Mortality rate

Mortality rate, or death rate,[1] is a measure of the number of deaths (in general, or due to a specific cause) in a particular population, scaled to the size of that population, per unit of time. Mortality rate is typically expressed in units of deaths per 1,000 individuals per year; thus, a mortality rate of 9.5 (out of 1,000) in a population of 1,000 would mean 9.5 deaths per year in that entire population, or 0.95% out of the total. It is distinct from "morbidity", which is either the prevalence or incidence of a disease,[2] and also from the incidence rate (the number of newly appearing cases of the disease per unit of time).

In the generic form, mortality rates are calculated as:

where d represents the deaths occurring within a given time period and p represents the size of the population in which the deaths occur.

Death rate world map
Crude death rate (per thousand per year) by country (2006)

Related measures of mortality

Other specific measures of mortality include:

Measures of Mortality [3]
Crude death rate – the total number of deaths per year per 1,000 people. As of 2017 the crude death rate for the whole world is 8.33 per 1,000 (up from 7.8 per 1,000 in 2016) according to the current CIA World Factbook.[4]
Perinatal mortality rate – the sum of neonatal deaths and fetal deaths (stillbirths) per 1,000 births.
Maternal mortality ratio – the number of maternal deaths per 100,000 live births in same time period.
Maternal mortality rate – the number of maternal deaths per 1,000 women of reproductive age in the population (generally defined as 15–44 years of age).
Infant mortality rate – the number of deaths of children less than 1 year old per 1,000 live births.
Child mortality rate: the number of deaths of children less than 5 years old per 1,000 live births.
Standardized mortality ratio (SMR) – a proportional comparison to the numbers of deaths that would have been expected if the population had been of a standard composition in terms of age, gender, etc.[5]
Age-specific mortality rate (ASMR) – the total number of deaths per year per 1,000 people of a given age (e.g. age 62 last birthday).
Cause-specific mortality rate – the mortality rate for a specified cause of death.[6]
Cumulative death rate: a measure of the (growing) proportion of a group that die over a specified period (often as estimated by techniques that account for missing data by statistical censoring).[7]
Case fatality rate (CFR) – the proportion of cases of a particular medical condition that lead to death.[8][9][10]
Sex-specific mortality rate - Total number of deaths in a population of a specific sex within a given time interval[3]

Use in epidemiology

In most cases, there are few ways, if at all possible to obtain exact mortality rates, so epidemiologists use estimation to predict correct mortality rates. Mortality rates are usually difficult to predict due to language barriers, health infrastructure related issues, conflict, and other reasons. Maternal mortality has additional challenges, especially as they pertain to stillbirths, abortions, and multiple births. In some countries, during the 1920s, a stillbirth was defined as "a birth of at least twenty weeks' gestation in which the child shows no evidence of life after complete birth". In most countries, however, a stillbirth was defined as "the birth of a fetus, after 28 weeks of pregnancy, in which pulmonary respiration does not occur".[11]

Census data and vital statistics

Ideally, all mortality estimation would be done using vital statistics and census data. Census data will give detailed information about the population at risk of death. The vital statistics provide information about live births and deaths in the population.[12] Often, either census data and vital statistics data is not available. This is especially true in developing countries, countries that are in conflict, areas where natural disasters have caused mass displacement, and other areas where there is a humanitarian crisis [12]

Household surveys

Household surveys or interviews are another way in which mortality rates are often assessed. There are several methods to estimate mortality in different segments of the population. One such example is the sisterhood method, which involves researchers estimating maternal mortality by contacting women in populations of interest and asking whether or not they have a sister, if the sister is of child-bearing age (usually 15) and conducting an interview or written questions about possible deaths among sisters. The sisterhood method, however, does not work in cases where sisters may have died before the sister being interviewed was born.[13]

