Many people living in low- and middle-income countries are not covered by civil registration and vital statistics systems. Consequently, a wide variety of other types of data, including many household sample surveys, are used to estimate health and population indicators. In this paper we combine data from sample surveys and demographic surveillance systems to produce small area estimates of child mortality through time. Small area estimates are necessary to understand geographical heterogeneity in health indicators when full-coverage vital statistics are not available. For this endeavor spatio-temporal smoothing is beneficial to alleviate problems of data sparsity. The use of conventional hierarchical models requires careful thought since the survey weights may need to be considered to alleviate bias due to nonrandom sampling and nonresponse. The application that motivated this work is an estimation of child mortality rates in five-year time intervals in regions of Tanzania. Data come from Demographic and Health Surveys conducted over the period 1991-2010 and two demographic surveillance system sites. We derive a variance estimator of under five years child mortality that accounts for the complex survey weighting. For our application, the hierarchical models we consider include random effects for area, time and survey and we compare models using a variety of measures including the conditional predictive ordinate (CPO). The method we propose is implemented via the fast and accurate integrated nested Laplace approximation (INLA).
BACKGROUND. The majority of countries in Africa and nearly one third of all countries require mortality models to infer complete age schedules of mortality, required for population estimates, projections/forecasts and many other tasks in demography and epidemiology. Models that relate child mortality to mortality at other ages are important because all countries have measures of child mortality. OBJECTIVE. 1) Design a general model for age-specific mortality that provides a standard way to relate covariates to age-specific mortality. 2) Calibrate that model using the relationship between child…
There is an increasing focus on reducing inequalities in health outcomes in developing countries. Subnational variation is of particular interest, with geographic data used to understand the spatial risk of detrimental outcomes and to identify who is at greatest risk. While some health surveys provide observations with associated geographic coordinates, many others provide data that have their locations masked and instead only report the strata within which the data resides. How to harmonize these data sources for spatial analysis has seen previously considered though no method has been agreed…
In order to implement disease-specific interventions in young age groups, policy makers in low- and middle-income countries require timely and accurate estimates of age- and cause-specific child mortality. High quality data is not available in settings where these interventions are most needed, but there is a push to create sample registration systems that collect detailed mortality information. Current methods that estimate mortality from this data employ multistage frameworks without rigorous statistical justification that separately estimate all-cause and cause-specific mortality and are no…
Most studies on inequality in infant and child mortality compare average mortality rates between large groups of births, for example, comparing births from different countries, income groups, ethnicities, or different times. These studies do not measure within-group disparities. The few studies that have measured within-group variability in infant and child mortality have used tools from the income inequality literature, such as Gini indices. We show that the latter are inappropriate for infant and child mortality. We develop novel tools that are appropriate for analyzing infant and child mort…
Estimates of the under-five mortality rate (U5MR) are used to track progress in reducing child mortality and to evaluate countries' performance related to Millennium Development Goal 4. However, for the great majority of developing countries without well-functioning vital registration systems, estimating the U5MR is challenging due to limited data availability and data quality issues. We describe a Bayesian penalized B-spline regression model for assessing levels and trends in the U5MR for all countries in the world, whereby biases in data series are estimated through the inclusion of a multil…
In recent years, much of the focus in monitoring child mortality has been on assessing changes in the under-five mortality rate (U5MR). However, as the U5MR decreases, the share of neonatal deaths (within the first month) tends to increase, warranting increased efforts in monitoring this indicator in addition to the U5MR. A Bayesian splines regression model is presented for estimating neonatal mortality rates (NMR) for all countries. In the model, the relationship between NMR and U5MR is assessed and used to inform estimates, and spline regression models are used to capture country-specific tr…
The United Nations' Sustainable Development Goal 3.2 aims to reduce under-5 child mortality to 25 deaths per 1,000 live births by 2030. Child mortality tends to be concentrated in developing regions where much of the information needed to assess achievement of this goal comes from surveys and censuses. In both, women are asked about their birth histories, but with varying degrees of detail. Full birth history (FBH) data contain the reported dates of births and deaths of every surveyed mother's children. In contrast, summary birth history (SBH) data contain only the total number of children bor…
Several approaches have been developed for forecasting mortality using the stochastic model. In particular, the Lee-Carter model has become widely used and there have been various extensions and modifications proposed to attain a broader interpretation and to capture the main features of the dynamics of the mortality intensity. Hyndman-Ullah show a particular version of the Lee-Carter methodology, the so-called Functional Demographic Model, which is one of the most accurate approaches as regards some mortality data, particularly for longer forecast horizons where the benefit of a damped trend …
