CHAPTER 3

MORTALITY

1
1. Concepts and Data Requirements of Death
Statistics
2. Basic Mortality Measures
3. Standardization
4. Conventional Infant Mortality Rates
5. Maternal Death Rate
6. Life Table

2
 3.1. Concepts and Data Requirements of Death Statistics
Death statistics are needed for demographic studies and

for public health administration.

“Death is the permanent disappearance of all evidence of

life at any time after live birth has taken place”.

“A live birth is 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.”
3
 Cot Cont...
The definition of a live birth excludes the incidences of a

birth of dead foetus.

“A fetal death is death (disappearance of life) prior to the

complete expulsion from its mother of a product of

conception irrespective of the duration of pregnancy”.

Data Requirements and Sources for Mortality Statistics:

Principally two types of data are required to measure levels

and patterns of mortality in any part of the world.

4
 Cont...
 The first is the number of deaths that should be obtained from

vital statistics registration system, while the second type is the

size of the population exposed to the risk of death at a
particular time that should be obtained through censuses or
surveys or population estimates.
 The vital statistics registration system is likely to be

inadequate in the underdeveloped countries.

 The principal alternative sources of data for measuring
mortality are
(1) national censuses and
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(2) national sample surveys
 Sources of death statistics data
Cont...

6
 Cont...
3.2. Basic Mortality Measures
Crude Death Rate
 The crude death rate is defined as the number of deaths in a
year per 1000 of the midyear population.

 The crude death rate does not take into account the effects of

variations in age structure among population groups, and

7 hence it is generally considered as a poor measure of mortality.
 Age Specific Death Rates (ASDR
 An age-specific death rate is defined conventionally as the

number of deaths of persons of a given age during a year

(Da) per 1000 of the midyear population at that age (Pa).

 Age-specific death rates are usually computed for 5- or 10-

year age groups; but, because of the relatively great

magnitude of the death rates among infants, separate rates

8 are usually shown for the age groups under 1 and 1 to 4.

 Cause Specific Death Rates (CSDR):
 It is the number of deaths attributable to a particular cause

(C) divided by population at risk, usually expressed in deaths

per 100,000. CSDR=*100,000

Proportionate cause mortality rate:

 It is the number of deaths attributable to a particular cause

(C) divided by total deaths, usually expressed in deaths per

1000.

CSPMR=*1000
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 Exercise 1: The table below shows mortality data for a population.

Population
Age group No. of persons Number of deaths
0-4 40000 162
5-19 128000 107
20-44 172000 449
45-64 58000 451
65+ 9000 444

a) Compute the crude death rate

b) Compute the age specific death rates
10
 Exercise 2: The table below provides mortality data for a
population.
Population
Age group Number of persons Age specific Death rates per
1000
0-4 4000 4
5-19 12800 1
20-44 17200 3
45-64 5800 8
65+ 900 50

Calculate and interpret the crude death rate of the population.

11
Exercise 3:
The mid-year population of a certain city was 2.5 million, and
6000 people died during a paricular year. Out of the deaths,
 1200 died due to leukemia,

 1750 died due to stroke,

 250 died to pneumonia,

 250 died due to Hodgkin’s disease, and

 2500 died due to acute myocardial infarction.

a) Compute the cause specific death rate for acute myocardial

infraction
b)
12 Compute the proportionate mortality rate for leukemia
 Graphical Presentation of Age-Specific Death Rates
 The general pattern of mortality, which is described by

graphing age-sex specific death rates for any

population follows roughly similar pattern where it
starts at a high level in infancy, drops to low levels
during childhood and early adulthood, then rises
gradually into old age. An age pattern of mortality for
one country at different time for both sexes is presented
below.
13
 E.g.

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 3.3. Standardization of death rates

 Standardization is a procedure of adjusting the crude rates

to eliminate the effect of differences in population

composition with respect to age and other variables.
 Age-adjusted rates can be interpreted as the hypothetical

death rate that would have occurred if the observed age

specific rates were associated with a population whose age
distribution equaled that of the standard population.
 It is important to recognize that age-adjusted or age

standardized rates have no direct meaning in themselves.

