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Population and fertility by age and sex for 195 countries and territories, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017
Abstract
Background: Population estimates underpin demographic and epidemiological research and are used to track progress on numerous international indicators of health and development. To date, internationally available estimates of population and fertility, although useful, have not been produced with transparent and replicable methods and do not use standardised estimates of mortality. We present single-calendar year and single-year of age estimates of fertility and population by sex with standardised and replicable methods.
Methods: We estimated population in 195 locations by single year of age and single calendar year from 1950 to 2017 with standardised and replicable methods. We based the estimates on the demographic balancing equation, with inputs of fertility, mortality, population, and migration data. Fertility data came from 7817 location-years of vital registration data, 429 surveys reporting complete birth histories, and 977 surveys and censuses reporting summary birth histories. We estimated age-specific fertility rates (ASFRs; the annual number of livebirths to women of a specified age group per 1000 women in that age group) by use of spatiotemporal Gaussian process regression and used the ASFRs to estimate total fertility rates (TFRs; the average number of children a woman would bear if she survived through the end of the reproductive age span [age 10-54 years] and experienced at each age a particular set of ASFRs observed in the year of interest). Because of sparse data, fertility at ages 10-14 years and 50-54 years was estimated from data on fertility in women aged 15-19 years and 45-49 years, through use of linear regression. Age-specific mortality data came from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 estimates. Data on population came from 1257 censuses and 761 population registry location-years and were adjusted for underenumeration and age misreporting with standard demographic methods. Migration was estimated with the GBD Bayesian demographic balancing model, after incorporating information about refugee migration into the model prior. Final population estimates used the cohort-component method of population projection, with inputs of fertility, mortality, and migration data. Population uncertainty was estimated by use of out-of-sample predictive validity testing. With these data, we estimated the trends in population by age and sex and in fertility by age between 1950 and 2017 in 195 countries and territories.
Findings: From 1950 to 2017, TFRs decreased by 49·4% (95% uncertainty interval [UI] 46·4-52·0). The TFR decreased from 4·7 livebirths (4·5-4·9) to 2·4 livebirths (2·2-2·5), and the ASFR of mothers aged 10-19 years decreased from 37 livebirths (34-40) to 22 livebirths (19-24) per 1000 women. Despite reductions in the TFR, the global population has been increasing by an average of 83·8 million people per year since 1985. The global population increased by 197·2% (193·3-200·8) since 1950, from 2·6 billion (2·5-2·6) to 7·6 billion (7·4-7·9) people in 2017; much of this increase was in the proportion of the global population in south Asia and sub-Saharan Africa. The global annual rate of population growth increased between 1950 and 1964, when it peaked at 2·0%; this rate then remained nearly constant until 1970 and then decreased to 1·1% in 2017. Population growth rates in the southeast Asia, east Asia, and Oceania GBD super-region decreased from 2·5% in 1963 to 0·7% in 2017, whereas in sub-Saharan Africa, population growth rates were almost at the highest reported levels ever in 2017, when they were at 2·7%. The global average age increased from 26·6 years in 1950 to 32·1 years in 2017, and the proportion of the population that is of working age (age 15-64 years) increased from 59·9% to 65·3%. At the national level, the TFR decreased in all countries and territories between 1950 and 2017; in 2017, TFRs ranged from a low of 1·0 livebirths (95% UI 0·9-1·2) in Cyprus to a high of 7·1 livebirths (6·8-7·4) in Niger. The TFR under age 25 years (TFU25; number of livebirths expected by age 25 years for a hypothetical woman who survived the age group and was exposed to current ASFRs) in 2017 ranged from 0·08 livebirths (0·07-0·09) in South Korea to 2·4 livebirths (2·2-2·6) in Niger, and the TFR over age 30 years (TFO30; number of livebirths expected for a hypothetical woman ageing from 30 to 54 years who survived the age group and was exposed to current ASFRs) ranged from a low of 0·3 livebirths (0·3-0·4) in Puerto Rico to a high of 3·1 livebirths (3·0-3·2) in Niger. TFO30 was higher than TFU25 in 145 countries and territories in 2017. 33 countries had a negative population growth rate from 2010 to 2017, most of which were located in central, eastern, and western Europe, whereas population growth rates of more than 2·0% were seen in 33 of 46 countries in sub-Saharan Africa. In 2017, less than 65% of the national population was of working age in 12 of 34 high-income countries, and less than 50% of the national population was of working age in Mali, Chad, and Niger.
