Di Disent ntang ngli ling ng S Sex-Di -Different ntials ls i - PowerPoint PPT Presentation

Di Disent ntang ngli ling ng S Sex-Di -Different ntials ls i in De n Death R h Registration & n & Mortali lity E y Estima mates: : Preli limi mina nary F y Find nding ngs f from M m Morocco & & K Kuwait Romesh Silva, Ph.D. Statistics Division, Economic and Social Commission for Western Asia United Nations Expert Group Meeting on Methodology for and Lessons Learned from CRVS Assessments Population Division, DESA, United Nations 3 November, 2016

Outline - Status of CRVS systems + mortality estimation in Western Asia - Regional strategy for CRVS systems improvements - Completeness assessment case studies: Kuwait & Morocco - Methodological limitations & next steps 2 Romesh Silva – UN DESA EGM, New York.

Current Status of CRVS Systems Source: Eastern Mediterranean Regional Office, World Health Organization, 2013. 3 Romesh Silva – UN DESA EGM, New York.

Mortality & Registration Paradox 100 100 KUW KUW EGY EGY BAH BAH OMN OMN UAE UAE QTR QTR PAL PAL 80 80 SYR SYR Death Registration Completeness (%) Death Registration Completeness (%) IRQ IRQ TUN TUN JOR JOR 60 60 SAU SAU LBN LBN 40 40 SDN SDN MOR MOR 20 20 YEM YEM 0 0 0 20 40 60 80 100 0 50 100 150 200 250 Under − five Mortality Rate Adult Mortality Rate (45q15) 4 Romesh Silva – UN DESA EGM, New York.

Heavy reliance on non-CRVS sources by UN when estimating summary mortality measures Syria Tunisia Lebanon Iraq Palestine Morocco Jordan Kuwait Egypt Bahrain Libya Qatar Saudi Arabia United Arab Emirates Oman Yemen Mortality Data Source for WPP 2012 Sudan Vital Registration Derived from Child Mortality Estimates Survey Data Indirect Estimates from Population Census Source: United Nations, Department of Economic and Social Affairs, Population Dicvision (2013), World Population Prospects: The 2012 Revision 5 Romesh Silva – UN DESA EGM, New York.

2014-2 -2019 R Regiona nal S l Strategy: y: WHO-E -EMRO & & UN UN-E -ESCWA F Focus • Strengthen the registration infrastructure and capacities • Improve production, use and dissemination of vital statistics • Improve inter-sectoral coordination and alignment among stakeholders • Strengthen and harmonize regional and global partnerships in support of country strategies 6

Study Objectives — To assess completeness and quality of recent death registration data in Kuwait, and Morocco with a particular focus on sex differences. — Completeness: Proportion of all deaths (b/w ages 15-59) that were registered by CRVS system — Quality: whether the age, sex, geographic, temporal patterns in the registration data are internally consistent and externally consistent with alternative data sources — Understand current deficiencies in death registration as a first step towards improvement of death registration systems and resulting DR-based mortality statistics 7 Romesh Silva – UN DESA EGM, New York.

Current Approaches to CRVS Completeness (& Quality) Assessment 1. Self lf-r -reporting ng i in H n HH s surveys ys 1. — Reporting ng b bias d due t to t termi mino nolo logical d l differenc nces — Reporting ng b bias d due t to s social d l desirabili lity y 2. Comparison o n of r registered d deaths hs t to E E(deaths hs) 2. — Misali lignme nment nt b between r n referenc nce p popula lations ns — Large s sampli ling ng e errors 3. Ind Indirect d demo mographi hic e estima mation: n: 3. De Death Di h Distribution M n Metho hods — Strong ng a assumptions ns: : [1] [1] closed population, [2] completeness of recording of deaths is constant by age, [3] the completeness of recording of population is constant by age, & [4] error-free age reporting — Non-negligible uncertainty intervals (Murray et al., PLoSMed-2013) Record-L -Link nkage 4. 4. — Labor i int ntens nsive & & T Techni hnically c lly cha halle lleng nging ng 8 Romesh Silva – UN DESA EGM, New York.

Data & Methods • Apply different variants of death distribution methods (DDMs) to data on national populations: • Generalized Growth Balance (GGB) method uses the observed population growth rates, the observed birth rate and the observed death rate to estimate the relative coverage of the population censuses along with the relative coverage of the death registration process. • Synthetic Extinct Generations (SEG) method compares the estimated future cohort deaths to the current cohort’s population size as a means to assessing the completeness of the death registration process during the intercensal time period. • Adjusted-SEG method involves application of the GGB method to the available data to adjust the raw data followed by application of the SEG method to the GGB-adjusted data. 9 Romesh Silva – UN DESA EGM, New York.

