Understanding Mortality Rates and Calculations

Measures of Mortality Measures of Mortality 6/7/2025 1

- Mortality is a term which means death or describes death and related issues. 6/7/2025 2

Why look at mortality rates? 1- Expressing mortality in quantitative Expressing mortality in quantitative terms allow comparison of death: terms allow comparison of death: 1 1- - between people in different between people in different geographic areas or different geographic areas or different countries. countries. 2 2- - between subgroups in the a between subgroups in the a population or country. population or country. 6/7/2025 3

2 2- - Mortality rates can serve as a Mortality rates can serve as a disease Severity, and can help to disease Severity, and can help to determine of whether the treatment determine of whether the treatment for a disease has become more for a disease has become more effective over time. effective over time. 6/7/2025 4

Crude rates: Crude rates: H How they calculated? ow they calculated? Crude rates are calculated for the Crude rates are calculated for the entire population. entire population. Refer to as crude because: Refer to as crude because: They ignore factors which may They ignore factors which may affect affect death rate such as: gender, death rate such as: gender, age, race, economic status age, race, economic status . . 6/7/2025 5

Crude Death rate (CDR): Number of all deaths due to all causes in a certain year and within certain locality x 1000 Mid-year population for the same year and same locality Example Example: : Suppose Suppose area 1 1- - 1200 1200 deaths, 2 2- - The The area's was was 150 150, ,000 area X X in deaths, all area's mid 000. . in 1432 1432 H, all causes causes. . mid year year population population H, we we have have: : 6/7/2025 6

3 3- -Find Find crude crude death death rate rate in in 1432 1432H H? ? Numerator: number of deaths all causes Numerator: number of deaths all causes = 1200 = 1200 Denominator: Mid Denominator: Mid- -year population year population =150,000 =150,000 CDR CDR = = 150 1200 1200 150, ,000 x x 1000 1000 000 = = 8 8/ /1000 1000; ; that is, 8 deaths per 1000 population. that is, 8 deaths per 1000 population. 6/7/2025 7

CMR By Sex And Nationality In The KSA (2004 to 2010) TOTAL TOTAL FEMALE FEMALE NON NON- -SAUDI SAUDI FEMALE FEMALE TOTAL TOTAL SAUDI SAUDI FEMALE FEMALE MALE MALE MALE MALE MALE MALE YEAR YEAR TOTAL TOTAL TOTAL TOTAL 4 3.8 4.3 3.3 3 3.4 4.3 3.9 4.7 2004 2004 4 3.7 4.2 3.3 2.9 3.4 4.3 3.9 4.7 2005 2005 4 3.7 4.2 3.2 2.9 3.4 4.2 3.8 4.6 2006 2006 3.9 3.6 4.2 3.2 2.8 3.4 4.2 3.8 4.6 2007 2007 3.9 3.6 4.2 3.3 2.8 3.5 4.1 3.7 4.5 2008 2008 3.9 3.5 4.2 3.3 2.7 3.5 4.1 3.7 4.5 2009 2009 3.9 3.5 4.2 3.3 2.7 3.6 4.1 3.7 4.4 2010 2010 6/7/2025 8

Crude Crude death rate death rate Crude Crude birth rate birth rate Infant Infant Maternal Maternal mortality rate mortality rate Country Country mortality rate mortality rate Per 1000 Per 1000 Per 1000 Per 100,000 Saudi Saudi Arabia Arabia 3.8 22.1 18.5 16 Yemen Yemen Palestine Palestine Iraq Iraq Bahrain Bahrain Emirates Emirates Oman Oman Qatar Qatar Jordon Jordon 7.0 3.6 6.3 2.8 1.4 3.8 1.6 26.4 38.6 35.9 36.6 20.7 14.0 22.2 14.1 4.1 53.3 22.2 34.6 7.0 10.9 18.5 9.0 21.0 200 32 63 20 12 11 6 63 6/7/2025 9

Why Why Mid Mid- -year year population population? ? For For example, example, for rate rate the the number number of to to the the risk risk of includes includes: : Persons 1 1 of of the the year year previous for the of persons persons exposed of dying dying (denominator) (denominator): : Persons alive alive in previous year year. . the crude crude death death exposed in Muharram Muharram 6/7/2025 10

plus plus all minus minus all year, year, all persons persons born all persons persons who born during during year who die die during year during adjustments adjustments made moved moved in in or or out made for out. . for persons persons who who 6/7/2025 11

A A common common solution of of determining determining the is is to to estimate estimate the year year. . solution to the population population at the population population at to this this problem problem at risk risk at mid mid- - In In our T The he population population at population population on our example example ( (1432 1432H) at risk risk will on Rajab Rajab1 1. . H): : will be be the the 6/7/2025 12

