Modeling Age-Specific Mortality for Countries with Generalized HIV Epidemics
Modeling Age-Specific Mortality for Countries with Generalized HIV Epidemics
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DOI：
10.1371/journal.pone.0096447
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发表时间：
2014-05-22
期刊：
影响因子：
3.7
通讯作者：
Raftery, Adrian E.
中科院分区：
文献类型：
--
作者：
Sharrow, David J.;Clark, Samuel J.;Raftery, Adrian E.
背景：在一个特定的人口中，死亡率的年龄模式是死亡总数、年龄结构的重要决定因素，并通过影响年龄结构、出生数量从而影响增长。除经历普遍艾滋病毒流行的人口和一些发展中国家人口外，大多数人口都有良好的死亡率模型。在感染艾滋病毒的人群中，大量的死亡集中在非常年轻和成年的年龄，这产生了一种独特的“驼峰”年龄死亡率模式，这是任何现有的死亡模型所不能再现的。疾病负担报告和人口预测方法都需要特定年龄的死亡率来估计死亡人数，并得出合理的年龄结构。对于普遍存在艾滋病毒流行的国家，这些估计应考虑到艾滋病毒流行的未来轨迹及其对特定年龄死亡率的影响。在这篇文章中，我们提出了一个简约的年龄特定死亡率模型。方法和发现：该模型将年龄特定死亡率的一个向量表示为三个独立的年龄变化分量的加权和。我们从特定年龄死亡率表的矩阵的奇异值分解中得到年龄变化分量。这些权重被建模为艾滋病毒流行率的函数和三种可能的输入之一：出生时预期寿命、儿童死亡率的指标，或者儿童死亡率和成人死亡率的指标。我们用《2010年世界人口展望》修订版中每个性别的320个五年生命表对模型进行了校准，这些表来自世界上40个已经和正在经历普遍艾滋病毒流行的国家。交叉验证表明，该模型能够超越现有的几个模型生命表系统。结论：我们为普遍存在艾滋病毒流行的国家提供了一个灵活、简约的年龄特定死亡率模型。结合现有流行病学和人口模型的结果，该模型可以预测艾滋病毒普遍流行国家未来特定年龄段的死亡率概况和死亡人数。
Background: In a given population the age pattern of mortality is an important determinant of total number of deaths, age structure, and through effects on age structure, the number of births and thereby growth. Good mortality models exist for most populations except those experiencing generalized HIV epidemics and some developing country populations. The large number of deaths concentrated at very young and adult ages in HIV-affected populations produce a unique 'humped' age pattern of mortality that is not reproduced by any existing mortality models. Both burden of disease reporting and population projection methods require age-specific mortality rates to estimate numbers of deaths and produce plausible age structures. For countries with generalized HIV epidemics these estimates should take into account the future trajectory of HIV prevalence and its effects on age-specific mortality. In this paper we present a parsimonious model of age-specific mortality for countries with generalized HIV/AIDS epidemics.Methods and Findings: The model represents a vector of age-specific mortality rates as the weighted sum of three independent age-varying components. We derive the age-varying components from a Singular Value Decomposition of the matrix of age-specific mortality rate schedules. The weights are modeled as a function of HIV prevalence and one of three possible sets of inputs: life expectancy at birth, a measure of child mortality, or child mortality with a measure of adult mortality. We calibrate the model with 320 five-year life tables for each sex from the World Population Prospects 2010 revision that come from the 40 countries of the world that have and are experiencing a generalized HIV epidemic. Cross validation shows that the model is able to outperform several existing model life table systems.Conclusions: We present a flexible, parsimonious model of age-specific mortality for countries with generalized HIV epidemics. Combined with the outputs of existing epidemiological and demographic models, this model makes it possible to project future age-specific mortality profiles and number of deaths for countries with generalized HIV epidemics.