Assessing mortality registration in Kerala: the MARANAM study

Complete or improving civil registration systems in sub-national areas in low- and middle-income countries provide several opportunities to better understand population health and its determinants. In this article, we provide an assessment of vital statistics in Kerala, India. Kerala is home to more than 33 million people and is a comparatively low-mortality context. We use individual-level vital registration data on more than 2.8 million deaths between 2006 and 2017 from the Kerala MARANAM (Mortality and Registration Assessment and Monitoring) Study. Comparing age-specific mortality rates from the Civil Registration System (CRS) to those from the Sample Registration System (SRS), we do not find evidence that the CRS underestimates mortality. Instead, CRS rates are smoother across ages and less variable across periods. In particular, the CRS records higher death rates than the SRS for ages, where mortality is usually low and for women. Using these data, we provide the first set of annual sex-specific life tables for any state in India. We find that life expectancy at birth was 77.9 years for women in 2017 and 71.4 years for men. Although Kerala is unique in many ways, our findings strengthen the case for more careful attention to mortality records within low- and middle-income countries, and for their better dissemination by government agencies.

Mongolia health situation: based on the Global Burden of Disease Study 2019

Background Over the past few decades, economic, political, and social changes have directly and indirectly affected the health of the Mongolian population. To date, no comprehensive analysis has been conducted on the burden of diseases in this country. Thus, we aimed to describe the leading causes of death and disabling conditions and their trends between 1990 and 2019 in the Mongolian population. Methods We used the data from the Global Burden of Disease (GBD) 2019 study. In the current study, we examined life expectancy at birth, healthy life expectancy, the 20 leading causes of death, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted-life-years (DALYs), and the contribution of major risk factors to DALYs in Mongolia. Findings The life expectancy at birth in Mongolia has gradually increased since 1995 and reached 63.8 years for men and 72.7 for women in 2019. The highest increase in the age-standardised death rate between 1990 and 2019 occurred in alcohol use disorders (628.6%; 95% UI 10.0–1109.6) among men, and in liver cancer (129.1%; UI 65.3–222.4) among women. Ischaemic heart disease and stroke showed the highest rates of death, YLLs, and DALYs among both men and women. In 2019, the highest age-standardised rates of DALYs were attributable to high systolic blood pressure and dietary risks. Interpretation Although Mongolia saw substantial improvements across many communicable diseases, maternal and neonatal disorders, and under-5 mortality between 1990 and 2019, non-communicable diseases remained leading causes of mortality. The mortality from the most preventable causes such as injury, alcohol use, and dietary risks remain substantially high, suggesting that individual and social efforts are needed to tackle these diseases. Our analyses will support the development of policy priorities and action plans in multiple sectors to improve the overall health of the Mongolian population. Funding Bill & Melinda Gates Foundation.

The Correlation Between Income Inequality and Population Health

Today, despite the increase in global wealth, the income gap between the rich and the poor gradually widens. This gap is significant in both developed and developing nations. Thus, increasing income inequality adversely affects several socio-economic indicators. Previous studies demonstrated that one of the socio-economic indicators that were negatively affected by income inequality is population health. The income inequality experienced by the individuals or throughout life adversely affects several populations' health outputs, especially life expectancy at birth. The present study aimed to test the correlation between income inequality and population health output indicators with canonical correlation method and based on the most current data available for several nations. To determine the correlation between the two datasets, the 2017 data for 29 European countries and Turkey were analyzed. Canonical correlation analysis revealed a significant correlation between the income inequality and population health indicator datasets.

ANALISIS K-MEANS CLUSTER PADA KABUPATEN/KOTA DI PROVINSI BANTEN BERDASARKAN INDIKATOR INDEKS PEMBANGUNAN MANUSIA

The Human Development Index (HDI) is one of the parameters of success in the development of the quality of human life, besides that at the regional level, the HDI is an indicator of the primary performance measurement and allocation of Regional Incentive Funds in promoting the welfare of the people in the area. In 2020 the Banten Province Human Development Index 72.45 only rose 0.01% compared to 2019, lower than the growth in 2019, which reached 0.68% and is still stuck in the high category (70≤HDI≤80), this indicates the progress of human development in Banten experienced a slowdown, In addition, when compared to the growth of the HDI-forming indicators in 2019, all components that make up the HDI experienced a slowdown in growth except for RLS which experienced growth acceleration of 0.33% from 1.39% in 2019 to 1.72% in 2020. So it is necessary to do a deeper analysis to determine the characteristics of the indicators that make up the HDI in the City as a contributor to the HDI value of the Banten Province so that efforts can be made to increase human development as evidence of improving the welfare of the people in the Banten Province. The K-Means Cluster method is used to group cities in Banten Province based on similar characteristics in terms of the HDI compiler indicators, including Life Expectancy at Birth, Expected Years of Schooling, and Average Length of School in, and Expenditure per Capita. Based on the results of the analysis obtained three clusters consisting of cities with similar characteristics in each cluster. Cluster 1 is a City with a low HDI indicator consisting of Pandeglang, Lebak, Serang. Cluster 2 is a City with a medium HDI indicator consisting of Tangerang, Cilegon, Serang City. Cluster 3 has a high HDI indicator consisting of Tangerang City and South Tangerang City. After obtaining City information based on the characteristics of each cluster, then the Banten Provincial government can provide direction and policies to each City in Clusters 1 and 2 to be able to develop activity programs with more attention to the HDI compiler indicators so that the Human Development Index in the City can increase

