Mortality from violent causes in adolescents and young adults from - - PDF document

Mortality from violent causes in adolescents and young adults from the Southern

• Cone. An analysis of the variations in the last 20 years

Eleonora Rojas Cabrera♥ Nancy Stiegler♣ Andrés Peranovich♦ Bruno Ribotta♠ Abstract This paper analyses, comparatively, the variations of mortality from violent causes in adolescents and young adults from the Southern Cone countries between triennia 1997- 99 and 2011-13, taking into account sex, age group and specific causes. Mortality rates are calculated and analysed based on information from the World Health Organization and the United Nations Department of Economic and Social Affairs. The results show that the most affected populations depend on the cause(s): 15-29 year-old men and traffic accidents; all adolescents and young adults and homicides (especially women aged 25-29 from all countries and Brazilian men regardless of age); and the population aged 15 and over and suicides (particularly in Uruguay). Thus, in order to reduce mortality levels, it is necessary to consider particularly inner characteristics of each population group and country, stressing issues as self-esteem, value of life, respect for people’s own rights and the rights of others.

♥CIECS (CONICET y UNC), Córdoba, Argentina. E-mail: eleonorarojascabrera@gmail.com. ♣Department of Statistics and Population Studies, University of the Western Cape, South Africa. E-mail:

nstiegler@uwc.ac.za.

♦CIECS (CONICET y UNC), Córdoba, Argentina. E-mail: andrescpera@gmail.com. ♠CIECS (CONICET y UNC), Córdoba, Argentina. E-mail: brunoribo@yahoo.com.ar.

Introduction Given the consequences of violent episodes on economic and social justice in countries and the increase of mortality levels related to these unrests, the governments of the Americas have taken action for many decades to reduce such situations (Banco Mundial, n.d.). Among them: reduction of factors that contribute to aggressive behaviours (alcohols, drugs, weapons); implementation of parents’ training programs on non-violent methods of education; and promotion of the use of seat belts and the reduction of speed in motor vehicles (BID, 2010). However, levels of violence continue increasing in the region (mainly for men). This increase reflects on the cause-of-death composition in the population, principally in adolescents and young adults. In this sense, during the triennia 1994-96 and 2011-13, the relative incidence of mortality by homicides among aged 10-291 rises from 23.6% to 28.5%, while the one associated to ground accidents and suicides grows, respectively, from 15.6% to 16.4% and from 3.2% al 5.9% (OPS, n.d.). As part of the region, the Southern Cone (integrated by Argentina, Brazil, Chile and Uruguay) is affected by this problem. Moreover, it reveals a more serious situation for the first cause cited. In fact, considering the same period, the relative weight of deaths by homicide among adolescents and young adults increased from 25.9% to 32%, while that related to ground accidents and suicides rose from 16.6% to 18.9% and from 3.1% to 5.2% (OPS, n.d.). In this context, and taking into account that previous studies revealed disparities in mortality from violent causes’ trends and structures among adolescents and young adults in the Southern Cone from the 80’s to mid-90’s2, we ask ourselves: Has mortality from violent causes varied in the same direction and with the same intensity in all these countries in the last 20 years? Which population groups have been the most affected according to sex and age? Which challenges can be deduced if the analysis is made by specific causes?

1 According to several documents produced in the United Nations context (OMS, 1986; CELADE -

División de Población de la CEPAL and FNUAP, 2000; UNICEF, 2008), we consider adolescents as all people aged 10-19 and young adults as those aged 20-29.

2 We remark the study made by Yunes and Zubarew (1999). According to this, death from traffic

accidents are more common in Argentina, Chile and Uruguay (generally, with increasing levels), followed by suicides (with increasing levels in the first country and decreasing levels in the last two) and homicides (with increasing levels in the three countries). On the contrary, in Brazil, deaths from traffic accidents and homicides have the same relative incidence, followed by suicides (all causes are associated to increasing mortality levels).

