Estimation and probabilistic projection of age- and sex-specific mortality rates across Brazilian municipalities between 2010 and 2030.

BACKGROUND: Mortality rate estimation in small areas can be difficult due the low number of events/exposure (i.e. stochastic error). If the death records are not completed, it adds a systematic uncertainty on the mortality estimates. Previous studies in Brazil have combined demographic and statistical methods to partially overcome these issues. We estimated age- and sex-specific mortality rates for all 5,565 Brazilian municipalities in 2010 and forecasted probabilistic mortality rates and life expectancy between 2010 and 2030. METHODS: We used a combination of the Tool for Projecting Age-Specific Rates Using Linear Splines (TOPALS), Bayesian Model, Spatial Smoothing Model and an ad-hoc procedure to estimate age- and sex-specific mortality rates for all Brazilian municipalities for 2010. Then we adapted the Lee-Carter model to forecast mortality rates by age and sex in all municipalities between 2010 and 2030. RESULTS: The adjusted sex- and age-specific mortality rates for all Brazilian municipalities in 2010 reveal a distinct regional pattern, showcasing a decrease in life expectancy in less socioeconomically developed municipalities when compared to estimates without adjustments. The forecasted mortality rates indicate varying regional improvements, leading to a convergence in life expectancy at birth among small areas in Brazil. Consequently, a reduction in the variability of age at death across Brazil's municipalities was observed, with a persistent sex differential. CONCLUSION: Mortality rates at a small-area level were successfully estimated and forecasted, with associated uncertainty estimates also generated for future life tables. Our approach could be applied across countries with data quality issues to improve public policy planning.

Complicaciones en los pacientes quemados

Introducción: La lesión por quemadura es uno de los eventos más traumáticos y devastadores que puede sufrir un ser humano. Este evento térmico produce profundas alteraciones en los mecanismos sistémicos de defensa del huésped. Las complicaciones en grandes quemados comienzan en la fase inmediata de la inflamación producida tras sufrir la agresión térmica. Las complicaciones en los pacientes quemados se han asociado con un mal pronóstico, con una alta morbilidad y mortalidad. Objetivo: Describir las complicaciones en los pacientes quemados. Métodos: Se realizó un estudio descriptivo, retrospectivo, de corte transversal para describir las complicaciones en los pacientes quemados que ingresaron en la sala de Caumatología del Hospital Universitario Manuel Ascunce Domenech de la ciudad Camagüey en el período comprendido desde enero de 2021 hasta febrero de 2022. Se estudiaron 32 pacientes en quienes se tuvieron en cuenta las variables: índice de gravedad, complicaciones generales, las complicaciones hidroelectrolíticas y acido básicas, así el estado al egreso de los pacientes. Resultados: Hubo un predominio de pacientes con complicaciones en aquellos lesionados con insulto térmico severo, presentes en 24 pacientes para un 75 %. La infección de la lesión por quemaduras, la hiperglucemia, la anemia y los estados de deshidratación fueron las complicaciones que mayormente se presentaron en los pacientes estudiados. La totalidad de los fallecidos fueron del grupo de pacientes que presentaron complicaciones, ocho pacientes para un 25 %. Conclusiones: La infección de las quemaduras es la principal complicación del paciente quemado. La mayoría de los pacientes de esta serie egresaron vivos.

Introduction: Burn injury is one of the most traumatic and devastating events that a human being can suffer. This thermal event produces profound alterations in the host's systemic defense mechanisms. Complications in major burns begin in the immediate phase of inflammation produced after suffering thermal aggression. Complications in the burned patients are associated with a bad prognosis with a high morbility and mortality. Objective: To decribe the complications in burned patient. Methods: A descriptive, retrospective, cross-section study was carried out to determine the complications in the burned patients that were admitted in the service of Caumatology, of the Universitary Hospital Manuel Ascunce Domenech in Camagüey city between January, 2021 and February, 2022. 32 patients were studied and the following variables were evaluated: severity rate, general complications, and acid-basic and hydroelectrolytic complications, as well as the state at discharge of the patients. Results: There was a predominance of patients with complications, in those injured persons with thermic harsh insult, present in 24 patients for 75 %. The infection of the injury for burns, the hyperglycemia, the anemia and the states of dehydration were the complications that largely showed up in the studied patients. All of the dead persons belonged to patient's group that had complications, eight patients showed (25 %). Conclusions: The infection of the burns continues to be the main complication of the burned patient. Most of the patients in this series were discharged alive.