Orphanhood surveys estimate mortality by questioning children are asked about the mortality of their parents. It has often been criticized as an adult mortality rate that is very biased for several reasons. The adoption effect is one such instance in which orphans often do not realize that they are adopted. Additionally, interviewers may not realize that an adoptive or foster parent is not the child's biological parent. There is also the issue of parents being reported on by multiple children while some adults have no children, thus are not counted in mortality estimates.[12]

Widowhood surveys estimate adult mortality by responding to questions about the deceased husband or wife. One limitation of the widowhood survey surrounds the issues of divorce, where people may be more likely to report that they are widowed in places where there is the great social stigma around being a divorcee. Another limitation is that multiple marriages introduce biased estimates, so individuals are often asked about first marriage. Biases will be significant if the association of death between spouses, such as those in countries with large AIDS epidemics.[12]

Sampling

Sampling refers to the selection of a subset of the population of interest to efficiently gain information about the entire population. Samples should be representative of the population of interest. Cluster sampling is an approach to non-probability sampling; this is an approach in which each member of the population is assigned to a group (cluster), and then clusters are randomly selected, and all members of selected clusters are included in the sample. Often combined with stratification techniques (in which case it is called multistage sampling), cluster sampling is the approach most often used by epidemiologists. In areas of forced migration, there is more significant sampling error. Thus cluster sampling is not the ideal choice.[14]

Mortality statistics

World historical and predicted crude death rates (1950–2050)
UN, medium variant, 2012 rev.[15]
Years CDR Years CDR
1950–1955 19.1 2000–2005 8.4
1955–1960 17.3 2005–2010 8.1
1960–1965 16.2 2010–2015 8.1
1965–1970 12.9 2015–2020 8.1
1970–1975 11.6 2020–2025 8.1
1975–1980 10.6 2025–2030 8.3
1980–1985 10.0 2030–2035 8.6
1985–1990 9.4 2035–2040 9.0
1990–1995 9.1 2040–2045 9.4
1995–2000 8.8 2045–2050 9.7

The ten countries with the highest crude death rate, according to the 2016 CIA World Factbook estimates, are:[16]

Rank Country Death rate
(annual deaths/1,000 persons)
1  Lesotho 14.9
2  Bulgaria 14.5
3  Lithuania 14.5
4  Ukraine 14.4
5  Latvia 14.4
6  Guinea-Bissau 14.1
7  Chad 14.0
8  Afghanistan 13.7
9  Serbia 13.6
10  Russia 13.6

According to the World Health Organization, the ten leading causes of death in 2015 (ranked by death per 100,000 population) were:[17]

  1. Ischaemic heart disease (119 per 100,000 population)
  2. Stroke (85 per 100,000 population)
  3. Lower respiratory infections (43 per 100,000 population)
  4. Chronic obstructive pulmonary disease (43 per 100,000 population)
  5. Trachea/bronchus/lung cancers (23 per 100,000 population)
  6. Diabetes mellitus (22 per 100,000 population)
  7. Alzheimer's disease and other dementias (21 per 100,000 population)
  8. Diarrhoeal diseases (19 per 100,000 population)
  9. Tuberculosis (19 per 100,000 population)
  10. Road traffic accidents (10 per 100,000 population)

Causes of death vary greatly between developed and less developed countries. See list of causes of death by rate for worldwide statistics.

Income death in logs graph
Scatter plot of the natural logarithm of the crude death rate against the natural log of per capita real GDP. The slope of the trend line is the elasticity of the crude death rate with respect to per capita real income. It indicates that a 10% increase in per capita real income is associated with a 1.5% decrease in the crude death rate. Source: World Development Indicators.

