Measures of mortality

MWS 307 / NUS 311

McGraw-Hill/Irwin ©The McGraw-Hill Companies, Inc. 2008

A mortality rate is a measure of the frequency
of occurrence of death in a defined population
during a specified period of time.

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 Measures of mortality

⚫ Mortality is clearly an index of the severity of the

problem from both clinical and public health
standpoints. Mortality can also be used as an index
of the risk of the disease.
⚫ Most of our information about deaths comes from
death certificate. Deaths are coded according to the
underlying causes. Analysis of mortality information
depends on the quality of the data included.
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 The Mortality Rates

⚫ A mortality rate is a measure of the frequency of

occurrence of death in a defined population during a
specified period of time.

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 How is mortality expressed in quantitative terms?

Annual crude mortality rate:

= All deaths during calendar year / Total mid year population*1000

Ex: In a population of 2 million, the total reported deaths from all causes were 12000
in 1995. The annual crude mortality rate in that year per 1000 persons was:
12000/2000000 X 1000 = 6 per 1000 population per year.
((The crude death rate is the starting point for further development of adjusted
rates)).

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 ⚫ It is important to use the population size at the midpoint of the
time interval as an estimate of the average population at risk
especially if a denominator population is growing or shrinking
during the period of time for which a rate is to be computed.

⚫ e.g. If a death rate is to be calculated for the year 2000, then the
population of July 1, 2000 is used for the denominator.

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 Proportionate mortality ratio:

= Total number of deaths due to a certain disease / Total number of

deaths from all causes * 1000

⚫ Ex: There were 6000 deaths (1200 leukemia, 1750 stroke, 250
pneumonia, 250 Hodgkin's disease, 2500 acute myocardial
infarction, and 50 others) in certain community which had a
population of 2.5 million populations in 1996. The Proportionate
mortality rate for leukemia is:
= 1200 /6000 X 1000 = 20%

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 Age (sex, race…..) specific mortality rate:

1. Age (sex, race…..) specific mortality rate: = Number of people who died
particular age (sex, race….) / Total mid year population of the same age
race….) during the same year.
Ex: Mortality from MI in community X regarding age group was as follow:
Age group in No. of No. of deaths
years population from MI
45-55 250'000 1000
56-65 150'000 750
≥66 50'000 50
TOTAL 450'000 1800

Age specific mortality rate (45-55):1000/250000X 1000= 4 per 1000.

Age specific mortality rate (56-65): 750/150000X1000= 5 per 1000.
Age specific mortality rate (≥66) : 50/50000X1000=1 per 1000
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 Cause specific mortality rate:

= Number of deaths due a specific disease/ Total mid year population*1000

⚫ Ex: There were 6000 deaths (1200 leukemia, 1750 stroke, 250
pneumonia, 250 Hodgkin's disease, 2500 acute myocardial infarction,
and 50 others) in certain community which had a population of 2.5
million populations in 1996. The cause specific mortality rate for acute
MI in this population was:
=2500/2'500'000X1000=1 per 1000

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 Case fatality rate:

= Number of deaths due to specific disease/ Number of people

with the same disease*100
(Usually express in percentage)

⚫ Ex: In a city, there were 500 HIV- positive people of whom 5 died
within a year after their initial diagnosis. The case fatality rate is
= 5/500 X100= 1%.

⚫ Note: The ''survival rate'' in that year was 99%(100%-1%)

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 Comparison of a mortality rate and case fatality rate:

Assume a population of 100'000 people of whom 20

are sick with disease ''X'', and in 1 year, 18 die from
that disease.
⚫ The mortality rate in that year from disease x =
18/100000= 0.018%.
⚫ The case fatality rate from disease x = 90/100=
90%.
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 Some special

Number of infant (< 1 year) deaths

Infant mortality
mortality rates:
rate
Number of live births
Neonate Number of neonate (≤ 28 days) deaths
mortality rate Number of live births

Perinatal Number of stillbirths + deaths in 1st week of life

mortality rate Total births

Stillbirth rate
Number of intrauterine deaths after 28 weeks
Total births

Maternal
mortality rate**
12 Number of deaths among women due to after 28 weeks
 ⚫ 2. Age (sex…..category) -specific mortality rate
– An age-specific mortality rate is a mortality rate limited to a particular age group.
⚫ The numerator is the number of deaths in that age group(or any
category)
⚫ The denominator is the number of persons in that age group or
category in the population.

