Taylor Richard, Bampton Dale, Lopez Alan D
School of Public Health, University of Sydney, New South Wales, Australia.
Int J Epidemiol. 2005 Feb;34(1):207-14. doi: 10.1093/ije/dyh337. Epub 2004 Oct 1.
The Pacific Island countries are at different stages of the demographic and epidemiological transitions. The availability of accurate and current mortality data is of vital importance for priority setting in health. Available mortality data generally underestimate death rates among both children and adults. In many Pacific Island populations, little is reliably known about levels and causes of death, particularly among adults.
The results of two comprehensive approaches to obtaining mortality estimates are reported. First, a systematic review of available life expectancy and infant mortality information reported by countries from 1990 onwards was undertaken and evaluated with respect to quality, and a final "best estimate" was established. Methods were based on registered deaths and indirect demographic methods. The second approach consisted of a demographic evaluation of vital registration data for completeness, with death rates adjusted accordingly, or where vital registration was not available, the application of new model life table methods to generate life tables from estimates of child mortality, as used by the World Health Organisation (WHO).
This analysis reveals substantial uncertainty about mortality conditions in Pacific Island populations. In some countries, life expectancy variations of 10 years or more were recorded in the 1990s, depending on the source. Best approaches suggest that life expectancy (at birth) varied considerably, from levels of around 55-60 years in some Melanesian and Micronesian states to levels above 70 years in low-mortality countries. The principal issues with regard to uncertainty around mortality levels include underenumerated vital registration data; annual stochastic fluctuations in mortality in small populations; errors in the imputation of adult mortality from infant and childhood rates; implausible results from indirect demographic methods; use of possibly inappropriate model life tables to adjust death data or for indirect methods; and inadequately described and implausible projections. The WHO model life table method based on adjusted vital registration generally yielded results similar to those suggested by an evaluation of published data, with some exceptions, which are further discussed.
This study indicates the urgent need to improve infrastructure, training, and resources for routine mortality estimation in many Pacific Island countries in order to better inform and evaluate health and public policy.
太平洋岛国处于人口和流行病学转变的不同阶段。准确和最新的死亡率数据对于卫生领域的优先事项设定至关重要。现有的死亡率数据通常低估了儿童和成人的死亡率。在许多太平洋岛民群体中，关于死亡水平和原因，尤其是成年人的死亡水平和原因，人们所知甚少。
报告了两种获取死亡率估计值的综合方法的结果。首先，对各国自1990年起报告的预期寿命和婴儿死亡率信息进行了系统回顾，并对质量进行了评估，最终确定了“最佳估计值”。方法基于登记死亡数据和间接人口统计方法。第二种方法包括对生命登记数据的完整性进行人口统计学评估，相应调整死亡率，或者在没有生命登记数据的情况下，应用新的模型生命表方法，根据儿童死亡率估计值生成生命表，世界卫生组织（WHO）就是这样做的。
该分析揭示了太平洋岛民群体死亡率状况存在很大的不确定性。在一些国家，根据数据来源不同，20世纪90年代记录的预期寿命差异达10年或更长。最佳方法表明，预期寿命（出生时）差异很大，一些美拉尼西亚和密克罗尼西亚国家约为55 - 60岁，而低死亡率国家则高于70岁。死亡率水平不确定性的主要问题包括生命登记数据记录不全；小群体中死亡率的年度随机波动；从婴儿和儿童死亡率推算成人死亡率时的误差；间接人口统计方法得出的不合理结果；使用可能不适当的模型生命表来调整死亡数据或用于间接方法；以及描述不充分和不合理的预测。基于调整后的生命登记数据的世卫组织模型生命表方法通常得出的结果与对已发表数据评估得出的结果相似，但有一些例外情况，将进一步讨论。
本研究表明，许多太平洋岛国迫切需要改善用于常规死亡率估计的基础设施、培训和资源，以便更好地为卫生和公共政策提供信息并进行评估。
