Mortality estimations for the indigenous population in Brazil based - PDF document

Mortality estimations for the indigenous population in Brazil based on census data Marden Barbosa de Campos Gabriel Mendes Borges Ricardo Ventura Santos Bernardo Lanza Queiroz Abstract This paper presents, for the first time, estimations of mortality in the indigenous population in Brazil based on data from the most recent national census (2010), along with a comparison with estimates for non-indigenous population. We use different methods to characterize indigenous households from the census data. The results point to striking differences, showing much higher mortality rates for the indigenous population in all age groups considered. keywords: Mortality, Indigenous populations, Demographic methods, Race/ethnicity 1

Introduction Indigenous peoples are among the most marginalized social segments in different parts of the world. In Latin America, increasing attention has been paid to the health conditions of indigenous peoples, especially in the context of efforts to reduce socioeconomic disparities. Availability of health statistics is a key point in order to achieve these goals (Coimbra et al. 2013; McSweeney and Arps 2005; Montenegro and Stephens 2006, Coimbra and Santos 2004; Garnelo et al. 2003; Montenegro and Stephens, 2006; Santos et al. 2008). In Brazil, significant advances have been made in recent decades in order to revert the lack of data on indigenous peoples in national statistics. In the 1990s, the category “indigenous” was included as one of the categories in the question about color or race in the decennial national census, resulting in the production of important demographic data for formulation, implementation and evaluation of public policies. An important innovation of the 2010 Brazilian National Census was the inclusion of questions on the occurrence of deaths in the households. Despite the wide recognition of major disparities across ethnic-racial groups in Brazil, analyses focusing on mortality differentials are relatively scarce, in particular those that take into consideration the indigenous segment of the population (Chor and Lima 2005; Matijasevich et al. 2007; Wong et al. 2014). In this scenario, the possibility of using census data to estimate indigenous mortality is of paramount importance. This paper aims to present, for the first time, estimations of mortality in the indigenous population in Brazil based on data from the most recent national census (2010), along with a comparison with estimates for the non-Indigenous population. Methods Death registration systems in Brazil, as in most developing countries, are incomplete, have several data quality limitations and lack detailed information for population subgroups, posing considerable challenge to mortality estimations in the country. Different methods have been proposed to overcome these limitations, for instance by adjusting death counts based on the relationships 2

between the distribution of deaths, the age structure and the rates of change in the populations or directly using questions included in surveys and censuses (Timæus et al., 2013). This paper adopts both approaches and uses information on household mortality recently incorporated into the 2010 Brazilian population census, which is further adjusted by a death distribution method. The 2010 census asked for all households whether someone living in that household had died in the previous 12 months. In the case there was a reported death in the household, it was asked the sex and age of the deceased. These data are analyzed through a simple two-step method, similar to the method previously used by Silva et al (2016). In the first step, evaluation methods are applied to the household mortality records in order to check the quality and to adjust the numbers of reported deaths, allowing for more accurate estimates of mortality levels. In this paper, we evaluate the quality of mortality data reported in the census at the national level. A recent study estimated that the completeness of deaths reported in the census was 80% for females and 85% for males (Queiroz and Sawyer, 2012). In the second step of the method, household mortality records (including age and sex of the deceased) are linked to household information such as race classification of the members of the household. This simple method allows the estimation of age-specific mortality rates by specific sub-population groups in Brazil, which in turn can be used to compute life tables. The two steps method and their caveats are detailed below. Queiroz and Sawyer (2012) showed that the quality of mortality data in the 2010 Census is satisfactory and can be used as a reliable source. A major advantage of census data is that the numerators and denominators derive from the same source. There are, however, important limitations, such as under- enumeration of deaths due to the dissolution of households following the death of a resident and the inexistence of survivors to report the death. In Brazil, this is a particularly relevant issue, as there is a relatively high proportion of single- person households. According to Queiroz and Sawyer (2012), the observed mortality structure is of good quality, except for the elderly. Notwithstanding, these limitations might be partially corrected by the use of demographic methods. 3

Census data also allow the investigation of regional and socioeconomic differentials in mortality, since they provide much more reliable and detailed information on these issues than vital statistics sources. Coverage of Reported Deaths The demographic literature has developed several methods based upon equations of population dynamics to evaluate the coverage of reported deaths relative to populations. The death distribution methods (DDM) are commonly used to estimate adult mortality in a non-stable population. A stable population is one in which the birth and death rates are unchanging over a long period of time. The DDM methods compare the distribution of deaths by age with the age distribution of the living and provide age patterns of mortality in a defined reference period. There are two major approaches: the General Growth Balance Methods, and the Synthetic Extinct Generation methods. In this paper, we use the General Growth Balance method (GGB), particularly the Benneth and Horiuchi Adjusted variant. This method is derived from the basic demographic balancing equation, which expresses the identity that the growth rate of a population is equal to the difference between its entry rate and exit rate. Equation 1 shows the basic relations of the method       1      N ' x 1 k k k D ' x 2           r ' x ln 1 1 2           (1) N x t k C N x     2 Where N’(x) is the number of persons who reach the exact age x in the period, N(x+) is the number of persons at exact age x and over, r(x+) is the population growth rate, k 1 and k 2 are the relative coverage of the enumerated population in two censuses, C is the degree of completeness of death records over the period, D’(x+) is the observed number of deaths of people with x or more years of age and t is the interval corresponding to the intercensal period This identity holds for open-ended age segments x+, and in a closed population the only entries are through birthdays at age x. The “birth” rate x+ minus the growth rate x+ thus provides a residual estimate of the death rate x+. If the residual estimate can be calculated from population data from two population censuses and compared to a direct estimate using the recorded 4