According to Jean Ziegler (the United Nations Special Rapporteur on the Right to Food for 2000 to March 2008), mortality due to malnutrition accounted for 58% of the total mortality in 2006: "In the world, approximately 62 millions people, all causes of death combined, die each year. In 2006, more than 36 million died of hunger or diseases due to deficiencies in micronutrients".[18]

Of the roughly 150,000 people who die each day across the globe, about two thirds—100,000 per day—die of age-related causes.[19] In industrialized nations, the proportion is much higher, reaching 90%.[19]

See also

References

  1. ^ Porta, M, ed. (2014). "Death rate". A Dictionary of Epidemiology (5th ed.). Oxford: Oxford University Press. p. 69. ISBN 978-0-19-939005-2.
  2. ^ Porta, M, ed. (2014). "Morbidity rate". A Dictionary of Epidemiology (5th ed.). Oxford: Oxford University Press. p. 189. ISBN 978-0-19-939005-2.
  3. ^ a b "Principles of Epidemiology | Lesson 3 - Section 3". www.cdc.gov. Retrieved 2017-12-18.
  4. ^ "CIA World Factbook. (Search for 'People and Society')". 2016.
  5. ^ Everitt, B.S. The Cambridge Dictionary of Statistics, CUP. ISBN 0-521-81099-X
  6. ^ Sun, Hongbing (2017-01-12). "Temperature dependence of multiple sclerosis mortality rates in the United States". Multiple Sclerosis Journal. 23 (14): 1839–1846. doi:10.1177/1352458516688954. ISSN 1352-4585. PMID 28080218.
  7. ^ Porta, M, ed. (2014). "Cumulative death rate". A Dictionary of Epidemiology (5th ed.). Oxford: Oxford University Press. p. 64. ISBN 978-0-19-939005-2.
  8. ^ Porta, M, ed. (2014). "Case fatality rate". A Dictionary of Epidemiology (5th ed.). Oxford: Oxford University Press. p. 36. ISBN 978-0-19-939005-2.
  9. ^ Benson, Michael D. (2017-08-17). "Amniotic fluid embolism mortality rate". Journal of Obstetrics and Gynaecology Research. 43 (11): 1714–1718. doi:10.1111/jog.13445. ISSN 1341-8076. PMID 28817205.
  10. ^ Turner, Paul J.; Jerschow, Elina; Umasunthar, Thisanayagam; Lin, Robert; Campbell, Dianne E.; Boyle, Robert J. (2017-09-01). "Fatal Anaphylaxis: Mortality Rate and Risk Factors". The Journal of Allergy and Clinical Immunology: In Practice. 5 (5): 1169–1178. doi:10.1016/j.jaip.2017.06.031. PMC 5589409. PMID 28888247.
  11. ^ Loudon, Irvine (1992-11-05). Death in Childbirth: An International Study of Maternal Care and Maternal Mortality 1800-1950 - Oxford Scholarship. Oxford University Press. doi:10.1093/acprof:oso/9780198229971.001.0001. ISBN 9780191678950.
  12. ^ a b c d Timæus, Ian M. (1991). "Measurement of Adult Mortality in Less Developed Countries: A Comparative Review". Population Index. 57 (4): 552–568. doi:10.2307/3644262. JSTOR 3644262.
  13. ^ Graham, W.; Brass, W.; Snow, R. W. (May 1989). "Estimating maternal mortality: the sisterhood method". Studies in Family Planning. 20 (3): 125–135. doi:10.2307/1966567. ISSN 0039-3665. JSTOR 1966567. PMID 2734809.
  14. ^ Migration, National Research Council (US) Roundtable on the Demography of Forced (2002). ESTIMATING MORTALITY RATES. National Academies Press (US).
  15. ^ "UNdata - record view - Crude death rate (deaths per 1,000 population)". data.un.org.
  16. ^ "The World Factbook — Central Intelligence Agency". www.cia.gov.
  17. ^ "Top 10 causes of death". World Health Organization.
  18. ^ Jean Ziegler, L'Empire de la honte, Fayard, 2007 ISBN 978-2-253-12115-2, p.130.
  19. ^ a b Aubrey D.N.J, de Grey (2007). "Life Span Extension Research and Public Debate: Societal Considerations" (PDF). Studies in Ethics, Law, and Technology. 1 (1, Article 5). CiteSeerX 10.1.1.395.745. doi:10.2202/1941-6008.1011. Retrieved August 7, 2011.