Cause Cause- -specific Mortality Rate specific Mortality Rate Is Mortality from a specified cause Is Mortality from a specified cause for a population during a specified for a population during a specified time period. time period. The numerator is the number of The numerator is the number of deaths from that cause. deaths from that cause. The denominator remains the size The denominator remains the size of the population at the mid of the population at the mid- -point of the time period. the time period. 6/7/2025 point of 13

Example: Example: In the previous example: suppose the In the previous example: suppose the tuberculosis death in tuberculosis death in 1432 Calculate mortality rate due to TB. Calculate mortality rate due to TB. 1432H was H was 5 5. . Numerator: number of deaths due to TB = Numerator: number of deaths due to TB = 5 5 Denominator: Mid Denominator: Mid- -year population year population 150,000 Mortality rate due to TB = Mortality rate due to TB = ( (5 5/ /150,000 150,000) x ) x 100,000 100,000 = 150,000 = 3.3 3.3/ /100,000 100,000 14

The Age Specific Death Rate D = 1000 X ASDR P X Where: ASDR= The Age Specific Death Rate. Dx= Deaths for population at age x during the year. Px= Mid year Population for the population at age x 6/7/2025 15

Deaths during the year and the population at the mid year for the different age groups Mid year Mid year Population Population 73795 48764 43635 63337 34423 26983 24548 Age Group Age Group Deaths Deaths 4143 4740 4304 3883 4062 4597 5085 15 20 25 30 35 40 45 19 24 29 34 39 44 49 - 6/7/2025 16

The age Specific Death Rates Age Group Age Group Mid year Mid year Population Population Death Death ASDR ASDR 73795 48764 43635 63337 34423 26983 24548 4143 4740 4304 3883 4062 4597 5085 15 20 25 30 35 40 45 19 24 29 34 39 44 49 56 56 97 97 99 99 61 61 118 118 - 170 170 207 207 6/7/2025 17

Why Age Specific Death Rates Why Age Specific Death Rates? ? Can compare mortality at different ages. Can compare mortality in the same age groups over time and/or between countries and areas 6/7/2025 18

3 3- - Infant mortality rates (IMR): Infant mortality rates (IMR): Are Are the most common used rates for the most common used rates for measuring the risk of dying during measuring the risk of dying during the first year of life. the first year of life. These These rates are rates are the used measures for comparing health used measures for comparing health services among nations. services among nations. the most frequently most frequently 6/7/2025 19

Infant Mortality Rate , Saudi Arabia ( Infant Mortality Rate , Saudi Arabia (2000 2000- -2011 2011) ) 6/7/2025 20

High infant mortality rates are High infant mortality rates are: : 1 1- - Reflection of poor economic Reflection of poor economic conditions conditions 2 2- - unmet health care needs and unmet health care needs and 3 3- - other unfavorable environmental other unfavorable environmental factors. factors. IMR = IMR = number of infant deaths number of infant deaths age 0 age 0- -365 days 365 days X 1000 1000 Number of live Number of live births during year births during year 6/7/2025 21

Country Country Infant mortality rate Infant mortality rate Per 1000 Saudi Arabia Saudi Arabia 18.5 Yemen Yemen 53.3 Palestine Palestine 22.2 Iraq Iraq 34.6 Bahrain Bahrain 7.0 Emirates Emirates 10.9 Oman Oman 18.5 Qatar Qatar 9.0 6/7/2025 22

Suppose Suppose at died died during during 1432 live live births births for 2600 2600. . Calculate Calculate IMR at KKU KKU hospital, hospital, 20 1432H H. . The for the the same IMR 20 infants infants number of same year year was The number of was Numerator: number of infants died = 20 Numerator: number of infants died = 20 Denominator: Number of live births = 2600 Denominator: Number of live births = 2600 IMR IMR = = 1000 = 7 7. .7 7/ /1000 1000 20 2600 20 x x 1000 2600 6/7/2025 23

That is; 7.7 infant deaths per 1,000 That is; 7.7 infant deaths per 1,000 live births in 1432H. live births in 1432H. Neonatal Neonatal mortality mortality rate Measures Measures risk risk of of dying born born infants infants under under the rate (NMR (NMR) ): : dying among among new the age age 28 28 days new days. . 6/7/2025 24

NMR NMR = = number of deaths for infants under number of deaths for infants under 28 days of age 28 days of age x 1,000 Number of live birth in the Number of live birth in the same year same year Example: In the previous example: Example: In the previous example: suppose out of the 20 who died, 12 suppose out of the 20 who died, 12 died in the first 28 days. Calculate died in the first 28 days. Calculate NMR for 1432H. NMR for 1432H. 6/7/2025 25