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  They are meaningful only in comparison with other similarly

computed rates.
 Since they are useful only for comparison, the commonest

application of the procedure is to compute such rates for the

areas or population groups whose mortality is to be compared
and to calculate the relative differences of the resulting rates.
 The meaningful measure then is a ratio, index, or percentage

difference between rates similarly adjusted. There are two

types of standardization, known as direct‖ and indirect
standardization.
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 Direct standardization

 It is the simplest and most straightforward measure is

the age-adjusted death rate derived by the direct

method.
 For most comparisons, this is the preferred procedure

and it provides the best basis for determining the

relative difference between mortality in two areas or at
two dates
 In this method, a “standard” population is selected and
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employed in deriving all the age-adjusted rates in a set
  If the same standard population is employed, as required, all
the rates are directly comparable.
 The formula calls for computing the weighted average of the
age- specific death rates in a given area, using as weights the
age distribution of the standard population. The formula for
direct standardization is

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 Example

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 For direct standardization,

Age adjusted death rate =

 Where Ma =Da/number of population at each age is age-

specific death rate in the given area;

Pa represents standard population at each age and

P or ∑Pa represents the total standard population.

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 Solution: Direct standardization

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Indirect standardization
 As we have seen, calculation of the age-adjusted death rate

by the direct method requires age-specific death rates or

deaths by age for the area under study.
 These may not be available, even though a count or estimate

of the total number of deaths and an estimate of the crude

death rate are at hand.
 In this case, if counts or estimates of the age distribution of

the population are also available, it is possible to adjust the

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death rate by an indirect method.
  With this method, one takes a set of standard rates and applies to

the population being compared to produce a number of expected

events. The ratio observed/ expected then gives a standard
mortality ratio (SMR).
 Age –adjusted death rates = SMR*Crude death rate of standard
population.

Where M represents the crude death rate of the standard

population

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Example: Apply the indirect standardization method for the
above example (country A as standard population)

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  The CDR for the standard population is 10.5.

 The age adjusted rates for country A is

SMR*10.5= 1*10.5= 10.5 and

 The age adjusted rates for country B is

SMR*10.5= 1.6*10.5= 16.8

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 Exercise 4: The table below shows mortality data for populations A and B.

Population A Population B
Age Number Age specific Number Age specific Standard
group of Death rates of Death rates population
persons per 1000 persons per 1000
0-4 4000 4 4600 5 8440
5-19 12800 1 12900 1 29430
20-44 17200 3 20000 2 31670
45-64 5800 8 8700 4 10570
65+ 900 50 1400 44 3500

Which population is at a higher risk of death?

Use direct method of standardization.
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Exercise 5: The table below shows mortality data for populations A and B.
District A District B
Age No of ASDR/1000 No. of ASDR/000
group persons persons
0-14 500 4 400 3
15-29 2000 4 300 4
30-44 2000 6 1000 5
45-59 1000 10 2000 9
60 - 74 500 40 2000 35
75+ 100 150 400 125

 Standardize the death rates using indirect method of

standardization by considering district B as standard population.
 Which population is at a higher risk of death?
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 Exercise 6: The table below provides mortality data for populations.

Population A Population B Standard population

Age Number Number Number of Number of Number of Age-specific
group of persons of deaths persons deaths persons death rate/1000
0-4 40000 162 546000 2049 84416 8
5-19 128000 107 1982000 1195 294353 3
20-44 172000 449 2676000 5098 316744 6
45-64 58000 451 1807000 19904 205745 12
65+ 9000 444 1444000 63506 98742 50

Standardize the death rates using indirect method of

standardization

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3.4. Infant mortality rate
 The conventional infant mortality rate is defined as the

number of infant deaths per year per 1000 live births during
the year:

• where D1 represents deaths of infants during a year and B

represents live births during the same year.

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Example 3.7: Consider the U.S infant mortality rate for
1988. In 1988, 38,910 infants died and 3.9 million children
were born, therefore the IMR of U.S is calculated as

 The figure indicates that among 1000 live births of U.S in

1988, 10 infants were died.

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Neonatal mortality rate
Neonatal mortality rate measures the risk of dying within 4

weeks after live birth. Neonatal mortality rate is defined as

the number of deaths under 4 weeks in a year per 1000 live
births.
Neonatal mortality Rate (NMR) =

• Where D0-4 represent deaths under four weeks and B

represents number of live births in a year.

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Post-Neonatal Mortality Rate
Post neonatal mortality rate is defined as the number of deaths

between 4 and 52 weeks in a year per 1000 live births .

Post-Neonatal Mortality Rate (PNMR) = ,

where D4-52 represent deaths between 4 and 52 weeks and B

represents number of live births in a year.

