Причины смерти и методы их анализа
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Причины смерти и методы их анализа. Н.С. Гаврилова. Causes of death and their classification. Established by the World Health Organization as International Classification of Diseases (ICD)

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Причины смерти и методы их анализа

Н.С. Гаврилова


Causes of death and their classification l.jpg
Causes of death and their classification анализа

  • Established by the World Health Organization as International Classification of Diseases (ICD)

  • Has several revisions. The most recent revision is the 10th revision. Adopted by most countries in the mid 1990s


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Classification of causes of death in Russia анализа

  • Classification of causes of death used in the Soviet statistical forms was different from WHO classification.

  • Form #5 (later called form C51) had 185 causes of death.

  • Main differences between WHO and Soviet classification are found in the groups of CVD and injuries


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New classification of causes of death in Russia анализа

  • After dissolution of the Soviet Union most FSU countries continued to use the old classification of causes of death

  • In 1999 Russia adopted a new classification of causes of death corresponding to the 10th ICD revision

  • Still incompatible with the WHO classification


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Selected Causes of Death анализа


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Major causes of death within the group of injuries. Men анализа

Иванова и др., Demoscope Weekly, N181-182, 2004


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Major causes of death within the group of injuries. Women анализа

Иванова и др., Demoscope Weekly, N181-182, 2004




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Proportion of deaths from ill-defined conditions is a measure of quality of mortality statisticsProportion higher than 5% indicates poor qualityIn developed countries most deaths from ill-defined conditions are diagnosed at older ages


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Is this increase in mortality from ill-defined conditions related to more cases of deaths from senility?


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Age Profile of Mortality from related to more cases of deaths from senility?Ill-Defined Conditions in Russia

Males

Females


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Top Five Causes of Death for related to more cases of deaths from senility?Young Adult Males (20-24)


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Top Five Causes of Death for related to more cases of deaths from senility?Young Adult Females (20-24)



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We Used Individual Death Certificates With More Detailed Description of Circumstances of Death Collected by Kirov Department of HealthKirov is a Typical Russian Region with Lower than Average Mortality from Ill-Defined Conditions


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Age-Adjusted Mortality from Injuries in 1996 Description of Circumstances of Death Collected by Kirov Department of Healthfor Russian Males Aged 0-64 yearsData from the WebAtlas Project (http://sci.aha.ru/ATL)


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Deaths from Ill-Defined Conditions in Kirov Region of Russia in 2003

  • Sudden infant death (R95) 3.3%

  • Decomposition in water (river, well, pond) (R99) 13.0%

  • Decomposition at home (R99) 53.5%

  • Decomposition in garden, summer house (R99) 1.7%

  • Decomposition in forest or field (R99) 6.0%

  • Decomposition in nonresidential building, on the street (R99) 12.3%

  • Decomposition in water pipe (R99) 0.7%

  • Decomposition on the cemetery (R99) 0.3%

  • Decomposition in bath, lavatory or barn (R99) 1.0%

  • Decomposition in other place (R99) 5.5%

  • unknown (R99) 2.3%

  • senility (R54) 0.3%


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Ill-defined conditions and external deaths of undetermined intent are two sides of the same coinIt appears that both causes of death may be used for concealing criminal cases of violent death




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Autopsies in Russia in 2001

  • Autopsies are used to verify cause of death

  • Autopsy is mandatory for violent death, death of woman during pregnancy, labor or postpartum period, death of infant below 1 year, death from cancer not supported morphologically, death from any infectious disease


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Situation with medical examiner services in 2001

  • Only 34-48% of jobs are filled by physicians

  • 38-54% of jobs are filled by histologists

  • 35% of workers reached retirement age


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Additional reading in 2001

Gavrilova N.S., Semyonova V.G., Dubrovina E., Evdokushkina G.N., Ivanova A.E., Gavrilov L.A. Russian Mortality Crisis and the Quality of Vital Statistics. Population Research and Policy Review, 2008, 27: 551-574.


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Measures of Mortality in 2001

  • Crude Death Rate

  • Age-Specific Death Rates (Age-Specific Mortality Rates)

  • Age-Adjusted Mortality Rates (Standardized Mortality Rates)

  • Life Expectancy (at birth or other age)

  • Measures of Infant Mortality


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Crude Death Rate in 2001

  • Number of deaths in a population during a specified time period, divided by the population size "at risk" of dying during that study period.

  • For one-year period, Crude Death Rate,

    CDR  = Deaths in that year /mid-year population size

    x 1,000  to adjust for standard-sized population of 1,000 persons

    mid-year population = total population for July 1


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Crude Death Rate Pros and Cons in 2001

  • Pros: - Easy to calculate, and require less detailed data than other mortality measures - Useful for calculation of the rate of natural increase (crude birth rate minus crude death rate)

  • Cons: - Depends on population age structure (proportions of younger and older people)




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Age-Specific Death Rates (ASDR) or Age-Specific Mortality Rates (ASMR)

  • Number of deaths in a specific age group during a specified time period, divided by the size of this specific age group during that study period. Example: For one-year study period, Age-Specific Death Rates, ASDR for males at age 45-49 years  = =  Deaths to males aged 45-49 in that year / Number of males aged 45-49 at mid-year x 1,000  to adjust for standard-sized population of 1,000 persons of that age.


