Pr Premat ature Mortality y and and Mortal ality y transi - PDF document

Pr Premat ature Mortality y and and Mortal ality y transi ansition n in n Indi dia Authors: Suryakant Yadav And Perianayagam Arokiasamy International Institute for Population Sciences Poster ID: 5759 at the 2017 International Population Conference __________________________________________________________________________ Abstract: The global rise of e 0 has attracted worldwide interest in understanding the pace of mortality transition in developing countries. In this study, we assessed the progress of mortality transition in India during the last four decades as indicated by mortality compression and changes in variance by examining inequalities in age-at-death for India and its bigger states. We estimated mortality compression measures C50 and the Gini ( G 10 ). Both measures showed steep decline with more pronounced decline for females than males. The distribution of age death also showed much lower inequality for females than males. Both trends testified to the progress of mortality compression for India. Results revealed stronger mortality compression for India and increasing homogeneity; both of which further confirmed the process of mortality transition in India. The decomposition of the Gini revealed that contribution to the pace of mortality transition was greater from adult than senescent mortality decline. The narrowing sex differentials in e 0 and G 10 and survival of motherhood together outpaced the life expectancy of females over males. This analysis has established that India has exited the middle stage of mortality transition and has entered into a new phase of low mortality. 1

1. Introduction: The global rise in life expectancy at birth (e 0 ) is attributed to improvements in mortality at all ages contributing to rising human longevity. The phenomenon has been established with relevant theoretical formulations and empirical evidence over the course of the mortality transition in developed nations (Vaupel 2010). Improvements in mortality result in a transformation in the age pattern of mortality. This transformation is a continuous process primarily because of the phenomenal mortality compression, a process in which deaths are concentrated in a narrower age-interval. Mortality compression is a necessary precursor for progress in the mortality transition. While India has experienced rapid transition from high- medium-low mortality in less than four decades (Yadav & Arokiasamy 2014); a key concern arises as to how quickly and persuasively the phenomenon of mortality compression, spurred by reduction in inequality in age-at-death, has formalized the mortality transition in India. India’s transformation in the age pattern of mortality began in the 1970s. The Infant Mortality Rate (IMR) has been cut by two-thirds from 129 in 1970, to 80 in 1990, to 37 per 1000 live births in 2015 (RGI 2016a, RGI 2016b). Mortality rates have also declined at higher ages. Numerous studies have documented how mortality decline among infants and children initially affects the level of e 0 ; then together with mortality decline in the adult and old ages, the age pattern of mortality reshapes itself (Heligman et al. 1980; Pool and Wong 2006; Rau et al. 2008). The declining mortality trends in conjunction with the transformations in the age pattern of mortality led to the process of mortality compression, advancing the mortality transition to later stage in less time compared to the developed nations. The developed nations are in the last phase of demographic transition where IMR is almost negligible, and currently the advances in mortality transition are because of mortality improvement in adult and old ages. At the later stage of mortality transition researchers have acknowledged shrinking variance in age-at-death as a fundamental demographic process (Smits and Monden 2009; Wilmoth and Horiuchi 1999). The reduction in premature (15–64) deaths contemporaneous with decline in IMR have underpinned the convergence in e 0 among the developed nations (Clark 2011; Vaupel, Zhang, and Raalte 2011). Today, the low level of disparity in life spans among the developed nations is attributable to aversion of premature deaths in the adult ages (Shkolnikov, Andreev, and Begun 2003; Shkolnikov et al. 2001). The developing country India has experienced rapid transformation in the age pattern of mortality for females compared to males as the IMR and U5MR have declined swiftly since the early 1980s (NIMS, ICMR and UNICEF 2012: 29) and maternal mortality rate have declined since late 1990s (Memoire 2007). The adult mortality for women and men in India fell from 358 and 330 respectively in 1970 to 145 and 228 respectively in 2010 (Rajaratnam et al. 2010), which is higher than East Asia and Southeast Asia and the developed nations. A higher adult mortality rate indicates a greater spread of deaths over the adult ages and hence signals a greater variation in disparity in life spans in India. In the past two decades, India has experienced a marked rise in e x at adult and older ages. At the national level, between 1970-75 and 2009-13, e 50 and e 60 increased by 5 and 4 years respectively to 25.7 and 17.9 years respectively. It indicates that the current phase of mortality transition is modulated through improved survival among adults and older ages contributing to the advances in mortality transition. Exploring the mortality data of developed nations, Edwards and Tuljapurkar (2005) acknowledged that higher order moments of distribution of age-at-death (e x; x>10 ) better demonstrate variability and differentials than the first order moment of distribution of age-at-death ( e 0 ), and therefore the advances in mortality 2

