Death distribution methods for estimating adult mortality

TThe General Growth Balance (GGB) and Synthetic Extinct Generations (SEG) methods have been widely used to evaluate the coverage of registered deaths in developing countries. However, relatively little is known about how the methods behave in the presence of different data errors. This paper applies the methods (both singly and in combination) using non-stable populations of known mortality to which various data distortions in a variety of combinations have been applied. Results show that the methods work very well when the only errors in the data are those for which the methods were developed. For other types of error, performance is more variable, but on average, adjusted mortality estimates using the methods are closer to the true values than the unadjusted. The methods do surprisingly well in the presence of typical patterns of age misreporting, though GGB is more sensitive to coverage errors that change with age; the Basic SEG method (e.g. not adjusting for any slope with age of completeness estimates) is very sensitive to changes in census coverage; but once slope is adjusted for changing census, coverage has little effect. Fitting to the age range 5+ to 65+ is clearly preferable to fitting to 15+ to 55+. Both GGB and SEG are very sensitive to net migration, which is an Achilles heel for all of the methodologies in this paper. In populations not greatly affected by migration, our results suggest that an optimal strategy would be to apply GGB to estimate census coverage change, adjust for it and then apply SEG; in populations affected by migration, applying both GGB and SEG, fitting both to the age range 30+ to 65+, and averaging the results appears best.adult mortality, death distribution methods, estimation, sensitivity analysis, simulation

Levels and trends in child mortality: Report 2022

In total, more than 5.0 million children under age 5, including 2.3 million newborns, along with 2.1 million children and youth aged 5 to 24 years – 43 per cent of whom are adolescents – died in 2021. This tragic and massive loss of life, most of which was due to preventable or treatable causes, is a stark reminder of the urgent need to end preventable deaths of children and young people. Sadly, these deaths were mostly preventable with widespread and effective interventions like improved care around the time of birth, vaccination, nutritional supplementation and water and sanitation programmes.Timely, high-quality and disaggregated data – which allow the most vulnerable children to be identified – are critical to achieving the goal of ending preventable deaths of children. Yet as the COVID-19 pandemic has put into stark light, data of this nature are more the exception than the rule: Just 36 countries have high-quality nationally representative data on under-five mortality for 2021, while about half the world's countries have no data on child mortality in the last five years. These substantial data gaps pose enormous challenges to policy- and decision-making and prolong the need for modelling mortality from what little data are available. To improve the availability, quality and timeliness of data for monitoring the health and survival situation of children and youth, much greater investments must be made to strengthen data systems

National, regional, and global sex ratios of infant, child, and under-5 mortality and identifi cation of countries with outlying ratios: a systematic assessment

Background Under natural circumstances, the sex ratio of male to female mortality up to the age of 5 years is greater than one but sex discrimination can change sex ratios. The estimation of mortality by sex and identifi cation of countries with outlying levels is challenging because of issues with data availability and quality, and because sex ratios might vary naturally based on diff erences in mortality levels and associated cause of death distributions. Methods For this systematic analysis, we estimated country-specifi c mortality sex ratios for infants, children aged 1–4 years, and children under the age of 5 years (under 5s) for all countries from 1990 (or the earliest year of data collection) to 2012 using a Bayesian hierarchical time series model, accounting for various data quality issues and assessing the uncertainty in sex ratios. We simultaneously estimated the global relation between sex ratios and mortality levels and constructed estimates of expected and excess female mortality rates to identify countries with outlying sex ratios. Findings Global sex ratios in 2012 were 1·13 (90% uncertainty interval 1·12–1·15) for infants, 0·95 (0·93–0·97) for children aged 1–5 years, and 1·08 (1·07–1·09) for under 5s, an increase since 1990 of 0·01 (–0·01 to 0·02) for infants, 0·04 (0·02 to 0·06) for children aged 1–4 years, and 0·02 (0·01 to 0·04) for under 5s. Levels and trends varied across regions and countries. Sex ratios were lowest in southern Asia for 1990 and 2012 for all age groups. Highest sex ratios were seen in developed regions and the Caucasus and central Asia region. Decreasing mortality was associated with increasing sex ratios, except at very low infant mortality, where sex ratios decreased with total mortality. For 2012, we identifi ed 15 countries with outlying under-5 sex ratios, of which ten countries had female mortality higher than expected (Afghanistan, Bahrain, Bangladesh, China, Egypt, India, Iran, Jordan, Nepal, and Pakistan). Although excess female mortality has decreased since 1990 for the vast majority of countries with outlying sex ratios, the ratios of estimated to expected female mortality did not change substantially for most countries, and worsened for India. Interpretation Important diff erences exist between boys and girls with respect to survival up to the age of 5 years. Survival chances tend to improve more rapidly for girls compared with boys as total mortality decreases, with a reversal of this trend at very low infant mortality. For many countries, sex ratios follow this pattern but important exceptions exist. An explanation needs to be sought for selected countries with outlying sex ratios and action should be undertaken if sex discrimination is present