Data & Methods • Apply different variants of death distribution methods (DDMs) to data on national populations: • Generalized Growth Balance (GGB) method uses the observed population growth rates, the observed birth rate and the observed death rate to estimate the relative coverage of the population censuses along with the relative coverage of the death registration process. • Synthetic Extinct Generations (SEG) method compares the estimated future cohort deaths to the current cohort’s population size as a means to assessing the completeness of the death registration process during the intercensal time period. • Adjusted-SEG method involves application of the GGB method to the available data to adjust the raw data followed by application of the SEG method to the GGB-adjusted data. 10 Romesh Silva – UN DESA EGM, New York.

Methodological Assumptions • Coverage of each individual census is the same for all ages • Completeness of reporting of deaths is the same for all ages from a minimum age (usually age 15) • Population is closed to migration (or information on migration is available) • No assumption of population stability (unlike earlier one-census methods) 11 Romesh Silva – UN DESA EGM, New York.

Death Register: Age Ratio Morocco Kuwait 2.0 2.0 1.5 1.5 Age Ratio 1.0 1.0 Male Female Male Female 0.5 0.5 Median Median Median Median Min Min Min Min Max Max Max Max 0.0 0.0 5 − 9 10 − 14 15 − 19 20 − 24 25 − 29 30 − 34 35 − 39 40 − 44 45 − 49 50 − 54 55 − 59 60 − 64 65 − 69 70 − 74 5 − 9 10 − 14 15 − 19 20 − 24 25 − 29 30 − 34 35 − 39 40 − 44 45 − 49 50 − 54 55 − 59 60 − 64 65 − 69 70 − 74 12 Age Group Age Group Romesh Silva – UN DESA EGM, New York.

13 Sex Ratio (Males per 100 Females) 100 200 300 400 500 600 0 Death Register: Sex Ratio 0 − 4 5 − 9 10 − 14 15 − 19 20 − 24 25 − 29 Age Group Morocco 30 − 34 35 − 39 40 − 44 45 − 49 Romesh Silva – UN DESA EGM, New York. 50 − 54 55 − 59 60 − 64 65 − 69 Max Min Median 70 − 74 75 − 79 80+ 100 200 300 400 500 600 0 0 − 4 5 − 9 10 − 14 15 − 19 20 − 24 25 − 29 Age Group 30 − 34 Kuwait 35 − 39 40 − 44 45 − 49 50 − 54 55 − 59 60 − 64 65 − 69 Max Min Median 70 − 74 75 − 79 80+

Death Registration Completeness Estimates 14 Romesh Silva – UN DESA EGM, New York.

Kuwait, , 2005-2 -2011 GGB Diagnostic Plots 15

Death registration completeness by age, male Death registration completeness by age, female 1.5 1.5 ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● 1.0 ● 1.0 ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● aNx aNx 0.5 0.5 Kuwait , , c_5Nx c_5Nx 0.0 0.0 aNx aNx 2005-2 -2011 15 − 19 25 − 29 35 − 39 45 − 49 55 − 59 65 − 69 75 − 79 15 − 19 25 − 29 35 − 39 45 − 49 55 − 59 65 − 69 75 − 79 c_5Nx c_5Nx Observed vs. Fitted Logits, male Observed vs. Fitted Logits, female 1 1 SEG ● ● 0 0 ● ● Diagnostic ● ● ● Y(x) ● Y(x) − 1 − 1 ● ● ● ● ● ● ● ● Plots ● ● ● ● − 2 − 2 ● ● ● ● ● ● ● ● ● − 3 − 3 − 3 − 2 − 1 0 1 − 3 − 2 − 1 0 1 Ys(x) Ys(x) Smoothed vs. Adjusted Mortality Rates, male Smoothed vs. Adjusted Mortality Rates, female 0.15 0.15 Smoothed m_x Smoothed m_x ● 0.10 0.10 ● ● ● 0.05 0.05 ● ● ● ● ● ● ● ● ● ● ● ● ● ● 0.00 ● ● ● ● ● ● ● 0.00 ● ● ● ● ● ● ● ● 16 5 − 9 15 − 19 25 − 29 35 − 39 45 − 49 55 − 59 65 − 69 75 − 79 85+ 5 − 9 15 − 19 25 − 29 35 − 39 45 − 49 55 − 59 65 − 69 75 − 79 85+ Adjusted m_x Adjusted m_x