Well beyond the 60s? The impact of a pandemic on the growth of the older population / Muito além dos 60? Impacto de uma pandemia na dinâmica de crescimento da população idosa

Contrary to expectations that the first decades of the 21st century would experience an increase in lived time, the 2020s cast doubts on the future of old age. The Brazilian population is expected to increase until 2030, when it will reach its maximum, with a total of approximately 215 million inhabitants. A trend of population decline was already in progress and had already been documented, but the pandemic accelerated this process. This study describes a set of projections for the older Brazilian population. The projections were elaborated using the main components method, whose advantages are the possibility of separately projecting the behavior of the three demographic variables (fertility, mortality, and migrations) and obtaining results disaggregated by sex and age groups. Birth data for 2018, 2019, and 2020 suggest a 3.51 and 5.28% decrease in total births between 2018 and 2019 and 2019 and 2020, respectively. Preliminary data for 2021, which indicate the continuation of this trend between 2020­2021, show a 2.32% reduction in the number of births. The hypotheses raised for the mortality patterns, if proven to be accurate, suggest a life expectancy of 72.8 years for men and 76.2 years for women at the final period of the projection, resulting in gains of 4.6 and 2.0 years, respectively. Despite these gains, the levels obtained in 2019, pre-pandemic, would be reached by the male population only between 2035 and 2040.

Contrariando expectativas de que as primeiras décadas do século XXI seriam um tempo de expansão do tempo vivido, os anos 2020 apontam dúvidas com relação ao futuro da velhice. A população brasileira deverá crescer até 2030, quando se projeta que atingirá o seu máximo, com um total de aproximadamente 215 milhões de habitantes. Uma tendência de redução populacional já era documentada e estava em curso, mas a pandemia acelerou o seu movimento. Este artigo apresenta um conjunto de projeções para a população brasileira e idosa. Para a sua elaboração, utilizamos o método das componentes, cujas vantagens são: (a) projetar, isoladamente, o comportamento de cada uma das três variáveis demográficas ­ fecundidade, mortalidade e migrações ­ e (b) obter resultados desagregados por sexo e grupos de idade. Os dados de nascimentos para 2018, 2019 e 2020 apontam para uma diminuição deste total de 3,51% entre 2018 e 2019 e de 5,28% entre 2019 e 2020. Os dados preliminares de 2021, que apontam para uma continuação dessa tendência entre 2020 e 2021 demonstram redução de 2,32% no número de nascimentos. As hipóteses feitas para os padrões de mortalidade, se verificadas, apontam para uma expectativa de vida de 72,8 e 76,2 anos no final do período da projeção, o que resultaria em ganhos de 4,6 e 2,0 anos, para homens e mulheres, respectivamente. Apesar desses ganhos, os níveis obtidos em 2019, pré-pandemia, seriam alcançados pelos homens entre 2035 e 2040.

O impacto demográfico e seus diferenciais por sexo nos custos assistenciais da saúde suplementar no Brasil / The demographic impact and its differentials by gender on the health care costs of supplementary health in Brazil

