Improving the measurement of adolescent and adult mortality in low-income countries

随着儿童死亡率迅速下降，低收入和中等收入国家所有死亡人数的比例越来越高。 (LMICs)将在未来几十年发生在青少年和成人年龄。即将到来的可持续发展 联合国制定的发展目标反映了这一转变：在未来15年(2015-2030年)， 若干可持续发展目标将侧重于减少主要影响这些年龄段的原因造成的死亡(例如， 孕产妇死亡、道路交通事故、自杀)。美国联邦政府对青少年和成人健康的投资 因此，预计小岛屿发展中国家的机构、国际组织和政府的数量将大幅增加。 然而，这种投资对死亡率的影响可能仍然未知，因为很少有LMIC拥有至关重要的 允许精确测量死亡率的登记系统。尽管目前正在努力改进这类系统， 以家庭为基础的调查(例如，人口和健康调查，DHS)仍将是主要数据 资料来源：LMICs中的青少年和成人死亡率。这些调查需要询问随机抽样的 受访者报告其兄弟姐妹的生存历史(SSH)，即，他们的兄弟姐妹是否都活着1)，2)如何 老S/他是；3)如果去世，S去世时和死后的年龄是多少。SSH许可证 直接估计15岁及以上的死亡率，还包括对 兄弟姐妹的死亡。然而，他们仍然受到普遍存在的报告错误的影响。例如，受访者可能会 省略一些死亡，而其他死亡可能会被添加，或在时间上转移。这些报道的净影响 死亡率指标的误差很大，很难预测，但现有的分析性修正是基于非常 有限的验证研究，没有捕捉到这种复杂性。他们冒着加剧偏见和/或 歪曲了死亡率估计中的不确定性。在这个项目中，我们建议提高 通过a)创新的数据收集技术对青少年和成人死亡率的基于调查的估计 (例如，事件历史日历、回忆线索)和b)综合贝叶斯方法，该方法考虑了采样和 非抽样误差。这项研究的结果将有助于青少年和成人健康的发展和目标 在低收入和中等收入国家采取干预措施，并评估全球卫生倡议的有效性。

With child mortality rapidly declining, an increasing proportion of all deaths in low and middle-income countries (LMICs) will occur at adolescent and adult ages in the next decades. The forthcoming Sustainable Development Goals (SDGs) set out by the United Nations reflect this shift: over the next 15 years (2015-2030), several SDG targets will focus on reducing deaths from causes that affect primarily those age groups (e.g., maternal mortality, road traffic accidents, suicides). Investments in adolescent and adult health from US federal institutions, international organizations and governments of LMICs are thus expected to increase significantly. The mortality impact of such investments may however remain unknown because few LMICs have vital registration systems that allow measuring mortality precisely. Despite current efforts to improve such systems, household-based surveys (e.g., the Demographic and Health Surveys, DHS) will remain the primary data source on adolescent an adult mortality in LMICs. These surveys entail asking a random sample of respondents to report their siblings' survival history (SSH), i.e., whether each of their siblings 1) is alive, 2) how old s/he is, and 3) if deceased, how old s/he was at the time of death and the time since death. SSH permit directly estimating mortality rates at ages 15 and older, and also include basic assessments of the causes of siblings' deaths. They are however still affected by pervasive reporting errors. For example, respondents may omit some deaths, whereas other deaths may be added, or displaced in time. The net effects of these reporting errors on mortality indicators are large and hard to predict, but existing analytical corrections are based on very limited validation studies and do not capture this complexity. They risk accentuating bias and/or misrepresenting uncertainty in mortality estimates. In this project, we propose to improve the accuracy of survey-based estimates of adolescent and adult mortality through a) innovative data collection techniques (e.g., event history calendars, recall cues) and b) integrated Bayesian methods that account for sampling and non-sampling errors. Results from this study will help develop and target adolescent and adult health interventions in low and middle-income countries, and evaluate the effectiveness of global health initiatives.