Theory and methods
Non-communicable disease mortality rates using the verbal autopsy
in a cohort of middle aged and older populations in Beirut during
wartime, 1983-93
A M Sibaia, A Fletcherb, M Hillsc, O Campbelld
a American University
of Beirut, Faculty of Health Sciences, Department of Epidemiology and
Biostatistics, Beirut, Lebanon, b Epidemiology Unit, Department of Epidemiology
and Population Health, London School of Hygiene and Tropical Medicine,
London, c Medical Statistics
Unit, Department of Epidemiology and Population Health, London School
of Hygiene and Tropical Medicine, d Maternal
and Child Epidemiology Unit, Department of Epidemiology and Population
Health, London School of Hygiene and Tropical Medicine
Correspondence to: Dr Sibai (ansibai{at}aub.edu.lb)
Accepted for publication 27 October 2000
STUDY
OBJECTIVES
Health priorities in middle to low
income countries, such as Lebanon, have traditionally been assumed to
follow those of a "typical" developing country, with a focus on the
young and on communicable diseases. This study was carried out to
quantify the magnitude of communicable and non-communicable disease
mortality and to examine mortality pattern among middle aged and older
populations in an urban setting in Lebanon.
DESIGN AND
PARTICIPANTSA representative cohort of 1567 men
and women (
50 years) who had participated in a cross sectional
multi-dimensional health survey in Beirut, Lebanon in 1983 and were
followed up 10 years later. Vital status was ascertained and causes of
death were obtained through verbal autopsy.
RESULTSTotal
mortality rates were estimated at 33.7 and 25.2/1000 person years among
men and women respectively. In both sexes, the leading causes of death
were non-communicable, mainly circulatory diseases (60%) and cancer
(15%). For all cause mortality, men had significantly higher risk than
women (age adjusted rate ratio, RR=1.42, 95% confidence intervals (CI) = 1.16, 1.72) especially at younger ages. Except for cerebrovascular
diseases, renal problems and injuries attributable to falls and
fractures, men were also at higher cause specific mortality risk than
women, in particular, for ischaemic heart disease (RR = 2.24, 95% CI = 1.62, 3.12). Comparison with earlier death certificate data in Lebanon
and current estimates from other regions in the world showed the
magnitude of cardiovascular disease over time.
CONCLUSIONSThe
results from this first cohort study in the Arab region show, in
contrast with popular perception, a mortality pattern more like a
developed country than a developing one. Strategies of public health
activities, in particular for countries in transition, need to be
continuously re-assessed in light of empirical epidemiological data and
other health indicators for evidence-based decision making.
Keywords: mortality; cardiovascular disease; Middle East
© 2001 by Journal of Epidemiology and Community Health
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