Culturally Informed Services in Tribal Communities

Indigenous populations have experienced hundreds of years of historical trauma, systemic racism, and oppression since colonization began in the Americas, Australia, and New Zealand. Settler colonialism has created and continues to perpetuate historical and ongoing trauma and systemic racism in Indigenous populations. Despite considerable diversity and resilience among Indigenous populations globally, there is a clear pattern of significant disparities and disproportionate burden of disease compared to other non-Indigenous populations, including higher rates of poverty, mortality, substance use, mental health and health issues, suicide, and lower life expectancy at birth. Substantial gaps related to access to healthcare and service utilization exist, particularly in low-income Indigenous communities. Implementation and sustainment of White dominant-culture frameworks of care in Indigenous communities perpetuate these systems of oppression. Development and implementation of culturally informed services that address historical trauma and oppression, and systematically integrate concepts of resiliency, empowerment, and self-determination into care, are issues of policy as well as practice in social work. The co-creation and subsequent implementation, monitoring, and sustainment of effective systems of care with Indigenous populations are essential in addressing health disparities and improving outcomes among Indigenous populations globally.

Decrease in Life Expectancy in Germany in 2020: Men from Eastern Germany Most Affected

The COVID-19 pandemic caused an increase in mortality in 2020 with a resultant decrease in life expectancy in most countries around the world. In Germany, the reduction in life expectancy at birth between 2019 and 2020 was comparatively small, at -0.20 years. The decrease was stronger among men than among women (-0.24 vs. -0.13 years) and in eastern rather than in western Germany (-0.36 vs. -0.16 years). Men in eastern Germany experienced the biggest decline in life expectancy at birth (-0.41 years). For western German men, the decline was less pronounced (-0.19 years). Among women, the decline in life expectancy at birth was also greater in eastern (-0.25 years) than in western Germany (-0.10 years). As a result of these developments, the differences in life expectancy between the two parts of Germany, and between women and men, increased compared with the previous year. Life expectancy at age 65 decreased more strongly than life expectancy at birth for both sexes and in all regions. This reflects the fact that it was mainly older age groups that were affected by the increase in mortality in 2020. This paper provides further insights into mortality changes in 2020, based on age decomposition and an analysis of lifespan inequality. We conclude that the population in eastern Germany was hit harder by the COVID-19 pandemic in 2020 than the population in the western Germany.

Heterogeneity in Subnational Mortality in The Context of The COVID-19 Pandemic: The Case of Belgian Districts

Background: The COVID-19 pandemic has caused major shocks in mortality trends in many countries. Yet few studies have evaluated the heterogeneity of the mortality shock at the sub-national level, rigorously accounting for the different sources of uncertainty.Methods: Using death registration data from Belgium, we first assess the change in the heterogeneity of subnational standardized mortality ratios in 2020, when compared to previous years. We then measure the shock of the pandemic using district-level values of life expectancy, comparing the observed and projected districts life expectancy, accounting for all sources of uncertainty (related to the life-table construction at district level and to the projection methods at country and district level). The Bayesian modelling approach makes it easy to combine the different sources of uncertainty in the assessment of the shock. This is of particular interest at a finer geographical scale characterized by high stochastic variation in annual death counts.Results: The heterogeneity in the impact of the pandemic on all-cause mortality across districts is substantial, with some districts barely showing any impact whereas the Bruxelles-Capital and Mons districts experienced a decrease in life expectancy at birth of 2.24 (95% CI:1.33-3.05) and 2.10 (95% CI:0.86-3.30) years, respectively. The year 2020 was associated with an increase in mortality levels ' heterogeneity at a subnational level in comparison to past years measured by both the standardized mortality ratios and the life expectancies at birth. Decisions on uncertainty thresholds have a large bearing on the interpretation of the results.Conclusion: Developing sub-national mortality estimates with their uncertainty is key to understanding why certain areas have been hard hit in comparison to others.