N.B.: IMR =NMR+PNMR

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 3.5. Maternal Death Rate

 The maternal mortality rate (MMR) is the annual number of

female deaths per 100,000 during live births from any cause

related or aggravated by pregnancy or its management

(excluding accidental or incidental causes).

 This rate is conventionally defined as the number of deaths due

to puerperal causes per 10,000 or 100,000 births. With a

constant of 100,000, the formula is;

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 Cont...

MMR = (Dp/ B)* 100,000

Where Dp represents deaths due to puerperal causes.
Formerly, when maternal deaths were more numerous, a

constant multiplier of 10,000 was commonly used, and it

may be reasonably used today for groups of countries with
relatively high maternal mortality.

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 Exercise 7: The following data were obtained from the 1994
population and housing census of a certain zone.
Total population = 847,048

Total number of deaths occurred during the last 12 months

before the census day =10,462

Out of the total deaths, 2,303 were occurred to those who

are below one year of age.

Number of live births in the last 12 months =25392

Number of deaths of mothers due to maternal conditions 12

months before the census day =300

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 Cont...

Based on these data, calculate and interpret the

following demographic indices
a) Crude death rate

b) Infant mortality rate

c) Maternal mortality rate

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 Measures of morbidity
 Morbidity rates are rates used to identify the occurrence of

diseases.
 Morbidity is measured by incidence rates and prevalence rates.

i. Incidence rate
 Incidence rate measures all new cases during a specified period

of time.
 It is defined as the number of new cases during a specified

period of time per 1000 population at risk.

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 Cont...
 Incidence rate = (number of new cases during a specified period

of time/ population at risk for case in the specified period of

time)* 1000.

ii. Prevalence rate

 Prevalence rate measures the proportion of the population affected

with disease or certain condition during a specified period of time.

 Prevalence rate=(number of all cases (new and old cases) during

a specified period of time/ total population in the specified period

of time)* 1000.
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 Exercise:
A study begins with 10,000 women. Of these, 500 have had
breast cancer before the study began. The remaining 9500
women are followed for five years, during which 250 breast
cancer cases occur.
a) What is the prevalence rate of breast cancer at the

beginning of the study?

b) What is the incidence rate of breast cancer in the cohort?

Interpret the incidence rate.

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 3.6 Life Table

 Life Table is a simple and fundamental tool in

Demographic analysis that is used to analyze and present

in a convenient way the mortality experience of a
population under consideration.
 The first life table was developed by Halley that was

published in 1693.
 It was constructed from statistics of deaths alone and was
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not regarded as a correct life table.
 Cont...
 Later on, in 1815 Milne has developed the first

scientifically correct life table based on population and

death data classified by age.
 The mortality rates in the life table are combined with

other demographic data into a more complex model that

measures the combined effect of mortality and changes in
one or more socioeconomic characteristics.

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 Cont...

 Life tables are, in essence, one form of combining mortality

rates of a population at different ages into a single statistical

model
 They are principally used to measure the level of mortality of

the population involved

 One of their main advantages over other methods of

measuring mortality is that they do not reflect the effects of

the age distribution of an actual population and do not require
the adoption of a standard population for acceptable
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comparisons of levels of mortality in different populations.
 3.6.1 Types of Life Tables
Life tables differ in several ways, including the reference
year of the table, the age detail, and the number of factors
comprehended by the table

Based on the reference year of the table, the age detail,

and the number of factors comprehended by the table,
there are two general forms of the life table.

 Current or Period life table

 Cohort or Generation life table

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 Current or Period Life Table

It is based on the experience over a short period of

time, such as 1 year, 3 years, or an inter-censal period,
in which mortality has remained substantially the same.

Therefore, a current life table may be viewed as a

snapshot of current mortality. It is an excellent
summary description of mortality usually in a year or a
short period.
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 Cohort or Generation Life Table

It is based on the mortality rates experienced by a

particular birth cohort (e.g., all persons born in the year
1900).

According to this type of table, the mortality experience

of the persons in the cohort would be observed from
their moment of birth through each consecutive age in
successive calendar years until all of them die.
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 Cont...

 Obviously, data over a long period of years are needed to

complete a single table, and it is not possible wholly on

the basis of actual data to construct generation tables for
cohorts born in the 20th century.
 constructing generation life table is very difficult and

hence uncommon to use them, except, in specific areas

such as, projections of mortality, studies of mortality
trends, and measurement of fertility and reproductively.
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 Cont...
 According to the length of the age interval in which the data

are presented, Life tables are also classified into two types;
A Complete (or unabridged) contains data for every
single year of age from birth to the last applicable age.
An abridged life table contains data at intervals of 5 or
10 years of age for most of the age range.

