HEALTH NEWS

Study Title:

US Adult Mortality Rates are Abysmal

Study Abstract

Background
Adult deaths are a crucial priority for global health. Causes of adult death are important components of Millennium Development Goals 5 and 6. However, adult mortality has received little policy attention, resources, or monitoring efforts. This study aimed to estimate worldwide mortality in men and women aged 15—59 years.

Methods
We compiled a database of 3889 measurements of adult mortality for 187 countries from 1970 to 2010 using vital registration data and census and survey data for deaths in the household corrected for completeness, and sibling history data from surveys corrected for survival bias. We used Gaussian process regression to generate yearly estimates of the probability of death between the ages of 15 years and 60 years (45q15) for men and women for every country with uncertainty intervals that indicate sampling and non-sampling error. We showed that these analytical methods have good predictive validity for countries with missing data.

Findings
Adult mortality varied substantially across countries and over time. In 2010, the countries with the lowest risk of mortality for men and women are Iceland and Cyprus, respectively. In Iceland, male 45q15 is 65 (uncertainty interval 61—69) per 1000; in Cyprus, female 45q15 is 38 (36—41) per 1000. Highest risk of mortality in 2010 is seen in Swaziland for men (45q15 of 765 [692—845] per 1000) and Zambia for women (606 [518—708] per 1000). Between 1970 and 2010, substantial increases in adult mortality occurred in sub-Saharan Africa because of the HIV epidemic and in countries in or related to the former Soviet Union. Other regional trends were also seen, such as stagnation in the decline of adult mortality for large countries in southeast Asia and a striking decline in female mortality in south Asia.

Interpretation
The prevention of premature adult death is just as important for global health policy as the improvement of child survival. Routine monitoring of adult mortality should be given much greater emphasis.

From press release:

The most comprehensive assessment to date of global adult mortality appears April 30, in The Lancet. The study shows that across countries, inequality in adult mortality has grown to the point where adult men in Swaziland -- the country with the worst mortality rate -- now have a probability of premature death that is nine times the mortality rate of the best country, Cyprus. The rates of mortality in southern Africa are now higher than mortality rates were in Sweden in 1751.

The research also shows that the United States has fallen significantly behind other countries in reducing deaths. In 1990, the United States ranked 34th in the world in female mortality and 41st in male mortality, but by 2010, it had dropped in the rankings to 49th for women and 45th for men. This puts it behind all of Western Europe and lower-income countries such as Chile, Tunisia, and Albania.

"With adult mortality, we are seeing this massive spread between the best and the worst off , unlike what we have seen with maternal mortality and what we are seeing with children, both of which have seen major progress since 1970," said Dr. Christopher Murray, University of Washington (UW) professor of global health and director of the Institute for Health Metrics and Evaluation at the UW.

Using new methods developed by IHME, researchers generated estimates for 187 countries of the probability that an individual who has just turned 15 will die a premature death before reaching age 60 (termed 45q15).

The researchers point to a range of factors for the widening disparities. AIDS sharply reversed positive trends in mortality in the 1990s in Africa. Increased incomes in some countries appear to be increasing the prevalence of risk factors for disease, such as high blood pressure and obesity. Smoking also continues to play a large role throughout the world.

Women overall have seen their health improve more than men have. In the 40 years between 1970 and 2010, adult mortality fell by 34 percent in women and 19 percent in men globally. The gap between adult male and female mortality widened by 27 percent in that period.

"We have had these estimates for child mortality for two decades now that have been enormously influential in informing debates about priorities for child survival. But we have been remarkably ignorant around adult mortality," said Dr. Alan Lopez, head of the School of Population Health at the University of Queensland and one of the paper's co-authors. "We need to apply the same passion that surrounds keeping children alive to keeping young adults alive."

Other key findings include:

The lowest risk of death in adults was recorded in Iceland (men) and Cyprus (women).

Mortality rates for men and women in 37 countries are higher in 2010 than they were in 1990.

Eastern Europe has seen one of the largest public health reversals of modern times. Russia has fallen from a rank of 43rd place for female mortality in 1970 to 121st.

Since 2005, sub-Saharan Africa has seen strong mortality declines, a possible result of efforts to prevent new HIV infections and to treat AIDS patients with antiretroviral drugs.

South Asia, and India in particular, had among the highest female mortality in the world in 1970. Both the region and the country have seen major declines. In 2010, it is better to be a woman in India than it was to be a man in the United States in 1997.

The list of countries with the lowest adult mortality has changed greatly. Only three -- Sweden, the Netherlands, and Norway -- remained in the top 10 for male mortality between 1970 and 2010.

Until now, adult mortality research has focused on a subset of the global population and has often relied on estimates derived from child mortality numbers. IHME calculated mortality rates using vital registration data, censuses, surveys on household deaths, and sibling survival histories.

Study Information

1.Julie Knoll Rajaratnam, Jake R Marcus, Alison Levin-Rector, Andrew N Chalupka, Haidong Wang, Laura Dwyer, Megan Costa, Alan D Lopez, Christopher JL Murray
Worldwide mortality in men and women aged 15-59 years from 1970 to 2010: a systematic analysis
Lancet
2010 May