Global, regional, and national mortality trends in older children and young adolescents (5–14 years) from 1990 to 2016: an analysis of empirical data

Summary Background From 1990 to 2016, the mortality of children younger than 5 years decreased by more than half, and there are plentiful data regarding mortality in this age group through which we can track global progress in reducing the under-5 mortality rate. By contrast, little is known on how the mortality risk among older children (5–9 years) and young adolescents (10–14 years) has changed in this time. We aimed to estimate levels and trends in mortality of children aged 5–14 years in 195 countries from 1990 to 2016. Methods In this analysis of empirical data, we expanded the United Nations Inter-agency Group for Child Mortality Estimation database containing data on children younger than 5 years with 5530 data points regarding children aged 5–14 years. Mortality rates from 1990 to 2016 were obtained from nationally representative birth histories, data on household deaths reported in population censuses, and nationwide systems of civil registration and vital statistics. These data were used in a Bayesian B-spline bias-reduction model to generate smoothed trends with 90% uncertainty intervals, to determine the probability of a child aged 5 years dying before reaching age 15 years. Findings Globally, the probability of a child dying between the ages 5 years and 15 years was 7·5 deaths (90% uncertainty interval 7·2–8·3) per 1000 children in 2016, which was less than a fifth of the risk of dying between birth and age 5 years, which was 41 deaths (39–44) per 1000 children. The mortality risk in children aged 5–14 years decreased by 51% (46–54) between 1990 and 2016, despite not being specifically targeted by health interventions. The annual number of deaths in this age group decreased from 1·7 million (1·7 million–1·8 million) to 1 million (0·9 million–1·1 million) in 1990–2016. In 1990–2000, mortality rates in children aged 5–14 years decreased faster than among children aged 0–4 years. However, since 2000, mortality rates in children younger than 5 years have decreased faster than mortality rates in children aged 5–14 years. The annual rate of reduction in mortality among children younger than 5 years has been 4·0% (3·6–4·3) since 2000, versus 2·7% (2·3–3·0) in children aged 5–14 years. Older children and young adolescents in sub-Saharan Africa are disproportionately more likely to die than those in other regions; 55% (51–58) of deaths of children of this age occur in sub-Saharan Africa, despite having only 21% of the global population of children aged 5–14 years. In 2016, 98% (98–99) of all deaths of children aged 5–14 years occurred in low-income and middle-income countries, and seven countries alone accounted for more than half of the total number of deaths of these children. Interpretation Increased efforts are required to accelerate reductions in mortality among older children and to ensure that they benefit from health policies and interventions as much as younger children. Funding UN Children\u27s Fund, Bill & Melinda Gates Foundation, United States Agency for International Development

Estimating the stillbirth rate for 195 countries using a Bayesian sparse regression model with temporal smoothing

Estimation of stillbirth rates globally is complicated because of the paucity of reliable data from countries where most stillbirths occur. We com-piled data and developed a Bayesian hierarchical temporal sparse regression model for estimating stillbirth rates for 195 countries from 2000 to 2019. The model combines covariates with a temporal smoothing process so that estimates are data-driven in country-periods with high-quality data and deter-mined by covariates for country-periods with limited or no data. Horseshoe priors are used to encourage sparseness. The model adjusts observations with alternative stillbirth definitions and accounts for various sources of uncer-tainty. In-sample goodness of fit and out-of-sample validation results suggest that the model is reasonably well calibrated. The model is used by the UN In-teragency Group for Child Mortality Estimation to monitor the stillbirth rate for 195 countries