Numerator: number died in ( 0 Numerator: number died in ( 0- - 28) days = 12 Denominator: Number of live births = 2600 Denominator: Number of live births = 2600 28) days = 12 NMR = NMR = 12 12 2600 2600 x x 1,000 1,000 = = 4.6 4.6/ /1000 1000 4.6 4.6 deaths per deaths per 1,000 1,000 live births. live births. 6/7/2025 26

Postneonatal Postneonatal mortality Number Number who who died age age. . For For the the previous previous example T The he number number of 28 28 days days of of age age is mortality rate rate (PNMR (PNMR) ): : died after after 28 28 days days of of example: : infants who is 8 8. . ( (20 20 - - 12 of infants who died 12 = = 8 8) ). . died after after 6/7/2025 27

PNMR PNMR = = deaths for infants more than 28 days old deaths for infants more than 28 days old through the age of 1 year through the age of 1 year Number Number of of live live birth birth in x x 1,000 1,000 in the the same same year year 12 2600 x 1,000 = 3.1/1000 PNMR = PNMR = 3.1 3.1/ /1000 1000 deaths per deaths per 1,000 1,000 live births. live births. 6/7/2025 28

Maternal Maternal Mortality Mortality Definition: Maternal death is death of a woman while pregnant ,or within 42 days of termination of pregnancy. Irrespective of the duration or site of the pregnancy. 6/7/2025 29

From any cause related to, or aggravated by the pregnancy or its management Not from accidental causes 6/7/2025 30

Maternal Mortality Indicators Maternal Mortality Indicators Maternal mortality ratio (per 100,000 live births -or per 1000 live births) Maternal mortality rate (per 100,000 women of childbearing age) 6/7/2025 31

Maternal Mortality Ratio Maternal Mortality Ratio Number of women who die as a result of complications of pregnancy or childbearing in a given year per 100,000 live births in that year Represents the risk associated with each pregnancy, i.e., the obstetric 6/7/2025 risk 32

The numerator is the number of The numerator is the number of deaths in a year from puerperal deaths in a year from puerperal causes. (complications of pregnancy, causes. (complications of pregnancy, childbirth, childbirth, puerperium puerperium). ). The The denominator denominator is live live births births during during the is the the number number of the same same year year. . of 6/7/2025 33

MMRatio MMRatio = = T Total maternal deaths for a period otal maternal deaths for a period (year) (year) x 100,000 Number of live birth in the Number of live birth in the same year same year Example: Example: The year The year- -end of 1432H report from end of 1432H report from the obstetrical ward: the obstetrical ward: 6/7/2025 34

1 1- - was 3 deaths (2 abortions, 1 pregnancy was 3 deaths (2 abortions, 1 pregnancy complications). complications). 2 2- - The number of live born was as before The number of live born was as before (2600). (2600). Numerator: number of mothers died = Numerator: number of mothers died = 3 3 Denominator: Number of live births = Denominator: Number of live births = 2600 3 3 2600 2600 2600 x x 1,000 1,000 = = 1.15 1.15/ /1000 1000 MMRatio MMRatio= = 1.15/1000 maternal deaths per 1,000 live 1.15/1000 maternal deaths per 1,000 live births births 6/7/2025 35

Maternal Maternal Mortality Mortality Rate Rate Number of women who die as a result of complications of pregnancy or childbearing in a given year per 100,000 women of childbearing age in the population Represents both the obstetric risk and the frequency with which women are exposed to this risk. 6/7/2025 36

Maternal mortality Maternal mortality rate rate Per 100,000 Per 100,000 Country Country Saudi Arabia Saudi Arabia Yemen Yemen Palestine Palestine Iraq Iraq Bahrain Bahrain Emirates Emirates Oman Oman Qatar Qatar 16 200 32 63 20 12 11 6 6/7/2025 37

MMRate MMRate = = T Total maternal deaths for a period otal maternal deaths for a period (year) (year) x 100,000 Number of women age 15 - 49 Example: Example: The year The year- -end of the obstetrical ward: the obstetrical ward: end of 1432 1432H report from H report from 6/7/2025 38

1 1- - was 10 deaths (2 abortions, 8 was 10 deaths (2 abortions, 8 pregnancy complications). pregnancy complications). 2 2- - The number of women aged 15 The number of women aged 15- -49 was: (250000). was: (250000). 49 10 10 MMRate MMRate = = 250000x x 100,000 100,000 250000 = = 4 4/ /100,000 100,000 6/7/2025 39

