2.2.

Mortality

1. Introduction

Mortality is one of the three components of population change, the other two
being fertility and migration. Historically, the factor of mortality has played a
dominant role in determining the growth of population, the size of which
fluctuated in the past mainly in response to variations in mortality. The
increase in the population of European countries following the Industrial
Revolution in the seventeenth century was mainly due to a decline in the
death rates. The developing countries, which are undergoing a typical
demographic transition, have also been affected initially by the fall in the
death rates. In fact, the single most important contribution of demography
has been the revelation of the fact that sharp declines in mortality rates,
rather than any rise in the fertility rates, have been responsible for bringing
about a rapid growth of population.

The study of mortality is useful is useful for analyzing current demographic

conditions as well as for determining the prospects of potential changes in
mortality conditions of the future. The public health administration depends
heavily on the study of mortality, for statistics on death in the population
cross-classified by age, sex and the cause of death are of great value for the
formulation, implementation and evaluation of public health programs.
Statistics on deaths also form the basis of the policies of insurance
companies.

It is, of course, possible to study mortality, from several angles, for various
biological, social, economic and cultural factors affect the health of an
individual and consequently the mortality rate in society. These factors
affecting mortality can be classified under heredity, constitution and
environment. Then mortality is viewed from demographic point of view, it is
studied to determine changes in the population size and structure, rather
than from the medical angle. The demographic study of mortality, therefore,
does not usually take into consideration the genetic factor. The remaining
two factors, namely, the constitutional and the environmental factors, on the
other hand, provide the basis of a demographic analysis of mortality. Of the
various constitutional factors – including the physical, physiological,
anatomical and psychological characteristics of a man – the most important
for the demographic study of mortality are age and sex. The environmental
factors affecting mortality include the natural physical surrounding of the
individuals as well as his/her social and economic environments and personal
habits.

2. Concepts

The study of mortality deals with the effects of death on population. Though
the meanings of terms life and death are obvious scientific study of
demographic processes calls for formal definitions.

The United Nations and the World Health Organization have defined death as
follows: “Death is the permanent disappearance of all evidence of life at any
time after birth has taken place (post –natal cessation of vital functions
without capacity of resuscitation).” A death can thus occur only after a live
birth, and the span between birth and death is life.

The above definition of death does not include any death prior to a live birth,
which has been defined by the United Nations as follows: “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, such as beating of the heart,
pulsation of the umbilical cord, or definitive movement of voluntary muscles,
whether or not the umbilical cord has been cut or the placenta is attached;
each product of such a birth is considered live-born. It is, therefore, evident
that any death prior to a live birth is not considered as a death. Thus
abortions and still births are referred to, not as deaths, but as foetal deaths.
Any expulsion of foetus, either spontaneous or induced, which occurs before
the foetus become viable, that is capable of independent existence outside
its mother, is known as an abortion. When a birth does not have any of the
characteristics included in either of these two definitions of live birth or
abortion, it is known as still birth.

3. Basic measures of mortality

Crude Death Rate

The crude death rate (CDR) is the simplest and one of the more common
indicators of mortality in a population. It is the ratio of the numbers of deaths
(D) observed in a population in a year to the population at risk of dying in
that year (N), usually multiplied by 1 000:

CDR=D/N.1000

Demographers tend to use a period of a year – typically a calendar year

running from 1 January to 31 December – to derive a CDR so as to eliminate
possible seasonal fluctuations in mortality (deaths of the elderly, for
example, tend to occur disproportionately in winter) while still retaining a
degree of precision in the estimate by not smoothing out trends in mortality
over a number of years.

The numerator comes directly from a tabulation of the number of deaths

observed. The denominator, however, is more problematic. To accurately
reflect the level of mortality, the denominator should reflect the person-years
of exposure to the risk of dying in the population over the course of the year.

