Back to home page

Chile (Santiago) 21

NOTAS DE POBLACION

1994 - VOLUME 22, NUMBER 60

96.21.1 - Spanish - Juan CHACKIEL and Renate PLAUT Latin America: Demographic trends with emphasis on mortality (AmŽrica Latina: Tendencias demogr‡ficas con Žnfasis en la mortalidad) (p. 11-46)

The paper presents the Latin American demographic situation and trends since 1950, with special emphasis on differential mortality across and within countries. Four groups of countries are identified, according to the stage of the demographic transition in the late 1980s: incipient, moderate, full and advanced transition countries. The large declines in mortality, specially those at young ages, are linked to changes in epidemiological profiles which imply a greater relative importance of non-transmisible diseases and a lesser role of infectious and parasitic diseases. Population ageing also contributes to these changes due to the increased fraction of adult and elderly population. In the majority of countries, excessive mortality due to avoidable causes is still present among the poor. Health policy-makers must confront the double challenge of improving adult health in the face of increasingly costly treatments, and continuing to deal with infant and child health problems which should have been solved by now with the help of currently available technologies. (LATIN AMERICA, DEMOGRAPHIC TRANSITION, MORTALITY TRENDS, DIFFERENTIAL MORTALITY)

96.21.2 - Spanish - Dirk JASPERS-FAIJER and Hern‡n ORELLANA Evaluation of vital statistics for the study of causes of death in Latin America (Evaluaci—n del uso de las estad'sticas vitales para estudios de causas de muerte en AmŽrica Latina) (p. 47-78)

The present article attempts to take a deeper look at the most relevant aspects of the problems presented by the data on adult mortality and causes of death in Latin America among adults. First statistical coverage of registred deaths by age and sex is analysed, finding importants differences among the countries and higher coverage in the registration of adult deaths then of younger ones, particularly the males, without verifying major improvements between 1960 and 1985. The review of ill-defined causes of death led to similar results. Both factors lead to the fact that higher quality information is available for the study of adult mortality by death causes than for that of younger mortality. Data quality on causes of death, estimated by the percentages of ill-defined causes and those causes verified by medical certification, which are very dissimilar in the Latin American countries, showed some improvement during the period studied. Finally, reference is made to topics related to the analysis of causes of death and which generally complicates the work, such as the heterogeneity of coverage and data quality at subnationals levels, the compatibility among different revisions of the ICD, the use of ill-defined causes and, finally, access and management of basic information. (LATIN AMERICA, ADULT MORTALITY, VITAL STATISTICS, CAUSES OF DEATH, HEALTH CONDITIONS)

96.21.3 - Spanish - Julio FRENK, Rafael LOZANO and JosŽ Luis BOBADILLA The epidemiological transition in Latin America (La transici—n epidemiol—gica en AmŽrica Latina) (p. 79-102)

During the second half of this century, most Latin American countries have experienced a complex transformation of their health conditions. These changes have had profound implications for the organization of health and other social services. This paper analyzes the main mechanisms involved in the epidemiologic transition, which are: changes in risk factors, fertility decline and improvements in health care technology. It also discusses some of the attributes that characterize different epidemiologic transition experiences (the patterns of change, the starting moment, the pace and the direction of changes), and the consequences of these changes on other social sectors. The results are based on the estimation of a mortality profile ratio (MPR). This is obtained by dividing the mortality rate due to infectious and parasitic diseases over the mortality rate due to cardiovascular diseases and neoplasms. We compared 15 Latin American countries according to their MPR. As a result, three distinct groups can be recognized. Each of them represents a different transitional experience. Such experiences are discussed in detail, including a new "protracted polarized model" of the epidemiologic transition, which characterizes several Latin American countries. Finally, evidence is provided to illustrate the relationship among economic development, fertility change, and mortality profiles. (LATIN AMERICA, EPIDEMIOLOGY, DEMOGRAPHIC TRANSITION, MORTALITY, HEALTH CONDITIONS)

96.21.4 - Spanish - Luis ROSERO-BIXBY Adult mortality decline in Costa Rica (La disminuci—n de la mortalidad de adultos en Costa Rica) (p. 103-140)