In order to answer these questions, we analyse, comparatively among countries, the mortality changes from violent causes among aged 10-29 by sex, age group and specific cause during the period 1997-99 and 2011-133 based on information from the World Health Organization (WHO) and the United Nations Department of Economic and Social Affairs (UN DESA). Methods We use mortality data on violent causes disaggregated by sex, age and specific cause related to people aged 10-29 from the WHO4; and population projections by sex and age group from the Population Division of the UN-DESA5. Following previous researches (Yunes and Zubarew, 1999; Serfaty et al., 2003; Rojas Cabrera, 2015), we consider these causes of death according to the International Classification of Diseases - Tenth Revision (ICD 10): Traffic accidents (V01-V99); Other accidents (W00-W99; X00-X59); Homicide (X85-Y09); and Suicide (X60-X84). Based on this information, we calculate specific mortality rates (MRs) by disaggregation referred for triennia 1997-99and 2009-13. The MRs are obtained by dividing the average number of deaths of each triennium6 by the mid-period population projection for each one of them (1998 and 2012, respectively). All MRs are expressed per 100,000 population, considering the unit of measurement applied in studies that focus in group of causes or specific causes (OPS-HA, 2015). In addition, we calculate MR ratios among the disaggregation to refine the comparison between countries. Concerning the triennia selected, it is worth noting that we consider the first year of application of ICD 10 in all countries under study; specifically: 19977. Additionally, 2013 was the last year with available information while we were working on this research.

3 It is worth to mention that we focus on comparing all Southern Cone countries, unlike other researchers

that have previously analysed mortality for one or some of them, taking into account one violent cause or all of them ((Burrone et al, 2012; Freitez et al, 2012; Bella et al, 2013; Cardona Arango et al, 2013).

4

Available at:http://apps.who.int/healthinfo/statistics/mortality/causeofdeath_query/. Accessed: December 2, 2016.

5 Available at:https://esa.un.org/unpd/wpp/Download/Standard/Population. Accessed: December 2, 2016. 6 In the case of Uruguay, the average number of deaths for the triennium 2011-13 excludes those related

to 2011 because the source used did not contain the information regarding this year when it was consulted.

7 Although Brazil started to apply ICD 10 since 1996, we decide to consider 1997 in order to make

comparisons among countries.

Results8 The MR from violent causes among people aged 10-29 rises in all countries of the Southern Cone during triennia 1997-99 and 2011-13. This increase is greater in Brazil (country with the highest MR; MR: 67 to 76.8 per 100,000 population), followed, according to its intensity, by Argentina (MR: 35.5 to 39.9 per 100,000 population); Chile (country with the lowest MR; MR: 27.6 to 30.8 per 100,000 population) and Uruguay (second country with the highest MR; MR: 51.1 to 54.1 per 100,000 population). These changes affect the relative incidence of violent causes in the cause-of-death composition of each country. This issue provides an overview of the seriousness of the situation in the region: as the relative incidence grows from 43.1% to 50.9% in Argentina, it increases from 57.3% to 65.1%, from 42% to 59.7% and from 63.3% to 67.3%, respectively, in Brazil, Chile and Uruguay. If we consider age in the analysis, the MR of 10-14 year-old adolescents (lower than the rest of the age groups in the four countries; higher in Brazil and Uruguay) decreases during the period under study regardless of the country (with greater intensity in Uruguay and lower in Chile). These variations produce a drop of the relative incidence

• f violent causes in this group of population in all cases (Table 1).

On the contrary, the MRs of people aged 20-24 and 15-19, in this order (greater than the

• thers age group MRs in all countries and particularly higher in Brazil) rise in all cases.

This change (stronger in 20-24 year-old Argentinean population) causes a growth of relative weight of these causes (Table 1). Finally, the MR associated to young adults aged 25-29 increases; consequently, the relative incidence of violent deaths among this group increases too (Table 1).

8It is worth stressing that Brazil’s results shown in this section could be affected by the low deaths

coverage level that this country has (shortly improved from 86.4% to 87% during the period 2000-2005 - 2005-2010) comparing with the rest of the countries including in this study (Argentina: 99%; Chile and Uruguay: 100% during the period referred) (OPS, 2013; CELADE - División de Población de la CEPAL, 2015).

