Mortality due to external causes of death in Suriname, 2004-2012
Abstract
External causes of death are worldwide one of the main causes of death. Also in the small scale population of Suriname external causes of death are yearly one of the three main causes of death and by district they are one of the five main causes. For Surinamese male population external causes of death are the main cause of death in the age groups 15-44 and 20-49. However, for female population it is depending on the year, the first or second main cause of death. Sex ratios for external causes of death are on average 305 for the period 2008-2012. Suicide and death through traffic accidents are the two main causes of external causes of death. The purpose of this article is to apply TOPALS methodology to external causes of death for the intercensal period 2004-2012 after the application of the combined method General Growth Balance (GGB) and General Synthetic Extinct Generation (SEG), one of the Death Distribution Methods. The GGB-SEG method is applied to determine adult mortality for the overall causes of death. For application of TOPALS multiple decrement tables for external causes of death will be constructed for Suriname and for the standard population consisting of the countries Lithuania and Belarus.
INTRODUCTION
Mortality due to external causes is in all countries over the world the second or third main cause of death (Jorge et.al, 1997). In Suriname external causes of death are 12 % on average for the last years and the second main cause of death. Male population of Suriname have in absolute terms three times more death due to external causes. Suicide is the main highest proportion of external causes of death in Suriname. The west neighbour country of Suriname, Guyana had the highest suicide rate (30.6 in 100000) in the world according to the World Health Organization (WHO, 2015)1. Suicide mortality rate in Suriname in 2015 is the second highest in the Americas namely 26.6 in 100.000 habitants. According to data of the Bureau of Public Health (BOG) in Suriname suicide occurs in the age groups 10-80+, but mainly in the age group 15-54 years. According to Graafsma et. al (2016) suicide in Suriname doubled since 2000, which is far beyond the average of the world and it looks like it flattens around 27 in 100000.
Mortality due to traffic accidents and violence are considered to be the second main part of external causes of death. In all countries over the world mortality due to accidents and violence brings with it increase of the overall mortality rates. According to the World Health Organisation mortality rate in 2013 due to road traffic accidents is 19.1 in 100.000 habitants in Suriname, one of the highest in the Americas (position nine). Mortality as a consequence of traffic accidents occurs in all age groups, however in the age group the 11- 59 the occurrence is the highest, about 78% (60 persons) in 2014 out of all deaths due to traffic accidents.
The objective of this paper is primary to present a statistical description of mortality due to external causes of death, and more specific the description of mortality due to the two main causes of external deaths. Secondly, the aim of the paper is to determine the probabilities of dying due to external causes of death, suicide and traffic road accident by age group, and furthermore smooth these data through the application of TOPALS (Beer, 2016). Suriname is a small scale population (541638 habitants in Census 2012) and thus death count data is sparse for specific causes of death.
1
https://www.worldatlas.com/articles/countries-with-the-most-suicides-in-the-world.html(accessed 20 February
DATA AND METHODOLOGY Data
Death count data of both sexes by age- group comes from the Bureau Openbare Gezondheidszorg (BOG). Mid- year population data is from the General Bureau of statistics of Suriname (GBS). Census data of 2004 and 2012 for Suriname will be considered for the application of the combined method General Growth Balance (GGB) and Synthetic Extinct Generation (SEG). The average death count data of external cause of death, death due to suicide and traffic road accident for male and female population in the period 2008-2012 is also the used data. FunctionnQxExternal,
the weighted average of external x
nq for Lithuania and Belarus for the year 2010 will also
be considered. The data of Lithuania and Belarus will be chosen as the standard population to smooth the probabilities of dying of the overall causes of death, external causes of death and suicide. According to the World Health Organization the two mentioned European countries had in 2015 one of the highest probability of dying due to suicide out of the most suicidal twenty five countries in the world.
The respective data on deaths and population from Belarus and Lithuania is available in the Human Cause- of -death Database (HCD). The choice for these two countries is because they have also high incidence of suicide. In Suriname cause of death due to suicide has the highest proportion out of all external causes of death.
