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Communicable disease mortality: now you see it, now you don't.

Abstract：

:This presentation proposes that cause-specific mortality analyses are greatly enhanced by first examining the cause-specific pattern of the entire mortality structure instead of restricting initial assessments to a limited number of leading causes of death. Six broad cause groups are defined toward this end. The advantage of defining a single category for communicable diseases, both for the structural and the leading-cause approach is also pointed out. Some examples illustrate the potential usefulness of this approach to the study of the cause-specific mortality structure: a few broad all-inclusive cause-groups provide a first rough--but nevertheless quite informative--overview of the mortality profile, while at the same time offering guidance in regard to groups which should be looked into in greater detail. :The discussion of communicable disease mortality highlights the problems of utilizing leading cause of death reporting, where the definition and characteristics of a short list influence the relative of all structural components, and thus the sequence of ranking. Leading cause structure is truncated and definitions and frequencies of nonleading causes are usually not made available. However, cause specific is all inclusive and can be easily visualized. Mortality analyses need to become more public health oriented and explanatory, to assist in the evaluation of the health status of the population, and be useful in delineating priorities and resource allocation. The importance of the issue is that developing countries appear to be similar to developed countries in their leading causes of death; communicable diseases are obscured as a leading cause. The broadness of the cause group gives a better chance of qualifying as a leading cause, i.e., diseases of the heart, cerebrovascular disease, malignant neoplasms, and accidents. Another problem is the use of a short list of causes when there has been a shift in the mortality pattern. When leading cause analysis is combined with infectious disease surveillance, infectious diseases are listed singly along with broad categories such as diseases of the heart. There is no one single best cause list of mortality. A given causal category may not qualify for all countries as a leading cause. Cause groups should be need determined. In consideration of these problems, a progressive structural approach and a new ICD--9 was recommended by PAHO in 1988. 6 principles were identified: hierarchy, comparability, expandability, consistency, suitability for identification of leading causes of death, and responsiveness to public health needs. The new short list is comprised of 61 all-inclusive categories in 6 broad cause groups (communicable diseases, neoplasms, diseases of the circulatory system, certain conditions originating in the neonatal period, external causes of injury and poisoning, and all other diseases, as well as symptoms, signs, and ill-defined conditions (SSI). The provision for SSI means data can be limited to defined causes only and if SSI becomes too large, a reappraisal is in order. This 6-group causal structure has been helpful in epidemiologic mortality patterns in the Americas, where communicable diseases (including influenza and pneumonia) rank in t he 5 leading causes of death. This was possible because of the modification of the communicable disease list to include all infectious and parasitic diseases, meningitis, and acute respiratory infections.

journal_name

J Public Health Policy

journal_title

Journal of public health policy

authors

Plaut RR,Silvi JJ

subject

Has Abstract

pub_date

1991-01-01 00:00:00

pages

464-74

issue

eissn

0197-5897

issn

1745-655X

journal_volume

pub_type

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Communicable disease mortality: now you see it, now you don't.