7:21783. [PMID: 24438873 PMCID: PMC3895202 DOI: 10.3402/gha.v7.21783] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 11/29/2013] [Accepted: 12/10/2013] [Indexed: 11/14/2022] Open
Abstract
Introduction Spectrum epidemiological models are used by UNAIDS to provide global, regional and national HIV estimates and projections, which are then used for evidence-based health planning for HIV services. However, there are no validations of the Spectrum model against empirical serological and mortality data from populations in sub-Saharan Africa. Methods Serologic, demographic and verbal autopsy data have been regularly collected among over 30,000 residents in north-western Tanzania since 1994. Five-year age-specific mortality rates (ASMRs) per 1,000 person years and the probability of dying between 15 and 60 years of age (45Q15,) were calculated and compared with the Spectrum model outputs. Mortality trends by HIV status are shown for periods before the introduction of antiretroviral therapy (1994–1999, 2000–2005) and the first 5 years afterwards (2005–2009). Results Among 30–34 year olds of both sexes, observed ASMRs per 1,000 person years were 13.33 (95% CI: 10.75–16.52) in the period 1994–1999, 11.03 (95% CI: 8.84–13.77) in 2000–2004, and 6.22 (95% CI; 4.75–8.15) in 2005–2009. Among the same age group, the ASMRs estimated by the Spectrum model were 10.55, 11.13 and 8.15 for the periods 1994–1999, 2000–2004 and 2005–2009, respectively. The cohort data, for both sexes combined, showed that the 45Q15 declined from 39% (95% CI: 27–55%) in 1994 to 22% (95% CI: 17–29%) in 2009, whereas the Spectrum model predicted a decline from 43% in 1994 to 37% in 2009. Conclusion From 1994 to 2009, the observed decrease in ASMRs was steeper in younger age groups than that predicted by the Spectrum model, perhaps because the Spectrum model under-estimated the ASMRs in 30–34 year olds in 1994–99. However, the Spectrum model predicted a greater decrease in 45Q15 mortality than observed in the cohort, although the reasons for this over-estimate are unclear.
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Affiliation(s)
- Denna Michael
- Sexual and Reproductive Health Program, National Institute for Medical Research-Mwanza Center, Mwanza, Tanzania; ;
| | - Chifundo Kanjala
- Sexual and Reproductive Health Program, National Institute for Medical Research-Mwanza Center, Mwanza, Tanzania; Department of Population Health, London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Clara Calvert
- Department of Population Health, London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | | | - Alison Wringe
- Department of Population Health, London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Jim Todd
- Sexual and Reproductive Health Program, National Institute for Medical Research-Mwanza Center, Mwanza, Tanzania; Department of Population Health, London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Balthazar Mtenga
- Sexual and Reproductive Health Program, National Institute for Medical Research-Mwanza Center, Mwanza, Tanzania
| | - Raphael Isingo
- Sexual and Reproductive Health Program, National Institute for Medical Research-Mwanza Center, Mwanza, Tanzania
| | - Basia Zaba
- Department of Population Health, London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Mark Urassa
- Sexual and Reproductive Health Program, National Institute for Medical Research-Mwanza Center, Mwanza, Tanzania; Department of Population Health, London School of Hygiene and Tropical Medicine (LSHTM), London, UK
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18
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Masquelier B, Reniers G, Pison G. Divergences in trends in child and adult mortality in sub-Saharan Africa: survey evidence on the survival of children and siblings. Popul Stud (Camb) 2013; 68:161-77. [PMID: 24303913 DOI: 10.1080/00324728.2013.856458] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This paper provides an overview of trends in mortality in children aged under 5 and adults between the ages of 15 and 60 in sub-Saharan Africa, using data on the survival of the children and siblings collected in Demographic and Health Surveys. If conspicuous stalls in the 1990s are disregarded, child mortality levels have generally declined and converged over the last 30-40 years. In contrast, adult mortality in many East and Southern African countries has increased markedly, echoing earlier increases in the incidence of HIV. In recent years, adult mortality levels have begun to decline once again in East Africa, in some instances before the large-scale expansion of antiretroviral therapy programmes. More surprising is the lack of sustained improvements in adult survival in some countries that have not experienced severe HIV epidemics. Because trends in child and adult mortality do not always evolve in tandem, we argue that model-based estimates, inferred by matching indices of child survival onto standard mortality schedules, can be very misleading.