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Age-Specific Death Rates Rates (ASMR)Pros and Cons

  • Pros: - Allows to study mortality by age (and sex)

  • Cons: - Requires detailed data on deaths by age (not always available for developing countries, war and crisis periods, historical studies)


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Infant Mortality Rate, IMR Rates (ASMR)

  • Proportion of infants who die in their first year Number of deaths under age one during a specified time period, divided by the number of live births For one-year period, Infant Mortality Rate

x 1,000  to standardize per 1,000 live births


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Infant Mortality Rate Pros and Cons Rates (ASMR)

  • Pros:

    - Sensitive indicator of overall health conditions in a country, particularly child health

    - Useful for indirect estimates of mortality in other age groups through imputation, using the so-called "model life tables"

  • Cons:

    - Requires accurate data on births and infant deaths (not always available for developing countries, war and crisis periods, historical studies)



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Definition of live birth in the USSR was not consistent with WHO definition

  • WHO definition of live birth: "the complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of pregnancy which, after such separation, breathes or shows any other evidence of life, such as beating of the heart, pulsation of the umbilical cord or definitive movement of voluntary muscles, whether or not the umbilical cord has been cut or the placenta is attached.“

  • The Soviet Union adopted a less inclusive definition, excluding infants born before 28 weeks and those weighing less than 1000 grams, regardless of signs of life.

  • Soviet definition resulted in underestimation of infant mortality

  • After getting independence, many FSU countries adopted WHO definition of live birth



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Стандартизованные показатели WHO definition

  • Стандартизованный коэффициент (прямой метод)

  • Стандартизованное отношение смертности

  • Потенциальные годы потерянной жизни


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Age-adjusted death rate (ADR), standardized death rate (SDR) or age-standardized death rate (ASDR)

  • Death rate expected if the studied population had the age distribution of another "standard" population (arbitrary chosen for the purpose of comparison). Calculated as weighted average  (with weights being proportions of the "standard" population at each age)


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Age-Adjusted Death Rate or or Age-Standardized Death Rate

  • Direct method of age standardization:

  • Mui is mortality rate in the studied population at age i

  • Psi – number of persons at age i in the standard population. Ps – total standard population.


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Age-Adjusted Death Rate or or Age-Standardized Death Rate

  • Pros: - Allows comparison of death rates of populations despite differences in their age distribution

  • Cons: - Requires data on death rates by age (not always available for developing countries, war and crisis periods, historical studies) - Results of comparison may depend on the arbitrary choice of standard.


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Стандартизованное отношение смертности или Standardized mortality ratio

где Du - суммарное число умерших в изучаемой популяции, Msi - коэффициент смертности в стандартной популяции в возрастной группе i, Pui - численность населения в возрастной группе i для изучаемой популяции


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Стандартизованное отношение смертности

  • Полезно использовать для маленьких регионов и редких причин смерти

  • За стандартное распределение обычно выбирается распределение смертей по всей стране


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Потенциальные годы потерянной жизни Potential Years of Life Lost (PYLL)

где T - верхний предельный возраст, до которого рассчитывается недожитие (обычно 70 или 65 лет), x - середина соответствующего возрастного интервала.

Потерянные годы потенциальной жизни рассчитываются как сумма произведений числа умерших на недожитые годы в каждой возрастной группе

Коэффициент потерянных лет потенциальной жизни рассчитывается соответственно:

RatePYLL = PYLL/Pu

где Pu - численность изучаемого населения в возрасте от 1 до T.


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The Concept of Life Table жизни

  • Life table is a classic demographic format of describing a population's mortality experience with age. Life Table is built of a number of standard numerical columns representing various indicators of mortality and survival. The concept of life table was first suggested in 1662 by John Graunt. Before the 17th century, death was believed to be a magical or sacred phenomenon that could not and should not be quantified.  The invention of life table was a scientific breakthrough in mortality studies.


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Life Table жизни

  • Cohort life table as a simple example

  • Consider survival in the cohort of fruit flies born in the same time




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Number of survivors at the beginning of the next age interval:

l(x+1) = l(x) – d(x)

Probability of death in the age interval:

q(x) = d(x)/l(x)



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Person-years lived in the interval, L(x) interval:

L(x) are needed to calculate life expectancy. Life expectancy, e(x), is defined as an average number of years lived after certain age.

L(x) are also used in calculation of net reproduction rate (NRR)


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Calculation of life expectancy, e(x) interval:

Life expectancy at birth is estimated as an area below the survival curve divided by the number of individuals at birth


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Life expectancy, e(x) interval:

  • T(x) = L(x) + … + Lω

    where Lω is L(x) for the last age interval.

    Summation starts from the last age interval and goes back to the age at which life expectancy is calculated.