Interpretation: Population trends create demographic dividends and headwinds (ie, economic benefits and detriments) that affect national economies and determine national planning needs. Although TFRs are decreasing, the global population continues to grow as mortality declines, with diverse patterns at the national level and across age groups. To our knowledge, this is the first study to provide transparent and replicable estimates of population and fertility, which can be used to inform decision making and to monitor progress.
Funding: Bill & Melinda Gates Foundation.
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Insufficient growth during childhood is associated with poor health outcomes and an increased risk of death. Between 2000 and 2015, nearly all African countries demonstrated improvements for children under 5 years old for stunting, wasting, and underweight, the core components of child growth failure. Here we show that striking subnational heterogeneity in levels and trends of child growth remains. If current rates of progress are sustained, many areas of Africa will meet the World Health Organization Global Targets 2025 to improve maternal, infant and young child nutrition, but high levels of growth failure will persist across the Sahel. At these rates, much, if not all of the continent will fail to meet the Sustainable Development Goal target—to end malnutrition by 2030. Geospatial estimates of child growth failure
provide a baseline for measuring progress as well as a precision public health platform to target interventions to those populations with the greatest need, in order to reduce health disparities and accelerate progress.
Objective:
This paper evaluates one aspect of data quality within DHS surveys, the accuracy of age reporting as measured by age heaping. Other literature has explored this phenomenon, and this analysis build on previous work, expanding the analysis of the extent of age heaping across multiple countries, and across time.
Results:
This paper makes a comparison of the magnitude of Whipple's index of age heaping across all Demographic and Health Surveys from 1986 to 2015 in Sub-Saharan Africa. A random slope multilevel model is used to evaluate the trend in the proportion of respondents within each survey rounding their age to the nearest age with terminal digit 0 or 5. The trend in the proportion of misreported ages has remained flat, in the region of 5% of respondents misreporting their age. We find that Nigeria and Ghana have demonstrated considerable improvements in age reporting quality, but that a number of countries have considerable increases in the proportion of age misreported, most notably Mali and Ethiopia with demonstrate increases in excess of 10% points.
Background:
During the Millennium Development Goal (MDG) era, many countries in Africa achieved marked reductions in under-5 and neonatal mortality. Yet the pace of progress toward these goals substantially varied at the national level, demonstrating an essential need for tracking even more local trends in child mortality. With the adoption of the Sustainable Development Goals (SDGs) in 2015, which established ambitious targets for improving child survival by 2030, optimal intervention planning and targeting will require understanding of trends and rates of progress at a higher spatial resolution. In this study, we aimed to generate high-resolution estimates of under-5 and neonatal all-cause mortality across 46 countries in Africa.
Methods:
We assembled 235 geographically resolved household survey and census data sources on child deaths to produce estimates of under-5 and neonatal mortality at a resolution of 5 × 5 km grid cells across 46 African countries for 2000, 2005, 2010, and 2015. We used a Bayesian geostatistical analytical framework to generate these estimates, and implemented predictive validity tests. In addition to reporting 5 × 5 km estimates, we also aggregated results obtained from these estimates into three different levels-national, and subnational administrative levels 1 and 2-to provide the full range of geospatial resolution that local, national, and global decision makers might require.
Findings:
Amid improving child survival in Africa, there was substantial heterogeneity in absolute levels of under-5 and neonatal mortality in 2015, as well as the annualised rates of decline achieved from 2000 to 2015. Subnational areas in countries such as Botswana, Rwanda, and Ethiopia recorded some of the largest decreases in child mortality rates since 2000, positioning them well to achieve SDG targets by 2030 or earlier. Yet these places were the exception for Africa, since many areas, particularly in central and western Africa, must reduce under-5 mortality rates by at least 8·8% per year, between 2015 and 2030, to achieve the SDG 3.2 target for under-5 mortality by 2030.
Interpretation:
In the absence of unprecedented political commitment, financial support, and medical advances, the viability of SDG 3.2 achievement in Africa is precarious at best. By producing under-5 and neonatal mortality rates at multiple levels of geospatial resolution over time, this study provides key information for decision makers to target interventions at populations in the greatest need. In an era when precision public health increasingly has the potential to transform the design, implementation, and impact of health programmes, our 5 × 5 km estimates of child mortality in Africa provide a baseline against which local, national, and global stakeholders can map the pathways for ending preventable child deaths by 2030.
Funding:
Bill & Melinda Gates Foundation.
