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      Age and sex patterns of premature mortality in India

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      1 , 2
      BMJ Open
      BMJ Publishing Group
      PUBLIC HEALTH

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          Abstract

          Objectives

          To estimate premature mortality by age, sex and cause of death in India.

          Background

          Studies on premature mortality in India are limited. Although evidence suggests recent reductions in infant and child mortality, little is known about the age and sex patterns of premature deaths in India.

          Methods

          Secondary data from the Sample Registration System and, census of India and report on cause of death. A set of indices are used to estimate the premature mortality were analysed.

          Primary and secondary outcome measures

          Standardised years of potential life lost (YPLL), premature years of potential life lost (PYPLL) and working years of potential life lost (WYPLL) for broad age groups and by selected causes of death.

          Results

          From 1991 to 2011, the age-standardised rate of YPLL (per 1000 population) declined from 310 to 235 for males and from 307 to 206 for females. The estimated YPLL (in millions) declined from 134 to 147 for males and from 123 to 108 for females, the YPLL for adults (aged 15–65) increased by 32% for males and 28% for females, the standardised PYPLL (per 1000 population) declined from 259 to 137 for males and from 258 to 115 for females, the estimated PYPLL increased by 13% for all adult males and by 32% for 30–45-year-old adult males, and the standardised rate of WYPLL declined from 274 to 131 for males and from 295 to 91 for females. These findings suggest a significant improvement in early childhood mortality and increasing mortality trends in 30–45-year-old adult males. The YPLL and WYPLL standardised rates for males and females were highest for cardiovascular disease.

          Conclusions

          The increasing share of premature deaths among adults and high levels of premature mortality suggest an improvement in child survival increased attention should be given to prevention and treatment of non-communicable diseases in order to avoid premature deaths in India.

          Related collections

          Most cited references10

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          Responding to the threat of chronic diseases in India.

          At the present stage of India's health transition, chronic diseases contribute to an estimated 53% of deaths and 44% of disability-adjusted life-years lost. Cardiovascular diseases and diabetes are highly prevalent in urban areas. Tobacco-related cancers account for a large proportion of all cancers. Tobacco consumption, in diverse smoked and smokeless forms, is common, especially among the poor and rural population segments. Hypertension and dyslipidaemia, although common, are inadequately detected and treated. Demographic and socioeconomic factors are hastening the health transition, with sharp escalation of chronic disease burdens expected over the next 20 years. A national cancer control programme, initiated in 1975, has established 13 registries and increased the capacity for treatment. A comprehensive law for tobacco control was enacted in 2003. An integrated national programme for the prevention and control of cardiovascular diseases and diabetes is under development. There is a need to increase resource allocation, coordinate multisectoral policy interventions, and enhance the engagement of the health system in activities related to chronic disease prevention and control.
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            Chronic diseases now a leading cause of death in rural India--mortality data from the Andhra Pradesh Rural Health Initiative.

            India is undergoing rapid epidemiological transition as a consequence of economic and social change. The pattern of mortality is a key indicator of the consequent health effects but up-to-date, precise, and reliable statistics are few, particularly in rural areas. Deaths occurring in 45 villages (population 180 162) were documented during a 12-month period in 2003-04 by multipurpose primary healthcare workers trained in the use of a verbal autopsy tool. Algorithms were used to define causes of death according to a limited list derived from the international classification of disease version 10. Causes were assigned by two independent physicians with disagreements resolved by a third. A total of 1354 deaths were recorded with verbal autopsies completed for 98%. A specific underlying cause of death was assigned for 82% of all verbal autopsies done. The crude death rate was 7.5/1000 (95% confidence interval, 7.1-7.9). Diseases of the circulatory system were the leading causes of mortality (32%), with similar proportions of deaths attributable to ischaemic heart disease and stroke. Second was injury and external causes of mortality (13%) with one-third of these deaths attributable to deliberate self harm. Third were infectious and parasitic diseases (12%). Tuberculosis and intestinal conditions each caused one-third of deaths within this category. HIV was assigned as the cause for 2% of all deaths. The fourth and fifth leading causes of death were neoplasms (7%) and diseases of the respiratory system (5%). Non-communicable and chronic diseases are the leading causes of death in this part of rural India. The observed pattern of death is unlikely to be unique to these villages and provides new insight into the rapid progression of epidemiological transition in rural India.
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              Potential years of life lost between ages 1 and 70: an indicator of premature mortality for health planning.

              The indicator of Potential Years of Life Lost between ages 1 and 70 (PYLL) is proposed with the primary objective of ranking major causes of premature mortality. This proposal is based on a review of existing mortality indicators and indices and of the history of the concept of potential years of life lost. The method of calculation along with the corresponding rate and the age-adjusted rate are discussed and presented with applications to Canadian data and interpretation. Several methodological aspects are discussed, particularly the comparison with more sophisticated approaches based on life tables which do not appear to alter the ranking of major causes of premature death. This indicator fits well into the category of Social Indicators and can help health planners define priorities for the prevention of premature deaths. Epidemiological studies could also make use of this indicator of premature mortality. The simplicity of calculation and ease of comprehension should facilitate its use.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2014
                5 August 2014
                : 4
                : 8
                : e005386
                Affiliations
                [1 ]International Institute for Population Sciences , Mumbai, Maharashtra, India
                [2 ]Department of Fertility Studies, International Institute for Population Sciences , Mumbai, Maharashtra, India
                Author notes
                [Correspondence to ] Dr Manisha Dubey; manikvdlw@ 123456gmail.com
                Article
                bmjopen-2014-005386
                10.1136/bmjopen-2014-005386
                4127933
                25095877
                5981403d-1dba-4797-b555-33801b6a1dab
                Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                : 2 April 2014
                : 28 June 2014
                : 17 July 2014
                Categories
                Public Health
                Research
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                Medicine
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                Medicine
                public health

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