24-Apr-25

PPHS 101: Introduction to Population Science

Module 5: Concepts and definitions

Mortality

Md. Sanaul Haque Mondal

Department of Social Relations
East West University, Bangladesh

1 2

Live birth: Death

Live birth is the complete expulsion or extraction from its “Death is the permanent disappearance of all evidence of life
mother of a product from its mother of a product of at any time after birth has taken place (post-natal cessation
conception, irrespective of the duration of pregnancy, which, of vital functions without the capacity of resuscitation)”
after such separation, breathes or shows any other evidence
of life, such as the beating of the heart, pulsation of the
• All deaths prior to a live birth are not considered as
umbilical cord, or definite movement of voluntary muscles,
death.
whether or not the umbilical cord has been cut or placenta is
attached; each product of such a birth is considered live-born.” • Abortions and still births are not referred to as deaths but
(World Health Organization) as foetal deaths.

(Source: Bhende & Kanitkar, 2019) (Source: Bhende & Kanitkar, 2019)

3 4
 24-Apr-25

Mortality
• Mortality refers to deaths that occur within a population.
• The probability of dying during a given time period is linked to
Measures of Mortality
many factors, such as age, sex, race, occupation, and
economic status. • A) Crude Death Rate (CDR)
• The incidence of death can reveal much about a population’s
standard of living and health care. • B) Age-specific Death Rate (ASDR)
• C) Childhood Mortality Rate
• D) Maternal Mortality Ratio (MMR)
• E) Cause-Specific Death Rate
(Haupt, Kane, & Haub, 2011)

5 6

A) Crude Death Rate (CDR)

• Deaths during the calendar year 2004 in USA = 2,398,343
• The number of deaths in a population in a given year per one • Population in mid-year 2004 in USA = 293,028,000
thousand members of the population

• Interpretation: This means that in the United States in 2004,

there were just over 8 deaths for every 1,000 persons in the
population.

(Haupt, Kane, & Haub, 2011) (Source: Poston & Bouvier, 2010)

7 8
 24-Apr-25

Critical Thinking: Critical Thinking (2):

• In 2009: • The main reason is that Panama (6 percent population is ages 65

and older) is much younger in average age than is the Sweden (18
Life expectancy in Sweden was 81 years, and in Panama 76 years percent), and younger people have lower death rates than older
Sweden’s CDR was 10 and in Panama’s 5. people.
• In other words, countries with large proportions of young people and
small proportions of old people will usually have lower CDRs than
countries with small proportions of young people and large
• Why is the CDR of the Sweden higher than that of the Panama? proportions of old people.
• Why are there so many more deaths per 1,000 population in the • Despite Sweden’s better health conditions, it has a higher proportion
Sweden than in the Panama? of deaths in the total population each year than Panama.

(Haupt, Kane, & Haub, 2011) (Haupt, Kane, & Haub, 2011)

9 10

14

12 B) Age-specific Death Rate (ASDR)

10
Crude death rates

8 • Age-specific death rate is the total number of deaths to

5.82

6 residents of a specified age or age group in a specified

4
geographic area (country, state, county, etc.) divided by the
2
population of the same age or age group in the same
0
geographic area (for a specified time period, usually a calendar
1982

1984

1986

1988

1990

1992

1994

1996

1998

2000

2002

2004

2006

2008

2010

2012

2014

2016

2018

2020

2022

Year
year) and multiplied by 1000.
Figure: Trends in CDR in Bangladesh, SVRS 2022
(Source: SVRS, 2022)

11 12
 24-Apr-25

Estimation of age-specific mortality rates: Japan, 2004

• In the United States in 2008, the age-specific death rate for

ages 15 to 24 was 0.8 per 1,000.