This paper examines the adult mortality transition in Costa Rica and its determinants. The risk of dying declined by 80% for young adults and by 40% for old adults from 1920 to 1990. The fastest decline took place in the 1950s for young-adult ages and in the late 1980s for old-adult ages. The 1980s acceleration took place during a period of economic recession and of deterioration of public health services. A sex-gap emerged and widened as by product of larger mortality declines among women. Since approximately 1960, adult men in Costa Rica face lower death risks than their counterparts in industrialized countries such as the United States and France. Heart diseases and lung cancer are the key factors for the comparatively low adult-mortality in Costa Rica. The author details various causes of death which contribute on mortality evolution, and shows some hypotheses from its determinants. (COSTA RICA, MORTALITY DECLINE, ADULT MORTALITY, CAUSES OF DEATH, DIFFERENTIAL MORTALITY)

96.21.5 - Spanish - Erika TAUCHER, Cecilia ALBALA and Gloria ICAZA Adult mortality from chronic diseases 1968-1990 (La mortalidad de adultos por enfermedades cr—nicas en Chile) (p. 141-170)

In Chile, the relative importance of deaths of those 15 years old and over increased from 68 to 91 per cent between 1970 and 1990. Circulatory system diseases, malignant tumors, liver cirrhosis, chronic diseases of the respiratory system, and diabetes mellitus are the most important causes of death among adults. The paper starts with a brief analysis of the sources and the quality of data and mortality indices. Important changes mortality over the last 20 years are the decreased deaths due to cerebrovascular diseases, heart attacks and gastric cancer; the increase in cancer and gall bladder mortality, and the oscillating trend of deaths due to liver cirrhosis. A comparison is made of mortality among the 13 regions of the country and an attempt is made to relate the observed differences to some environmental and life-style factors. Rural-urban and educational differences of mortality by cause of death are also analyzed. The paper ends by comparing mortality by chronic disease in Chile with that of other countries of the Latin American region, noting some difficulties such a comparison and proposing hypotheses for future studies. (CHILE, ADULT MORTALITY, CAUSES OF DEATH, DIFFERENTIAL MORTALITY)

96.21.6 - Spanish - David BRANDLING-BENNETT, Mario LIBEL and AmŽrico MIGLIîNICO Cholera in the Americas in 1991 (El c—lera en las AmŽricas en 1991) (p. 171-186)

While cholera afflicted the Americas for much of the century, the hemisphere was free of epidemic cholera for the first 90 years of the 20th century. In January 1991, V. cholerae (El Tor Inaba) was isolated in Peru, beginning one of the largest documented epidemics. By the end of September 1991, Peru has reported 270 000 cases and 2 577 deaths. Subsequently, 5 other countries in South America, 3 in Central America and 2 in North America were affected, with a total of 317 000 cases and 3 327 deaths reported by late September. Major routes of transmission have been contaminated drinking water, improperly handled foods and raw seafood. Environmental contamination with V. cholerae has been confirmed at several sites throughout the region. Case-fatality ratios have been low in all affected countries, especially in Peru, though some remote areas have had case-fatality ratios 8-fold higher than large municipalities. It is reasonable to estimate that the health services in Peru prevented over 40 000 deaths from cholera. Nonetheless, improvements in case management are needed, and epidemiological surveillance and field investigation have been weak in most countries. Present trends suggest that cholera is likely to spread to most countries of the region within the next two years and will remain endemic in several countries already infected. (AMERICAS, PERU, CHOLERA, EPIDEMIOLOGY)

96.21.7 - Spanish - Danuta RAJS, Soledad PARADA and Alexia PEYSER Maternal mortality in Latin America and the Caribbean (La mortalidad materna en AmŽrica Latina y el Caribe) (p. 187-228)