Methodology
Primarily the GGB-SEG considering age segments 5+ to 65+ for overall causes of death and external causes of death and age segment 15+ to 75+ for deaths due to suicide will be used for calculation of adjusted probabilities of dying for male and female population of Suriname. The multiple decrement table for external causes of death and suicide for male and female population will be constructed for the average population from census 2004 and 2012, using: 1) the registered death count data and adjusted overall death count data (average of death for the period 2004-2012); 2) the average death count data by five year age group due to, external causes of death and suicide between 2008-2012; 3) The average population of census from 2004 and 2012.
How data of external cause’s death are sparse in the small scale population TOPALS (Beer, 2016), a new relational model will be adopted to smooth the probability of dying (nq ). TOPALS gives through a linear spline a description of age-ix specific probabilities of death of a country and those according to a standard age schedule. In case the standard age schedule shows smooth pattern, the multiplication of the linear spline by the standard age schedule results in a smooth age pattern of death.
The model for the age schedule is at time t 0 is:
x x x r Q
q , where, qxin case of this study is the adjusted probability of death at age x, rxis the risk ratio, and Qx is the probability of death according to the standard age
schedule. The age pattern of the risk ratio is a linear spline function. According to Gonzaga and Schmertmann (2016) TOPALS method works well for big areas and also for small areas whereby in some cases no recorded deaths are observed at many ages.
For the standard population the standard life tables and multiple decrement tables due to external causes of death and suicide for the year 2010 for male and female population for Belarus and Lithuania will be constructed. The weighted average of the probabilities of dying will be used as the standardQx.
External causes of death General information
According to BOG in Suriname the five main external causes of death during the period 2008-2009 were:
1) Intentional self- harm (suicide) X60-X84; 2) Land transport accident (V01-V89);
3) All other accidents (W20-W31, W35-W64, W88-W99, X10-X39, X50-X59,Y40-Y84);
4) Assault (homicide) X85-Y09);
5) Accidental drowning and submersion (W65-W74).
Most of the suicide cases in Suriname in the period 2008-2013 occurred on average through autointoxication by pesticides (66%) followed by intentional and self – harm
hanging (23%). In case of land road accidents, the deaths were on average primary moped drivers (34.41%), secondly passengers (19.02%) and thirdly it were pedestrians (29.03%). More over male population presents higher numbers of suicide and traffic road accidents. Figure 1 presents the absolute number of deaths due to suicide and traffic road accidents from 2004-2012. The absolute numbers for suicide and traffic road accidents are on average for the 10 years respectively, 128 and 85 cases.
Figure 1: Deaths due to suicide and traffic road accidents, 2004-2012
Source: General Bureau of Statistics
Figure 2 reveals the sex ratios of death due to, suicide and traffic road accidents for 2008-2012. In both causes of deaths male population are more represented and at least twice more than female. As can be observed sex ratios due to traffic road accidents are beyond sex ratios due to suicide and external causes of death. For the period 2008-2013 sex ratios due to suicide and external causes of death follows the same pattern. In 2009 the highest sex ratio was observed for traffic road accidents, namely 558.82. 0 20 40 60 80 100 120 140 160 2004 2005 2006 2007 2008 2009 2010 2011 2012 D e a t h s Years SUICIDE ACCIDENT
Figure 2: Sex ratios due to external causes of death, suicide and traffic road accidents, 2008-2013.
Source: General Bureau of Statistics
It is also relevant to mention that the occurrence of suicide takes more place in the urban coastal area (capital district Paramaribo and district Wanica) with 65 % of the population in 2012. District Nickerie in the rural coastal area is the third district with the occurrence of suicide. Figure 3 shows the occurrence of suicide in the ten districts of Suriname for the period 2008-2013.
Figure 3: Average percentages of suicide by districts in Suriname, 2008-2013
Source: Bureau of Public Health (BOG) 0.00 100.00 200.00 300.00 400.00 500.00 600.00 2008 2009 2010 2011 2012 2013 S e x r a tio s Years Suicide traffic road accident External causes of death 1.31 6.94 0.25 1.31 12.83 2.05 29.27 6.60 28.48 1.200.74 9.02 Brokopondo Commweijne Coronie Marowijne Nickerie Para Paramaribo Saramacca Wanica Sipaliwinin
Considering the occurrence of suicide among the different ethnic group data shows that the ethnic group of Indians (28% of the population in Census 2012) presents the highest percentage of committed suicide in Suriname. Figure 4 presents the average percentages suicide during 2008-2013 and percentages of the population by ethnic group in Census 2012.