transition can be better established on that basis. The estimation of higher moments allows examination of mortality compression and change in inequality in age-at-death, which are pivotal to understanding the progression in mortality transition, especially at the later stage. The varying e 0 across the Indian states is a manifestation of existing disparity in life spans. A demographically advanced state Kerala has the highest e 0 value 78.1 years for rural females in 2012. Other demographically advanced states such as Maharashtra, Punjab and Tamil Nadu has e 0 value 72.4 years, 72.4 years, and 71.3 years respectively for rural females in 2012. The less demographically advanced states Uttar Pradesh, Assam and Odisha have e 0 value 64.7, 64.6 and 66.5 years respectively for rural females in 2012 (RGI 2016b). The leader and laggard states while the demographic transition partially explain the inequality in e 0 ; nonetheless, the less advanced states recorded greater temporal increase in e 0 as compared to the advanced states in the last two decades. For example, the less advanced states gained about 10 years in e 0 , whereas, the advanced states gained 5–6 years in e 0 between the years 1990 and 2012 (RGI 2016a). Furthermore, in most of the developed nations, it is notable that modal age-at-deaths are quite different even though e 0 are similar (Thatcher et al. 2010). The developed nations such as Canada, Denmark, France, and United States showed divergence in adult mortality despite overall convergence in mortality leading to differences in the evolution of life spans amongst them (Edwards and Tuljapurkar 2005). The historical lowering of mortality rates is more pronounced and possible in the young ages than in old ages. These processes vary across the developed nations and is responsible for inequality in age-at-death within the countries (Wilmoth and Horiuchi 1999). The phenomenon of mortality compression has been an integral part of demographic and epidemiological transition (Robine 2001, Cheung et al. 2005) as witnessed in the developed nations. For India, this study for the first time examines the process of and advances in mortality compression and inequality in age-at-death. Studies on the association of age pattern of mortality and its linkages with mortality transition are limited. Recognizing such theoretical gaps, this study aims to investigate the progress of mortality transition by testing the phenomena of mortality compression and inequality in age-at-death. The specific objectives of the study are to: (1) test the hypothesis of mortality compression (2) examine the changes in inequality in age-at-death and (3) to examine the age specific- contributions to the G 10 . The study examined the progression in mortality transition through advances in mortality compression and changes in variance by examining inequality in age- at-death for India and its bigger states during 1970-2013. 2. Background: Worldwide, human longevity has been increasing and its repercussions are wide-ranging. The more developed nations such as Americas and Europe are ahead of Africa and South-East Asia in mortality transition; on average e 0 is higher by almost 8-10 years in developed nations than in less developed nations (WHO 2015). During the last stage of the mortality transition, the age pattern of mortality is changed. At this stage, the contours of mortality and morbidity are characterized by low mortality and heavier burden of non-communicable diseases (NCDs). India has higher mortality rates than the developed nations. Until the mid 20 th century, endemic diseases including small pox, cholera, plague and malaria made important contributions to the higher mortality rates in India. However, since the 1950s, India experienced a steep fall in mortality rates but with the rise of a dual burden of diseases (Banthia and Dyson 1999, 2000). 3