Elsevier

Public Health

Volume 151, October 2017, Pages 121-130
Public Health

Original Research
An evaluation of cause-of-death trends from recent decades based on registered deaths in Turkey

https://doi.org/10.1016/j.puhe.2017.07.006Get rights and content

Highlights

  • This is the first study to examine the long-term trends in causes-of-death in Turkey.

  • The study provides information for better understanding of the epidemiologic transition experienced in Turkey.

  • Deaths caused from communicable, maternal, perinatal, and nutritional conditions have significantly reduced.

  • Deaths caused from chronic and degenerative diseases have become a major problem.

  • After the reforms implemented in the Turkish Statistical Institute death reporting system in 2009, the proportion of ill-defined codes decreased significantly.

Abstract

Objectives

Although cause-of-death analyses are very important to define public health policy priorities and to evaluate health programs, there is very limited knowledge about mortality profiles and trends in Turkey. The aim of this study was to measure the trends in mortality within three broad cause-of-death groups and their distribution by age groups and gender and to describe the changes of leading causes of death between 1980 and 2013 in Turkey.

Study design

Descriptive study.

Methods

In the study, data on the number of deaths by year, gender, age and cause was obtained from the Turkish Statistical Institute. The causes of death were classified as group I: communicable, maternal, perinatal, and nutritional conditions; group II: non-communicable diseases (NCDs); and group III: injuries. Unknown or ill-defined causes of death were distributed within group I and group II. The percentage distribution of the cause-of-death groups by gender and age groups between 1980 and 2013 was identified. Age-standardized mortality rates (ASMRs) per 100,000 of broad causes-of-death groups were calculated using European Standard Population 1976 between 1980 and 2008. Changes in mortality rates per hundred were calculated using the formula ([the rate of last year of the period−the rate of the first year of the period]/the rate of the first year of the period). Gender and age-specific data were analyzed using the Joinpoint software to examine trends and significant changes in trends of mortality rates.

Results

Crude death rates for group I, group II, and group III were 157.3, 147.2, and 21.4 per 100,000 in 1980 and 35.3, 377.5, and 15.8 in 2008 for males; 161.8, 120.2, and 5.8 in 1980 and 38.6, 318.4, and 6.4 in 2008 for females, respectively. ASMRs for group I, group II, and group III were 146.3, 394.3, and 29.3 per 100,000 in 1980 and 49.7, 723.6, and 18.8 in 2008 for males; 138.0, 291.5, and 7.6 per 100,000 in 1980 and 47.7, 478.8, and 7.2 in 2008 for females, respectively. The mortality rates of group I for almost all age groups particularly below 5 years of age decreased significantly.

Conclusion

This study indicates that Turkey is at an advanced stage in the epidemiological transition, with the majority of the causes of death from NCDs. Considering the regional differences, it is necessary to carry out studies on the specific details of epidemiological transition and the social determinants of deaths in Turkey.

Introduction

In recent decades, as a result of demographic and socio-economic factors, many developing countries are experiencing a process which includes a shift in the leading causes of morbidity and mortality from infectious and parasitic diseases to non-communicable diseases (chronic and degenerative diseases, NCDs). This process, defined as the epidemiologic transition, is characterized by a decline in mortality and fertility, an increase in life expectancy, and the changing patterns of causes of death. The epidemiologic transition has paralleled the demographic and technologic changes in developed countries and is still underway in developing countries.1, 2

According to the estimation of the World Health Organization, 55.8 million deaths occurred globally in 2012. The causes of death consisted of 23% (12.8 million) from communicable, maternal, perinatal, and nutritional conditions, 68% (37.8 million) from NCDs, and 9% (5.1 million) from injuries. NCDs were already the dominant causes of death in developed regions. Compared to year 2000, while the deaths from communicable diseases decreased, the level of deaths from NCDs increased significantly, and those are the most frequent causes of death in almost all developing regions except Africa. The magnitude of deaths due to intentional and unintentional injuries has also gradually increased globally.3

Turkey has been experiencing a rapid change in its demographic and socio-economic structure since the 1970s. The total fertility rate decreased from 4.3 in 1978 to 2.3 per thousand females in 2013, the life expectancy at birth increased from 56 years in 1980 to 74 years in 2012.4, 5 On the other hand, because of rapid urbanization and economic conditions shaped by neoliberal policies and the transformation of lifestyles, Turkey has been confronted with the burden of chronic and communicable diseases at the same time,6, 7 with very little preparation to tackle these challenges. Although there are studies on determining the prevalence, trend, and risk factors of several NCDs,8, 9, 10, 11, 12, 13 there has been no systematic analysis exploring the national-level change in causes of death recently in Turkey. For this reason, the causes-of-death pattern and the epidemiologic trends are not sufficiently understood.

The Turkish Statistical Institute (TURKSTAT) is responsible for compilation and publication of mortality statistics since 1931. Initially, statistical data covered only the provincial centers until 1956, and the coverage was subsequently expanded to all district centers between 1957 and 2008. Besides TURKSTAT, the Ministry of Interior Population and Citizenship Affairs Department also collects routine administrative records regarding deaths at the national level through the Central Population Administrative System (MERNIS).

Until 2009, these institutions operated independently from each other, although they collected similar data on mortality, at which time the databases of TURKSTAT and MERNIS were combined and TURKSTAT death reporting system coverage was expanded to the whole country. Within the scope of the new regulations, death certificates were aligned with international standards, allowing reporting of the underlying, intermediate, immediate, and contributory causes of death. Also, the International Statistical Classification of Diseases and Related Health Problems (ICD) 8th revision was replaced with ICD-10 to code the causes of death, resulting in improvements in the cause-of-death data from the Turkish Statistical Institute (TURKSTAT).

This study aimed to examine the distribution and trends in mortality by three broad cause-of-death groups, age groups, and gender, and to describe the change of leading causes of death from 1980 to 2013 in Turkey using the data from TURKSTAT.

Section snippets

Data sources

In this descriptive study, the data on causes of death and population were obtained from TURKSTAT by gender and age groups. The causes of death were provided in coded form in ICD-8 for 1980–2008 and ICD-10 for 2009–2013. The population data were obtained from the general census for 1980, 1985, 1990, and 2000 and from the Address-Based Population Registration System of TURKSTAT for 2007–2013.14 The population data of other years were estimated by linear regression.

Evaluation methods

Based on the methods used in

Results

There were a total of 5,628,619 deaths records (3,159,087 males and 2,469,532 females) between 1980 and 2013 in the TURKSTAT database. In Fig. 1, the percentage distribution of the cause-of-death groups by year and gender are presented. The proportion of deaths due to group I declined from 48.2% in 1980 to 6.7% in 2013 in males and from 55.5% in 1980 to 8.1% in 2013 in females, and the proportion of deaths due to group II increased from 45.3% to 85.8% in males and from 43.0% to 87.7% in females

Discussion

This is the first study aiming to examine the changes in causes of death in Turkey for a period of 33 years, which provides useful information for better understanding of the epidemiologic transition experienced in Turkey.

Mortality rates significantly changed between 1980 and 2008. Despite the decrease in group I rates, there was an increase in group II rates including chronic and degenerative diseases. This change in the cause-of-death pattern is one of the main characteristics in countries

Ethical approval

None sought.

Funding

None declared.

Competing interests

None declared.

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