Age Specific Mortality Rates

Among other limitations, the crude death rate makes no allowance for the
mortality pattern in a population by age. In most populations, mortality rates
are very high in infancy, fall to a low-point in late childhood (around the age
of 10), and increase with increasing age thereafter. It therefore makes sense
to calculate mortality rates by single years of age (although often there will
be a significant element of random variation in these) or for fairly narrow age
groups. The high level of mortality in infancy means that conventional
demographic practice is to mortality in the first year of life distinctly from
mortality at other ages in early childhood, resulting in a usual classification
of age-specific mortality measures covering ages 0-1; 1-4; and 5-year age
groups thereafter up to some final open interval, perhaps beginning at age
80, or some higher age above which rather few deaths occur.

Therefore differences between populations in the Crude Death Rate may

reflect differences in their age structures rather than accurately reflect
differences in individuals’ propensity to die given their ages.

An age-specific death rate is defined similarly to that of a crude death rate:

The infant mortality rate (IMR)

The infant mortality rate (IMR) is a very common indicator of mortality in a

population, and the reduction in this indicator is one of the more important
Millennium Development Goals. It is defined as the ratio of the number of
deaths of infants (that is, under the age of 1 year), D0, to the number of live
births, B, in the year, multiplied by 1 000:

IMR=d0/B.1000

The timing of infant deaths over the first year of life is highly non-linear. The
majority of infant deaths occur in the first few hours, days or weeks of life –
especially in developed countries where many causes of infant death are
avoidable. In developing countries, significant numbers of children may still
die after the first month of life, especially where unsanitary conditions or
tropical diseases (e.g. malaria) are common.

To assist policy makers, and to allow for more careful tracking of infant
mortality trends, the infant mortality rate is commonly disaggregated into
measures of neonatal and post-neonatal infant mortality:

Neonatal Mortality Rate The number of deaths to infants under 28 days of

age in a given year per 1,000 live births in that year.

Post-Neonatal Mortality Rate The annual number of deaths of infants

ages 28 days to 1 year per 1,000 live births in a given year

Perinatal Mortality Rate The number of fetal deaths after 28 weeks of

pregnancy (late fetal deaths) plus the number of deaths to infants under 7
days of age per 1,000 live births.

Fetal Deaths. Fetal death refers to the spontaneous intrauterine death of a

fetus at any time during pregnancy. Fetal deaths later in pregnancy (at 20
weeks of gestation or more, or 28 weeks or more, for example) are also
sometimes referred to as stillbirths.

Fetal mortality rate: The ratio of fetal deaths divided by the sum of the
births (the live births + the fetal deaths) in that year.

4. Life table

In actuarial science and demography, a life table (also called a mortality

table or actuarial table) is a table which shows, for each age, what the
probability is that a person of that age will die before his or her next birthday
("probability of death"). In other words, it represents the survivorship of
people from a certain population.

Types of life table

There are two types of life tables:

 Period or static life tables show the current probability of death (for
people of different ages, in the current year)
 Cohort life tables show the probability of death of people from a
given cohort (especially birth year) over the course of their lifetime.

Static life tables sample individuals assuming a stationary population with

overlapping generations. "Static Life tables" and "cohort life tables" will be
identical if population is in equilibrium and environment does not change. If a
population were to have a constant number of people each year it would
mean that the probabilities of death from the life table were completely
accurate. Also, an exact number of 100,000 people were born each year with
no immigration or emigration involved. "Life table" primarily refers to period
life tables, as cohort life tables can only be constructed using data up to the
current point, and distant projections for future mortality.

Life tables can be constructed using projections of future mortality rates, but
more often they are a snapshot of age-specific mortality rates in the recent
past, and do not necessarily purport to be projections. For these reasons, the
older ages represented in a life table may have a greater chance of not being
representative of what lives at these ages may experience in future, as it is
predicated on current advances in medicine, public health, and safety
standards that did not exist in the early years of this cohort. A life table is
created by mortality rates and census figures from a certain population,
ideally under a closed demographic system. This means that immigration
and emigration do not exist when analyzing a cohort. A closed demographic
system assumes that migration flows are random and not significant, and
that immigrants from other populations have the same risk of death as an
individual from the new population. Another benefit from mortality tables is
that they can be used to make predictions on demographics or different
populations.
The life table observes the mortality experience of a single generation,
consisting of 100,000 births, at every age number they can live through.