We describe bayesPop, an R package for producing probabilistic population projections for all countries. This uses probabilistic projections of total fertility and life expectancy generated by Bayesian hierarchical models. It produces a sample from the joint posterior predictive distribution of future age-and sex-specific population counts, fertility rates and mortality rates, as well as future numbers of births and deaths. It provides graphical ways of summarizing this information, including trajectory plots and various kinds of probabilistic population pyramids. An expression language is introduced which allows the user to produce the predictive distribution of a wide variety of derived population quantities, such as the median age or the old age dependency ratio. The package produces aggregated projections for sets of countries, such as UN regions or trading blocs. The methodology has been used by the United Nations to produce their most recent official population projections for all countries, published in the World Population Prospects.
This study investigates whether older workers have adapted their preferred retirement age to the pension reforms aimed at extending working life. Based on data from Eurobarometer and the European Social Survey in 12 European countries, the analysis shows that future pensioners have indeed increased their preferred retirement age and adjusted to the new credo of late retirement. However, the strength of the increase was found to vary between different groups of older workers: it is much stronger for the higher educated than for the lower educated. This finding supports recent concerns regarding the re-emergence of social inequality in the retirement process.
Measurements of health indicators are rarely available for every population and period of interest, and available data may not be comparable. The Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER) define best reporting practices for studies that calculate health estimates for multiple populations (in time or space) using multiple information sources. Health estimates that fall within the scope of GATHER include all quantitative population-level estimates (including global, regional, national, or subnational estimates) of health indicators, including indicators of health status, incidence and prevalence of diseases, injuries, and disability and functioning; and indicators of health determinants, including health behaviours and health exposures. GATHER comprises a checklist of 18 items that are essential for best reporting practice. A more detailed explanation and elaboration document, describing the interpretation and rationale of each reporting item along with examples of good reporting, is available on the GATHER website.
This article provides the first detailed account of recent fertility trends in Iraq, with a particular focus on the changes resulting from the 2003–2011 war and the factors underlying them. The study is based on retrospective birth history data from the 2006 and 2011 Iraq Multiple Indicator Cluster Surveys (I-MICS). Estimates from the two surveys indicate that total fertility remained stable from 1997 to 2010, at about 4.5 children per woman. However, examination of the age patterns of fertility reveals an abrupt shift in the timing of births, with adolescent fertility rising by over 30 percent soon after the onset of the war. A decomposition analysis shows that the rise in early childbearing is due to an increased prevalence of early marriage among less-educated women. The prevalence of early marriage and childbearing among women with secondary or higher education is relatively low and has not increased after 2003.
The United Nations regularly publishes projections of the populations of all
the world's countries broken down by age and sex. These projections are the de
facto standard and are widely used by international organizations, governments
and researchers. Like almost all other population projections, they are
produced using the standard deterministic cohort-component projection method
and do not yield statements of uncertainty. We describe a Bayesian method for
producing probabilistic population projections for most countries which are
projections that the United Nations could use. It has at its core Bayesian
hierarchical models for the total fertility rate and life expectancy at birth.
We illustrate the method and show how it can be extended to address concerns
about the UN's current assumptions about the long-term distribution of
fertility. The method is implemented in the R packages bayesTFR, bayesLife,
bayesPop and bayesDem.
Large scale surveys are the main source of data pertaining to all the social and demographic indicators, hence its quality is also of great concern. In this paper, we discuss the indicators used to examine the quality of data. We focus on age misreporting, incompleteness and inconsistency of information; and skipping of questions on reproductive and sexual health related issues. In order to observe the practical consequences of errors in a survey; the District Level Household and Facility Survey (DLHS-3) is used as an example dataset.
Whipple's and Myer's indices are used to identify age misreporting. Age displacements are identified by estimating downward and upward transfers for women from bordering age groups of the eligible age range. Skipping pattern is examined by recording the responses to the questions which precede the sections on birth history, immunization, and reproductive and sexual health.
The study observed errors in age reporting, in all the states, but the extent of misreporting differs by state and individual characteristics. Illiteracy, rural residence and poor economic condition are the major factors that lead to age misreporting. Female were excluded from the eligible age group, to reduce the duration of interview. The study further observed that respondents tend to skip questions on HIV/RTI and other questions which follow a set of questions.
The study concludes that age misreporting, inconsistency and incomplete response are three sources of error that need to be considered carefully before drawing conclusions from any survey. DLHS-3 also suffers from age misreporting, particularly for female in the reproductive ages. In view of the coverage of the survey, it may not be possible to control age misreporting completely, but some extra effort to probe a better answer may help in improving the quality of data in the survey.