Table 1.Southern Cone countries. MR from violent causes (per 100,000 population) and relative incidence of death from violent causes among all deaths (%) by age group. Triennia 1997-99 and 2011-13 Country and indicator Age group 10-14 15-19 20-24 25-29 1997- 99 2011- 13 1997- 99 2011- 13 1997- 99 2011- 13 1997- 99 2011- 13 Argentina MR 12.1 9.2 39.1 45.4 49.2 58 44.5 48.1 Relative incidence 38.1 34.8 49.6 55.1 47.1 55.8 35.6 46.7 Brazil MR 16.2 13 67 85.8 100.2 113.4 94 96.2 Relative incidence 43.6 41.3 63.1 69.9 63 70.7 51.2 60.9 Chile MR 7.8 7 24 29.1 40.2 43 40.1 42 Relative incidence 31.9 38.7 43.5 61.9 46.3 64.3 40.2 58.6 Uruguay MR 15.5 10.9 55.2 64.6 65.6 71.3 69.1 70.6 Relative incidence 47.6 45.5 69.9 73.2 67.3 72.4 59.4 62.1

Source: Own elaboration based on data from the WHO and the Population Division of the UN DESA (See Annex, Table 1).

These conclusions are the same for most of the countries if the analysis is made by sex, mainly to the detriment of men (whose MRs are higher). In particular, our conclusions stress the MRs’ reduction in women from Uruguay aged 10-24; and the increase of MRs associated to women aged 10-14 in Chile (tables 2 and 3). Differences by sex are stronger as age increases, basically in population aged 15-24 and with more emphasis on the Brazilian case. Moreover, these differences rise during the triennia under study (except in Chile, where they reduce regardless of the age)9 (tables 2 and 3). According to previous researches (Yunes and Zubarew, 1999), the disaggregation of deaths by causes shows a similar pattern in Argentina, Chile and Uruguay. In this sense, “Other accidents” is the leading cause among adolescents aged 10-14 regardless of sex (in the triennium 1997-99, the MR reaches a maximum in men from Uruguay) (tables 2 and 3).

9 Differences according to sex persist even when the analysis is made by causes, as it can be deduced

from the following paragraphs.

From the age of 15 onwards, the relative incidence of this category is still relevant only in Uruguay (mainly in men, though the MR related to it decreases), while in the first two countries deaths occur more often from Traffic accidents. MR related to them increases in most countries and age groups, reaching maximums in men aged 20-24 from Argentina and Uruguay (tables 2 and 3). “Suicides” continues in order of relevance, associated to MRs that increase with age and time in most of the age groups. In this instance, MRs in Uruguay are greater than the rest of the countries (tables 2 and 3). Although Homicides are the last in the ranking, it is worth noting that: a) the MR among aged 15 and over rises in three countries (men aged 25-29 from Uruguay reveal the maximum of the rate in the period 2011-13); b) the female’s MR increases in Chile regardless of the age and in those aged 25-29 from Argentina and Uruguay (rates reach up to 3 per 100,000 women), according to increasing levels of gender-based violence and femicides (tables 2 and 3). This described pattern is different to the Brazilian one, especially in the case of men aged 15 and over. “Homicides” lead the cause-of-death structure of this population group (the MR increases regardless of the age, reaching a maximum nearly 120 per 100,000 men aged 20-24 in the triennium 2011-13), followed by deaths from Traffic accidents (increasing MR) (Table 2). Among women, deaths from Traffic accidents are more usual (the MRs are similar than the ones in other countries), followed by Homicides (the MRs are higher than the rates in the rest of the countries, nearly 8 per 100,000 women aged 15-29 at the end of the period under study) (Table 3). At last, categories “Other accidents” and “Suicide” do not reveal great gender

• differences. While the MR associated to the first one decreases, the one related to the

second one rises (though the relative incidence is smaller than the incidence in other countries) (tables 2 and 3).

