Impacto directo e indirecto del COVID-19 en la esperanza de vida al nacer de Chile en el año 2020 / Direct and indirect impact of COVID-19 on life expectancy at birth in Chile in 2020 / Impacto direto e indireto da COVID-19 na expectativa de vida ao nascer no Chile em 2020

Resumen: El artículo muestra el impacto directo e indirecto del COVID-19 en la esperanza de vida de Chile durante el año 2020, utilizando las estadísticas de defunciones definitivas publicadas en marzo del año 2023. Para ello, se estimó una mortalidad contrafactual para año 2020 sin el COVID-19, siguiendo el patrón de mortalidad según causas de muerte desde 1997 a 2019, se elaboraron tablas de mortalidad para calcular la esperanza de vida para los años 2015 a 2020 y para el año 2020 estimado, y luego se descompuso la diferencia entre la esperanza de vida esperada y observada del año 2020 según grupos de edad y causas de muerte. La esperanza de vida del año 2020 quiebra la tendencia a su aumento entre 2015 y 2019, mostrando un retroceso, en hombres y en mujeres, con respecto al año 2019, de 1,32 y 0,75 años respectivamente. Con respecto al año 2020 estimado, la esperanza de vida del 2020 observado es 1,51 años menor en hombres y 0,92 en mujeres, pero el impacto directo del COVID-19 en pérdida de esperanza de vida fue mayor, 1,89 para los hombres y 1,5 para las mujeres, concentrándose en las edades entre los 60 y 84 años en hombres y entre 60 y 89 años en mujeres. El impacto directo negativo del COVID-19 a la esperanza de vida en parte fue contrarrestado por impactos indirectos positivos significativos en dos grupos de causas de muerte, las enfermedades del sistema respiratorio y las enfermedades infecciosas y parasitarias. El estudio muestra la necesidad de distinguir los impactos directos e indirectos del COVID-19, por la incidencia que pueden tener en la salud pública cuando el COVID-19 baje su intensidad y se eliminen las restricciones de movilidad.

Abstract: This article shows the direct and indirect impacts of COVID-19 on life expectancy in Chile in 2020, based on mortality statistics published in March 2023. To this end, a counterfactual mortality was estimated for 2020 without COVID-19; based on the pattern of mortality by cause of death from 1997 to 2019, mortality charts were created to calculate life expectancy from 2015 to 2020 and an estimation for 2020, and the difference between expected and observed life expectancy in 2020 was then separated by age group and cause of death. Life expectancy in 2020 interrupted the upward trend from 2015 to 2019, showing a decline of 1.32 years in men and 0.75 years in women compared to 2019. Compared to the estimated 2020, life expectancy was 1.51 years lower in men and 0.92 years lower in women, but the direct impact of COVID-19 on the decrease in life expectancy was greater (1.89 for men and 1.5 for women) in the 60-84 age group in men and the 60-89 age group in women. The direct negative impact of COVID-19 on life expectancy was partially mitigated by significant positive indirect impacts on two groups of causes of death: diseases of the respiratory system and infectious and parasitic diseases. This study shows the need to differentiate direct and indirect impacts of COVID-19, due to the implications for public health when the intensity of COVID-19 decreases and mobility restrictions are suspended.

Resumo: Este artigo apresenta os impactos direto e indireto da COVID-19 na expectativa de vida no Chile em 2020 a partir de estatísticas de mortalidade publicadas em março de 2023. Para tanto, foi estimada uma mortalidade contrafactual para 2020 sem a COVID-19; a partir do padrão de mortalidade por causa de morte de 1997 a 2019, foram criadas tabelas de mortalidade para calcular a expectativa de vida para o período de 2015 a 2020 e para o ano estimado de 2020 e, em seguida, a diferença entre a expectativa de vida esperada e observada em 2020 foi separada por faixa etária e causa de morte. A expectativa de vida em 2020 interrompe a tendência de aumento entre 2015 e 2019, mostrando um declínio com relação a 2019 de 1,32 ano nos homens e 0,75 ano nas mulheres. Com relação ao ano estimado de 2020, a expectativa de vida observada é 1,51 ano menor nos homens e 0,92 nas mulheres, mas o impacto direto da COVID-19 na diminuição da expectativa de vida foi maior (1,89 para homens e 1,5 para mulheres), concentrando-se nas idades entre 60 e 84 anos nos homens e entre 60 e 89 anos nas mulheres. O impacto direto negativo da COVID-19 na expectativa de vida foi parcialmente atenuado por impactos indiretos positivos significativos em dois grupos de causas de morte: doenças do sistema respiratório e doenças infecciosas e parasitárias. Este estudo mostra a necessidade de diferenciar impactos diretos e indiretos da COVID-19, devido às implicações para a saúde pública quando a intensidade da COVID-19 diminuir e as restrições de mobilidade forem suspensas.