Figure 4: Percentage Suicide and population Census 2012, by ethnic group
Source: Bureau of Public Health (BOG)
As can be observed the Indian population committed 6 times more suicide than the creole population.
RESULTS
External causes of death, suicide and traffic accidents in Suriname, 2008-2013
Suicide
Observed logarithm of mortality rates due to external causes of death for both sexes in the period 2008-2013 are described (Figure 5 a). The log function of the observed mortality rates by age groups for both sexes are also presented for suicide, the first main cause of death and number one cause of death for young and mature adults. The logarithms for infant and child specific mortality rates are below those of the adults. For all the years the highest logarithm of age specific mortality rate for external causes of death for the young and mature adults are in the age group 20-24 up to 55-59. On average the curve starts to increase in the age group 60+.
0.00 10.00 20.00 30.00 40.00 50.00 60.00 70.00
Indian Creole Javanese Marroon Mix
population Census 2012 27.41 15.68 13.66 21.71 13.36 Suicide 66.03 11.07 5.40 9.68 4.51 P e rc e n ta g e s population Census 2012 Suicide
However, the logarithm of the age specific mortality rates due to suicide increases from 10-14 to 20-24 (Figure 5b). For the age groups 25-29 up to 80+ there are oscillations for the different years. In the elderly ages 70 until 80+ the logarithms of mortality rates due to suicide are a little bit higher than in the young and mature adult ages.
Figures 5:
a) Log mortality rates due to b) Log mortality rates due to suicide External causes of death
Source: Bureau of Public Health (BOG)
It also important to present the logarithm of the probabilities of dying due to the overall causes of death, external causes of death and suicide (Figure 6). As Beer (2016) mentions that probabilities of death are always lower than the mortality rates and for the oldest ages there is an increasing difference between the values of rates and probabilities for overall deaths. The use of probabilities of dying is also an advantage because it is easy to interpret.
From 0 to 1-4 age groups the logarithm of the probabilities of dying for the overall deaths for male population increases, then a decline takes place up 5-9. After the age group 10-14 an increase takes place up to 80+. The logarithm of probabilities of dying due to, external causes of death for male population increases also from 0 to 1-4, decreases than up to 5-9 and then increases again up to 20-24 and remaining nearly constant up to age group 80+.
-4.5 -4 -3.5 -3 -2.5 -2 -1.5 -1 -0.5 0 L o g m o rt a lit y r a te Age groups 2008 2009 2010 2012 2013 2011 -5 -4.5 -4 -3.5 -3 -2.5 -2 -1.5 -1 -0.5 0 1 0 -1 4 1 5 -1 9 2 0 -2 4 2 5 -2 9 3 0 -3 4 3 5 -3 9 4 0 -4 4 4 5 -4 9 5 0 -5 4 5 5 -5 9 6 0 -6 4 6 5 -6 9 7 0 -7 4 7 5 -7 9 8 0 + L o g m o rt a lit y r a te s Age groups 2013 2009 2010 2013 2011 2008
Figure 6: Logarithm of probabilities of dying for overall causes of death (nqx), Logarithm of probabilities of dying due external causes of death (nqx (i)) and logarithm of the probabilities of dying due to suicide (nqx(k)) for male population in Suriname, 2004-2012.
Source: Data General Bureau of Statistics Suriname and Bureau of Public Health
For the female population (figure 7) the results of the logarithm of the probabilities of dying for overall causes of death, external causes of death and suicide are at the lower levels compared to the male population. As seen before sex ratios due to external causes of death are an advantage for women.