Sources

External links

Age adjustment

In epidemiology and demography, age adjustment, also called age standardization, is a technique used to allow populations to be compared when the age profiles of the populations are quite different.

Case fatality rate

In epidemiology, a case fatality rate (CFR)—or case fatality risk, case fatality ratio or just fatality rate—is the proportion of deaths within a designated population of "cases" (people with a medical condition) over the course of the disease. A CFR is conventionally expressed as a percentage and represents a measure of risk. CFRs are most often used for diseases with discrete, limited time courses, such as outbreaks of acute infections.

For example: Assume 9 deaths among 100 people in a community all diagnosed with the same disease. This means that among the 100 people formally diagnosed with the disease, 9 died and 91 recovered. The CFR, therefore, would be 9%. If some of the cases have not yet resolved (either died or recovered) at the time of analysis, this could lead to bias in estimating the CFR.

A mortality rate—often confused with a CFR—is a measure of the number of deaths (in general, or due to a specific cause) in a population, scaled to the size of that population, per unit of time. (For example, a rate of 50 deaths per 10,000 population in a year resulting from diabetes. The mortality rate, therefore, would be 50:10,000 or 5:1,000.)

Technically, CFRs are actually risks (or "incidence proportions") and take values between 0 and 1. They are not rates, incidence rates, or ratios (none of which are limited to the range 0-1). If one wants to be very precise, the term "case fatality rate" is incorrect, because the time from disease onset to death is not taken into account. Nevertheless, the term case fatality rate (and the abbreviation "CFR") is often used in the scientific literature.

Centre-Est Region

Centre-Est is one of Burkina Faso's 13 administrative regions. The population of Centre-Est was 1,132,023 in 2006. The region's capital is Tenkodogo. Three provinces—Boulgou, Koulpélogo, and Kouritenga, make up the region.

As of 2010, the population of the region was 2,043,943 with 49.78 per cent females. The population in the region was 12.99 per cent of the total population of the country. The child mortality rate was 39, infant mortality rate was 56 and the mortality of children under five was 93. As of 2007, the literacy rate in the region was 16.6 per cent, compared with a national average of 28.3 per cent.

Centre-Nord Region

Centre-Nord is one of thirteen administrative regions of Burkina Faso, a landlocked country in Africa. The population of Centre-Nord in 2006 was 1,203,073. The region's capital is Kaya. Three provinces—Bam, Namentenga, and Sanmatenga, make up the region.

As of 2010, the population of the region was 1,334,860 with 52.97 per cent females. The population in the region was 8.49 per cent of the total population of the country. The child mortality rate was 55, infant mortality rate was 64 and the mortality of children under five was 116. As of 2007, the literacy rate in the region was 16.6 per cent, compared to a national average of 28.3 per cent. The coverage of cereal need compared to the total production of the region was 70.00 per cent.

Centre-Sud Region

Centre-Sud is one of Burkina Faso's 13 administrative regions. The population of Centre-Sud was 638,379 in 2006 and was estimated at 722,631 in 2011. The region's capital is Manga. Three provinces—Bazèga, Nahouri, and Zoundwéogo, make up the region.

As of 2010, the population of the region was 703,358 with 52.90 per cent females. The population in the region was 4.47 per cent of the total population of the country. The child mortality rate was 61, infant mortality rate was 70 and the mortality of children under five was 127. As of 2007, the literacy rate in the region was 15.9 per cent, compared to a national average of 28.3 per cent. The coverage of cereal need compared to the total production of the region was 69.00 per cent.

