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. 2024 Feb 14;53(2):dyae016.
doi: 10.1093/ije/dyae016.

On the measurement of cause of death inequality

Iñaki Permanyer  1   2 , Júlia Almeida Calazans  1
Affiliations

On the measurement of cause of death inequality

Iñaki Permanyer et al. Int J Epidemiol. .

Abstract

Background: Attempts at assessing heterogeneity in countries' mortality profiles often rely on measures of cause of death (CoD) diversity. Unfortunately, such indicators fail to take into consideration the degree of (dis)similarity among pairs of causes (e.g. 'transport injuries' and 'unintentional injuries' are implicitly assumed to be as dissimilar as 'transport injuries' and 'Alzheimer's disease')－an unrealistic and unduly restrictive assumption.

Development: We extend diversity indicators proposing a broader class of heterogeneity measures that are sensitive to the similarity between the causes of death one works with. The so-called 'CoD inequality' measures are defined as the average expected 'dissimilarity between any two causes of death'. A strength of the approach is that such measures are decomposable, so that users can assess the contribution of each cause to overall CoD heterogeneity levels-a useful property for the evaluation of public health policies.

Application: We have applied the method to 15 low-mortality countries between 1990 and 2019, using data from the Global Burden of Disease project. CoD inequality and CoD diversity generally increase over time across countries and sex, but with some exceptions. In several cases (notably, Finland), both indicators run in opposite directions.

Conclusions: CoD inequality and diversity indicators capture complementary information about the heterogeneity of mortality profiles, so they should be analysed alongside other population health metrics, such as life expectancy and lifespan inequality.

Keywords: Cause of death; dissimilarity; diversity; heterogeneity; mortality inequality; mortality profile.

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Conflict of interest statement

None declared.

Figures

Figure 1.
Figure 1.
Schematic representation of the cause-of-death (CoD) classification tree used in the Global Burden of Disease project
Figure 2.
Figure 2.
Trends in cause-of-death diversity (S) and inequality (I) indices between 1990 and 2019 in 15 select low-mortality countries for women and men. Source: Authors’ elaboration based on Global Burden of Disease/Institute for Health Metrics and Evaluation (GBD/IHME)
Figure 3.
Figure 3.
Levels and cause-specific decompositions of the cause-of-death diversity (S) and inequality (I) indices in Finland for men and women (1990 and 2019). Note: the scale of the cause-specific decomposition contributions is shown on the left-hand vertical axis, and the indices scale is on the right-hand axis. In order to facilitate visualization, the 133 causes of death in level 3 have been aggregated in the graph into their corresponding level 2 categories. Source: Authors’ elaboration based on Global Burden of Disease/Institute for Health Metrics and Evaluation (GBD/IHME)
See this image and copyright information in PMC

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