-4.5 -4 -3.5 -3 -2.5 -2 -1.5 -1 -0.5 0 0 1 -4 5 -9 1 0 -1 4 1 5 -1 9 2 0 -2 4 2 5 -2 9 3 0 -3 4 3 5 -3 9 4 0 -4 4 4 5 -4 9 5 0 -5 4 5 5 -5 9 6 0 -6 4 6 5 -6 9 7 0 -7 4 7 5 -7 9 8 0 + L o a g a rit m o f p ro b a b ilit ie s o fd y in g Age groups Log(nqx (i)) Log( nqx (k)) Log ( nqx)
Figure 7: Logarithm of probabilities of dying for overall causes of death (nqx), Logarithm of probabilities of dying due external causes of death (nqx (i)) and logarithm of the probabilities of dying due to suicide (nqx(k)) for female population in Suriname, 2004-2012.
Source: Data General Bureau of Statistics Suriname and Bureau of Public Health
Traffic accidents
Data on deaths due to traffic accidents are available in age groups of 9 years. Mid-year population data is available in age groups of 10 Mid-years. In order to provide age specific mortality rates on traffic accidents two data sources were used. Most of the victims of traffic accidents are in the age group 20-29.
Figure 8 presents the logarithm of the age specific mortality rates due to traffic accidents. -4.5 -4 -3.5 -3 -2.5 -2 -1.5 -1 -0.5 0 0 1 -4 5 -9 1 0 -1 4 1 5 -1 9 2 0 -2 4 2 5 -2 9 3 0 -3 4 3 5 -3 9 4 0 -4 4 4 5 -4 9 5 0 -5 4 5 5 -5 9 6 0 -6 4 6 5 -6 9 7 0 -7 4 7 5 -7 9 8 0 + L o g a rit h m o f p ro b a b ilit ie s o f d y in g Age groups Log (nqx) Log (nqx (i)) Log(nqx(k))
Figure 8: Logarithm of age specific mortality rates of both sexes due to traffic road accidents in Suriname, 2008-2013.
Source: General Bureau of Statistics
Overall causes of death, external causes of death, suicide in Belarus and Lithuania, 2010.
In figure 9 the logarithm of the weighted average of the overall probabilities of dying (nqx), logarithm of the weighted probabilities of dying due to external causes (nqx(i)) and logarithm of weighted probabilities of dying due to suicide (nqx (k)) for female population and male population are presented.
Obviously, there is a difference in the logarithm of probabilities of dying between male and female population of the standard population. The curves for male population are at higher levels compared to the female population. For male population the levels for the age groups 10-14 to 20-24 for overall causes of death are very close to those of the external causes of death.
-6 -5 -4 -3 -2 -1 0 0-9 10-19 20-29 30-39 40-49 50-59 60-69 70+ L o g a g e s p e c if ic m o rt a lit y r a te s Age groups 2008 2009 2010 2011 2012 2013
Figure 9: Logarithm of weighted average of probabilities of dying for overall causes of death (nqx), Logarithm of probabilities of dying due external causes of death (nqx (i)) and logarithm of the probabilities of dying due to suicide (nqx(k))for female population in Belarus and Lithuania, 2010
Source: Human Cause of death data base
Figure 10: Logarithm of weighted average of probabilities of dying for overall causes of death (nqx), Logarithm of probabilities of dying due external causes of death (nqx (i)) and logarithm of the probabilities of dying due to suicide (nqx(k))for female population in Belarus and Lithuania, 2010
Source: Human Cause of death data base -5 -4.5 -4 -3.5 -3 -2.5 -2 -1.5 -1 -0.5 0 0 1 -4 5 -9 1 0 -1 4 1 5 -1 9 2 0 -2 4 2 5 -2 9 3 0 -3 4 3 5 -3 9 4 0 -4 4 4 5 -4 9 5 0 -5 4 5 5 -5 9 6 0 -6 4 6 5 -6 9 7 0 -7 4 7 5 -7 9 8 0 -8 4 8 5 + L o g a rit h m o f th e P ro b iilit ie s o f d y in g Age groups Log (nqx) Log (nqx(i)) Log (nqx(k)) -4.5 -4 -3.5 -3 -2.5 -2 -1.5 -1 -0.5 0 0 1 -4 5 -9 1 0 -1 4 1 5 -1 9 2 0 -2 4 2 5 -2 9 3 0 -3 4 3 5 -3 9 4 0 -4 4 4 5 -4 9 5 0 -5 4 5 5 -5 9 6 0 -6 4 6 5 -6 9 7 0 -7 4 7 5 -7 9 8 0 -8 4 iL o g a rit h m o f t h e p ro b a b ilit ie s o f d y in g Age groups Log(nqx) Log (nqx(i)) Log(nqx(k))
Application of TOPALS for overall causes of death, external causes of death and suicide.