Case Case- - fatality fatality rate (expressed (expressed usually CFR CFR = = Number of deaths during a specified Number of deaths during a specified period of time after disease period of time after disease diagnosed diagnosed rate (CFR) (CFR): : usually as as percent) percent): : x 100 x 100 Number of individuals with the Number of individuals with the specified disease specified disease 6/7/2025 40

Example Example 1 1: : At 1 1) ) 110 110 cases 2 2) ) 29 29 died died in Find Find CFR CFR: : At X X city of cancer cancer in in 1433 1433H H. . city: : cases of in 1433 1433H H Numerator: # died of cancer = 29 Numerator: # died of cancer = 29 Denominator: Number with cancer = 110 Denominator: Number with cancer = 110 CFR CFR = = 110 29 29 110 x x 100 100 = = 26 26. .4 4% % 41

Proportionate Proportionate Mortality T The he proportionate proportionate of specified specified disease disease is PM PM = = Number of deaths from a disease Number of deaths from a disease during a specified period of time during a specified period of time Total deaths in the same time Total deaths in the same time period period Mortality (PM) of mortality mortality from is defined defined as (PM): : from as: : x 100 6/7/2025 42

Example Example 1 1: : At 1 1) ) 10 10 deaths disease disease in 2 2) ) 500 500 deaths 1427 1427 At X X city from cardiovascular cardiovascular in 1427 1427 deaths from from all all diseases city: : deaths from diseases in in Find Find PM PM PM = = 500 PM: : 10 500 10 x x 100 100 = = 2 2% % 6/7/2025 43

Years Years of Is Is a a measure measure of Death Death occurring occurring in at at a a younger younger age loss loss of of future future productive death death occurring occurring at Steps Steps in in calculation calculation of 1 1- - subtract subtract each each person predetermined predetermined age of potential potential life life lost lost (YPLL) of early early deaths deaths. . in the the same age involves involves a a greater productive years at an an older older age of YPLL YPLL: : person s s death age (differs (differs according (YPLL) same person person greater years than age. . than death from according from 6/7/2025 to to country) country). . 44

For For example example a a person 32 32, , and and suppose suppose the age age is is 65 65, , then then this ( (65 65 32 32) ) = = 33 33 years person died the predetermined predetermined this person person has years of of life life. . died at at age age has lost lost The The younger younger the occurs, occurs, the the more life life are are lost lost. . 2 2- - YPLL YPLL for added added together together to YPLL YPLL. . the age more years age at years of at which which death of potential potential death for each each individual individual are to yield are then then the total total yield the 6/7/2025 45

Example Example: : 5 5 workers workers died to to toxic toxic chemical chemical. . The The ages ages of 35 35, , and and 40 40 years Use Use age age 65 age age. . Calculate Calculate the died because because of of exposure exposure of death death were years. . 65 as as the were 20 20, , 25 25, , 30 30, , the predetermined predetermined the YPLL And so so find YPLL for find the the mean for these these 5 5 mean YPLL YPLL. . 6/7/2025 workers workers. . And 46

YPLL YPLL = = ( (65 30 30) ) + + ( (65 65 20 65 35 35) ) + + ( ( 65 20) ) + + ( (65 65 40 65 25 40) ) = = 175 25) ) + + ( (65 175. . 65 2 2- - The The mean mean YPLL YPLL = = 175 175/ /5 5 = = 35 35 On On average, average, the premature premature workers workers who the number number of death death who died died is of years years of among among is 35 35 years years. . of those those 6/7/2025 47

Country Country Sex ratio Sex ratio Life expectancy Life expectancy Total fertility rate Total fertility rate Male Female 105 : 100 71 75 3.03 Saudi Arabia Saudi Arabia 105 : 100 61 60 5.48 Yemen Yemen 106 : 100 73 77 4.65 Palestine Palestine 105 : 100 70 73 4.86 Iraq Iraq 103 : 100 76 81 2.63 Bahrain Bahrain 105 : 100 75 80 2.36 Emirates Emirates 105 : 100 75 77 2.52 Oman Oman 102 : 100 74 77 1.92 Qatar Qatar Jordon Jordon 106 : 100 79 82 3.27 6/7/2025 48

Sex differentials: Sex differentials: The average life expectancy of females is greater than that of males, partly due to biological factors and partly because of behavioral differences. Men smoke more tobacco, drink alcohol, have more motor vehicle accidents, engage in more 6/7/2025 49

dangerous occupation and are more prone to suicide. There is an Excess male mortality in many countries. Comparing the number of male Comparing the number of male deaths with the number of female deaths with the number of female deaths can be misleading due to deaths can be misleading due to sex ratio (more male babies being sex ratio (more male babies being born and hence more deaths. born and hence more deaths. 6/7/2025 50