Table 2.Southern Cone countries.Male MR from violent causes by selected causes and age group. Per 100,000 men.Triennia 1997-99 and 2011-13 Country and MRs Age group 10-14 15-19 20-24 25-29 1997- 99 2011- 13 1997- 99 2011- 13 1997- 99 2011- 13 1997- 99 2011- 13 Argentina All violent causes 1.6 1.2 6 7.1 8.2 9.8 7.6 8.1 Traffic accidents 0.5 0.4 1.9 2.4 2.9 3.6 2.7 3 Other accidents 0.8 0.5 2.2 1.5 2.6 2.1 2.3 1.8 Homicide 0.1 0.1 1.2 1.4 1.6 1.8 1.5 1.4 Suicide 0.1 0.2 0.8 1.8 1.1 2.3 1.1 1.8 Brasil All violent causes 2.2 1.9 11.4 14.9 18 20.3 17.1 17.2 Traffic accidents 0.8 0.6 2.5 3.4 4.4 5.8 4.4 5.1 Other accidents 1 0.6 2.1 1.4 2.5 1.5 2.5 1.4 Homicide 0.4 0.6 6.4 9.5 10.3 12 9.3 9.6 Suicide 0.1 0.1 0.4 0.5 0.9 1 0.9 1.1 Chile All violent causes 1.1 0.8 3.7 4.4 6.8 7.2 7.1 7 Traffic accidents 0.4 0.3 1.2 1.3 2.5 2.3 2.6 2.1 Other accidents 0.5 0.3 1.3 0.8 1.8 1.1 1.8 1.1 Homicide 0.1 0.5 1.1 0.8 1.5 0.9 1.4 Suicide 0.1 0.2 0.7 1.3 1.7 2.3 1.7 2.3 Uruguay All violent causes 2.1 1.4 8.5 10.5 10.6 12.4 11.8 12 Traffic accidents 0.6 0.4 2.2 3.5 3.2 3.8 3 3 Other accidents 1.2 0.8 3.9 2.9 3.8 3.1 4.4 2.5 Homicide 0.1 0.1 0.9 1.7 1.4 2.2 1.7 2.5 Suicide 0.2 0.2 1.4 2.4 2.1 3.4 2.8 4

Source: Own elaboration based on data from the WHO and the Population Division of the UN DESA (See Annex, Table 1).

Table 3.Southern Cone countries.Female MR from violent causes by selected causes and age group.Per 100,000 women.Triennia 1997-99 and 2011-13 Country and MRs Age group 10-14 15-19 20-24 25-29 1997- 99 2011- 13 1997- 99 2011- 13 1997- 99 2011- 13 1997- 99 2011- 13 Argentina All violent causes 0.8 0.7 1.8 1.9 1.7 1.7 1.3 1.5 Traffic accidents 0.3 0.2 0.7 0.7 0.7 0.7 0.6 0.6 Other accidents 0.3 0.2 0.5 0.4 0.5 0.4 0.4 0.3 Homicide 0.1 0.1 0.1 0.1 0.2 0.2 0.2 0.2 Suicide 0.1 0.2 0.4 0.7 0.3 0.4 0.2 0.3 Brasil All violent causes 1 0.7 1.9 2.1 2 2.2 1.8 2 Traffic accidents 0.4 0.3 0.8 0.9 0.8 1 0.7 0.8 Other accidents 0.4 0.2 0.4 0.2 0.3 0.2 0.3 0.2 Homicide 0.2 0.2 0.6 0.8 0.7 0.8 0.7 0.7 Suicide 0.1 0.1 0.2 0.2 0.2 0.2 0.2 0.2 Chile All violent causes 0.5 0.6 1.1 1.3 1.2 1.3 0.9 1.3 Traffic accidents 0.3 0.2 0.5 0.6 0.6 0.6 0.4 0.5 Other accidents 0.2 0.1 0.3 0.1 0.2 0.2 0.2 0.2 Homicide 0.1 0.1 0.1 0.1 0.1 0.1 Suicide 0.1 0.3 0.5 0.3 0.4 0.3 0.5 Uruguay All violent causes 1.0 0.8 2.4 2.3 2.4 1.7 1.9 2.1 Traffic accidents 0.4 0.2 0.8 1 0.7 0.7 0.7 0.8 Other accidents 0.4 0.2 1 0.5 0.9 0.3 0.5 0.3 Homicide 0.1 0.2 0.2 0.4 0.2 0.2 0.3 Suicide 0.1 0.2 0.4 0.6 0.5 0.4 0.5 0.7

Source: Own elaboration based on data from the WHO and the Population Division of the UN DESA (See Annex, Table 1).

