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Young adult and middle age mortality in Butajira demographic surveillance site, Ethiopia: lifestyle, gender and household economy.

Fantahun M, Berhane Y, Högberg U, Wall S, Byass P - BMC Public Health (2008)

Bottom Line: Rural lifestyle carried a significant survival disadvantage [mortality rate ratio 1.62 (95% CI 1.44 to 1.82), adjusted for gender, period and age group], while the overall effects of gender were negligible.Higher mortality was associated with a lack of literacy in a household, poor economic status and lack of women's decision making.Individual factors such as a lack of education, low economic status and social disadvantage all contribute to increased risks of mortality.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Community Health, Addis Ababa University, PO Box 24762, Code 1000, Addis Ababa, Ethiopia. mesganaw.f@gmail.com

ABSTRACT

Background: Public health research characterising the course of life through the middle age in developing societies is scarce. The aim of this study is to explore patterns of adult (15-64 years) mortality in an Ethiopian population over time, by gender, urban or rural lifestyle, causes of death and in relation to household economic status and decision-making.

Methods: The study was conducted in Butajira Demographic Surveillance Site (DSS) in south-central Ethiopia among adults 15-64 years old. Cohort analysis of surveillance data was conducted for the years 1987-2004 complemented by a prospective case-referent (case control) study over two years. Rate ratios were computed to assess the relationships between mortality and background variables using a Poisson regression model. In the case-referent component, odds ratios (95% confidence intervals) were used to assess the effect of certain risk factors that were not included in the surveillance system.

Results: A total of 367,940 person years were observed in a period of 18 years, in which 2860 deaths occurred. One hundred sixty two cases and 486 matched for age, sex and place of residence controls were included in the case referent (case control) study. Only a modest downward trend in adult mortality was seen over the 18 year period. Rural lifestyle carried a significant survival disadvantage [mortality rate ratio 1.62 (95% CI 1.44 to 1.82), adjusted for gender, period and age group], while the overall effects of gender were negligible. Communicable disease mortality was appreciably higher in rural areas [rate ratio 2.05 (95% CI 1.73 to 2.44), adjusted for gender, age group and period]. Higher mortality was associated with a lack of literacy in a household, poor economic status and lack of women's decision making.

Conclusion: A complex pattern of adult mortality prevails, still influenced by war, famine and communicable diseases. Individual factors such as a lack of education, low economic status and social disadvantage all contribute to increased risks of mortality.

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Related in: MedlinePlus

Adjusted mortality rate ratios (reference group urban females 15–44 yr), Butajira. Adjusted for time period mortality rate ratios (reference group urban females 15–44 yr), Butajira, Ethiopia (vertical bars represent 95% confidence intervals) by sex, age group and place of residence.
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Figure 3: Adjusted mortality rate ratios (reference group urban females 15–44 yr), Butajira. Adjusted for time period mortality rate ratios (reference group urban females 15–44 yr), Butajira, Ethiopia (vertical bars represent 95% confidence intervals) by sex, age group and place of residence.

Mentions: The complex patterns of mortality during the period 1987–2004 are shown as mortality rates per 1000 person years and 3-year moving averages in Figures 1 and 2, for the 15–44 and 45–64 year age groups respectively. Table 1 shows mortality rates by age group, gender, period and area. There was a modest downward trend in adjusted mortality over the 18-year period, with 1993–98 at 93% of the initial mortality (95% CI 84% to 102%), and 1999–2004 at 73% (95% CI 67% to 81%) (adjusted for age group, area and gender), but behind these trends substantial epidemic peaks were observed. Considerable excess male mortality was evident in the urban area up to 1991, and the rural area experienced a substantial peak in mortality from 1998 to 2000. These phenomena contributed substantially to the overall higher male mortality rate in the urban area [rate ratio 1.42 (95% CI 1.15 to 1.77), adjusted for age group and period] and the overall higher mortality in the rural area [rate ratio 1.62 (95% CI 1.44 to 1.82), adjusted for gender, age group and period]. There was no significant overall association between gender and mortality. Apart from the effect of age, the most evident influence on mortality was the divide between urban and rural lifestyles, with consistently higher mortality for rural dwellers [rate ratio 1.62 (95% CI 1.44 to 1.82), after adjusting for gender, period and age group], as shown further in Figure 3.