Socioeconomic inequalities in premature mortality in Colombia, 1998-2007: the double burden of non-communicable diseases and injuries.

OBJECTIVES: Non-communicable diseases have become the leading cause of death in middle-income countries, but mortality from injuries and infections remains high. We examined the contribution of specific causes to disparities in adult premature mortality (ages 25-64) by educational level from 1998 to 2007 in Colombia. METHODS: Data from mortality registries were linked to population censuses to obtain mortality rates by educational attainment. We used Poisson regression to model trends in mortality by educational attainment and estimated the contribution of specific causes to the Slope Index of Inequality. RESULTS: Men and women with only primary education had higher premature mortality than men and women with post-secondary education (RRmen=2.60, 95% confidence interval [CI]: 2.56, 2.64; RRwomen=2.36, CI: 2.31, 2.42). Mortality declined in all educational groups, but declines were significantly larger for higher-educated men and women. Homicide explained 55.1% of male inequalities while non-communicable diseases explained 62.5% of female inequalities and 27.1% of male inequalities. Infections explained a small proportion of inequalities in mortality. CONCLUSION: Injuries and non-communicable diseases contribute considerably to disparities in premature mortality in Colombia. Multi-sector policies to reduce both interpersonal violence and non-communicable disease risk factors are required to curb mortality disparities.

[Adult mortality among indigenous and non-indigenous populations of Guatemala and Bolivia]. / Mortalidad adulta entre poblaciones indigenas y no indigenas de Guatemala y Bolivia.

PIP: "Use of the maternal orphanhood method permits comparison of adult female mortality levels between indigenous and non-indigenous population [in Guatemala and Bolivia].... Results show that in both countries adult female mortality is higher for the indigenous population. Comparison with infant mortality levels reveals differences in the mortality patterns between the two ethnic groups. In Guatemala--where estimates are more consistent--comparisons across time reveal a more rapid descent for infant than for adult mortality. As a consequence, differences in levels of adult mortality between indigenous and non-indigenous populations are higher than differences in infant mortality. In Bolivia estimates are not as consistent as in Guatemala." This paper was originally presented at the 1992 Annual Meeting of the Population Association of America. (EXCERPT)^ieng

[The use of years of life lost for measuring the level and change of mortality]. / Los anos de vida perdidos: su utilizacion para medir el nivel y cambio de la mortalidad.

"The use of the new index of years of life lost allows us to relate mortality by age and causes of death to the change of the life expectancy, at birth or between any given ages. This index replaces the use of the multiple decrement life tables for analyzing the impact of the change in mortality by age and cause of death on the life expectancies....The article presents the theoretical derivation of the index, some examples of its use, and a detailed calculation." Examples provided include Mexico, Chile, and Argentina. (SUMMARY IN ENG)

Epidemiological transition in Trinidad and Tobago, West Indies 1953-1992.

