Mortality in Iraq Associated with the 2003-2011 War and Occupation: Findings from a National Cluster Sample Survey by the University Collaborative Iraq Mortality Study
Mortality in Iraq Associated with the 2003-2011 War and Occupation: Findings from a National Cluster Sample Survey by the University Collaborative Iraq Mortality Study
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DOI：
10.1371/journal.pmed.1001533
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发表时间：
2013-10-01
期刊：
影响因子：
15.8
通讯作者：
Burnham, Gilbert
中科院分区：
文献类型：
--
作者：
Hagopian, Amy;Flaxman, Abraham D.;Burnham, Gilbert
背景：以前对2003年入侵伊拉克造成的伊拉克死亡率的估计是不同的和有争议的，2006年以后没有估算过。这项研究的目的是估计2003年至2011年期间伊拉克战争造成的直接和间接死亡人数。方法和发现：我们对伊拉克各地随机选择的2000户家庭进行了调查，采用两阶段整群抽样方法，以确保家庭样本具有全国代表性。我们询问了自2001年以来每个户主的出生和死亡情况，以及所有家庭成年人的兄弟姐妹死亡率。我们使用次级数据来源来校正外迁。从2003年3月1日至2011年6月30日，伊拉克的粗死亡率为每1 000人年4.55人（95%不确定区间为3.74-5.27），比战前26个月期间的死亡率高出0.5倍以上，导致冲突造成的死亡多出约405 000人（95%不确定区间为48 -751 000人）。在成年人中，从战前时期（2001年1月1日至2003年2月28日）到战争高峰期（2005-2006年），妇女的死亡风险增加了0.7倍，男子的死亡风险增加了2.9倍。我们估计，超过60%的超额死亡可直接归因于暴力，其余则与基础设施崩溃和其他与战争有关的间接原因有关。我们使用二手资料来估计移民的死亡率。这些估计表明，如果这些家庭留在伊拉克，而不是迁移到其他地方，我们至少错过了5.5万例死亡。只有24个家庭拒绝参与这项研究。另有5个家庭因敌对或威胁行为而未接受采访，回复率为98.55%。依赖于过时的人口普查数据和参与者需要较长的回忆期是我们研究的局限性。结论：除了预期的死亡率外，伊拉克大多数死亡率的增加可归因于直接暴力，但约三分之一可归因于间接原因（如卫生、卫生、交通、通信和其他系统的失败）。伊拉克大约有50万人死于这场战争。
Background: Previous estimates of mortality in Iraq attributable to the 2003 invasion have been heterogeneous and controversial, and none were produced after 2006. The purpose of this research was to estimate direct and indirect deaths attributable to the war in Iraq between 2003 and 2011.Methods and Findings: We conducted a survey of 2,000 randomly selected households throughout Iraq, using a two-stage cluster sampling method to ensure the sample of households was nationally representative. We asked every household head about births and deaths since 2001, and all household adults about mortality among their siblings. We used secondary data sources to correct for out-migration. From March 1, 2003, to June 30, 2011, the crude death rate in Iraq was 4.55 per 1,000 person-years (95% uncertainty interval 3.74-5.27), more than 0.5 times higher than the death rate during the 26-mo period preceding the war, resulting in approximately 405,000 (95% uncertainty interval 48,000-751,000) excess deaths attributable to the conflict. Among adults, the risk of death rose 0.7 times higher for women and 2.9 times higher for men between the pre-war period (January 1, 2001, to February 28, 2003) and the peak of the war (2005-2006). We estimate that more than 60% of excess deaths were directly attributable to violence, with the rest associated with the collapse of infrastructure and other indirect, but war-related, causes. We used secondary sources to estimate rates of death among emigrants. Those estimates suggest we missed at least 55,000 deaths that would have been reported by households had the households remained behind in Iraq, but which instead had migrated away. Only 24 households refused to participate in the study. An additional five households were not interviewed because of hostile or threatening behavior, for a 98.55% response rate. The reliance on outdated census data and the long recall period required of participants are limitations of our study.Conclusions: Beyond expected rates, most mortality increases in Iraq can be attributed to direct violence, but about a third are attributable to indirect causes (such as from failures of health, sanitation, transportation, communication, and other systems). Approximately a half million deaths in Iraq could be attributable to the war.