The original version of Bayesian reconstruction, a method for estimating
age-specific fertility, mortality, migration and population counts of the
recent past with uncertainty, produced estimates for female-only populations.
Here we show how two-sex populations can be similarly reconstructed and
probabilistic estimates of various sex ratio quantities obtained. We
demonstrate the method by reconstructing the populations of India from 1971 to
2001, Thailand from 1960 to 2000, and Laos from 1985 to 2005. We found evidence
that in India, sex ratio at birth exceeded its conventional upper limit of
1.06, and, further, increased over the period of study, with posterior
probability above 0.9. In addition, almost uniquely, we found evidence that
life expectancy at birth was lower for females than for males in India
(posterior probability for 1971--1976 0.79), although there was strong evidence
for a narrowing of the gap through to 2001. In both Thailand and Laos, we found
strong evidence for the more usual result that life expectancy at birth was
greater for females and, in Thailand, that the difference increased over the
period of study.
The implications of ageing populations over the coming decades at the global level will be significant in terms of not only a slowdown in the growth rate of output and living standards but also with regard to fiscal and financial market trends. Given the backdrop of the downward trend in world-wide potential growth rates over the past number of decades, driven by falling rates of capital accumulation and a slowdown in productivity growth, the additional negative impact of relative declines in the growth rate of working age populations over the coming decades bodes ominously for future world-wide economic developments. The focus of the present paper is to quantify and analyse the nature, extent and geographical reach of the "real" economy and budgetary aspects of ageing populations as well as providing an initial assessment of the financial market implications of this phenomenon.
Current methods for reconstructing human populations of the past by age and sex are deterministic or do not formally account for measurement error. We propose a method for simultaneously estimating age-specific population counts, fertility rates, mortality rates, and net international migration flows from fragmentary data that incorporates measurement error. Inference is based on joint posterior probability distributions that yield fully probabilistic interval estimates. It is designed for the kind of data commonly collected in modern demographic surveys and censuses. Population dynamics over the period of reconstruction are modeled by embedding formal demographic accounting relationships in a Bayesian hierarchical model. Informative priors are specified for vital rates, migration rates, population counts at baseline, and their respective measurement error variances. We investigate calibration of central posterior marginal probability intervals by simulation and demonstrate the method by reconstructing the female population of Burkina Faso from 1960 to 2005. Supplementary materials for this article are available online and the method is implemented in the R package "popReconstruct."
Projections of countries' future populations, broken down by age and sex, are widely used for planning and research. They are mostly done deterministically, but there is a widespread need for probabilistic projections. We propose a bayesian method for probabilistic population projections for all countries. The total fertility rate and female and male life expectancies at birth are projected probabilistically using bayesian hierarchical models estimated via Markov chain Monte Carlo using United Nations population data for all countries. These are then converted to age-specific rates and combined with a cohort component projection model. This yields probabilistic projections of any population quantity of interest. The method is illustrated for five countries of different demographic stages, continents and sizes. The method is validated by an out of sample experiment in which data from 1950-1990 are used for estimation, and applied to predict 1990-2010. The method appears reasonably accurate and well calibrated for this period. The results suggest that the current United Nations high and low variants greatly underestimate uncertainty about the number of oldest old from about 2050 and that they underestimate uncertainty for high fertility countries and overstate uncertainty for countries that have completed the demographic transition and whose fertility has started to recover towards replacement level, mostly in Europe. The results also indicate that the potential support ratio (persons aged 20-64 per person aged 65+) will almost certainly decline dramatically in most countries over the coming decades.
The Hermite polynomials are simple, effective interpolants of discrete data.
These interpolants can preserve local positivity, monotonicity, and convexity of the data
if we restrict their derivatives to satisfy constraints at the data points. This paper describes the conditions that must be satisfied for cubic and quintic Hermite interpolants to
preserve these properties when they exist in the discrete data. We construct algorithms
to ensure that these constraints are satisfied and give numerical examples to illustrate
the effectiveness of the algorithms on locally smooth and rough data.
A simple and effective algorithm to construct a monotonicity-preserving cubic Hermite interpolant for data with rapid variations is presented. Constraining the derivatives of the interpolant according to geometric considerations makes the interpolant consistent with local monotonicity properties of the data. Numerical examples are given that compare the quality and accuracy of the proposed interpolation method with other standard interpolants.