It has been shown by multiples studies, at the national and subnational levels, the existence of a direct relation between maternal mortality and factors such as high fertility rates, lack of prenatal care and attention at delivery and high abortion rates. These variables are associated, at the same time, with social and economic development indicators, which could be the ultimate responsible factors for the relations observed. However, to make these relationships more precise it is necessary to analyze the mechanisms through which these factors could be influencing the region's maternal mortality levels. The underlying analytical scheme in this study follows these guidelines, focusing on the phenomena of maternal mortality in relation to fertility rates. Thus, the countries of the Region are classified under a tipology, formulated in function of the association between maternal mortality and fertility rates. Using that tipology, the causes of maternal death are then presented, stressing its recent trends. Finally, the intermediate factors and the contextual variables related to fertility are discussed, all which could be influencing in the magnitude and the structure of the region's maternal mortality. (LATIN AMERICA, CARIBBEAN, MATERNAL MORTALITY, CAUSES OF DEATH, MORTALITY DETERMINANTS)

96.21.8 - Spanish - Elida MARCONI Use of the vital statistics system in maternal death prevention programs (Uso de las estad'sticas vitales en programas de prevenci—n de las muertes maternas) (p. 229-254)

The statistics on mortality which form part of The Vital Statistics System (SEV), constitute an important source of data for researchs related to health injury prevention programs such as the maternal death prevention program. In the first part of the article, The Vital Statistics System of the Republic of Argentina is presented, highlighting its characteristics as a data source, the integrity of its death records, the quality of the medical certification as to the cause of death by means of indirect indicators and the under registration of maternal causes. In the second part, the results of a research on maternal mortality carried out in the Federal Capital from 1987 to 1989, which was later extended to other jurisdictions of the country (Cordoba, Tucuman and Corrientes), is synthesized. This research was undertaken within the institutional framework of the National Department of Health: The National Board of Maternity and Infancy with the support of the Board of Statistics and Health, sponsored by the Panamerican Health Organization (PAHO/WHO). Dr. Jorge Vinacur was the principal researcher. The investigation assumed, through indirect estimates, that the maternal mortality rates present an over dimension of the problem in virtue of the under registration of this group of causes. The principal objectives were, therefore, to know the real structure of maternal mortality in the Federal Capital and to identify the factors associated with it, in order to orient the activity of the health services and reduce these deaths. The study was based on the direct measuring of the maternal mortality (auditing). The methodology employed consisted of the identification and evaluation of the under registration by means of the matching of the registered cause in the Death Statistical Report with the records and information consigned in the Medical Record of the deceased woman. The information corresponds to the year 1985. The matching comprised 326 institutional deaths of women between the ages of 14 and 49 years (target population of the study). The registered and selected data from the Medical Record was transcribed on a specially designed form in order to avoid heterogeneity in the reading and interpretation of the above mentioned documentation. The analysis of the obtained data made it possible to identify an under registration of 53.3%, thereby modifying the initial maternal mortality rate in the Federal Capital from 50 deaths per 100 000 live births to 91.4. The real structure of maternal mortality demonstrates the large contribution of abortion and sepsis not originating from abortion. The study was completed with the social characterization of the deceased women through the social variables registered in the Death Statistical Report and in the Medical Record. The results make it possible to orient the health services in the maternal death prevention programs and to make the necessary adjustments in the Vital Statistics System of the Republic of Argentina. (ARGENTINA, MATERNAL MORTALITY, VITAL STATISTICS, UNDERREGISTRATION)

96.21.9 - Spanish - Tom‡s FREJKA and Lucille C. ATKIN Induced abortion as a cause of maternal mortality in Latin America (El aborto inducido como causa de mortalidad materna en AmŽrica Latina) (p. 255)

Due to the restrictive abortion legislation which operates in almost all Latin American countries, knowledge about the incidence of induced abortions, their associated complications and related mortality is unreliable and approximate. There is little doubt, however, that the incidence of induced abortion in Latin America is among the highest in the world. The number of deaths due to complications from unsafe induced abortions is severely underestimated throughout the region. Based on Royston's method called the "maternal mortality route", the authors estimate that the actual number of abortion-related deaths in Latin America is between 5 and 10 thousand per year. Thus, compared to the estimated 4 to 6 million annual induced abortions, the abortion-related mortality rate would range from 83 to 250 deaths per 100 000 abortions. It is clear from the calculations presented that induced abortion in Latin America is a serious public health problem associated with deaths and health complications which could largely be avoided through the provision of accessible and appropriate family planning methods and the availability of high quality abortion services. (LATIN AMERICA, INDUCED ABORTION, MATERNAL MORTALITY)