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19
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Sartorius B, Kahn K, Collinson MA, Sartorius K, Tollman SM. Dying in their prime: determinants and space-time risk of adult mortality in rural South Africa. Geospat Health 2013; 7:237-49. [PMID: 23733287 PMCID: PMC3725424 DOI: 10.4081/gh.2013.83] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
A longitudinal dataset was used to investigate adult mortality in rural South Africa in order to determine location, trends, high impact determinants and policy implications. Adult (15-59 years) mortality data for the period 1993-2010 were extracted from the health and demographic surveillance system in the rural sub-district of Agincourt. A Bayesian geostatistical frailty survival model was used to quantify significant associations between adult mortality and various multilevel (individual, household and community) variables. It was found that adult mortality significantly increased over time with a reduction observed late in the study period. Non-communicable disease mortality appeared to increase and decrease in parallel with communicable mortality, whilst deaths due to external causes remained constant. Male gender, unemployment, circular (labour) migrant status, age and gender of household heads, partner and/or other household death, low education and low household socio-economic status were identified as significant and highly attributable determinants of adult mortality. Health facility remoteness was a risk for adult mortality and households falling outside a critical buffering zone were identified. Spatial foci of higher adult mortality risk were observed, indicating a strong non-random pattern. Communicable diseases differed from non-communicable diseases with respect to spatial distribution of mortality. Areas with significant excess mortality risk (hot spots) were found to be part of a complex interaction of highly attributable factors that continues to drive differential space-time risk patterns of communicable (HIV/AIDS and tuberculosis) mortality in Agincourt. The impact of HIV mortality and its subsequent lowering due to the introduction of antiretroviral therapy was found to be clearly evident in this rural population.
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Affiliation(s)
- Benn Sartorius
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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20
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Narh-Bana SA, Chirwa TF, Mwanyangala MA, Nathan R. Adult deaths and the future: a cause-specific analysis of adult deaths from a longitudinal study in rural Tanzania 2003-2007. Trop Med Int Health 2012; 17:1396-404. [PMID: 22974416 DOI: 10.1111/j.1365-3156.2012.03080.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine patterns and risk factors for cause-specific adult mortality in rural southern Tanzania. METHODS The study was a longitudinal open cohort and focused on adults aged 15-59 years between 2003 and 2007. Causes of deaths were ascertained by verbal autopsy (VA). Cox proportion hazards regression model was used to determine factors associated with cause-specific mortality over the 5-year period. RESULTS Thousand three hundred and fifty-two of 65 548 adults died, representing a crude adult mortality rate (AMR) of 7.3 per 1000 person years of observation (PYO). VA was performed for 1132 (84%) deaths. HIV/AIDS [231 (20.4%)] was the leading cause of death followed by malaria [150 (13.2%)]. AMR for communicable disease (CD) causes was 2.49 per 1000 PYO, 1.21 per 1000 PYO for non-communicable diseases (NCD) and 0.53 per 1000 PYO for accidents/injury causes. NCD deaths increased from 16% in 2003 to 24% in 2007. High level of education was associated with a reduction in the risk of dying from NCDs. Those with primary education (HR = 0.67, 95% CI: 0.49, 0.92) and with education beyond primary school (HR = 0.11, 95% CI: 0.02, 0.40) had lower mortality than those who had no formal education. Compared with local residents, in-migrants were 1.7 (95% CI: 1.37, 2.11) times more likely to die from communicable disease causes. CONCLUSION NCDs are increasing as a result of demographic and epidemiological transitions taking place in most African countries including Tanzania and require attention to prevent increased triple disease burden of CD, NCD and accident/injuries.