Population aging is a global phenomenon and countries of Eastern European are also experiencing a rapid increase in the proportion
of older people. The proportion of elderly people in Eastern Europe is currently lower than in the European region as a whole.
However population aging in this region is expected to continue over the next few decades, eventually leading to the convergence
in the proportion of older people in the countries of Eastern and Western Europe.
Population growth remains rapid in the poorest countries, particularly in sub-Saharan Africa, despite substantial AIDS mortality. Voluntary family-planning programs reduce unplanned pregnancies by providing access to and information about contraception and by reducing socioeconomic obstacles to use. With sufficient political will and resources, well-run voluntary programs have been shown to bring about sustained declines in fertility and population growth across much of Asia, the Middle East, and Latin America, simply by permitting people to realize their individual reproductive goals. Such programs represent a cost-effective approach to relieving population pressures, stimulating economic development, improving health, and enhancing human freedom.
This paper uses age-at-school-entry policies to identify the effect of female education on fertility and infant health. We focus on sharp contrasts in schooling, fertility, and infant health between women born just before and after the school entry date. School entry policies affect female education and the quality of a woman's mate and have generally small, but possibly heterogeneous, effects on fertility and infant health. We argue that school entry policies manipulate primarily the education of young women at risk of dropping out of school.
The People's Republic of China consists of 32 provinces and a special administrative region (Hong Kong) and is home to 1.27 billion or roughly one-fifth of the world's population. Although the majority ethnic group (94%) is Han, there are altogether 56 ethnic groups with differences in language, religion, and life- style. There is huge income inequality, from multi-millionaires in urban regions to those in rural areas who have difficulty getting enough money for daily necessities. As a result there is a wide variation in lifestyle, morbidity and mortality patterns. A government survey in 1999 showed that the number of people aged over 60 has reached 127 million, or 10.1% of the total population.1 With population ageing, the increasing degenerative disease burden and social implications have placed elderly issues on the agenda of all government sectors. This article describes the demography, living arrangements, morbidity and mortality of the ageing population, and the present health and welfare systems. How the government responds to the health and social consequences of ageing, and the future outlook will be discussed.
Replacement fertility is a term commonly used by demographers when referring to levels of childbearing and yet is rarely explained. It is normally presented as being around 2.1 children per woman. Continued below replacement fertility in developed countries and fertility falling in developing countries has given the concept of replacement fertility a higher profile. This article explains how replacement level is calculated and explores the concept further. Past replacement fertility levels are calculated for England and Wales. A possible alternative definition of replacement is also presented. Simple projection scenarios are used to show the effect on population of below replacement fertility, and also of postponement of fertility. The importance and implications of below replacement fertility are discussed.
This textbook offers a comprehensive overview of applied demography by presenting both basic concepts and methodological techniques. It allows students from the social and human sciences, demographers, consultants and anyone interested in applied demography to gain an understanding of a wide range of practical applications of demographic concepts, methods and techniques to real- world problems. Featured sidebars highlight relevant terms and concepts and case studies and exercises throughout the book offer first-hand exposure to demographic applications. Charts and graphs supplement the presentation of demographic concepts and a glossary provides an inventory of relevant terms.
The first section reviews basic components of applied demography as a context for understanding and addressing societal issues. It details the methods, techniques and data sources applied by demographers in a variety of areas. Coverage includes cohort analysis, data standardization, population estimation, and the use of geographic in- formation systems (GIS). The second section focuses on the substantive areas in which demography is currently applied. The topics covered include business demography, health demography, political demography, educational demography, and applications to urban and regional planning. The book illustrates the many ways in which demographers contribute to the formulation of public policy and the resolution of societal issues.
An indirect estimation method is used to derive country to country migration flows from changes in global bilateral stock data. Estimates are obtained over five- and 10-year periods between 1960 and 2015 by gender, providing a comprehensive picture of past migration patterns. The estimated total of global international migrant flows generally increases over the 55-year time frame. The global rate of migration over five- and 10-year periods fluctuate at around 0.65 and 1.25 percent of the population, respectively. The sensitivity of estimates to alternative input stock and demographic data are explored.
Significance
Projected populations to the end of this century are an important factor in many policy decisions. Population forecasts become less reliable as we look farther into the future, suggesting a probabilistic approach to convey uncertainty. Migration projections have been largely deterministic until now, even in probabilistic population projections. Deterministic migration projections neglect a substantial source of population uncertainty. We incorporate a probabilistic migration model with probabilistic models of fertility and mortality to produce probabilistic population projections for all countries until 2100. The result is a substantial increase in uncertainty about the populations of Europe and Northern America, with very little change to uncertainty about the population of Africa, Asia, and the world as a whole.