Conclusion The results show that the most affected populations depend on the violent cause: 15-29 year-olds men are most affected by traffic accidents; all adolescents and young adults by homicides (especially women aged 25-29 from all countries and Brazilian men regardless of age); and the population aged 15 and over by suicides (particularly in Uruguay). Thus, in order to reduce mortality levels, it is necessary to consider particularly inner characteristics of each population group and country, stressing issues asself-esteem, value of life, respect for people’s own rights and the rights of others. References Banco Mundial. América Latina: La violencia pone en riesgo una década de avances. Available at:http://blogs.worldbank.org/latinamerica/es/am-rica-latina-la-violencia- pone-en-riesgo-una-d-cada-de-avances. Accessed: December 4, 2016. Bella, M.; Acosta, L.; Villace, B.; López de Neira, M.; Enders, J.; Fernández, R. (2013). “Análisis de la mortalidad por suicidio en niños, adolescentes y jóvenes. Argentina, 2005-2007. Archivos Argentinos de Pediatría, 111(1): 16-21. BID (Inter-American Development Bank, according to its initials in Spanish) (2010). Prevención del Delito y la Violencia en América Latina y el Caribe: Evidencia de las Intervenciones del BID. RE-378. Washington, D.C. Burrone, M; Bella, M., Acosta, L.; Villace, B.; López de Neira, M.; Fernández, R.; Enders, J. (2012). “Estudio de muertes por causas violentas: un análisis de la tendencia en jóvenes, Argentina, 2000-2008”. Cadernos Saúde Coletiva, Rio de Janeiro, 20(4): 460-5. Cardona Arango, D.; Escanés, G.; Fantín, M.; Peláez, E. (2013). “Mortalidad por causas externas: un problema de salud pública. Argentina, Chile y Colombia. 2000-2008”. Población y Salud en Mesoamérica, 10(2): informe técnico 2. CELADE (The Latin American and Caribbean Demographic Centre, according to its initials in Spanish) - División de Población de la CEPAL (Economic Commission for Latin America and the Caribbean, according to its initials in Spanish) (2015). Evaluaciones e indicadores de cobertura y calidad: Experiencias regionales. Taller sobre Principios y Recomendaciones para un Sistema de Estadísticas Vitales, Revisión 3, para países de América del Sur. Santiago de Chile, November 9 -12, 2015. CELADE (The Latin American and Caribbean Demographic Centre, according to its initials in Spanish) - División de Población de la CEPAL (Economic Commission for Latin America and the Caribbean, according to its initials in Spanish) andFNUAP (United Nations Population Fund, according to its initials in Spanish) (2008). Juventud, población y desarrollo en América Latina y el Caribe. Problemas, oportunidades y desafíos. Santiago de Chile. Freitez, A.; Romero, D.; Di Brienza, M. (2012). La Mortalidad juvenil por causas violentas en Brasil y Venezuela, 1997-2007, Paper presented in IV Latin American

