Mortality from violent causes in adolescents and young adults from - PDF document

Mortality from violent causes in adolescents and young adults from the Southern Cone. An analysis of the variations in the last 20 years Eleonora Rojas Cabrera ♥ Nancy Stiegler ♣ Andrés Peranovich ♦ Bruno Ribotta ♠ Abstract This paper analyses, comparatively, the variations of mortality from violent causes in adolescents and young adults from the Southern Cone countries between triennia 1997- 99 and 2011-13, taking into account sex, age group and specific causes. Mortality rates are calculated and analysed based on information from the World Health Organization and the United Nations Department of Economic and Social Affairs. The results show that the most affected populations depend on the cause(s): 15-29 year-old men and traffic accidents; all adolescents and young adults and homicides (especially women aged 25-29 from all countries and Brazilian men regardless of age); and the population aged 15 and over and suicides (particularly in Uruguay). Thus, in order to reduce mortality levels, it is necessary to consider particularly inner characteristics of each population group and country, stressing issues as self-esteem, value of life, respect for people’s own rights and the rights of others. ♥ CIECS (CONICET y UNC), Córdoba, Argentina. E-mail: eleonorarojascabrera@gmail.com. ♣ Department of Statistics and Population Studies, University of the Western Cape, South Africa. E-mail: nstiegler@uwc.ac.za. ♦ CIECS (CONICET y UNC), Córdoba, Argentina. E-mail: andrescpera@gmail.com. ♠ CIECS (CONICET y UNC), Córdoba, Argentina. E-mail: brunoribo@yahoo.com.ar.

Introduction Given the consequences of violent episodes on economic and social justice in countries and the increase of mortality levels related to these unrests, the governments of the Americas have taken action for many decades to reduce such situations (Banco Mundial, n.d.). Among them: reduction of factors that contribute to aggressive behaviours (alcohols, drugs, weapons); implementation of parents’ training programs on non-violent methods of education; and promotion of the use of seat belts and the reduction of speed in motor vehicles (BID, 2010). However, levels of violence continue increasing in the region (mainly for men). This increase reflects on the cause-of-death composition in the population, principally in adolescents and young adults. In this sense, during the triennia 1994-96 and 2011-13, the relative incidence of mortality by homicides among aged 10-29 1 rises from 23.6% to 28.5%, while the one associated to ground accidents and suicides grows, respectively, from 15.6% to 16.4% and from 3.2% al 5.9% (OPS, n.d.). As part of the region, the Southern Cone (integrated by Argentina, Brazil, Chile and Uruguay) is affected by this problem. Moreover, it reveals a more serious situation for the first cause cited. In fact, considering the same period, the relative weight of deaths by homicide among adolescents and young adults increased from 25.9% to 32%, while that related to ground accidents and suicides rose from 16.6% to 18.9% and from 3.1% to 5.2% (OPS, n.d.). In this context, and taking into account that previous studies revealed disparities in mortality from violent causes’ trends and structures among adolescents and young adults in the Southern Cone from the 80’s to mid-90’s 2 , we ask ourselves: Has mortality from violent causes varied in the same direction and with the same intensity in all these countries in the last 20 years? Which population groups have been the most affected according to sex and age? Which challenges can be deduced if the analysis is made by specific causes? 1 According to several documents produced in the United Nations context (OMS, 1986; CELADE - División de Población de la CEPAL and FNUAP, 2000; UNICEF, 2008), we consider adolescents as all people aged 10-19 and young adults as those aged 20-29. 2 We remark the study made by Yunes and Zubarew (1999). According to this, death from traffic accidents are more common in Argentina, Chile and Uruguay (generally, with increasing levels), followed by suicides (with increasing levels in the first country and decreasing levels in the last two) and homicides (with increasing levels in the three countries). On the contrary, in Brazil, deaths from traffic accidents and homicides have the same relative incidence, followed by suicides (all causes are associated to increasing mortality levels).