We show that Bayesian population reconstruction, a recent method for estimating past populations by age, works for data of widely varying quality. Bayesian reconstruction simultaneously estimates age-specific population counts, fertility rates, mortality rates, and net international migration flows from fragmentary data, while formally accounting for measurement error. As inputs, Bayesian reconstruction uses initial bias-reduced estimates of standard demographic variables. We reconstruct the female populations of three countries: Laos, a country with little vital registration data where population estimation depends largely on surveys; Sri Lanka, a country with some vital registration data; and New Zealand, a country with a highly developed statistical system and good quality vital registration data. In addition, we extend the method to countries without censuses at regular intervals. We also use it to assess the consistency of results between model life tables and available census data, and hence to compare different model life table systems. Supplementary material for this article is available at: http://dx.doi.org/10.1080/00324728.2016.1139164.
The author evaluates the evidence that the data from the 1963 and 1973-1974 censuses of Nigeria were falsified for political or other purposes. The two main questions considered are: "how truthful was the allegation of massive distortion of data in favour of Northern Nigeria? Could there have been other factors which though downplayed as a result of ethnic biases contributed more to the errors observed in the reported figures?" The author concludes that although errors in the census data are evident the pattern of errors in the returns does not indicate a serious inflation of totals or regionally selective distortions. The prospects for the proposed 1991 census are discussed. (EXCERPT)
As the average age of the population continues to rise in industrialized nations, the fiscal impacts of aging demand ever-closer attention. Closing the Deficit examines one oft-discussed approach to the issue-encouraging people to work longer than they now do. Workers would spend more years paying taxes and fewer years drawing pension and health benefits. But how much difference to spending and revenues would longer working lives make? What steps could be taken to make longer working lives attractive? And what would happen to older Americans not in a position to prolong their work lives? Leading scholars examine these issues in Closing the Deficit, edited by Brookings economists Gary Burtless and Henry Aaron.
The first Australian baby boomers are starting to retire. Consequently, it is essential to develop and apply a strong evidence base to facilitate their successful retirement and ongoing wellbeing. This review focuses on recent literature on pre-retirement baby boomers to identify available research findings and gaps to be filled on retirement preparation. A notable shortage of empirical literature was found on pathways to retirement and financial plans. A trend emerged towards an intention to retire at an older age, and the main source of retirement income was expected to be superannuation. Over half of Australian boomers expect their savings to be sufficient; however, 30-50% anticipate a decline in their standard of living. The majority want the responsibility for funding retirement shared between the individual, government and employers. Further research is needed on the varying plans and expectations of men and women, of low-skilled workers, and those from culturally diverse backgrounds.
The Handbook of Cliometrics is a milestone in the field of historical economics and econometric history through its emphasis on the concrete contribution of cliometrics to our knowledge in economics and history. The articles in the handbook authored by the leading scholars in the fields, stress the usefulness of cliometrics for economists, historians and social scientists in general. The Handbook offers a comprehensive coverage of topics with each article providing an overview of the contributions of cliometrics to a particular topic. The Handbook sets a new standard of quality in the field by offering a world-wide forum of discussion in cliometrics.
Objective: To provide reliable risk-adjusted morbidity and mortality rates after major surgery to the 123 Veterans Affairs Medical Centers (VAMCs) performing major surgery, and to use risk-adjusted outcomes in the monitoring and improvement of the quality of surgical care to all veterans. Summary Background Data: Outcome-based comparative measures of the quality of surgical care among surgical services and surgical subspecialties have been elusive. Methods: This study included prospective assessment of presurgical risk factors, process of care during surgery, and outcomes 30 days after surgery on veterans undergoing major surgery in 123 medical centers; development of multivariable risk-adjustment models; identification of high and low outlier facilities by observed-to-expected outcome ratios; and generation of annual reports of comparative outcomes to all surgical services in the Veterans Health Administration (VHA). Results: The National VA Surgical Quality Improvement Program (NSQIP) data base includes 417,944 major surgical procedures performed between October 1, 1991, and September 30, 1997. In FY97, 11 VAMCs were low outliers for risk-adjusted observed-to-expected mortality ratios; 13 VAMCs were high outliers for risk-adjusted observed-to-expected mortality ratios. Identification of high and low outliers by unadjusted mortality rates would have ascribed an outlier status incorrectly to 25 of 39 hospitals, an error rate of 64%. Since 1994, the 30-day mortality and morbidity rates for major surgery have fallen 9% and 30%, respectively. Conclusions: Reliable, valid information on patient presurgical risk factors, process of care during surgery, and 30-day morbidity and mortality rates is available for all major surgical procedures in the 123 VAMCs performing surgery in the VHA. With this information, the VHA has established the first prospective outcome-based program for comparative assessment and enhancement of the quality of surgical care among multiple institutions for several surgical subspecialties. Key features to the success of the NSQIP are the support of the surgeons who practice in the VHA, consistent clinical definitions and data collection by dedicated nurses, a uniform nationwide informatics system, and the support of VHA administration and managerial staff.