JUNE 1995 - VOLUME 23, NUMBER 61

96.21.10 - Spanish - Guaraci Adeodato ALVES DE SOUZA Diffusion of fertility control practices: Moments, mechanisms and determinants (Difusi—n de pr‡cticas para limitar la procreaci—n: momentos, mecanismos y determinantes) (p. 9-28)

In Brazil and in Bahia, distinct fertility control practices, performed through the so-called traditional techniques, have been socially diffused among the traditional elites and the more highly educated groups of the middle class since the end of the 19th century. These practices have produced a slow but systematic tendency to inter-generational decline in completed parity. The couples who belong to these classes were the most prolific in the 19th century and turned to have 1-4 children by the beginning of the 1950s. These facts support the hypothesis that the ethical changes involved in the acceptance and legitimacy of those practices were themselves a consequence of their increased prevalence and the consolidation of norms regarding the patterns of fertility control in these social classes. This seems at odds with the hypothesis of "cultural diffusion". Once anti-natality has been consolidated as a theoretical and practical reference system for the behaviour of the higher classes, the institutional apparatus of the society turned on the popular classes with lower levels of education and medical care, and diffused fertility control in these groups. (BRAZIL, CONTRACEPTIVE PREVALENCE, SOCIAL CLASSES, SOCIAL NORMS)

96.21.11 - Spanish - Luis ROSERO BIXBY and John B. CASTERLINE Diffusion through social interaction and fertility transition: Evidences from Costa Rica (Difusi—n por interacci—n y transici—n de la fecundidad: evidencia cuantitativa y cualitativa de Costa Rica) (p. 29-78)

Explanations of the fertility transition in Costa Rica, as elsewhere in developing societies, have stressed the impacts of socioeconomic changes on the demand for children and of increased supply of family planning services. This paper goes beyond this demand-supply paradigm and examines the additional causal contribution of the "contagion" of birth control practices by social interaction. Aiming at conceptual precision, a simple dynamic model is used to simulate a fertility transition process with interaction diffusion effects. An inspection of the data about the Costa Rican transition shows several characteristics suggesting interaction diffusion effects, notably its pervasiveness toward all socioeconomic strata and the lack of evidence of a downward shift in fertility preferences. Maps of the timing of fertility transition indicate an ordered spatial pattern suggestive of contagion between neighboring areas. An areal regression analysis reveals inter- and within-area contagion effects on birth control adoption. Focus group discussions show real-life situations of interaction diffusion for birth control adoption. These discussions also give qualitative hints of the circumstances surrounding diffusion of birth control, as well as give hints of major value changes that paralleled fertility transition in Costa Rica. (COSTA RICA, CONTRACEPTIVE PREVALENCE, DIFFUSION OF INNOVATIONS)

96.21.12 - Spanish - Eduardo E. ARRIAGA Adult mortality in developing countries: A global overview (La mortalidad adulta en pa'ses en desarrollo: una visi—n general) (p. 79-110)

The article analyzes few developing countries with reliable information on adult mortality between ages 15 and 65 years. First, the differences in mortality among certain social groups in China, Indonesia, Mexico, Philippines and Turkey are presented. Latter, the article concentrates in an historical analysis of adult mortality by causes of death in Argentina, Chile, Costa Rica, Cuba, Mexico, Panama and Uruguay. Guatemala is also included, in order to see the impact of violence on mortality. A brief analysis of each country indicates the following aspects. Females maintained a more sustained and systematic decline of adult mortality than males. There are some countries that in spite of a reasonable development, as Mexico, still have a great excess of male mortality in relation to other countries. Finally, some countries experienced a stagnation of the male mortality decline, while females continued benefiting from a decline of mortality. The main reason of this fact seems to be violent deaths and an excess of mortality as consequence of an increase of the consumption of alcoholic beverages, tobacco and fats. (DEVELOPING COUNTRIES, ADULT MORTALITY, MORTALITY DECLINE, SEX DIFFERENTIALS, CAUSES OF DEATH)

96.21.13 - Spanish - Carlos O. GRUSHKA Adult mortality in Argentina: Recent trends, causes and differentials (Mortalidad adulta en Argentina: tendencias recientes, causas y diferenciales) (p. 111-146)