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Affiliation(s)
- S A Narh-Bana
- Dodowa Health Research Centre, Accra Region, Ghana Dangme West District Health Administration, Ghana Health Service, Dodowa, Ghana Division of Epidemiology and Biostatistics, University of Witwatersrand, Johannesburg, South Africa Ifakara Health Institute, Dar es salaam, Tanzania
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21
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Abstract
In the former Soviet republics of central Asia, ethnic Russians have exhibited higher adult mortality than native ethnic groups (e.g., Kazakh, Kyrgyz, Uzbek) in spite of the higher socioeconomic status of ethnic Russians. The mortality disadvantage of ethnic Russians at adult ages appears to have even increased since the breakup of the Soviet Union. The most common explanation for this "Russian mortality paradox," is that deaths are better reported among ethnic Russians. In this study, we use detailed mortality data from Kyrgyzstan between 1959 and 1999 to evaluate various explanations for the Russian mortality paradox: data artifacts, migration effects, and cultural effects. We find that the most plausible explanation is the cultural hypothesis because the personal behaviors that appear to generate a large part of the observed mortality differences (alcohol consumption, in particular) seem to be closely tied to cultural practices. We examine the implications of this finding for understanding the health crisis in post-Soviet states.
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Affiliation(s)
- Michel Guillot
- Population Studies Center, University of Pennsylvania, Philadelphia, PA 19104, USA.
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22
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Collinson MA. Striving against adversity: the dynamics of migration, health and poverty in rural South Africa. Glob Health Action 2010; 3. [PMID: 20531981 PMCID: PMC2882287 DOI: 10.3402/gha.v3i0.5080] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Revised: 04/12/2010] [Accepted: 04/20/2010] [Indexed: 11/23/2022] Open
Abstract
This article is a review of the PhD thesis of Mark Collinson, titled, ‘Striving against adversity: the dynamics of migration, health and poverty in rural South Africa’. The findings show that in rural South Africa, temporary migration has a major impact on household well-being and health. Remittances from migrants make a significant difference to socioeconomic status (SES) in households left behind by the migrant. For the poorest households the key factors improving SES are government grants and female temporary migration, while for the less poor it is male temporary migration and local employment. Migration is associated with HIV but not in straightforward ways. Migrants that return more frequently may be less exposed to outside partners and therefore less implicated in the HIV epidemic. There are links between migration and mortality patterns, including a higher risk of dying for returnee migrants compared with permanent residents. A mother's migration impacts significantly on child survival for South African and former refugee parents, but there is an additional mortality risk for children of Mozambican former refugees. It is recommended that national censuses and surveys account for temporary migration when collecting information on household membership, because different migration types have different outcomes. Without discriminating between different migration types, the implications for sending and receiving communities will remain lost to policy-makers.
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Affiliation(s)
- Mark A Collinson
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Acornhoek, South Africa
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23
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Abstract
Urbanization is high and growing in low- and middle-income countries, but intraurban variations in adult health have been infrequently examined. We used spatial analysis methods to investigate spatial variation in total, cardiovascular disease, respiratory disease, and neoplasm adult mortality in Buenos Aires, Argentina, a large city within a middle-income country in Latin America. Conditional autoregressive models were used to examine the contribution of socioeconomic inequalities to the spatial patterning observed. Spatial autocorrelation was present in both men and women for total deaths, cardiovascular deaths, and other causes of death (Moran's Is ranging from 0.15 to 0.37). There was some spatial autocorrelation for respiratory deaths, which was stronger in men than in women. Neoplasm deaths were not spatially patterned. Socioeconomic disadvantage explained some of this spatial patterning and was strongly associated with death from all causes except respiratory deaths in women and neoplasms in men and women [relative rates (RR) for 90th vs 10th percentile of percent of adults with incomplete high school and 95% confidence intervals: 1.23 and 1.09-1.39 vs 1.24 and 1.08-1.42 for total deaths in men and women, respectively; 1.36 and 1.15-1.60 vs 1.22 and 1.01-1.47 for cardiovascular deaths; 1.21 and 0.97-1.52 vs 1.07 and 0.85-1.34 for respiratory deaths; 0.94 and 0.85-1.04 vs 1.03 and 0.87-1.22 for neoplasms; and 1.49 and 1.20-1.85 vs 1.63 and 1.31-2.03 for other deaths]. There is substantial intraurban variation in risk of death within cities. This spatial variability was present for multiple causes of death and is partly explained by the spatial patterning of socioeconomic disadvantage. Our results highlight the pervasive role of space and social inequalities in shaping life and death within large cities.
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Affiliation(s)
- Ana V Diez Roux
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan, 1214 South University 2nd floor, Ann Arbor, MI 48103, USA.
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