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 ⚫ Sex-specific mortality rate

⚫ A sex-specific mortality rate is a mortality rate among either males or

females.
⚫ Both numerator and denominator are limited to the one sex.

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 Infant mortality rate:

No. of infants dying under one year of age in a year per thousand
live birth in a given geographical region.
D0
IMR=  1000
B

D0 : No. of infants who died before completing their first year.

B : Total No. live births occurring in that year and geographical

region.
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Neonatal Mortality Rate (NMR):
No. of infants dying within the first 4 weeks or up to 28 days of life per
1000 live birth in a year and geographical region.

Deaths of infants up to 4 weeks

NMR = × 1000
No. of live births
Early Neonatal Mortality Rate (NMR):
No. of infant deaths during the first seven days of life per 1000 live
births in a year and geographical region.

ENMR = Deaths of infants in the first week of life

× 1000
No. of live births 16
Post Neonatal Mortality Rate (PNMR)

Number of infants deaths after 28 days to less than 1yr

(between 4 weeks to 52 weeks) of age per 1000 live births in a
given year.

No. of deaths of newborns between

4weeks or less than 1yr old in a year
PNMR= × 1000
No. of live births during the same yr

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 Maternal Mortality Ratio (MMR)

No. of deaths of women while pregnant or within 42 days of

termination of pregnancy from any cause related to pregnancy/
childbearing and child birth per 100,000 live births in a given year.

Deaths of pregnant women and women after

termination of pregnancy within 6 weeks from any
cause related to pregnancy

MMR= × 100000
No. of live births during the same year

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Maternal Mortality Rate (MMRT)

Number of maternal deaths while pregnant or within 42 days of

termination of pregnancy from any cause related to pregnancy/
childbearing and childbirth per 100,000 women in reproductive ages
15-49.

No. of maternal deaths of

women in age 15-49
MMRT = × 1000
No. of women in age 15-49
in a given yr

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❑ Foetal Death:
Deaths prior to the complete expulsion or extraction from its
mother of a product of conception at any time of pregnancy.
❑ Still Birth
Death of foetus after completing 28 weeks and till the time of
birth.

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Time Reference for Mortality in Childhood and Infancy

28 weeks of gestation completed

Still Birth
Perinatal Death
Live Birth

Neonatal
Death
Early

Neonatal
7 Days

Death
Neonatal

Child Death (<5 Years)

Infant Death
Death
Late
28 Days

Neonatal
Death
Post
1 Year
Toddler
Death

5 Years 21
Limitations of Measures of Mortality

➢The risk in a population may vary largely with

various socio-economic and biological traits.
➢ The lack of reliable and requisite data presents
serious problem sometimes of considerable
magnitude.

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 6. Maternal mortality rate (ratio)

The maternal mortality rate is really a ratio used to measure mortality

associated with pregnancy.
The numerator is the number of deaths assigned to causes related to
pregnancy during a given time period.
The denominator is the number of live births reported during the same
time period.
Because maternal mortality is much less common than infant mortality, the
maternal mortality rate is usually expressed per 100,000 live births.
In 1988, the maternal mortality rate was 8.4 per 100,000 live births.
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 Combinations of specific mortality rates

Different combinations of specific mortality rates can be calculated e.g.

cause-specific, age-specific,…
For example, the mortality rate attributed to HIV among 25- to 44-year-
olds in the United States in 1987 was 9,820 deaths among 77.6 million 25-
to 44-yearolds, or 12.7 per 100,000.
This is a cause- and age-specific mortality rate, because it is limited to one
cause (HIV infection) and one age group (25 to 44 years).