Resumo Introdução As consequências do processo de Transição Demográfica afetam a demanda por saúde e, por conseguinte, o setor de saúde suplementar. Objetivo Examinar as consequências futuras do envelhecimento populacional e dos ganhos em longevidade, diferenciados por sexo, nos custos assistenciais das operadoras de planos de saúde. Para tanto, utilizaram-se os dados disponibilizados pela Agência Nacional de Saúde Suplementar (ANS) e pelo Instituto Brasileiro de Geografia e Estatística (IBGE). Método Utilizou-se o modelo de padronização, entre 2016 e 2045, variando apenas a estrutura etária populacional. Resultados Os resultados indicam que o processo de envelhecimento populacional é mais acentuado para a população feminina e mais intenso entre os beneficiários dos planos individuais/familiares se comparados aos dos planos coletivos. As internações e os exames complementares permanecerão os mais onerosos entre os itens assistenciais. Em relação aos impactos da longevidade, constatou-se que os maiores gastos esperados de usuários com mais de 59 anos de idade até a morte são com as internações e entre as mulheres, nos planos individuais/familiares. Conclusão O envelhecimento populacional e aumento de longevidade, principalmente para mulheres, vão impactar os custos dos planos de saúde, com maior intensidade os individuais/familiares. A saúde suplementar precisa se preparar para os desafios demográficos impostos aos custos futuros, buscando políticas capazes de minimizá-los.

Abstract Background The consequences of the Demographic Transition process affect the demand for health, including the private health sector. Objective To examine the consequences of population aging and the longevity gains, gender differentials, in the healthcare costs of healthcare operators. Data from The National Regulatory Agency for Private Health Insurance and Plans (Agência Nacional de Saúde Suplementar (ANS)) and the Brazilian Institute of Geography and Statistics (Instituto Brasileiro de Geografia e Estatística (IBGE)) were used for this purpose. Method The standardization model has been used between 2016 and 2045, varying only the population age structure. Results The results indicate that the population aging process is more accentuated for the female population and more intense among the beneficiaries of individual/family plans compared to collective plans. The hospitalization and complementary examinations showed the highest absolute monetary values between care items, for both types of plans, in all years analyzed. The findings of the impacts of longevity, the expected costs for the users of the last age group will be higher for hospitalizations, especially among women and with individual / family plans. Conclusion Population aging and increased longevity, especially for women, will impact the costs of health plans, with greater intensity for individual / family members. Supplementary health needs to prepare for the demographic challenges imposed by future costs by pursuing policies that can minimize them.

[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)

[The population of China and its development]. / La poblacion de China y su desarrollo.

PIP: The author reviews trends in population dynamics in China. Aspects considered include socioeconomic development and population growth; the government's focus on population and development problems and its fundamental strategy; population policies and goals; family planning and protection of maternal-child health; and demographic opportunities and challenges for China in the 1990s.^ieng

The uncertain connection: free trade and rural Mexican migration to the United States.

"Will a North American Free Trade Agreement (NAFTA) decrease Mexican migration to the United States, as the U.S. and Mexican governments assert, or increase migration beyond the movement that would otherwise occur, as NAFTA critics allege? This article argues that it is easy to overestimate the additional emigration from rural Mexico owing to NAFTA-related economic restructuring in Mexico. The available evidence suggests four major reasons why Mexican emigration may not increase massively, despite extensive restructuring and displacement from traditional agriculture....NAFTA-related economic displacement in Mexico may yield an initial wave of migration to test the U.S. labor market, but this migration should soon diminish if the jobs that these migrants seek shift to Mexico."

Rural-to-urban and urban-to-urban migration patterns in Colombia.

"The object of this study was to identify the factors that may explain, and help to predict, the direction and intensity of migration flows from rural to urban and from urban to urban areas in Colombia. For this purpose, statistical models were used with a view to obtaining a better insight into the push-and-pull causes of the migration patterns and a better understanding of their consequences."

The 6 "biggies".