Child mortality

Child mortality, also known as child death, refers to the death of children under the age of 14 and encompasses national mortality, under-5 mortality, and mortality of children aged 5–14. Many child deaths go unreported for a variety of reasons, including lack of death registration and lack of data on child migrants. Without accurate data on child deaths, we cannot fully discover and combat the greatest risks to a child's life.

Reduction of child mortality is reflected in several of the United Nations' Sustainable Development Goals. Rapid progress has resulted in a significant decline in preventable child deaths since 1990, with the global under-5 mortality rate declining by over half between 1990 and 2016. While in 1990, 12.6 million children under age five died, in 2016 that number fell to 5.6 million children. However, despite advances, there are still 15,000 under-five deaths per day from largely preventable causes. About 80 per cent of these occur in sub-Saharan Africa and South Asia, and just 6 countries account for half of all under-five deaths: India, Nigeria, Pakistan, the Democratic Republic of the Congo, Ethiopia and China. 45% of these children died during the first 28 days of life.

Demographics of Nepal

In the 2011 census, Nepal's population was approximately 26 million people with a population growth rate of 1.35% and a median age of 21.6 years. In 2016, the female median age was approximately 25 years old and the male median age was approximately 22 years old. Only 4.4% of the population is estimated to be more than 65 years old, comprising 681,252 females and 597,628 males. 61% of the population is between 15 and 64 years old, and 34.6% is younger than 14 years. In 2011, the Birth rate is estimated to be 22.17 births per 1,000 people with an infant mortality rate of 46 deaths per 1,000 live births. Compared to the infant mortality rate in 2006 of 48 deaths per 1000 live births, the 2011 IMR is a slight decrease within that 5-year period. Infant mortality rate in Nepal is higher in rural regions at 44 deaths per 1000 live births, whereas in urban regions the IMR is lower at 40 deaths per 1000 live births. This difference is due to a lack of delivery assistance services in rural communities compared to their urban counterparts who have better access to hospitals and neonatal clinics. Life expectancy at birth is estimated to be 67.44 years for females and 64.94 years for males. The mortality rate is estimated to be 681 deaths per 100,000 people. Net migration rate is estimated to be 61 migrants per 100,000 people. According to the 2011 census, 65.9% of the total population is literate.

Demographics of the Palestinian territories

This article is about the demographic features of the population of the area which is commonly described as Palestinian territories and includes information on ethnicity, education level, health of the populace, economic status, religious affiliations and other aspects of that population.

According to a commonly used definition as relating to an application of the 1949 Armistice Agreement green line, the Palestinian territories have contributory parts of the West Bank (including East Jerusalem) and the Gaza Strip.

The Palestinian National Authority, the United Nations Security Council, the United Nations General Assembly, the European Union, the International Court of Justice, and the International Committee of the Red Cross use the terminology "Palestinian territories" or "occupied Palestinian territories". Israel refers to the administrative division encompassing Israeli-controlled Jewish-majority civilian areas of Area C of the West Bank, excluding East Jerusalem, as Judea and Samaria Area (Hebrew: אֵזוֹר יְהוּדָה וְשׁוֹמְרוֹן‬, Ezor Yehuda VeShomron).

Est Region (Burkina Faso)

Est is one of Burkina Faso's 13 administrative regions. It was created on 2 July 2001. The region's capital is Fada N'gourma. Five provinces make up the region—Gnagna, Gourma, Komondjari, Kompienga, and Tapoa.

As of 2010, the population of the region was 1,369,233 with 50.97 per cent females. The population in the region was 8.70 per cent of the total population of the country. The child mortality rate was 98, infant mortality rate was 98 and the mortality of children under five was 186. As of 2007, the literacy rate in the region was 28.5 per cent, compared with a national average of 28.3 per cent. The coverage of cereal need compared with the total production of the region was 108.00 per cent.