Populations around the world are rapidly ageing. This demographic shift presents both opportunities and challenges. Most of us aspire to live a long and healthy life, and older people can be valuable economic, social, cultural, and familial resources. However, ageing populations are also likely to be associated with a shrinking workforce and higher demand for health care, social care, and social pensions.
Between now and 2030, every country will experience population ageing—a trend that is both pronounced and historically unprecedented. Over the past six decades, countries of the world had experienced only a slight increase in the share of people aged 60 years and older, from 8% to 10%. But in the next four decades, this group is expected to rise to 22% of the total population—a jump from 800 million to 2 billion people. Evidence suggests that cohorts entering older age now are healthier than previous ones. However, progress has been very uneven, as indicated by the wide gaps in population health (measured by life expectancy) between the worst (Sierra Leone) and best (Japan) performing countries, now standing at a difference of 36 years for life expectancy at birth and 15 years for life expectancy at age 60 years. Population ageing poses challenges for countries’ economies, and the health of older populations is of concern. Older people have greater health and long-term care needs than younger people, leading to increased expenditure. They are also less likely to work if they are unhealthy, and could impose an economic burden on families and society. Like everyone else, older people need both physical and economic security, but the burden of providing these securities will be falling on a smaller portion of the population. Pension systems will be stressed and will need reassessment along with retirement policies. Health systems, which have not in the past been oriented toward the myriad health problems and long-term care needs of older people and have not sufficiently emphasized disease prevention, can respond in different ways to the new demographic reality and the associated changes in population health. Along with behavioural adaptations by individuals and businesses, the nature of such policy responses will establish whether population ageing will lead to major macroeconomic difficulties.
Elderly individuals exhibit wide disparities in their sources of income. For those in the bottom half of the income distribution, Social Security is the most important source of support; program changes would directly affect their well-being. Income from private pensions, assets, and earnings are relatively more important for higher-income elderly individuals, who have more diverse income sources. The trend from private sector defined benefit to defined contribution pension plans has shifted responsibility for retirement security to individuals. A significant subset of the population is unlikely to be able to sustain their standard of living in retirement without higher pre-retirement saving.
quality of life of families, either financially or by allowing parents to combine more easily employment and family responsibilities. But while such policies have been welcomed by the electorate, we know very little about their actual effect. Few studies have evaluated the impact of these policies on the quality of life of families, and even fewer have evaluated their impact on the demographic
We consider the evidence for the effect of access to reproductive health services on the achievement of Millennium Development Goals 1, 2, and 3, which aim to eradicate extreme poverty and hunger, achieve universal primary education, and promote gender equality and empower women. At the household level, controlled trials in Matlab, Bangladesh, and Navrongo, Ghana, have shown that increasing access to family planning services reduces fertility and improves birth spacing. In the Matlab study, findings from long-term follow-up showed that women's earnings, assets, and body-mass indexes, and children's schooling and body-mass indexes, substantially improved in areas with improved access to family planning services compared with outcomes in control areas. At the macroeconomic level, reductions in fertility enhance economic growth as a result of reduced youth dependency and an increased number of women participating in paid labour.