We investigate the decline of infant mortality in 42 low and middle income countries (LMIC) using detailed micro data from 84 Demographic and Health Surveys. We estimate infant mortality risk for each infant in our data and develop a novel extension of Oaxaca decomposition to understand the sources of these changes. We find that the decline in infant mortality is due to a declining propensity for parents with given characteristics to experience the death of an infant rather than due to changes in the distributions of these characteristics over time. Our results suggest that technical progress …
State-space representation of early-life child mortality dynamics: linking event history analysis and orbit-based models
School of Computer Science and Applied Mathematics, University of the Witwatersrand（威特沃特斯兰德大学计算机科学与应用数学学院）；Department of Mathematics and Applied Mathematics, University of Johannesburg（约翰内斯堡大学数学与应用数学系）；National Institute for Theoretical and Computational Sciences (NITheCS)（国家理论与计算科学研究所）
I present three types of applications of generalized additive models (GAMs) to COVID-19 mortality rates in the US for the purpose of advancing methods to document inequities with respect to which communities suffered disproportionate COVID-19 mortality rates at specific times during the first three years of the pandemic. First, GAMs can be used to describe the changing relationship between COVID-19 mortality and county-level covariates (sociodemographic, economic, and political metrics) over time. Second, GAMs can be used to perform spatiotemporal smoothing that pools information over time and…
Kernel smoothing represents a useful approach in the graduation of mortality rates. Though there exist several options for performing kernel smoothing in statistical software packages, there have been very few contributions to date that have focused on applications of these techniques in the graduation context. Also, although it has been shown that the use of a variable or adaptive smoothing parameter, based on the further information provided by the exposed to the risk of death, provides additional benefits, specific computational tools for this approach are essentially absent. Furthermore, l…
Estimation of stillbirth rates globally is complicated because of the paucity of reliable data from countries where most stillbirths occur. We compiled data and developed a Bayesian hierarchical temporal sparse regression model for estimating stillbirth rates for all countries from 2000 to 2019. The model combines covariates with a temporal smoothing process so that estimates are data-driven in country-periods with high-quality data and deter-mined by covariates for country-periods with limited or no data. Horseshoepriors are used to encourage sparseness. The model adjusts observations with al…
To analyze and project age-specific mortality or morbidity rates age-period-cohort (APC) models are very popular. Bayesian approaches facilitate estimation and improve predictions by assigning smoothing priors to age, period and cohort effects. Adjustments for overdispersion are straightforward using additional random effects. When rates are further stratified, for example, by countries, multivariate APC models can be used, where differences of stratum-specific effects are interpretable as log relative risks. Here, we incorporate correlated stratum-specific smoothing priors and correlated over…
Individual-level health data are often not publicly available due to confidentiality; masked data are released instead. Therefore, it is important to evaluate the utility of using the masked data in statistical analyses such as regression. In this paper we propose a data masking method which is based on spatial smoothing techniques. The proposed method allows for selecting both the form and the degree of masking, thus resulting in a large degree of flexibility. We investigate the utility of the masked data sets in terms of the mean square error (MSE) of regression parameter estimates when fitt…
Undernutrition, resulting in restricted growth, and quantified here using height-for-age z-scores, is an important contributor to childhood morbidity and mortality. Since all levels of mild, moderate and severe undernutrition are of clinical and public health importance, it is of interest to estimate the shape of the z-scores' distributions. We present a finite normal mixture model that uses data on 4.3 million children to make annual country-specific estimates of these distributions for under-5-year-old children in the world's 141 low- and middle-income countries between 1985 and 2011. We inc…
Numerous studies have examined the associations between long-term exposure to fine particulate matter (PM2.5) and adverse health outcomes. Recently, many of these studies have begun to employ high-resolution predicted PM2.5 concentrations, which are subject to measurement error. Previous approaches for exposure measurement error correction have either been applied in non-causal settings or have only considered a categorical exposure. Moreover, most procedures have failed to account for uncertainty induced by error correction when fitting an exposure-response function (ERF). To remedy these def…
Traditionally health statistics are derived from civil and/or vital registration. Civil registration in low-income countries varies from partial coverage to essentially nothing at all. Consequently the state of the art for public health information in low-income countries is efforts to combine or triangulate data from different sources to produce a more complete picture across both time and space - data amalgamation. Data sources amenable to this approach include sample surveys, sample registration systems, health and demographic surveillance systems, administrative records, census records, he…
Relatively little is known regarding the influence of surveyor traits on respondent behavior. In this paper, we assess the extent to which survey gender modifies average survey responses in the context of health-focused household surveys. We pool data from four recent health-focused household surveys using both male and female surveyors: Burkina Faso (2014), Cameroon (2012), Central African Republic (2012), and Republic of Congo (2014). In all surveys, surveyors were pre-assigned to households based on an initial household listing. We compare responses given to male and female surveyors across…