BACKGROUND: This study aimed to describe trends in age-specific mortality from diabetes mellitus, hypertension, cerebrovascular disease and ischaemic heart disease in Trinidad and Tobago between 1953 and 1992 and to relate them to earlier changes in infant mortality rates. METHODS: Average annual age-specific mortality rates per 100 000 were calculated for 5-year time periods from 1953-1957 to 1988-1992 and plotted by mid-year of birth for cohorts born 1874-1882 to 1944-1952. Regression analyses were performed to test associations between adult mortality rates, and infant mortality rates for the same birth cohorts and period of death. RESULTS: Infant mortality declined from 180 per 1000 in 1901 to 10 per 1000 in 1992. Age-standardized mortality from diabetes mellitus increased, in men, from 60 in 1958-1962 to 278 in 1988-1992, in women the increase was from 89 to 303. Mortality from hypertension declined, in men, from 232 in 1953-1957 to 73 in 1988-1992, and in women, from 206 to 67. Cerebrovascular mortality increased, in men, from 341 in 1953-1957 to 451 in 1963-1967 before declining to 224 in 1988-1992. In women cerebrovascular mortality increased from 292 in 1953-1957 to 361 in 1963-1967 before declining to 196 in 1988-1992. There was evidence of a deceleration in cerebrovascular mortality for cohorts born after 1908-1918. Ischaemic heart disease mortality remained constant. Mid-cohort infant mortality rates were not associated with adult mortality after adjusting for age and period of death. CONCLUSION: Declining infant mortality was subsequently associated with declining mortality from cerebrovascular disease and hypertensive disease and increasing mortality from diabetes mellitus but there was no association with ischaemic heart disease mortality. These relationships were confounded by secular changes associated with year of death.

[Adult mortality in developing countries: a global overview]. / La mortalidad adulta en paises en desarrollo: una vision general.

"The article analyzes [selected] developing countries with reliable information on adult mortality between ages 15 and 65 years....A brief analysis of each country indicates the following aspects. Females maintained a more sustained and systematic decline of adult mortality than males. There are some countries that in spite of reasonable development, as Mexico, still have a great excess of male mortality in relation to other countries. Finally, some countries experienced a stagnation of the male mortality decline, while females continued benefiting from a decline of mortality." (SUMMARY IN ENG)

An alternative procedure for fitting relational model life tables.

"The paper considers the problem of fitting a relational model life table to mortality data which does not include reliable estimates of infant and child mortality. This type of data could arise from indirect estimation of adult mortality using orphanhood or widowhood, or from adjustment of incomplete registration data using growth balance methods in a population recently de-stabilized by falls in fertility. The proposed fitting technique can give equal weight to all the age specific mortality risk information available, rather than giving more weight to the information for younger ages, as is the case with the traditional method. An application to Brazilian data is presented." (SUMMARY IN ITA AND FRE)

[Adult mortality decline in Costa Rica]. / La disminucion de la mortalidad de adultos en Costa Rica.

"This paper examines the adult-mortality transition in Costa Rica and its determinants. The risk of dying declined by 80% for young adults and by 40% for old adults from 1920 to 1990. The fastest decline took place in the 1950s for young-adult ages and in the late 1980s for old-adult ages.... By 1990, about 40% of Costa Rican deaths are caused by accidents and violence at young-adult ages and by cardiovascular diseases at old ages. Infectious and nutritional-related conditions (especially respiratory tuberculosis and malaria) account for three-fourths of the adult-mortality decline between 1951 and 1971, but only for 30% since that year on." (SUMMARY IN ENG)

[Adult mortality from chronic diseases in Chile, 1968-1990]. / La mortalidad de adultos por enfermedades cronicas en Chile, 1968-1990.

"The paper starts with a brief analysis of the sources and the quality of the data and the mortality indices [for trends in adult mortality from chronic diseases in Chile]....A comparison is made of mortality among the 13 regions of the country and an attempt is made to relate the observed differences to some environmental and life-style factors. Rural-urban and educational differences of mortality by cause of death are also analyzed. The paper ends by comparing mortality by chronic disease in Chile with that of other countries of the Latin American region, noting some difficulties [in] such a comparison and proposing hypotheses for future studies." (SUMMARY IN ENG)

[Evaluation of vital statistics for the study of causes of death in Latin America]. / Evaluacion del uso de las estadisticas vitales para estudios de causas de muerte en America Latina.

"The present article attempts to take a deeper look at the most relevant aspects of the problems presented by the data on adult mortality and causes of death in Latin America.... Statistical coverage of registered deaths by age and sex is analysed, finding important differences among the countries and higher coverage in the registration of adult deaths than of younger ones.... Data quality on causes of death...showed some improvement during the period studied.... Reference is made to topics related to the analysis of causes of death [that] generally complicate the work, such as the heterogeneity of coverage and data quality at subnational levels, the compatibility among different revisions of the ICD, the use of ill-defined causes and, finally, access and management of basic information." (SUMMARY IN ENG)

[Differential mortality in women of reproductive age]. / La mortalidad diferencial de las mujeres en edades reproductivas.