PIP: The 6 developing nations with the largest populations in mid-1993 were China with 1.18 billion people, India 897 million, Indonesia 188 million, Brazil 152 million, Pakistan 122 million, and Bangladesh 114 million. Successful expansion of population planning programs in these nations could help defuse the population bomb. China's fertility rate has hardly declined for several years, and the year 2000 projection had to be revised from 1.2 billion to 1.29 billion people. India's family planning efforts have also stalled, and even if it attains the two-child family by the year 2015, population growth will not level out before the total reaches 1.9 billion. In India, Kerala State's population density matches that of Bangladesh, and per-capita income is among the lowest in the country. Yet, life expectancy is one quarter above the national average, infant mortality less than half, and literacy almost twice. And the fertility rate is down to 2.3, contrasting strongly with India's average of 3.9. Indonesia's population growth rate has plunged from 2.3% per year in the mid-1960s to 1.97% in the mid-1980s and to 1.7% today. Women now have an average of only three children. Brazil has achieved an annual population growth rate of only 1.5% and a fertility rate of 2.6, but fewer than 3 married women in 5 use modern contraception. There are an estimated 2 million illegal abortions a year. Part of the problem is the gulf between poverty and affluence. As a result of this gulf, child mortality remains the fourth highest in Latin America. Pakistan's population is projected to grow to 275 million people by the year 2025. The current growth rate is 3.1% per year. Family size is 6.7 children, the desired size is 4 children, and only 9% of married women use modern contraception. In Bangladesh, in 1975, the family size was 7 children. In 1993, it was fewer than 5. The spread of family-planning facilities boosted contraceptive use from 3% in 1971 to 40% in 1991.^ieng

[Population and employment in Latin America]. / Poblacion y empleo en America Latina.

Both high rates of labor force growth and large dependency ratios are forecast in this paper for the countries of Latin America in the 1990s. The author concludes that "population and employment problems must be given high priority in bilateral negotiations and/or with international organizations when deciding upon structural adjustment strategies." (SUMMARY IN ENG)

[The volume, age structure, and rate of growth of the population of Mexico]. / El volumen, la estructura por edad y el ritmo de crecimiento de la poblacion de Mexico.

PIP: The author analyzes the effects of levels and trends in fertility, mortality, and migration in Mexico during the period 1950-1985 on the volume, growth rate, and age structure of the population. In addition, the future consequences of recent demographic trends are considered, with a focus on the demand for primary education, the size of the economically active population, household size and structure, and the need for medical services.^ieng

[Population distribution and economic crisis in the 1980s: dichotomies and speculations]. / Distribucion de poblacion y crisis economica en los anos ochenta: dicotomias y especulaciones.

PIP: The author attempts to determine whether the economic crisis of the 1980s has caused an increase or a decrease in population concentration in Mexico. Theories related to the topic are summarized, and data on past and current trends in population and economy in Mexico are analyzed. A forecast of future trends in population distribution and urbanization is also provided.^ieng

[Demographic knowledge and family planning in Colombia]. / Crecimiento demografico y planificacion familiar situacion en Colombia

PIP: One of the criticisms made of family planning programs, especially when they are as successful as that of PROFAMILA, is the lowering of fertility rates to the alarming degree as that experienced by many European countries. This demographic phenomenon, characteristic of developed countries has acquired a negative effect because of the rapidly aging population without a replacement young population. This "European" problem can be analyzed from 2 perspectives: 1) the low rates of the region's total population; and 2) the European population can be connected to that of the world population. Based on data from Dr. Day's article in Family Planning Perspectives (May/June 1988) the amount of time required to replace Europe's population of 1940 is substantial. For example, it would take 45 years for Austria and 135 for France to replace their populations. Instead, the issue of concern could be Europe's loss of power in the world in lieu of the rapidly growing populations of the Third World. The author discounts such a notion by referring to historical events and by projecting that by the year 2025 Europe will represent 18% of the world population. Ultimately it is the quality of the people that is important, not the quantity. According to Day it is more important to know the amount of time left than knowing how long one has been alive. Life expectancy is based on the health standards of a country, and the genetic quality of the population in question. The issue of longevity includes people whose life expectancy at the time of the census was 10 years or less; the majority of those over 65 in Europe, represent 10-15% of this category. 1 out of 7 Europeans over 65 are in excellent physical condition, while those over 65 in the Third World represent a small minority. The article discusses several alternatives in raising fertility rates in Europe but concludes that the most rational approach is keeping 15% of the population over 65 gainfully employed.^ieng

[Population growth rate of one percent in the year 2000: an unattainable target]. / Tasa de crecimiento poblacional de 1% en al ano 2000: una meta inalcanzable.