(Haupt, Kane, & Haub, 2011) (Source: Yusuf, et al., 2014)

13 14

250
C) Early Childhood Mortality
200
Age-specific Death Rates

150
(a) Infant mortality rate (IMR) Deaths under one year of age
Male
Female
(b) Neo-natal mortality rate (NMR) Deaths under 4 weeks of life
100
Both sexes (c) Post neo-natal mortality rate Deaths between 4 weeks and under
50
(PMR) one year
(d) Child mortality rate Deaths between first and the fifth birth
0 day
>1
1-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74

80-84
85-89
90+
75-79

(e) Under-five mortality rate Deaths between birth and fifth birth day

Figure: Age-specific death rates by sex in Bangladesh, SVRS 2022

(Source: SVRS,2022) (Source: BBS, 2021)

15 16
 24-Apr-25

a) Infant Mortality Rate (IMR)

• The infant mortality rate is the number of deaths of infants under
age 1 per 1,000 live births in a given year.

• There were 24 deaths of infants under age 1 per 1,000 live

births in a country in a given year.

(Haupt, Kane, & Haub, 2011) (Source: Poston & Bouvier, 2010)

17 18

90 120
80
100

Infant Mortality Rates

70
60 80

50 60
40
40
30
20 20
10
0
0 Chattogr Mymens Rajshah
Barishal Dhaka Khulna Rangpur Sylhet
am ingh i
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022

Both sexes 22.74 25.28 20.77 22.02 22.09 25.98 22.44 35.82
Female 26.98 22.29 17.3 23.06 15.53 22.55 26.67 33.87
Infant Mortality rates Neo-natal Mortality rates
Male 19.1 28.32 24.07 21.02 28.03 29.09 18.53 37.74
Post Neo-natal Mortality rates Under-5 Mortality rates
Figure: Trends in IMR in Bangladesh by sex & division, SVRS 2022
Figure: Trends in child mortality rate in Bangladesh, SVRS 2022 (Source: SVRS, 2022) (Source: SVRS,2022)

19 20
 24-Apr-25

80
45
70

Post Neo-natal Mortality Rates

40
Neo-natal Mortality Rates

60 35
50 30
25
40
20
30
15
20 10
10 5
0 0
Chattogr Mymens Chattogr Mymensi
Barishal Dhaka Khulna Rajshahi Rangpur Sylhet Barishal Dhaka Khulna Rajshahi Rangpur Sylhet
am ingh am ngh
Both sexes 14.02 16.76 13.11 17.2 15.39 20.87 15.13 22.98 Both sexes 8.7 8.52 7.64 4.85 6.71 5.15 7.31 12.82
Female 13.81 15.2 10.16 17.98 9.95 18.56 18.13 20.71 Female 13.09 7.09 7.11 5.11 5.57 4.04 8.53 13.12
Male 14.19 18.34 15.92 16.44 20.31 22.97 12.35 25.21 Male 4.93 9.96 8.15 4.61 7.74 6.17 6.18 12.52

Figure: Trends in NMR in Bangladesh by sex & division, SVRS 2022 Figure: Trends in PNMR in Bangladesh by sex & division, SVRS 2022
(Source: SVRS,2022) (Source: SVRS,2022)

21 22

140
120 D) Maternal Mortality Ratio
Under-5 Mortality Rates

100
80
Maternal mortality:
60
40 • Maternal mortality refers to the death of a woman while
20
pregnant or within 42 days of termination of pregnancy,
0
Chattogr Mymens Rajshah
Barishal
am
Dhaka Khulna
ingh i
Rangpur Sylhet irrespective of the duration and site of pregnancy, from any
Both sexes 28.99 32.72 24.74 26.73 29.63 34.69 31.92 43.9
Female 32.39 30.84 21.09 27.49 19.88 28.63 37.86 41.32 cause related to or aggravated by the pregnancy or its
Male 26.08 34.63 28.22 25.98 38.46 40.21 26.43 46.45
management but not from accidental or incidental causes
Figure: Trends in U5MR in Bangladesh by sex & division, SVRS 2022

(Source: SVRS,2022) (Haupt, Kane, & Haub, 2011)

23 24
 24-Apr-25

• The maternal mortality ratio is the number of women who die as Number of maternal deaths
Maternal Mortality Ratio = X 100,000
Total live births
a result of complications from pregnancy or childbearing in a
given year per 100,000 live births in that year. Number of maternal deaths
Maternal Mortality Rate = X 100,000

• Deaths due to complications from spontaneous or induced

abortions are included.