Hepeviridae

Hepeviridae is a family of viruses. Human, pig, wild boar, sheep, cow, camel, monkey, some rodents, bats and chickens serve as natural hosts. There are five species in this family, divided between two genera. Diseases associated with this family include: hepatitis; high mortality rate during pregnancy; and avian hepatitis E virus is the cause of hepatitis-splenomegaly (HS) syndrome among chickens.Orthohepevirus used to be known as Hepevirus. The virus that causes Hepatitis E belongs to the genus Orthohepevirus.

Infant mortality

Infant mortality is the death of young children under the age of 1. This death toll is measured by the infant mortality rate (IMR), which is the number of deaths of children under one year of age per 1000 live births. The under-five mortality rate is also an important statistic, considering the infant mortality rate focuses only on children under one year of age.Premature birth is the biggest contributor to the IMR. Other leading causes of infant mortality are birth asphyxia, pneumonia, congenital malformations, term birth complications such as abnormal presentation of the foetus umbilical cord prolapse, or prolonged labor, neonatal infection, diarrhea, malaria, measles and malnutrition. One of the most common preventable causes of infant mortality is smoking during pregnancy. Many factors contribute to infant mortality, such as the mother's level of education, environmental conditions, and political and medical infrastructure. Improving sanitation, access to clean drinking water, immunization against infectious diseases, and other public health measures can help reduce high rates of infant mortality.

Child mortality is the death of a child before the child's fifth birthday, measured as the under-5 child mortality rate (U5MR). National statistics sometimes group these two mortality rates together. Globally, 9.2 million children die each year before their fifth birthday; more than 60% of these deaths are seen as being avoidable with low-cost measures such as continuous breast-feeding, vaccinations and improved nutrition.Infant mortality rate was an indicator used to monitor progress towards the Fourth Goal of the Millennium Development Goals of the United Nations for the year 2015. It is now a target in the Sustainable Development Goals for Goal Number 3 ("Ensure healthy lives and promote well-being for all at all ages").Throughout the world, infant mortality rate (IMR) fluctuates drastically, and according to Biotechnology and Health Sciences, education and life expectancy in the country is the leading indicator of IMR. This study was conducted across 135 countries over the course of 11 years, with the continent of Africa having the highest infant mortality rate of any other region studied with 68 deaths per 1,000 live births.

List of countries by infant and under-five mortality rates

The under-five mortality rate is the number of deaths of infants and children under five years old per 1000 live births. The under-five mortality rate for the world is 40.8 deaths according to the World Bank and the World Health Organization. 5.6 million children under age five died in 2016, 15 000 every day.The infant mortality rate (IMR) figures are from the United Nations World Population Prospects report, by five years averages, and the CIA World Factbook.The infant mortality rate is the number of deaths of infants under one year old per 1,000 live births. This rate is often used as an indicator of the level of health in a country. The infant mortality rate of the world is 49.4 according to the United Nations and 34.1 according to the CIA World Factbook.

Note that due to differences in reporting, these numbers may not be comparable across countries. The WHO recommendation is that all children who show signs of life should be recorded as live births. In many countries this standard is not followed, artificially lowering their infant mortality rates relative to countries which follow those standards.

Note: The tables can be variously sorted using the icon.

List of countries by maternal mortality rate

Maternal death or maternal mortality is defined by the World Health Organization (WHO) as "the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes." The maternal mortality rate, on the other hand, is the number of maternal deaths per 100,000 births. The maternal mortality is used as a criterion for the quality of medical care in a country.

List of sovereign states and dependent territories by mortality rate

This article includes two versions of the list of countries by crude mortality rate.