Assessment оf the Economic Potential of Change in the Population of Modern Ukraine

The influence of the macroeconomic factor on the long-term trends of reproduction the population of Ukraine since independence is considered. Based on the author’s concept of “demoeconomic niche” the results of calculation of two options for estimating the “current” (per year) economic potential of population changes in Ukraine on the criteria of conditionally autonomous consumption of population and the actual subsistence level (including necessary payments) were analyzed. The potential for population decline according to the first criterion is considered as a pessimistic (maximum) estimate (–30 million in 2019), according to the second - as an optimistic estimate (–2 million in 2019). The aim of the study was to perform a statistical analysis of the relationship between demographic and economic indicators of population reproduction in Ukraine and their relationship with certain options for assessing the economic potential of population change to determine their greater or lesser relevance to demographic and economic realities. Novelty: the assessment of the economic potential of population change is performed within the economic and demographic methodology developed and maintained by the author (based on the macroeconomic concept of “demoeconomic niche”). Research methods: to study the statistical relationship between indicators used methods of correlation and regression analysis (linear models), as well as a comparative analysis of the results of calculations with the actual dynamics of demographic and economic indicators. Calculations were made by means of PPP STATISTICA 8.0. A statistical analysis of the relationship between demographic and economic indicators and their relationship with the studied options for assessing the economic potential of Ukraine population change was performed to determine compliance with demographic and economic realities. All-time series of indicators (30 and 22 years) subjected to statistical analysis are translated into a single form of annual increments to ensure comparability, as a percentage of the value of the initial year of analysis. The direct linear relationship of GDP changes with the dynamics of the total fertility rate and average life expectancy at birth was recorded, and close feedback - with the dynamics of the migration balance. It is noticed that changes in GDP and the total fertility rate for the whole and rural population have cophase quasi cyclic fluctuations with a 3-4 year lag of reaction delay. It is shown that the assessment of the economic potential of population change by the criterion of conditionally autonomous consumption of population is closely statistically dependent on macroeconomic indicators and economic dynamics. The assessment based on the criterion of the actual subsistence level (including necessary payments) depends more closely on the indicators that directly reflect the well-being of households. It turned out that the adequacy of the assessment based on the criterion of conditionally autonomous consumption of population gradually decreases over time due to the peculiarities of the calculation algorithm, growing inaccuracy can only be neglected at intervals of +/-5 years from the base year. The adequacy of the assessment according to the criterion of the actual subsistence level (including necessary payments) depends on the correspondence to the real cost of life values for each year of the observation period, these values need to be clarified.

The life table paradox: has Brazil already overcome it?

Ideally, life expectancy should be a decreasing function of age. When this fact is not observed, this situation is known as the life table paradox. This paper investigated the timing (and health metrics at the time) in which Brazil and its Federation Units (FU) overcame (or are expected to overcome) this paradox. The data were gathered from the Brazilian Institute of Geography and Statistics and contained 3,416 sex-specific abridged life tables, from 2000 to 2060. At national level, females and males overcame the paradox in 2016 and 2018, respectively. However, when the FU were examined separately, much heterogeneity was observed. Through the decomposition analysis of the change over time in the difference between life expectancy at birth and at age one, we found that Brazil and most of its FU are expected to have both changes declining over time and the total change is expected to be decreasing and greater than zero. Nevertheless, for some Northeastern states the total change is expected to pass from a positive to a negative value; and for two Northern states the total change is expected to be neither decreasing nor increasing. In a public planning perspective, we understand that achieving balancing in the life tables is a goal to be pursued, especially because having an imbalanced table means that life expectancy at birth is still strongly influenced by high levels of infant mortality. Therefore, this knowledge could help planners to properly define strategies to accelerate the balancing process and revert unequal scenarios.

Gender gap in life expectancy in India and role of age groups: A comparison between before and after male – female life expectancy at birth crossover

To assess the gender gap in life expectancy at birth in India and its major states as well as the timing of male-female life expectancy at birth crossover. To analyze the age-specific contributions to the changing gender differences before and after the crossover at the national and sub-national levels. We have used sample-survey-based age-specific mortality data available for the periods 1970–2018 to construct abridged life tables. The contribution of different age groups to the gender gap is estimated by using Arriaga’s method of decomposition. During 1981–85 female life expectancy at birth caught up with male life expectancy at birth for India and by 2005 all major states completed the crossover. The male-female crossover in life expectancy at the national level in the early 80s is remarkable in the face of continued female disadvantage from birth till adolescence, even for some richer states. We provide evidence that gender difference in longevity in favour of females is largely a function of adult age groups and younger age groups contribute negatively to the gender gap in life expectancy at birth in most states. Juxtaposing the results from contribution in an absolute number of years and their relative contribution change before and after the crossover, it is established that although the adult and old age groups contribute the highest in the absolute number of years before and after the crossover, the contribution of the reproductive age groups and childhood years in the recent time is most relevant in relative terms.