25 26

700
E) Cause-Specific Death Rate
600
MMR per 100,000 live births

500 • Cause-specific death rates are usually expressed in deaths per

400
100,000, because for most causes of death, the rates of
occurrence are very low.
300

200

100

0
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022

• In 2008, 203 people per 100,000 died of heart disease, the

Year leading cause of death in the United States.
Figure: Trends in MMR in Bangladesh, SVRS 2022
(Source: SVRS, 2021) (Haupt, Kane, & Haub, 2011)

27 28
 24-Apr-25

Table: Death rates per 1000 population from top 15 causes in Bangladesh,
SVRS 2020 Causes of death
• The Global Burden Disease (GBD) divided causes of into three
groups:
• (a) communicable disease: infectious and parasitic diseases,
which can be transmitted from one person to another.
• Communicable diseases

• Maternal and perinatal conditions

• Nutritional deficiencies

(Source: BBS, 2021) (Source: Anderson, 2014)

29 30

• (b) Non-communicable diseases: which are caused by diseases or

Life Expectancy
degenerative conditions and are not transmitted from one person to
• Life expectancy is an estimate of the average number of
another, such as cancer, heart disease. additional years a person could expect to live if the age-specific
death rates for a given year prevailed for the rest of his or her
• (c) External causes: caused by human action by the person affected life.
another person, whether intentionally or unintensionally. • Life expectancy is a hypothetical measure because it is based
on current death rates and actual death rates change (usually
• Accidents improving) over the course of a person’s lifetime.
• Homicide

• Suicide

(Source: Anderson, 2014) (Haupt, Kane, & Haub, 2011)

31 32
 24-Apr-25

Foetal Deaths
• death prior to the complete expulsion or extraction from its • Abortion:
mother of a product of human conception, irrespective of the refers to the termination of a pregnancy. This can occur with medical
duration of pregnancy and which is not an induced termination
of pregnancy. (Source: National Center for Health Statistics) intervention such as medications or surgical procedures or it can occur
on its own.
• Abortions and still births are referred to, not as death, but as Induced abortion – when a woman chooses to end a pregnancy, often
foetal death
called a termination of pregnancy, or TOP

Spontaneous abortion – more commonly known as a miscarriage.

33 34

Others mortality
measures
Perinatal mortality rate

• Miscarriages: any loss that happens before 20 weeks of • The sum of the number of stillbirths and the number of deaths to
babies age 0 to 7 days, divided by the sum of the number of live
pregnancy. Miscarriage is a naturally occurring event, unlike births and stillbirths in the year, multiplied by 1,000;
medical or surgical abortions. A miscarriage may also be called • Also known as pregnancy wastage.

a "spontaneous abortion."

• Stillbirth is any loss that happens after 20 weeks.

(Source: Poston & Bouvier, 2010)

35 36
 24-Apr-25

Others mortality
measures
Stillbirth rate

• Stillbirth (foetal death) is a late fetal death at 20 to 28 weeks or • A fetus may die prior to the onset of labor, that is, in
more of gestation utero, because of pregnancy complications or various
• These are fetuses that are not born alive. maternal diseases. Or a fetus may be alive at the onset
• They are not registered as deaths because the fetuses were of labor but die during the process and, thus, emerge
never born.
from its mother in a dead state.
• Stillbirth is also known as miscarriages or fetal deaths

(Source: Poston & Bouvier, 2010) (Source: Poston & Bouvier, 2010)