PIP: The author demonstrates the unattainability of Mexico's population policy target of reducing the natural increase rate to one percent by the end of this century. In order to reach this goal, the net reproduction rate would have to decrease to significantly below replacement level, or 0.667; this would produce dramatic changes in the age structure as well. The policy's objectives are also analyzed in terms of the extent of family planning necessary to reach the target growth rate.^ieng

[The development of the population of Cuba in the five-year period 1981-1985 and a comparison with 1976-1980: expected developments for the five-year period 1986-1990]. / Evolucion de la poblacion de Cuba en el quinquenio 1981-1985 y su comparacion con el de 1976-1980: evolucion perspectiva para el quinquenio 1986-1990.

PIP: Cuban demographic trends for the periods 1976-1980 and 1981-1985 are examined, and trends for the period 1986-1990 are forecasted. The results indicate that Cuban population trends are becoming increasingly similar to those of developed countries due to successful socioeconomic development. (SUMMARY IN ENG AND RUS)^ieng

[The demographic situation of Latin America as evaluated in 1983. Estimates for 1960-1980 and projections for 1980-2025]. / Situacion demografica de America Latina evaluada en 1983: estimaciones para 1960-1980 y proyecciones para 1980-2025.

PIP: This paper analyzes and comments upon the results presented in Demographic Bulletin No. 32, which shows the new projections obtained after revising the population estimates and projections for 10 of 20 countries integrating what is usually called Latin America. While it is very general and descriptive, it can be considered a supplement to the Fasciculos de Poblacion, the series of publications recently initiated that is constituted by documents prepared separately for each country, showing the population estimates and projections, the main demographic indicators, and a methodological summary. The revised projections constiute almost 80% of the total population of Latin America. The paper has 5 chapters: chapter 1 reviews population growth, by country, subregions, and Latin America as a whole; chapters 2 and 3 analyze the situation of the main determinants of population (fertility and mortality); chapter 4 describes the age structure of the population; and chapter 5 summarizes and comments on the main conclusions. An appendix shows some population estimates and projections for the English-speaking Caribbean. Both a Demographic Bulletin and Fasciculo de Poblacion specifically devoted to that region are expected to be prepared in the near future. (author's modified)^ieng

[A case of population estimation according to sex and age performed in a limited time: methodology and evaluation]. / Un caso estimacion de la poblacion, segun sexo y edad realizado en tiempo limitado: metodologia y evaluacion

PIP: The author examines a method of producing annual Cuban population estimates according to age and sex for the period 1970 to 1985. He suggests that this type of demographic estimation is useful when a relatively uncomplicated procedure is desired and very precise values are not necessary (SUMMARY IN ENG, FRE, GER,)^ieng

[On the use of the logistic curve for projecting population]. / O uso da curva logistica para projecao de populacoes.

PIP: The author critically examines a three-point method of population projection. Problems encountered in the use of this method and its modifications are illustrated using examples from Brazil.^ieng

[Comparison between the U.N. population projections for Latin America and actual estimates, 1950-1980]. / Comparacion entre proyecciones de poblacion elaboradas por las Naciones Unidas para la America Latina y estimaciones actuales, 1950-1980

"The purpose of this paper is to compare population projections prepared by the United Nations in the 1950's with the actual estimates for the countries and the regions of Central (including Mexico) and South America. The comparison is made in terms of (a) base population used in the projections (1950), (b) the projected and the estimated population for 1980, and (c) the projected and the estimated rates (including rates of growth) and numbers of births, deaths and migration over the 30 year period of the projections (1950-1980)." (SUMMARY IN ENG)

[Regional population projections: a methodological note]. / Proyecciones regionales de poblacion: una nota metodologica.

PIP: The availability of packaged computer programs have facilitated the use of age and sex projections at the regional level, but misleading results may be generated when program data requirements are not met. This paper discusses the problem of obtaining and preparing migration data for use in the Shorter and Pasta model which utilizes a modified component method. The Shorter and Pasta procedure for estimating migration and alternative procedures are followed and the resulting figures are used to illustrate the necessity of meeting data requirements exactly. Computer results should not be considered the end product but rather a first approximation to the projection, and steps necessary to arrive at the final projection are outlined. Procedures for making regional estimates using the Shorter and Pasta program are included.^ieng