ADULT MORTALITY IN DEVELOPING-COUNTRIES
ADULT MORTALITY IN DEVELOPING-COUNTRIES
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DOI：
10.1016/0035-9203(90)90364-k
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发表时间：
1990-01-01
影响因子：
2.2
通讯作者：
FEACHEM, RGA
中科院分区：
文献类型：
--
作者：
MURRAY, CJL;FEACHEM, RGA
在过去十年中，国际卫生界关注发展中国家儿童死亡率和发病率的负担。因此，与特定疾病相比，人们对成年人的健康问题几乎没有全面的兴趣。这种缺乏关注的背后是一种普遍的信念，即一个人一旦成年，发展中国家和工业化国家的死亡经历几乎没有区别。有些人甚至可能认为，一些发展中国家的成人死亡率应该更低，因为慢性病的某些“西方”风险因素很少见。现实是不同的：发展中国家的成人死亡率和儿童死亡率比工业化国家高得多，是发展政策和干预措施的重要目标。成年人的定义可以参照他们在社会中扮演的角色来定义。他们是所有社区的父母、工人和领导者。成年人也是儿童和老年人的提供者和照顾者。成年期的功能定义虽然很吸引人，但不太适合进行量化分析。因此，我们将成年定义为15岁至59岁的人口。这一定义与联合国对“老年人”的定义一致，“老年人”包括60岁以上的人口。15岁至59岁的年龄跨度包括在工业化国家中，我们预计死亡率将保持相当低的年龄段。对于我们大多数人来说，60岁之前死亡还为时过早，应该加以预防。按照这个成人的定义，发展中国家56%的人口是成年人；他们的数量略高于2×10；其中32%生活在中国。据世界银行估计，在整个发展中国家，38%的死亡发生在15岁的儿童中，27%发生在成人(15-59岁)中。为了对低死亡率国家的预期死亡年龄分布进行调整，我们可以计算可避免的死亡人数。如果某一特定低死亡率参考人口的死亡率适用于发展中国家，这些死亡就不会发生。日本1987年的死亡率一直被用作参考--日本的预期寿命是世界上最高的。根据这些计算，世界银行每年有800万例可避免的成人死亡。本文报告的结果源于世界银行在即将出版的《发展中国家成年人的健康》一书中所做的工作。我们感谢兰迪·布拉托、艾伦·洛佩兹、伊恩·蒂梅乌斯和杨功焕对本文内容的特殊贡献。然而，内容的责任完全在作者身上。
For the past decade, the international health community has focused on the burden of childhood mortality and morbidity in developing countries. As a consequence, there has been little comprehensive, as contrasted with disease-specific, interest in the health problems of adults. Underlying this lack of attention is the widespread belief that once a person reaches adulthood, there is little difference in mortality experience between developing and industrialized countries. Some would probably go so far as to suggest that adult mortality should be lower in some developing countries because of the rarity of certain ‘western’risk factors for chronic diseases. The reality is different: adult mortality, as well as child mortality, is much higher in developing than in industrialized countries and represents an important target for development policy and intervention. Adults may be defined with reference to the roles that they play in society. They are the parents, the workers, and the leaders in all communities. Adults are also the providers and care-givers for children and the elderly. A functional definition of adulthood, while appealing, is not well suited to quantitative analysis. We have, therefore, defined adulthood as the population aged 15 to 59 years. This definition is consistent with the United Nations defmition of the ‘aged’, which includes the population over age 60. The age-span 15 to 59 includes those age-groups in which, in industrialized countries, we expect mortality to remain quite low. For most of us, deaths before age 60 are premature and should be prevented. With this definition of adulthood, 56% of the developing world’s population are adults; they number a httle over 2x 10; and 32% of them live in China. According to World Bank estimates, in the developing world as a whole, 38% of deaths occur in children aged ti years, while 27% occur in adults (15-59). To adjust for the expected age-distribution of deaths in a low mortality country, we can calculate avoidable deaths. These are deaths that would not occur if the mortality rates of a specified low mortality reference population applied to developing countries. Japanese death rates in 1987 have been used as a reference-Japan has the highest life expectancy in the world. According to these computations, there are 8 million avoidable adult deaths each year in the‘The results reported here derive from work undertaken by or for the World Bank in the preparation of a forthcoming book entitled The Health of Adults in the Developing World. We acknowledge the particular contribution to the content of this paper of Randy Bulatao, Allan Lopez, Ian Timaeus and Yang Gonghuan. Responsibility for the contents lies, however, solely with the authors.