37 38

Morbidity
• Stillbirth rate (or fetal death rate):
• Morbidity refers to disease and illness, injury, and disability in a
population.
• Incidence: measures new cases of disease
(Source: Poston & Bouvier, 2010) • Prevalence: measures existing cases of disease (both old
and new cases)
• The stillbirth rate in Bangladesh in 2022 is 9.5 per 1000 live
births (Source: SVRS, 2022)

39 40
 24-Apr-25

Theories of Mortality Epidemiological transition

• Definition: Shift in cause-of-death patterns that comes with the
over-all decline of death rates.
• The Epidemiological Transition Theory
• 1971: Omran proposed three basic patterns of epidemiological
transition
• 1986: S. Jay Olshansky and A. Brian Ault expanded this model
by adding 4th stage

(Source: Anderson, 2014)

41 42

Stage 1: The Age of Pestilence and Famine:

Stage 2: The Age of Receding Pandemics
• mortality is high and fluctuating, thus precluding sustained
• when mortality declines progressively; and the rate of decline
population growth. accelerates as epidemic peaks become less frequent or disappear.
• the average life expectancy at birth is low and variable (between • The average life expectancy at birth increases steadily from about 30
20 and 40 years). to about 50 years.

• Population growth is sustained and begins to describe an

exponential curve.

(Source: Anderson, 2014) (Source: Anderson, 2014)

43 44
 24-Apr-25

Stage 3: The Age of Degenerative and Man-Made Diseases

Stage 4: Age of Delayed degenerative disease
• mortality continues to decline and eventually approaches
stability at a relatively low level. • The causes of death remains similar to those third stage, but

• The average life expectancy at birth rises gradually until it death rates at older stages decline further and average age at
exceeds 50 years. death continue to increase.

• It is during this stage that fertility becomes the crucial factor in

population growth.

(Source: Anderson, 2014) (Source: Anderson, 2014)

45 46

Mortality Differentials Factors responsible for mortality decline

• Age • Mother education
• Sex
• Marital status • Status of Women

• Race and ethnicity • Public health programs

• Income level
• Disease Control Medicines
• Education attainment
• Occupation • Medical Facilities
• Rural –urban differentials • Life Expectancy
(Source: Bhende & Kanitkar, 2019)

47 48
 24-Apr-25

References
Home task
• Poston DL and Bouvier LF (2010) Population and Society: An Introduction to Demography. Cambridge
University Press.
• Identify the CBR, TFR, CDR and IMR of the following regions
• Haupt, A., Kane, T. T., & Haub, C. (2011). PRB's population handbook.
from the World Population Data Sheet (latest version):
• Lucas, D., Mcdonald, P., Young, E., & Young, C. (1980). Beginning Population Studies: Demography
Teaching Notes 2. • World
• Lucas, D., & Roettger, M. E. (2021). The scope of population studies and demography. In Beginning
Population Studies 3rd Edition. ANU Press.
• More developed region
• Bhende, A. A., & Kanitkar, T. (2019). Principles of population studies. Bombay: Himalaya Publishing • Least developed regions
House (19th Edition).
• Asia
• Yusuf, F., Swanson, D. A., & Martins, J. M. (2014). Methods of demographic analysis. Springer: Germany
• BBS. (2021). Report on Bangladesh Sample Vital Statistics 2018. Dhaka: Bangladesh Bureau of • South Asia
Statistics
• Bangladesh
• Anderson, B. A. (2014). World population dynamics: an introduction to demography. Pearson Higher Ed.

49 50

Think
•In 2006
CDR of United States was 8 and Venezuela was 4

• Could it be that mortality • Should we use CDRs to

Standardization was really higher in the
United States than in
Venezuela?
compare the mortality
experiences of countries?

51 52
 24-Apr-25

Age Mid-year Death (b) CDR ASDR=

population (a) {(b/a)*100}
0-34 2000 40 40 20
35+ 1000 80 80
Total 3000 120 40

53