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Chapter 7

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University of Toronto St. George
Brent Berry

SOC312: Chapter 7: Mortality and Population Health Determinants of Population Health  Mortality: the aggregate incidence and number of deaths in a population at specified periods  Demographers use aggregate level analyses and more recently, emphasis on individual observations through cross-sectional and longitudinal surveys o Both say that death rates and other mortality measures provide an accurate indication of pop’s overall health  Population Health Perspective: complex interactions of individual and structural factors in determining health o Including the interplay of individual characters (including genetics) with social and economic factors (including culture) and physical environments (family, neighbourhood, work, community) o Premise  determinants of health doesn’t exist in isolation of each other o Strategies to improve pop health must address the entire range of factors that determine health o Assumes that social disparities in health are related to disparities in income and wealth o Health gains achieved by focusing interventions not only on the entire pop but also on disadvantaged minorities within larger society  Population health= crucial determinant of society’s economic prosperity and standard of living o Ex. better health= more productive work force = higher levels of affluence  Socioeconomic status= key determinant in individual health (including quality of physical environment, lifestyle choices, etc.)  Social environments= support healthy lifestyles (support from families/friends/communities)  Physical environment=poor air and water quality, pollution, exposure to toxic materials on job or at home compromise one’s health  Genetic predispositions condition wide range of individual responses that affect health (ex. some people more genetically prone to alcoholism)  Robust health care  essential to overall health of pop Demographic and Sociological Dimensions of Mortality:  Mortality: Number of events (‘deaths’) taking place in a given interval in a specific population o Death does not include miscarriage, stillbirth or abortion Basic Measures of Mortality Crude Death Rate (CDR): Number of deaths in a given interval (usually a year, divided by the midpoint pop), expressed per 1000 pop:  The CDRS of developed countries > CDRS of some developing countries  Therefore comparisons can’t be taken as a definitive indication of each country’s level of mortality Age Specific Death Rate (M ): number of deaths to persons of a given age divided by mid year pop at risk in x the same age category Age Pattern of Mortality  shape of the pattern of death rates over age  Risk of death is high in first month after birth but declines during rest of infancy + childhood, low in adolescence, rises in young adulthood, stabilises, increasingly only slightly until past middle age, intensifies after retirement  Age specific death rates for pre-transitional societies follow a U-shaped pattern o Exceptionally high mortality in infancy + early childhood and old age  Age specific death rates for post-transitional societies Level of mortality  overall death rate of a pop  Mortality rates are higher for men than women (easier to see on a natural logarithm scale) Infant Mortality Rate and its components:  Infant Mortality: death occurring between birth and the end of the first year of life; subdivided into 3 categories: 1. Early neonatal Mortality a. Deaths between birth and end of first week of life 2. Late neonatal mortality a. Deaths between 8 day after birth to end of 27 day after birth 3. Post-neonatal mortality a. Deaths from 28 day after birth to end of 1 year *** Early neonatal and late neonatal mortality sometimes combined under ‘neonatal mortality’  Vital statistics in developed countries collect info on fetal deaths (death of a fetus)  Problem when comparing infant mortality rates (not all countries apply a uniform definition of fetal death)  Infant mortality rate (IMR) is number of infant deaths in a given year/number of live births in same year *1000   Limitations of this formula: o Overlooks that a proportion of the infant deaths that occur during a given year are deaths of infants who were born during the preceding year  therefore not part of the same ‘universe’ of births used to compute the rate  Causes of death in infancy: o Pichat  infant deaths can be classified in two categories:  Endogenous death: related to complications arising in the neonatal period  Include chromosomal abnormalities, malformations of heart, central nervous system), complications during delivery, low birth weight  Difficult to control because they stem from complications with newborn’s constitution  Exogenous death: occur mainly in the post neonatal period  Associated with external factors or situations in the socioeconomic environment of the infant  Ex. Exposure to cold, heat, infection, inadequate care, malnutrition, accidents, violence o One of the major causes of death in neonates is low birth weight (associated with prematurity); there are different categories of low birth weight:  Low birth weight infants: weight at birth falls