This paper presents an assessment of the overall economic impact of ageing for the EU Member States. It draws upon the macroeconomic assumptions developed by the Ageing Working Group attached to the Economic Policy Committee and the Directorate General for Economic and Financial Affairs for the purpose of making age related expenditure projections. The paper presents and analyses projections of the impact of ageing populations on the labour market using a refined cohort approach by age and gender, as well as projections for potential economic growth rates up to 2050. The projections point to pressing economic policy challenges for the EU. From an economic perspective, potential growth rates and living standards are projected to fall to levels below those observed in recent decades: moreover, the sources of economic growth will alter over time, with productivity becoming the dominant source. Fiscal challenges will come from both a higher share of the total population in older age cohorts and a decline in the share of the population that is economically active. As regards policy conclusions, the paper underlines the critical need for further labour market reforms, and the possible need for the EU to look beyond the Lisbon employment targets and deadlines. Even if the EU as a whole achieves the Lisbon employment targets, this will not be sufficient to offset the effects of demographic change and considerable unused labour capacity would remain in many Member States. The paper also argues that ageing is an evolving process, and that a key challenge will be to develop labour market and welfare state policies that are sustainable in the face of uncertain economic and demographic developments. Current financing problems in pension schemes stem to a large extent from the failure of contribution/entitlement parameters in public pension schemes to adjust in the face of increased life expectancy. It will be important to ensure that retirement behaviour takes due account of future increases in life expectancy.
Age is an important variable in epidemiological studies and an invariable part of community-based study reports.
The aim was to assess the accuracy of age data collected during community surveys.
A cross-sectional study was designed in rural areas of the Yavatmal district.
Age data were collected by a house-to-house survey in six villages. An open-ended questionnaire was used for data collection.
Age heaping and digit preference were measured by calculating Whipple's index and Myers' blended index. Age Ratio Scores (ARS) and Age Accuracy Index (AAI) were also calculated.
Whipple's index for the 10-year age range, i.e., those reporting age with terminal digit "0" was 386.71. Whipple's index for the 5-year range, i.e., those reporting age with terminal digit '0' or '5' was 382.74. Myer's blended index calculated for the study population was 41.99. AAI for the population studied was 14.71 with large differences between frequencies of males and females at certain ages.
The age data collected in the survey were of very poor quality. There was age heaping at ages with terminal digits '0' and '5', indicating a preference in reporting such ages and 42% of the population reported ages with an incorrect final digit. Innovative methods in data collection along with measuring and minimizing errors using statistical techniques should be used to ensure the accuracy of age data which can be checked using various indices.
We use HILDA data to examine the retirement plans of middle-aged Australians. We find that approximately two-thirds of men and more than half of women report a numeric expected retirement age which we refer to as having a standard retirement plan. Still, one in five individuals seem to have delayed their retirement planning and approximately 1 in 11 either does not know when he or she expects to retire or expects to never retire. Retirement plans are closely related to current labour market position, with workers in jobs with well-defined superannuation benefits more likely to report numeric expected retirement ages. Copyright © 2009 The Economic Society of Australia.
If the pace of increase in life expectancy in developed countries over the past two centuries continues through the 21st century, most babies born since 2000 in France, Germany, Italy, the UK, the USA, Canada, Japan, and other countries with long life expectancies will celebrate their 100th birthdays. Although trends differ between countries, populations of nearly all such countries are ageing as a result of low fertility, low immigration, and long lives. A key question is: are increases in life expectancy accompanied by a concurrent postponement of functional limitations and disability? The answer is still open, but research suggests that ageing processes are modifiable and that people are living longer without severe disability. This finding, together with technological and medical development and redistribution of work, will be important for our chances to meet the challenges of ageing populations.
If age-specific birth rates drop immediately to the level of bare replacement the ultimate stationary number of a population will be given by (9): multiplied by the present number, where b is the birth rate, r the rate of increase, the expectation of life, and R
0 the Net Reproduction Rate, all before the drop in fertility, and μ the mean age of childbearing afterwards. This expression is derived in the first place for females on the stable assumption; extension to both sexes is provided, and comparison with real populations shows the numerical error to be small where fertility has not yet started to drop. The result (9) tells how the lower limit of the ultimate population depends on parameters of the existing population, and for values typical of underdeveloped countries works out to about 1. 6. If a delay of 15 years occurs before the drop of the birth rate to replacement the population will multiply by over 2. 5 before attaining stationarity. The ultimate population actually reached will be higher insofar as death rates continue to improve. If stability cannot be assumed the ultimate stationary population is provided by the more general expression (7), which is still easier to calculate than a detailed projection.
"Coverage checks of censuses of population usually show an undercount. However, in [the] 1953 census of population in Yugoslavia a slight overcount was found. This was attributed to housing rationing that created a tendency [to over report].... Similar tendencies are also likely in the enumeration of emigrants. Therefore, more attention is needed to the problem of overcount in countries with housing rationing and strong emigration." (SUMMARY IN GER)