Life-tables and their demographic applications

One important method of assessing the health of a population is to ask how

long people can expect to live. Life expectancy, usually reported at birth
although it can be applied to other ages as well, is a commonly used
summary measure which can also be used to compare against countries.
Life expectancy is calculated using life tables.

A life table is a table which shows, for a person at each age, what the
probability is that they die before their next birthday. From this starting
point, a number of statistics can be derived and thus also included in the
table is:

 the probability of surviving any particular year of age

 the remaining life expectancy for people at different ages
 the proportion of the original birth cohort still alive.

Life tables are usually constructed separately for men and for women
because of their substantially different mortality rates.

Construction of life tables

Age specific mortality rates are applied to a notional population, typically of

100,000. Starting at birth, the probability of dying in each period is applied
to the number of people surviving to the beginning of the period, so that the
initial figure slowly reduces to zero. The different elements required for a life
table include (using standard notations):

Age interval(x to x+n): The period of life between two exact ages; e.g. “20
to 25” means the 5-year interval between the 20th and 25th birthdays
Age Specific Mortality Rate (nMx): The age specific mortality rate , nMx =

Dx/nPx where nDx is the number of deaths occurring to persons aged x to x+n,
n

and nPx is the number of persons aged x to x+n alive at the mid-point of the
period under consideration. Mortality rates are usually presented as deaths
per x persons per year, where x is a convenient population base, e.g. 10,000.
If a longer period is used to count the number of deaths (e.g. 5 years as in
the life table template) then an adjustment must accordingly be made to
calculate the annual age specific mortality rate by dividing the derived rate
by the period of observation years.

Probability of dying (nqx): To estimate the exact probability of dying

between age x and x+n (nqx) the deaths to persons aged x to x+n must be
related to the true population at risk. The mid-period population estimate
must be adjusted by adding half the number of deaths occurring over the
period to it. This assumes that deaths are evenly spread throughout the
time period and across the period of life under consideration.

In general for age groups; nqx = 2 x n ( nMx) / 2 + n (nMx)

The assumption that deaths are spread evenly across the time period of life
under consideration is particularly unrealistic in the case of infants, where
the majority of deaths occur within the first few days of life. To calculate the
probability of dying for infants therefore, the infant mortality rate is used, as
the number of live births is an exact estimate of the population at risk of
dying. Therefore for infant deaths we have;

1q0 = 1D0/B where B = number of live births over period of

consideration.

Another exception occurs in the final open-ended age group (85+ in the life
table templates). As everybody within this age group must die, the
probability of dying is equal to 1, i.e. qn = 1.000.

Persons alive (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 life table.

The number of persons alive at the beginning of an age interval (l x+n) is equal
to the number alive at the beginning of the previous age interval (l x), minus
the numbers of persons dying within that previous age interval over the
time period considered (ndx);

i.e. lx+ n = lx - ndx

Persons dying (ndx): The number of persons dying within the indicated age
interval (x to x+n) out of the total number of births assumed in the table.

The number of persons dying within a particular age interval ( ndx) is equal to
the number persons alive at the beginning of that age interval (l x) multiplied
by the probability of dying within that age interval ( nqx), i.e. ndx = lx x nqx

Person-years lived in age interval ( nLx): The number of person-years

that would be lived within the indicated age interval (x to x+n) by the
assumed cohort of 100,000 births. Again, assuming that deaths are spread
equally across the age intervals and also across the period of consideration,
then the number of person-years lived in an age interval is calculated as the
mean of the populations at the beginning and end of each age interval,
multiplied by the length of each age interval in years i.e. L = n/2 x (lx +
n x

lx+n)

A difficulty arises with the estimation of 1L0 that is the average number of
infants alive who have not yet reached their first birthday. Again the
problem is that it cannot be assumed that infant deaths occur uniformly
throughout the 0 to 1 age interval. For this reason ‘separation factors’ are
used to weight the average of l0 and l1 as follows;
 L = 0.3l0 + 0.7l1
1 0

An additional problem lies with L85, the average number of persons alive
over age 85. This is approximated from L
 85 = d85/M85.