Young adult and middle age mortality in Butajira demographic surveillance site, Ethiopia: lifestyle, gender and household economy.

Fantahun M, Berhane Y, Högberg U, Wall S, Byass P - BMC Public Health (2008)

Adjusted mortality rate ratios (reference group urban females 15–44 yr), Butajira. Adjusted for time period mortality rate ratios (reference group urban females 15–44 yr), Butajira, Ethiopia (vertical bars represent 95% confidence intervals) by sex, age group and place of residence.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2519081&req=5

Figure 3: Adjusted mortality rate ratios (reference group urban females 15–44 yr), Butajira. Adjusted for time period mortality rate ratios (reference group urban females 15–44 yr), Butajira, Ethiopia (vertical bars represent 95% confidence intervals) by sex, age group and place of residence.
Mentions: The complex patterns of mortality during the period 1987–2004 are shown as mortality rates per 1000 person years and 3-year moving averages in Figures 1 and 2, for the 15–44 and 45–64 year age groups respectively. Table 1 shows mortality rates by age group, gender, period and area. There was a modest downward trend in adjusted mortality over the 18-year period, with 1993–98 at 93% of the initial mortality (95% CI 84% to 102%), and 1999–2004 at 73% (95% CI 67% to 81%) (adjusted for age group, area and gender), but behind these trends substantial epidemic peaks were observed. Considerable excess male mortality was evident in the urban area up to 1991, and the rural area experienced a substantial peak in mortality from 1998 to 2000. These phenomena contributed substantially to the overall higher male mortality rate in the urban area [rate ratio 1.42 (95% CI 1.15 to 1.77), adjusted for age group and period] and the overall higher mortality in the rural area [rate ratio 1.62 (95% CI 1.44 to 1.82), adjusted for gender, age group and period]. There was no significant overall association between gender and mortality. Apart from the effect of age, the most evident influence on mortality was the divide between urban and rural lifestyles, with consistently higher mortality for rural dwellers [rate ratio 1.62 (95% CI 1.44 to 1.82), after adjusting for gender, period and age group], as shown further in Figure 3.

Bottom Line: Rural lifestyle carried a significant survival disadvantage [mortality rate ratio 1.62 (95% CI 1.44 to 1.82), adjusted for gender, period and age group], while the overall effects of gender were negligible.Higher mortality was associated with a lack of literacy in a household, poor economic status and lack of women's decision making.Individual factors such as a lack of education, low economic status and social disadvantage all contribute to increased risks of mortality.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Community Health, Addis Ababa University, PO Box 24762, Code 1000, Addis Ababa, Ethiopia. mesganaw.f@gmail.com

ABSTRACT

Background: Public health research characterising the course of life through the middle age in developing societies is scarce. The aim of this study is to explore patterns of adult (15-64 years) mortality in an Ethiopian population over time, by gender, urban or rural lifestyle, causes of death and in relation to household economic status and decision-making.

Methods: The study was conducted in Butajira Demographic Surveillance Site (DSS) in south-central Ethiopia among adults 15-64 years old. Cohort analysis of surveillance data was conducted for the years 1987-2004 complemented by a prospective case-referent (case control) study over two years. Rate ratios were computed to assess the relationships between mortality and background variables using a Poisson regression model. In the case-referent component, odds ratios (95% confidence intervals) were used to assess the effect of certain risk factors that were not included in the surveillance system.

Results: A total of 367,940 person years were observed in a period of 18 years, in which 2860 deaths occurred. One hundred sixty two cases and 486 matched for age, sex and place of residence controls were included in the case referent (case control) study. Only a modest downward trend in adult mortality was seen over the 18 year period. Rural lifestyle carried a significant survival disadvantage [mortality rate ratio 1.62 (95% CI 1.44 to 1.82), adjusted for gender, period and age group], while the overall effects of gender were negligible. Communicable disease mortality was appreciably higher in rural areas [rate ratio 2.05 (95% CI 1.73 to 2.44), adjusted for gender, age group and period]. Higher mortality was associated with a lack of literacy in a household, poor economic status and lack of women's decision making.

Conclusion: A complex pattern of adult mortality prevails, still influenced by war, famine and communicable diseases. Individual factors such as a lack of education, low economic status and social disadvantage all contribute to increased risks of mortality.

Show MeSH
Related in: MedlinePlus