The risk ratio r is determined based on the relationx qx rxQx for the female and
male population and the results are presented in table 1 and table 2. In this paper five year age groups are used instead of single years. For the ages younger than 20 years the risk ratios for the overall causes of death are below 0.60 for female population, however for the male population the values are higher than one.
Table 1: Values of risk ratios of five year age-specific death probabilities of dying for female population in Suriname (2004-2012) compared with the weighted average of Lithuania and Belarus (2010).
Agegroups Overall causesof death rx
External causes of death rx rxSuicide 0 0.301933321 4.111121757 1-4 0.393390992 1.291066094 5-9 0.579266728 1.362003867 10-14 0.35646899 0.24239267 15-19 0.437430122 0.485682063 0.061157 20-24 0.363910822 0.594107083 0.204765 25-29 0.453644108 0.766653534 0.293194 30-34 0.706555175 1.585234999 0.434944 35-39 0.774022755 1.566022401 1.130537 40-44 0.796992178 1.922018658 0.510523 45-49 0.854628092 2.265684744 1.166739 50-54 0.971121126 1.886877822 0.840737 55-59 1.061662045 1.722461552 0.844729 60-64 0.961925125 1.845256331 0.862574 65-69 0.871651619 1.616767884 0.538285 70-74 0.913288542 0.655090543 0.508687 75-79 1.033075175 0.791201431 0.342294 80-84 0.918674272 0.707331776 0.83116
Source: Data Human Mortality database and data General Bureau of Statistics
In table 2 the risk ratios for male population are presented. As can be seen the risk ratios for male population are for the external causes of death and death due to suicide much lower than for female population. For the age group 35-39 the risk ratios for the overall causes of death for the female population are higher than for the
Table 2: Values of risk ratios of five year age-specific death probabilities of dying for male population in Suriname (2004-2012) compared with the weighted average of Lithuania and Belarus (2010).
Agegroups Overall causes of death rx External causes of death rx Suiciderx 0 3.388722 0.315697 1-4 3.058009 1.525667 5-9 1.552066 0.818688 10-14 1.591241 1.346332 15-19 1.053727 0.818545 4.335828 20-24 0.960593 1.014348 0.918203 25-29 0.894688 0.830962 0.998602 30-34 0.729909 0.587291 1.004176 35-39 0.643136 0.48447 0.892064 40-44 0.567274 0.419814 0.746448 45-49 0.611062 0.446951 0.634436 50-54 0.548934 0.371207 0.978663 55-59 0.567821 0.409524 0.736725 60-64 0.528611 0.351739 0.53197 65-69 0.591509 0.54864 0.471646 70-74 0.680454 0.50734 0.603977 75-79 0.722714 1.232679 0.694398 80-84 0.881361 1.59107 1.354675
Source: Data Human Mortality database and data General Bureau of Statistics
DISCUSSION
Belarus and Lithuania were chosen as standard age schedule for the application of TOPALS. Both European countries have a population of more than one million habitants and are in terms of population size they are bigger than Suriname. The results presented here reveal that the risks ratios for female and male population are different. In this paper only r is determined without description of the spline functionx
and thus without considering the knots. The use in this article is made of five year age groups which implies that the results of r are smaller than in case of consideringx nine years to fit the linear spline.
References
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Human Cause-of-Death Database. French Institute for Demographic Studies (France) and Max Planck Institute for Demographic Research (Germany). Available at www.causeofdeath.org (data downloaded on [21 -03-2018]-DATA RUSSIA).
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