 Demographers usually prepare the simpler abridged life

table rather than the more elaborate complete life table
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 3.6.2 Life Table Functions
 The basic life table’s functions are nqx, lx, ndx, nLx, Tx, and ex. These
six functions are generally calculated and published for every life
table.
 However, in some cases, because of limitations of space, some of

them may be omitted.

 This is done without a significant loss of information because the

functions are interrelated and some can be directly calculated from

the others

 In general, the mortality rate (nqx) is the basic function in the table

(i.e., the initial function from which all other life table functions are
48 derived
 Cont…

 nqx =The proportion of the persons in the cohort alive at the

beginning of an indicated age interval (x) who will die

before reaching the end of that age interval (x + n)
 lx =The number of persons living at the beginning of the

indicated age interval (x) out of the total number of births

assumed as the radix of the table.
 ndx =The number of persons who would die within the

indicated age interval (x to x + n) out of the total number of

49
births assumed in the table.
 Cont…
 nLx =The number of person-years that would be lived within

the indicated age interval (x to x + n) by the cohort of

100,000 births assumed.
 Tx=The total number of person-years that would be lived

after the beginning of the indicated age interval by the cohort

of 100,000 births assumed.
 ex =The average remaining lifetime (in years) for a person

who survives to the beginning of the indicated age interval.

This function is also called the complete expectation of life
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or, simply, life expectancy.
 3.6.3 Construction of a Simple Life Table

The construction of life table can be accomplished through

the following three broad phases
 The basic data on deaths, population and births are
checked for inconsistencies, bias and other error and are
made where necessary
 Mortality rates are computed and mathematically
smoothed

 The remaining functions of the life table are calculated

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carefully
Assumptions of constructing conventional life table are

The data on birth, death and population are fully accurate

The death occurring in between two consecutive birth
days are evenly distributed

There is no effect of immigration and emigration on the

cohort.

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A) Complete Life Table
A complete life table is a life table in which the values of
the functions are shown for single years of age. i.e. the
age interval n is equals to 1 in this case and x = 1,2,3
Column 1.
 The earlier and fundamental step in life table

construction is to convert the observed age

specific death rate (mx) into their corresponding

mortality rates (qx); or probability of dying. This

transformation is done using the following
53
formula
 Cont...

Where mx is the observed death rate at age x and qx is

probability of dying at age x The remaining life table
functions are calculated using standard procedure.
Column 2.
 The second value to be computed is lx; the number
of persons living at age x

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 Cont...
Where is radix of the life table = 100,000
For instance

l1 = (1- q0).( l0) =(1- q0).100,000

l2 = (1- q1).( l1)

Column 3.
The third value to be computed is dx; the number of
persons who would die at age x

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 Column 4.
 The fourth value to be computed is Lx; the number
of person-years that would be lived

But =0.207+0.793

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 Column 5.

 The fifth value to be computed is Tx; the

total number of person-years that would be

lived after the beginning x.

Where w is the last age in the life table

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 Column 6.

 The sixth value to be computed is ex ; the

average remaining lifetime (in years) for a person
who survives to the beginning of age x.

eo is the expectation of life at birth

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Example : Complete Life Table for the Total Population of
the United States: 1989– 1991displayed in the following table

59
 Cont…

. . . . . . . . . . . .
. .
.
60 .
B) Abridge Life Table
 An abridge life table is a life table in which the

values of the functions are shown for a 5 or 10 years

of age interval. In this case we use age interval of n
= 5 or 10.

Column 1: The method of converting the observed age

specific death rate (ndx )in to their corresponding
probability of dying (nqx) is given by

61
 Cont…
Where ndx is observed age specific death rate and nqx
is fraction of years lived at the age x to x + n by those
who die, it varies from country to country, according
to the level of Mortality, especially for developing
countries when mortality is high its value is assumed
to be

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63
 n Lx=n(In+x+(nqx-1*ndx-1))
Given that

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65
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67
 In measuring longevity, two concepts should be
distinguished

1. Life expectancy is the expected number of years to be

lived, on the average, by a particular population at a
particular time.
2. Life Span is limit of human life. There is no known
exact figure for the life span of human beings or any
other species. However, by using the verified age of the
longest lived individual, one operational definition of
life span for a species can be constructed, namely, the
maximum recorded age at death. Using this operational
definition, the life span for humans appears to be just
68 over 120 years
 THANK
YOU

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