Trends in Sri Lankan cause-specific adult mortality 1950–2006

Abstract

BackgroundAlthough all-cause mortality in Sri Lanka decreased significantly from 1950 to 1970, subsequent declines have been more modest with divergent trends by age and sex. This study investigates these trends through cause of death analysis for 1950–2006 in adults aged 15–64 years.MethodsDeaths were obtained from the World Health Organisation (WHO) mortality database for 1950 to 2003, and the Department of Census and Statistics Sri Lanka for 1992–95 and 2004–06 where WHO data was unavailable. Adult deaths were categorised by age (15–34 and 35–64 years) and sex into: infectious diseases; external-causes; circulatory diseases; cancers; digestive diseases; respiratory diseases; pregnancy-related; ill-defined; and other-causes. Cause-specific mortality rates were directly age-standardised to the 2001 Sri Lankan Census population.ResultsMortality declined in females aged 15–34 years by 85% over 1950–2006, predominantly due to sharp declines in infectious disease and pregnancy-related mortality over 1950–70. Among males aged 15–34 years the mortality decline was less at 47%, due to a rise in external-cause mortality during 1970–2000. In females aged 35–64 years mortality declined by 67% over 1950–2006, predominantly due to a sharp decline in infectious disease, ill-defined and other cause mortality over 1950–70. Among males aged 35–64 years, decline in mortality is evident to 1960 (19%) from decline in infectious disease mortality, followed by increased mortality from circulatory diseases and external cause mortality, despite continued decline in infectious disease mortality. All-cause mortality in males 35–64 years has stagnated since 1970, with fluctuating increases. Circulatory diseases were the leading cause of death among adults 35–64 years in 2002–06, with the male rate almost three times higher than females.ConclusionsSignificant disparities are demonstrated in Sri Lankan cause-specific adult mortality by sex and age group for 1950–2006. Female mortality progressively declined while male mortality demonstrated periods of increase and stagnation. Among males aged 15–34 years this coincides with periods of civil conflict over 1970–2000. Among males aged 35–64 years the increased mortality from non-communicable disease and external causes are the main reasons for stagnation in all-cause mortality since the 1970’s.

Prevalence of Chronic Complications, Their Risk Factors, and the Cardiovascular Risk Factors among Patients with Type 2 Diabetes Attending the Diabetic Clinic at a Tertiary Care Hospital in Sri Lanka

“…According to the WHO 2014 update, the three highest causes of death in Sri Lanka were reported as CVD, stroke, and diabetes. A study done on trends in Sri Lankan cause-specific adult mortality concluded that chronic diseases are the greatest cause of morbidity and mortality and highlighted the importance in adaptation of the health sector to this alarming trend [ 22 ].…”

Differentials in Cardiovascular Risk Factors and Diabetes by Socioeconomic Status and Sex in Kalutara, Sri Lanka

“…Since 1950, Sri Lanka has experienced an impressive decline in all-cause mortality in adults aged 35 to 64 years from reductions in infectious disease in women, and little change in noncommunicable disease (NCD) mortality rates, with a consequent increase in proportional mortality from CVD and cancer to 53% by 2002-2006. 1 By contrast, in men, there was little decline in the mortality rate for over half a century, with CVD and cancer mortality replacing infection as the main cause of death, and accounting for 40% of proportional mortality by 2002-2006, similar to women, but at much higher mortality rates. The latest Sri Lanka mortality data for 2011-2013, after the end of the civil war in 2009, indicate a life expectancy of 72 years for men and 79 years for women.…”

Community intervention for cardiovascular disease risk factors in Kalutara, Sri Lanka

“…During the past century Sri Lanka has experienced declines in rates of infectious disease mortality in women, leading to reduction in total female mortality and continued improvement in female life expectancy. By contrast, the absolute decline in infectious disease mortality in men has been accompanied by increased cardiovascular disease (CVD) mortality, leading to a prolonged plateau in male life expectancy [1]. The increasing burden of non-measures, with less emphasis on the high-risk approach and more stress on a population approach [3,4].…”