In order to answer these questions, we analyse, comparatively among countries, the mortality changes from violent causes among aged 10-29 by sex, age group and specific cause during the period 1997-99 and 2011-13 3 based on information from the World Health Organization (WHO) and the United Nations Department of Economic and Social Affairs (UN DESA). Methods We use mortality data on violent causes disaggregated by sex, age and specific cause related to people aged 10-29 from the WHO 4 ; and population projections by sex and age group from the Population Division of the UN-DESA 5 . Following previous researches (Yunes and Zubarew, 1999; Serfaty et al., 2003; Rojas Cabrera, 2015), we consider these causes of death according to the International Classification of Diseases - Tenth Revision (ICD 10): Traffic accidents (V01-V99); Other accidents (W00-W99; X00-X59); Homicide (X85-Y09); and Suicide (X60-X84). Based on this information, we calculate specific mortality rates (MRs) by disaggregation referred for triennia 1997-99and 2009-13. The MRs are obtained by dividing the average number of deaths of each triennium 6 by the mid-period population projection for each one of them (1998 and 2012, respectively). All MRs are expressed per 100,000 population, considering the unit of measurement applied in studies that focus in group of causes or specific causes (OPS-HA, 2015). In addition, we calculate MR ratios among the disaggregation to refine the comparison between countries. Concerning the triennia selected, it is worth noting that we consider the first year of application of ICD 10 in all countries under study; specifically: 1997 7 . Additionally, 2013 was the last year with available information while we were working on this research. 3 It is worth to mention that we focus on comparing all Southern Cone countries, unlike other researchers that have previously analysed mortality for one or some of them, taking into account one violent cause or all of them ((Burrone et al, 2012; Freitez et al, 2012; Bella et al, 2013; Cardona Arango et al, 2013). 4 Available at:http://apps.who.int/healthinfo/statistics/mortality/causeofdeath_query/. Accessed: December 2, 2016. 5 Available at:https://esa.un.org/unpd/wpp/Download/Standard/Population . Accessed: December 2, 2016. 6 In the case of Uruguay, the average number of deaths for the triennium 2011-13 excludes those related to 2011 because the source used did not contain the information regarding this year when it was consulted. 7 Although Brazil started to apply ICD 10 since 1996, we decide to consider 1997 in order to make comparisons among countries.

Results 8 The MR from violent causes among people aged 10-29 rises in all countries of the Southern Cone during triennia 1997-99 and 2011-13. This increase is greater in Brazil (country with the highest MR; MR: 67 to 76.8 per 100,000 population), followed, according to its intensity, by Argentina (MR: 35.5 to 39.9 per 100,000 population); Chile (country with the lowest MR; MR: 27.6 to 30.8 per 100,000 population) and Uruguay (second country with the highest MR; MR: 51.1 to 54.1 per 100,000 population). These changes affect the relative incidence of violent causes in the cause-of-death composition of each country. This issue provides an overview of the seriousness of the situation in the region: as the relative incidence grows from 43.1% to 50.9% in Argentina, it increases from 57.3% to 65.1%, from 42% to 59.7% and from 63.3% to 67.3%, respectively, in Brazil, Chile and Uruguay. If we consider age in the analysis, the MR of 10-14 year-old adolescents (lower than the rest of the age groups in the four countries; higher in Brazil and Uruguay) decreases during the period under study regardless of the country (with greater intensity in Uruguay and lower in Chile). These variations produce a drop of the relative incidence of violent causes in this group of population in all cases (Table 1). On the contrary, the MRs of people aged 20-24 and 15-19, in this order (greater than the others age group MRs in all countries and particularly higher in Brazil) rise in all cases. This change (stronger in 20-24 year-old Argentinean population) causes a growth of relative weight of these causes (Table 1). Finally, the MR associated to young adults aged 25-29 increases; consequently, the relative incidence of violent deaths among this group increases too (Table 1). 8 It is worth stressing that Brazil’s results shown in this section could be affected by the low deaths coverage level that this country has (shortly improved from 86.4% to 87% during the period 2000-2005 - 2005-2010) comparing with the rest of the countries including in this study (Argentina: 99%; Chile and Uruguay: 100% during the period referred) (OPS, 2013; CELADE - División de Población de la CEPAL, 2015).