National, regional, and worldwide estimates of stillbirth rates in 2015, with trends from 2000: a systematic analysis

Data produced by the Every Newborn Action Plan (ENAP) study to estimate national stillbirth rates (SBRs) and numbers for 195 countries. SBR data was collated through a systematic review of national routine/registration systems, nationally representative surveys, and other data sources, and subsequently modelled using restricted maximum likelihood estimation with country-level random effects. Data outputs include a list of 2207 stillbirth rate data points used as an input to the modelled estimates, yearly national-level covariates for each of the 195 countries studied from 2000 to 2015, and information on estimated stillbirth rates from 2000 to 2015 for countries with higher quality national routine time-series data for stillbirth rates, using loess regression of the country reported rates

Countdown to 2030 : tracking progress towards universal coverage for reproductive, maternal, newborn, and child health

Building upon the successes of Countdown to 2015, Countdown to 2030 aims to support the monitoring and measurement of women's, children's, and adolescents' health in the 81 countries that account for 95% of maternal and 90% of all child deaths worldwide. To achieve the Sustainable Development Goals by 2030, the rate of decline in prevalence of maternal and child mortality, stillbirths, and stunting among children younger than 5 years of age needs to accelerate considerably compared with progress since 2000. Such accelerations are only possible with a rapid scale-up of effective interventions to all population groups within countries (particularly in countries with the highest mortality and in those affected by conflict), supported by improvements in underlying socioeconomic conditions, including women's empowerment. Three main conclusions emerge from our analysis of intervention coverage, equity, and drivers of reproductive, maternal, newborn, and child health (RMNCH) in the 81 Countdown countries. First, even though strong progress was made in the coverage of many essential RMNCH interventions during the past decade, many countries are still a long way from universal coverage for most essential interventions. Furthermore, a growing body of evidence suggests that available services in many countries are of poor quality, limiting the potential effect on RMNCH outcomes. Second, within-country inequalities in intervention coverage are reducing in most countries (and are now almost non-existent in a few countries), but the pace is too slow. Third, health-sector (eg, weak country health systems) and non-health-sector drivers (eg, conflict settings) are major impediments to delivering high-quality services to all populations. Although more data for RMNCH interventions are available now, major data gaps still preclude the use of evidence to drive decision making and accountability. Countdown to 2030 is investing in improvements in measurement in several areas, such as quality of care and effective coverage, nutrition programmes, adolescent health, early childhood development, and evidence for conflict settings, and is prioritising its regional networks to enhance local analytic capacity and evidence for RMNCH

A call for standardised age-disaggregated health data.

The 2030 Sustainable Development Goals agenda calls for health data to be disaggregated by age. However, age groupings used to record and report health data vary greatly, hindering the harmonisation, comparability, and usefulness of these data, within and across countries. This variability has become especially evident during the COVID-19 pandemic, when there was an urgent need for rapid cross-country analyses of epidemiological patterns by age to direct public health action, but such analyses were limited by the lack of standard age categories. In this Personal View, we propose a recommended set of age groupings to address this issue. These groupings are informed by age-specific patterns of morbidity, mortality, and health risks, and by opportunities for prevention and disease intervention. We recommend age groupings of 5 years for all health data, except for those younger than 5 years, during which time there are rapid biological and physiological changes that justify a finer disaggregation. Although the focus of this Personal View is on the standardisation of the analysis and display of age groups, we also outline the challenges faced in collecting data on exact age, especially for health facilities and surveillance data. The proposed age disaggregation should facilitate targeted, age-specific policies and actions for health care and disease management

UN IGME and IHME estimates of the annual rate of reduction for 1990–2010.

<p>UN IGME estimates are plotted against IHME estimates. Grey area illustrates absolute differences of up to 1%, 2%, and 3%, respectively (absolute difference). Red indicates that the difference is at least 2% and the conclusion as to whether the country is on track to meet MDG 4 (a 4.4% annual decline) differs between the IHME and the UN IGME.</p