Person years lived from age x (T x): The total number of person-years
that would be lived after the beginning of the indicated age interval by the
assumed cohort of 100,000 births. This is calculated by simply cumulating
the nLx column from the oldest to the youngest age.

Life expectancy (ex): The average remaining lifetime (in years) for a
person who survives to the beginning of the indicated age interval.
Calculated by dividing the total number of person-years lived from age x (T x)
by the number of persons alive at age x (l x)

i.e. e x = Tx/lx

This sort of life table is based on current age-specific death rates for each
age or age band used and are called period life tables and are the most
frequently used type. In contrast, actual life expectancy of a particular birth
cohort can only be calculated when everyone in this cohort is dead. This
approach uses a cohort life table and requires data over many years to
prepare just a single complete cohort life table.

Strength
Summary measure of mortality providing an overall picture of mortality,
allowing countries and regions to be compared.

Weaknesses
Hypothetical measure that has the potential to be misunderstood by general
public/media.
It does not say much about who is still alive, and their quality of life; for
example, how many years are lived with disability before dying. This has led
to attempts to bring together morbidity and mortality, with measures such as
Health Adjusted Life Expectancy and Disability Adjusted Life Years

5. Lexis diagram

In demography (the branch of statistics that deals with the study of

populations) a Lexis diagram (named after economist and social scientist
Wilhelm Lexis) is a two dimensional diagram that is used to represent events
(such as births or deaths) that occur to individuals belonging to different
cohorts. Calendar time is usually represented on the horizontal axis, while
age is represented on the vertical axis.

Lexis diagrams provide a graphical representation of the relationships

between demographic events in time and persons at risk and they also assist
in calculating rates

Every demographic event is characterized by two numbers: the time (e.g.,

year) at which it occurs and the age (or other duration measure) of the
person to whom it occurs
Life lines

A person’s life is represented in the Lexis diagram by a straight line called

“life line” The line begins on the time axis at the time of the person’s birth.
Continues diagonally upwards
And ends at the age/time point representing the person’s death (or other
demographic event)

The sum of all the life line lengths in a particular portion of the diagram
represents person-years lived or exposure in that area.

Life lines and events can be considered from a cohort or period perspective

Cohort data

Cohort—A group of persons who experience an event in the same time

period, e.g., birth, marriage
The Lexis diagram can show the experience of a cohort in a particular age
interval (A)
It can also show the experience of a cohort as they move through life (B)
Period data

Most demographic data are period data

Square (C) = person-time of exposure at a particular age and period
A square includes the life lines from experiences of two different cohorts
Column (D) = experience of all age groups of interest during a specific time
period
Example: Male Deaths in 1955 by year of birth and by age

Year of Age in Number of

Birth completed deaths
years
1955 0 11,400
1954 0 4,359
1954 1 986
1953 1 705
1953 2 325
1952 2 275
1952 3 218
1951 3 204
1951 4 162

Representation of the deaths occurring to a specific cohort at a particular

age

Cohort of people aged 40 years old: 287,970

Deaths in 1954: 589

Deaths in 1955: 563

Each square in a Lexis Diagram represents the experience of two birth
cohorts (distribution of the deaths occurring at a specific age during a
calendar year)

Population aged 40 yrs on the 1 Jan 1954: 298,299

Population aged 40 yrs on 1 Jan 1955: 287,970

Deaths of the 1st cohort (1913): 604

Deaths of the 2nd cohort (1914): 589