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 Rates whose denominators are total population:
⚫ Crude mortality rate (crude death rate)
⚫ Crude Birth rate (crude Birth rate)
⚫ Cause-specific mortality rate

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 Rates whose denominators are total population:
⚫ Infant mortality rate
⚫ Neonatal mortality rate
⚫ Postneonatal mortality rate
⚫ Maternal mortality rate

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 Exersice 1:
• A total of 2,123,323 deaths were recorded in the United States
in 1987. The mid-year population was estimated to be
243,401,000 calculate Crude mortality rate.

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 Exersice 1:
• A total of 2,123,323 deaths were recorded in the United States
in 1987. The mid-year population was estimated to be
243,401,000 calculate Crude mortality rate.
All deaths during calendar year / Total mid year population*1000

• Crude mortality rate= 2,123,323/ 243,401,000 *1000

• =8.7 per 1000 28
Exercise 2:
-In 2008 a total of 12,088 TB-related deaths occurred in males
and 1,380 TB-related deaths occurred in females. The
estimated 2008 midyear population for males and females was
118,531,000 and 124,869,000, respectively.
a. Calculate the TB-related death rate for males and for
females.
b. What type of mortality rates did you calculate in step a?
c. Calculate the TB-mortality rate ratio for males versus females29
a. TB -related death rate for males
= (12,088/118,531,000) × 100,000 = 10.2 per 100,000
HIV-related death rates for females
= (1,380/124,869,000) × 100,000 = 1.1 per 100,000

b. These rates are cause-specific and sex-specific mortality rates

c. TB -mortality rate ratio for males versus females

=(10.2 per 100,000) / (1.1 per 100,000) = 9.3
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HIV-related mortality rate was 9.3 times higher for males than for
females.
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Exercise 3: From table

• Calculate HIV (cause)-specific mortality rate for

the entire population
• calculate HIV-related mortality rate among 35- to
44-year-olds (cause-specific and age-specific
mortality rate) in all races

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a. HIV –related mortality rate for the intire population

= (13,468/243,401) × 1000 = 55.3 per 1000

b. HIV-related mortality rate among 35- to 44-year-olds (cause-

specific and age-specific mortality rate) in all races

=(4,794/34,305) × 1000 = 139.7 per 1000

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:
Exersice 4 :
in 2001, a total of 15,555 homicide deaths occurred among males and
4,753 homicide deaths occurred among females. The estimated 2001
midyear populations for males and females were 139,813,000 and
144,984,000, respectively.
1-Calculate the homicide-related death rates for males and for females.
2-What type(s) of mortality rates did you calculate in Question 1?
3-Calculate the ratio of homicide-mortality rates for males compared to
females.
Interpret the rate you calculated in Question 3 as if you were presenting
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information to a policymaker.
a. Homicide-related death rate for males
= (15,555/139,813,000) × 100,000 = 11.1 per 100,000

Homicide-related death rate for females

= (4,735/144,984,000) × 100,000 = 3.3 per 100,000

b. These rates are cause-specific and sex-specific mortality rates

c. Homicide-related death ratio for males versus females
=(11.1 per 100,000) / (3.3 per 100,000) = 3.4
Homicide-related death rate was 3.4 times higher for males than for 35females.
Exersice 5:
• In an epidemic of hepatitis A from a restaurant,
555 cases were identified. Three of the case-
patients died as a result of their infections.
Calculate the case-fatality rate

• Which mortality measurement, can give us idea

about the mortality& morbidity at the same time?
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 = Number of deaths due to specific disease/ Number
of people with the same disease*100
(Usually express in percentage)
3/555*100
=0.54%

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QUIZ : Calculate the crude death rate and age specific mortality rate
among (20-40) years old from the following data

Age-group Population Deaths

(Years)
Under 10 20,000 600
10-20 12,000 240
20-40 50,000 1,250
40-60 30,000 1,050

Above 60 10,000 500

TOTAL 122,000 3,640
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