Population Conference, ALAP, La Habana, Cuba, November, 16 -19, 2010. Available at: http://www.somosavepo.org.ve/download/cdt_573.pdf. Accessed: December 21, 2012. OMS (World Health Organization, according to its initials in Spanish) (1986). La salud de los jóvenes: un desafío para la sociedad. Serie Informes Técnicos 731, Ginebra. OPS (Pan American Health Organization, according to its initials in Spanish) (2013). Plan regional para el fortalecimiento de las estadísticas vitales y de salud (informe de progreso). 52° Consejo Directivo de la OPS, 65ª sesión del Comité Regional de la OMS para las Américas; September 30 - October 4, 2013, Washington, DC.; CD52/INF/4. OPS (Pan American Health Organization, according to its initials in Spanish). Causas principales de mortalidad en las Américas. Available at: http://ais.paho.org/phip/viz/mort_causasprincipales_lt_oms.asp. Accessed: December4, 2016. OPS (Pan American Health Organization, according to its initials in Spanish) - HA (Health Information and Analysis Unit) (2015). Iniciativa Regional de Datos Básicos en Salud; Glosario de Indicadores. Washington D.C., June 2015. Rojas Cabrera, E. (2015). “Mortalidad por causas violentas en adolescentes y jóvenes de dos ciudades del Cono Sur: Córdoba (Argentina) y Porto Alegre (Brasil), 1990-2010”. Ciência & Saúde Coletiva, 20(1): 29-37. Serfaty, E., Foglia, V., Masaútis, A.; Negri, G. (2003). “Mortalidad por causas violentas en adolescentes y jóvenes de Argentina”, 1991-2000. Vertex, 14 (2). UNICEF (United Nations Children's Fund) (2008). La adolescencia y la juventud en las políticas públicas de Iberoamérica, Discurso de Marta Maurás, Enviada Especial de UNICEF para América Latina para la Cumbre Iberoamericana 2008. Available at: http://www.unicef.org/lac/Discurso_de_Marta_Mauras.pdf. Accessed: April 1, 2013. Yunes, J. and Zubarew, T. (1999). “Mortalidad por causas violentas en Adolescentes y Jóvenes: Un Desafío para la Región de las Américas”. Revista Brasileira de Epidemiologia, 2 (3).

Annex Table 1.Southern Cone countries.Number of deaths from violent causes and population by sex and age group.Triennia 1997-99 and 2011-13

Country and indicator Age group 10-14 15-19 20-24 25-29 1997-99 2011-13 1997-99 2011-13 1997-99 2011-13 1997-99 2011-13 Argentina Number of deaths from violent causes Both sexes 1,205 965 3,875 4,703 4,633 5,927 3,498 4,673 Men 814 615 3,009 3,744 3,857 5,075 2,975 3,974 Women 391 350 866 959 776 852 523 699 Population at mid-period Both sexes 3,330,206 3,484,701 3,302,505 3,455,158 3,141,904 3,406,769 2,618,574 3,235,131 Men 1,689,516 1,771,582 1,668,750 1,755,452 1,575,220 1,725,479 1,307,068 1,633,278 Women 1,640,683 1,713,107 1,633,749 1,699,692 1,566,680 1,681,279 1,311,503 1,601,844 Brasil Number of deaths from violent causes Both sexes 8,782 6,890 35,957 43,639 48,127 58,198 40,597 51,767 Men 6,199 5,018 30,916 38,409 43,332 52,625 36,612 46,441 Women 2,583 1,872 5,041 5,230 4,795 5,573 3,985 5,326 Population at mid-period Both sexes 18,098,356 17,683,810 17,892,424 16,951,168 16,015,677 17,101,591 14,393,869 17,943,195 Men 9,193,239 9,007,129 9,048,452 8,619,010 8,034,470 8,654,525 7,140,509 9,014,137 Women 8,905,099 8,676,685 8,843,956 8,332,161 7,981,199 8,447,070 7,253,358 8,929,060 Chile Number of deaths from violent causes Both sexes 315 266 886 1,187 1,456 1,848 1,511 1,720 Men 215 159 681 921 1,242 1,574 1,341 1,454 Women 100 107 205 266 214 274 170 266 Population at mid-period Both sexes 1,343,839 1,274,637 1,228,520 1,359,763 1,206,317 1,432,137 1,256,696 1,363,813 Men 678,196 649,003 618,709 693,938 606,893 730,681 630,187 693,115 Women 665,643 625,628 609,812 665,819 599,423 701,448 626,509 670,692 Uruguay Number of deaths from violent causes Both sexes 121 56 435 342 531 365 497 328 Men 82 37 341 283 435 323 429 280 Women 39 19 94 59 96 42 68 48 Population at mid-period Both sexes 260,726 255,768 262,781 264,603 269,739 255,856 239,809 232,255 Men 133,062 130,328 133,758 134,764 137,055 129,983 120,847 117,150 Women 127,665 125,435 129,024 129,834 132,686 125,868 118,964 115,103

Source: WHO and Population Division of the UN DESA. Note: Differences between the total of population projected and the result of the addition of men and women are according to the data source used.