Maternal death

Maternal death or maternal mortality is defined by the World Health Organization (WHO) as "the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes."There are two performance indicators that are sometimes used interchangeably: maternal mortality ratio and maternal mortality rate, which confusingly both are abbreviated "MMR". By 2017, the world maternal mortality rate had declined 44% since 1990, but still every day 830 women die from pregnancy or childbirth related causes. According to the United Nations Population Fund (UNFPA) 2017 report, this is equivalent to "about one woman every two minutes and for every woman who dies, 20 or 30 encounter complications with serious or long-lasting consequences. Most of these deaths and injuries are entirely preventable."UNFPA estimated that 303,000 women died of pregnancy or childbirth related causes in 2015. These causes range from severe bleeding to obstructed labour, all of which have highly effective interventions. As women have gained access to family planning and skilled birth attendance with backup emergency obstetric care, the global maternal mortality ratio has fallen from 385 maternal deaths per 100,000 live births in 1990 to 216 deaths per 100,000 live births in 2015, and many countries halved their maternal death rates in the last 10 years.Although attempts have been made in reducing maternal mortality, there is much room for improvement, particularly in impoverished regions. Over 85% of maternal deaths are from impoverished communities in Africa and Asia. The effect of a mother's death results in vulnerable families. Their infants, if they survive childbirth, are more likely to die before reaching their second birthday.

Mortality displacement

Mortality displacement denotes a temporary increase in the mortality rate (number of deaths) in a given population, also known as excess mortality or excess mortality rate. It is usually attributable to environmental phenomena such as heat waves, cold spells, epidemics and pandemics, especially influenza pandemics, famine or war.

During heat waves, for instance, there are often additional deaths observed in the population, affecting especially older adults and those who are sick. After some periods with excess mortality, however, there has also been observed a decrease in overall mortality during the subsequent weeks. Such short-term forward shift in mortality rate is also referred to as harvesting effect. The subsequent, compensatory reduction in mortality suggests that the heat wave had affected especially those whose health is already so compromised that they "would have died in the short term anyway".Death marches can also lead to a significant mortality displacement, such as in the Trail of Tears, the Armenian Genocide, and the Bataan death march, wherein the oldest, weakest, and sickest died first.

Perinatal mortality

Perinatal mortality (PNM), also perinatal death, refers to the death of a fetus or neonate and is the basis to calculate the perinatal mortality rate. Variations in the precise definition of the perinatal mortality exist, specifically concerning the issue of inclusion or exclusion of early fetal and late neonatal fatalities. The World Health Organization defines perinatal mortality as the "number of stillbirths and deaths in the first week of life per 1,000 total births, the perinatal period commences at 22 completed weeks (154 days) of gestation, and ends seven completed days after birth", but other definitions have been used.The UK figure is about 8 per 1,000 and varies markedly by social class with the highest rates seen in Asian women. Globally, an estimated 2.6 million neonates died in 2013 before the first month of age down from 4.5 million in 1990.

Risk adjusted mortality rate

The risk adjusted mortality rate (RAMR) is a mortality rate that is adjusted for predicted risk of death. It is usually utilized to observe and/or compare the performance of certain institution(s) or person(s), e.g., hospitals or surgeons.

It can be found as:

RAMR = (Observed Mortality Rate/Predicted Mortality Rate)* Overall (Weighted) Mortality Rate

In medical science, RAMR could be a predictor of mortality that takes into account the predicted risk for a group of patients. For example, for a group of patients first we need to find the observed mortality rates for all the hospitals of interest. Then we can build/construct a model or use an existing model to predict mortality rates for each of the hospitals. It is expected that the number of patients in each hospital will be different and hence we need an overall (weighted) mortality rate for all these hospitals. Once we have the above three rates, then we can utilize the above formula to find the risk adjusted mortality rate which will reflect the actual mortality rate of a particular hospital without being biased from the observed mortality.

In the English NHS the Summary Hospital-level Mortality Indicator, the Hospital Standardised Mortality Rate and the Risk Adjusted Mortality Index are all used. The BBC produced a table in 2011 comparing mortality on various measures across all NHS acute trusts.

Standardized mortality ratio

In epidemiology, the standardized mortality ratio or SMR, is a quantity, expressed as either a ratio or percentage quantifying the increase or decrease in mortality of a study cohort with respect to the general population.

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