"This paper begins by reviewing some conceptual frameworks for the study of female mortality and indicates some of its application problems. Next it presents results of mortality of women in reproductive-age classified by age, causes of death, and socio-demographic traits (marital status, schooling, and occupation) for ten states [in Mexico] differentiated according to level of development and well-being. The data suggests differences according to age, marital status, and schooling. Finally, testing of the mutual independence and partial independence hypotheses indicates that age, marital status, and schooling correlate to the degree of development of each state." (SUMMARY IN ENG)

[Modeling and projecting mortality in Chile]. / Modelacion y proyeccion de la mortalidad en Chile.

"In a recent paper, Lee and Carter developed a new method for analyzing and forecasting time series of age specific mortality, and applied it to the U.S. population. In this paper, we extend that method to deal with various problems of incomplete data common in Third World populations, and then apply the method to forecast mortality in Chile." (SUMMARY IN ENG)

[A comparative analysis of mortality in the Americas]. / Comparacion de la mortalidad en las Americas.

"The analysis concentrates on the mortality of [the] adult population at ages 15 to 74 in 8 countries of the American continent.... Results are presented by age, sex and principal groups of causes of death. It is concluded that: a) mortality can significantly decline further in the Americas; b) there are noticeable mortality differentials by cause among countries; [and] c) all the countries still have excess mortality in certain age groups and causes of death, and hence, the mortality transition has not ended." (SUMMARY IN ENG)

Worldwide variations in the lifetime probability of reproductive cancer in women: implications of best-case, worst-case, and likely-case assumptions about the effect of oral contraceptive use.

Cancer incidence in countries representative of three patterns of reproductive cancer and age-specific mortality was used to estimate the effect of oral contraceptive use on the lifetime probability of reproductive cancer under three sets of assumptions about the effects of oral contraceptives. Under the set of assumptions considered likely, oral contraceptives were estimated to reduce or increase only slightly the lifetime probability of any reproductive cancer in each setting. Under worst-case assumptions, oral contraceptives were estimated to increase the lifetime probability of reproductive cancer only modestly in settings with low cancer rates and in settings with high rates of breast, ovarian, and endometrial cancer, but it might have a large impact on lifetime probability of reproductive cancer in settings with high cervical cancer rates. Under best-case assumptions, oral contraceptives were estimated to decrease the lifetime probability of reproductive cancer in each setting; this reduction was estimated to be greatest in settings where endometrial and ovarian cancer incidence are high.

PIP: Researchers applied published data on cancer incidence and age specific mortality to standard life table techniques to estimate the lifetime probability of developing reproductive cancer for women living in countries representative of 3 patters of risk of reproductive cancer and for long term oral contraceptives (OC) users under best case, worst case, and likely case assumptions. The reproductive cancers included breast, ovarian, endometrial, and cervical cancers. The data consisted of urban women from China, Japan, United States (California), England, Wales, Costa Rica, and Colombia. Under the likely case assumption, OCs just barely reduced or increased the lifetime probability of any reproductive cancer in any setting. Further, under the worst case scenario, OCs increased the lifetime probability or reproductive cancer moderately in countries with low cancer rates (Asian countries) and in countries with high rates of breast, ovarian, and endometrial cancer (Western Europe, North America, and Australia). Yet in countries with high cervical rates (South and Central America), OC use significantly affected the lifetime probability of reproductive cancer. The best case scenario revealed that OCs decreased lifetime probability of reproductive cancer in each country, especially those countries where endometrial and ovarian cancer incidences were great. The analysis also showed that OC use has the greatest effect on lifetime probability of reproductive cancer, be it positive or negative, in countries with high underlying rates of reproductive cancer. Further it demonstrated that the effect of OC use will most likely be small in countries with low incidence of reproductive cancers. Overall the researchers felt reassured about OC use and reproductive cancer. Even though long term OC use increases the risk of breast cancer in young ages.

Age misreporting and its effects on adult mortality estimates in Latin America.