Despite the economic decline of the '80s, adult mortality rates in Argentina decreased by about 14% between 1980 and 1990. The percentage decline was similar for males and females and for every five-years-age group between 15 and 65. The data used for this analysis come from vital statistics registration and the 1980 and 1991 censuses. The reduction in mortality rates for diseases of the circulatory system was the most important factor, accounting for 40% of the total decline for females and 50% for males. Analysis of province-level data reveal a significant correlation between adult mortality and socioeconomic indicators in the case of females but not for males. The impact of different causes is considered through a decomposition of the correlation into cause-specific associations. (ARGENTINA, ADULT MORTALITY, CAUSES OF DEATH, MORTALITY DECLINE)

96.21.14 - Spanish - Jacques VALLIN Causes of adult mortality in countries with low mortality rates: A comparison between several industrialized and developing countries (Causas de defunci—n de adultos en pa'ses en desarrollo y desarrollados con bajas tasas de mortalidad) (p. 147-176)

In a certain number of developing countries, life expectancy levels now approach those of the developed world. But, though life expectancies at birth may be similar, the infant mortality rate in developing countries remains higher, but is compensated by a lower rate of mortality for adults. Is it to expected that as infant mortality rates continue to decline, the developing countries will maintain their advantageous adult mortality rates and that life expectancy will forge ahead of the level achieved in developed countries? Alternatively, are they likely to lose their advantage and pay a price for their continuing social and economic organization? To answer this question, recent trends in adult cause-specific mortality rates in four developing countries (Chile, Hong Kong, Mexico, and Costa Rica) were compared with those in three industrialized countries (France, Germany and Japan). The results were inconclusive. Whilst life expectancies in some of these countries may be expected to forge ahead (Chile, Hong Kong), in others the margin between their life expectancies and those of developed countries have already narrowed. (DEVELOPING COUNTRIES, DEVELOPED COUNTRIES, EXPECTATION OF LIFE AT BIRTH, COMPARATIVE ANALYSIS, ADULT MORTALITY, CAUSES OF DEATH)

96.21.15 - Spanish - Francisco MU„OZ Looking for a new past: Strategies and problems of methodologies on historical demography (V'as hacia un nuevo pasado: estrategias y problemas en las metodolog'as de la demograf'a hist—rica) (p. 177-210)

This article presents a state of the art on the methodologies of historical demography. It analyses the main methodological streams in the study of populations of the past and it does not describe any kind of specific technique. This analysis is oriented to evaluate goals, possibilities and limitations in the methods of historical demography. These methods are introduced in terms of answers to two basic questions in this field: how demographers reconstruct population dynamics of the past and how they explain behaviour of these demographical systems. The approach taken in this pages stresses the relationships between changes in this field of population studies and the changes and innovations in the whole discipline, specially along this last decade. (HISTORICAL DEMOGRAPHY, METHODOLOGY)

96.21.16 - Spanish - Ana Mar'a OYARCE and Susana SCHKOLNIK Mapuche population: A multidisciplinary research in indigenous communities in Chile (Los mapuches: una investigaci—n multidisciplinaria en reducciones ind'genas de Chile) (p. 211-240)

The main purpose of this document is to present a multidisciplinary research experience upon the mapuche population living in indigenous communities in Chile. The project was developed in three stages. The first one was a preliminary overview of the demographic characteristics and living conditions of the population in the indigenous communities in the Araucania Region (IX Region), based on the 1982 National Population Census. In the second stage an experimental census was carried out in four districts in the area of Temuco, Cautin province. Information on demographic and socioeconomic characteristics as well as cultural and mother and child care data was collected. The third stage was an in-depth case study of the risk factors related to infant mortality. The authors consider that the main objectives of the project have been achieved, not only in the collection of a great amount of data on this population but also in the development of an multidisciplinary and collaborative approach in all the stages of the project. Finally, results in connection with the relationship of infant mortality with biological, health, medical care, social, economic and cultural risk factors may help to identify the most vulnerable groups at risk as well as to point out the direction in which preventive and follow-up health care actions should take. (CHILE, INDIGENOUS POPULATION, DEMOGRAPHIC PROFILES, INFANT MORTALITY)

Back to home page