between 500-2499g  Very low birth weight infants: weigh less than 1500g  Extremely low birth weight infants: weight is less than 1000g  Cause-Specific Death Rate: o In industrialized nations, two of the deadliest killers are heart disease and cancer o Just imagine it to be a crude death rate for a given cause of death. Can be easily expanded to include age, sex, other characteristics o International Classification of Diseases (ICD) system where shows a detailed listing of all known diseases and medical conditions that can result in death The Life Table Basic Description of the Life Table:  Tool for describing a population’s mortality using period cross-sectional, age-specific death rates  Describes the survival experience of a fictional cohort subjected to the current age-specific death rates of an actual population over the cohort’s imagined lifetime (period life table)  Cohort life table computed from historical data for birth cohort that was born many years ago and is now extinct  Life expectancy  average number of years of life remaining for someone aged x.  Useful for comparing mortality across populations or sub-groups within a population having different age-sex compositions  Assumptions of life table: 1. It is a hypothetical population that is closed to migration (so births and deaths are the only demographic processes) 2. The crude death rate and birth rate are identical because it doesn’t take migration into account (so rate of natural increase will always be 0) a. Imagine 100 people born, the same will eventually die b. Therefore the life table is a stationary population (stable unchanging annual age-specific mortality rates with unchanging numbers of births) 3. Number of births in life table population is set at 100,000 4. Birth cohort of 100,000 dies according to a predetermined schedule of age-specific death rates 5. Distribution of deaths uniform with every age category except for infancy, early childhood and very old age (where distribution is not clearly uniform) Mortality Change through History  There exists a dramatic increase in life expectancy since mid 1700s since degenerative causes of death have largely replaced deaths caused by infectious and pathogenic diseases Epidemiological Transition:  Omran’s theory  societies as they modernize experience a gradual change in their patterns of disease and mortality **Omran environmental and lifestyle factors is not key  Move from long period of infectious and parasitic diseases (+ famine, pestilence, war) to chronic and degenerative diseases (ex. cancer/heart disease) become leading killers  3 Stages of Epidemiological change: 1. Age of Famine and Pestilence (Prehistory to c. 1750) a. Pattern of pop growth= cyclic, minute net increases b. Mortality + fertility rates high (fluctuate radically from year to year) c. Very little natural increase d. Pop predominantly rural e. Traditional society, economy dependent on manual labour intensive production f. Standards of living low g. Life expectancy ~20-40 years, infant and childhood mortality very high h. Mortality higher in urban> rural areas 2. Age of Receding Pandemics (c. 1750 to the early 1920s) a. Early phase i. Early phase  preconditions for mortality decline and improved health ii. Improvements in agriculture + modest developments in transportation and communications iii. Standard of living low but starting to improve iv. Mortality high, showed signs of declining v. Overall life expectancy rose to mid 20’s and early 30’s vi. Tuberculosis peaked with industrialization b. Late phase i. Explosive population growth  sustained pattern of mortality decline + high fertility + young population concentrated more and more in cities ii. Improvement in agriculture practices  greater availability of food and better nutrition, advances in sanitation and hygiene iii. Pandemics of infection, malnutrition and childhood diseases receded iv. Infection still leading cause of death, but non-infectious diseases began to become more significant 3. Age of Human Made and Degenerative Causes of Death (early 1920s to the 1960s) a. High life expectancy (70years +) b. Low infant mortality rate, low maternal death rates c. Cancer + heart disease leading killers d. Predominantly urban  Hypothesis explaining what caused the plague to virtually disappear: Stands of living thesis by McKeown  Standards of living thesis: attributes declines in Europe’s death rate to the recession of virulent epidemic diseases, thanks to major improvements in standards of living and improved nutrition, which enabled people to withstand infections and live longer th th o Declines in mortality (18 + early 19 C) from infectious diseases, and secondarily from two non- infective causes: infanticide and starvation o Some infectious diseases declined as a result of change in relationship between organism and host, this can’t account for enormous reduction of mortality and growth of pop during this time o Mortality not greatly affected by immunization before 1935 o Reduction of mortality due to improvements in socioeconomic environment o 2 half of 19 C, new hygienic measures  decrease in mortality from intestinal infections o Most acceptable explanation that trumps adv
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