  • e(x) = T(x)/l(x)

    where x = 0, 1, …,ω


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Life Tables for Human Populations interval:

  • In the majority of cases life tables for humans are constructed for hypothetic birth cohort using cross-sectional data

  • Such life tables are called period life tables

  • Construction of period life tables starts from q(x) values rather than l(x) or d(x) as in the case of experimental animals


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Formula for q(x) using interval:age-specific mortality rates

a(x) called the fraction of the last interval of life is usually equal to 0.5 for all ages except for the first age (from 0 to 1)

Having q(x) calculated, data for all other life table columns are estimated using standard formulas.



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Period life table for hypothetical population and USA. 2005

  • Number of survivors, l(x), at the beginning is equal to 100,000

  • This initial number of l(x) is called the radix of life table







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Special methods based on life table approach 2005

  • Таблицы смертности множественного выбытия

  • Таблицы смертности при устранении причины смерти

  • Декомпозиция ожидаемой продолжительности жизни


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Таблицы смертности множественного выбытия

  • Multiple decrement life tables

  • Часто используется для построения таблиц смертности по причинам

  • Декременты – смерти от различных причин


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Таблицы смертности множественного выбытия – этапы построения

  • Построить обычную таблицу смертности от всех причин

  • Рассчитать вероятность смерти от причины k


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Таблицы смертности множественного выбытия – этапы построения (продолжение)

  • Рассчитать число декрементов от причины k в интервале (x, x+n):

  • Рассчитать числа доживших до возраста y для тех, кто в течение последующей жизни умрет от причины k:


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Таблицы смертности множественного выбытия – этапы построения (продолжение)

  • Рассчитать вероятность умереть от данной причины в течение жизни:

    lk/l0

  • Рассчитать средний ожидаемый возраст умерших, рассчитав соответственно Lkx и Tkx

  • Рассчитывается так же как ожидаемая продолжительность жизни в обычной таблице


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Средний ожидаемый возраст смерти по причинам, женщины России

Васин С., доклад в Киеве 2006


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Вероятность для новорожденного умереть на протяжении жизни от семи групп причин смерти (на 100 родившихся), мужчины России

БСК и новообр. – правая ось Васин С., доклад в Киеве 2006


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Сравнение структуры смертности мужчин России и Западных стран. 1965 год

Васин С., доклад в Киеве 2006


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Сравнение структуры смертности мужчин России и Западных стран. 2004 год

Васин С., доклад в Киеве 2006


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Декомпозиция продолжительности жизни по возрасту и причинам смерти


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Метод декомпозиции жизни по возрасту и причинам смерти

  • Предложен Андреевым (1982), Поллардом (1982) и Арриагой (1984)


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Декомпозиция по возрасту жизни по возрасту и причинам смерти

где величины lx, Lx, Tx представляют собой стандартные величины из обычной таблицы смертности, а индексы 1 и 2 соответствуют не возведению в степень, а популяции 1 и популяции 2 соответственно (то есть двум сравниваемым популяциям).

Необходимо рассчитать обычные таблицы смертности для двух сравниваемых популяций


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Декомпозиция по возрасту жизни по возрасту и причинам смерти

Последний открытый возрастной интервал


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Декомпозиция вклада отдельных причин в различия по продолжительности жизни

где Rix обозначает пропорцию смертей от причины i в возрастной группе (x, x+n), то есть Dix/Dx. В данном случае Dix соответствует наблюдаемому чилу умерших от причины i в возрастном интервале (x, x+n), а Dx - соответсвующее число умерших от всех причин.


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Декомпозиция по причинам смерти причин в различия по продолжительности жизни

Индексы (1) и (2) соответсвуют сравниваемым популяциям. Значения mx соответсвуют табличным коэффициентам смертности от всех причин, которые можно получить из обычной таблицы смертности, поскольку mx = dx/Lx. В данной формуле величина Δx соответствует вкладу различий в смертности от всех причин в возрастном интервале (x, x+n) в наблюдаемые различия в ожидаемой продолжительности жизни. Можно показать, что

а также что


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Decomposition of the U.S.-Russia gap in life expectancy by cause

USA – 1999; Russia – 2001. Source: Shkolnikov et a. Mortality reversal in Russia.


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Decomposition of the U.S.-Russia gap in life expectancy by cause

USA – 1999; Russia – 2001. Source: Shkolnikov et a. Mortality reversal in Russia.






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Contribution of causes of death to campaign: Women40e20(CA) - 40e20(Slav)Males (total difference = 2.90 years)


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Contribution of causes of death to campaign: Women40e20(CA) - 40e20(Slav)Females (total difference = .28 years)


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Additional reading campaign: Women

Preston S. H., Heuveline P., Guillot M. Demography. Measuring and modeling population processes. Blackwell Publ., Oxford, 2001.


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Таблицы смертности при устранении причины смерти


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Таблица смертности при устранении причины смерти

  • Использует свойство аддитивности интенсиности смертности

  • Метод Чанга (1978) – допущение пропорциональности смертности от отдельных причин


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Основная формула для расчета таблицы смертности при устранении причины смерти

В данной формуле индекс –k означает не возведение в степень, а тот факт, что показатель относится к случаю, когда причина смерти k устранена.

Коэффициент пропорциональности rk можно получить из отношения наблюдаемых чисел умерших в данном возрастном интервале:


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