"This article investigates whether misreporting of ages contributes to the apparently low mortality at older ages in Latin America. It compares the size of cohorts enumerated at two censuses, after allowance for intercensal deaths, in 10 intercensal periods in four countries. It finds evidence of very pervasive overstatement of age at advanced ages. Using an empirical age-reporting matrix for Costa Rica, it estimates the bias that such misstatement produces in measured adult mortality levels in that country."

Index of years of potential life lost in Mexico.

PIP: The index of years of potential life lost (IYPL) is calculated for the states of Mexico in comparison to that of Mexico as a whole. Based on deaths notified in 1985, standardized reasons for mortality and the IYPL were calculated for 5-year cohorts in 32 Mexican states. The IYPL was first calculated for the State of Aguascalientes, a small state in central Mexico, using the formula of Haenszel and Yerushalmy. Columns were generated showing 1) the middle point for each cohort, by calculating the semi-sum of the relative limits in each age category; 2) number of deaths subtracted from an arbitrary life expectancy of 70; 3) population of each cohort; 4) rate of general mortality for each cohort; 5) expected deaths the state had a mortality equal to the Mexican Republic; and 6) IYPL. Results for IYPL for all the Mexican states are tabulated, next to life expectancy, and standardized reason for mortality. The results are also plotted graphically on maps. While at first the 2 figures do not seem consistent, socioeconomic factors such as child mortality, occupational mortality, nutrition, and environmental sanitation can explain some of the discrepancies. Usually mortality rates and life expectancy are used to describe and compare health in different regions. IYPL has it uses, despite its simple calculation, because it can suggest ways to allocate resources according to health needs.^ieng

[Premature mortality by selected causes, Cuba 1981]. / Mortalidad prematura por algunas causas de defuncion seleccionadas, Cuba 1981.

PIP: The authors estimate premature mortality due to selected causes of death for different age groups, particularly at early ages, using an indicator of potential years of life lost by a population. Premature mortality in Cuba in 1981 is calculated by sex for 10 selected causes of death and for all causes. (SUMMARY IN ENG AND FRE)^ieng

[Adult mortality between ages 15 and 49 in Cuba. Levels and trends, 1960-1982]. / La mortalidad del adulto de 15 a 49 anos en Cuba. Niveles y evolucion, 1960-1982.

Mortality levels and trends for the population of Cuba aged 15-49 are analyzed. Differences according to age, sex, and cause of death are described. "Results show a trend to decreased mortality in most of the causes, particularly marked for infectious diseases and maternal deaths; accidents and other unnatural causes are [the] first cause of death in the younger groups; cardiovascular diseases and neoplasias increased their relative importance, even more in those older than 30 years." (SUMMARY IN ENG AND FRE)

Maternal and child mortality along the U.S.-Mexico border.

This paper examines the maternal mortality and the age-specific mortality rates for the under 25 year olds in six border regions on the U.S. side of the U.S.-Mexico border and compares them with those of adjoining regions in Mexico. On the U.S. side of the border, the improvement in the general mortality status of maternal and child health from 1970 to 1980 was equal to or better than that of the nation as a whole. Despite this improvement, in 1980 five of the six border regions showed higher mortality rates due to external causes for the 1-4 age-group. On the Mexican side, maternal and child mortality was lower in the border region than in other parts of Mexico but much higher than in the United States. The 1-4 year olds in Mexico had the highest mortality rates among the three age-groups over 1 year of age.

[Estimation of adult mortality in six parishes of the central valley of Costa Rica (1888-1910) based on information on orphanhood]. / Estimacion de la mortalidad adulta en seis parroquias del valle central de Costa Rica (1888-1910) a partir de la informacion sobre orfandad

"This paper contains an application of the orphanhood method for estimating adult mortality, based on information provided during the period 1888-1910 by the brides and bridegrooms of six parishes of the Central Valley of Costa Rica.... Using the Brass technique for estimating adult mortality from orphanhood and interpolating the resulting probabilities of surviving into... Coale and Demeny's regional model life tables, the life expectancy at the age of 25 years is estimated [at] 41 years for women and 40 years for men." Mortality differences by region and social-occupational group are considered. (summary in ENG)