DEMOGRAPHY and VITAL

STATISTICS

M. Sakundarno Adi, MD,MSc

Demography is scientific study of

human population
It focuses on 3 phenomena:

Changes in population size

Composition of population
Population distribution in space

Important demographic processes include: fertility,

mortality, marriage, education & social mobility
In a broader sense, additional characteristics such as :
- ethnicity (race, mother tongue),
- social characteristics (marital status, literacy, educational
attainment, womens status),
- economic characteristics (employment status, occupation,
income)

need to be considered when describing population

characteristics

Demographic data include those

variables that describe the
characteristics of a population (i.e.,
population size and how it changes
over time)

Vital Statistics (Events)

Include:
Births
Deaths
Marriages
Divorces

Demographic data and vital statistics are

useful tools in:
- Determining a communitys health status
- Deciding whats the best way for providing health services
- Planning a public health program
- Evaluating a programs effectiveness

SOURCES OF DEMOGRAPHIC STATISTICS

Census
National Survey
Registration of vital events
Demographic Studies

Population Studies:
Population studies are concerned
not only with population variables but
also with relationships between
population changes & other variables
social, economic, political,
biological, genetic, geographical,
environmental, health & the like

Definition of key words:

Size refers to the number persons in the population
Distribution refers to the arrangement of the
population in space at a given time

Structure is the distribution of population among its

sex & age groupings

Change

is the growth or decline of the total

population or one of its structural units. The
components of change total population are births,
deaths, & migrations

Definition of key words:

Age-Sex Composition of a population

refers to the proportion of males & females in different agegroups. It has a direct bearing on social, economic, health
needs of communities or countries. In an old population,
for example, the society has to arrange for the care of the
elderly, & the countrys health system must be organized
accordingly. In a young population, on the other hand, the
country has to provide more schools, immunizations, &
economic support for the young

Net-Migration

refers to the total number of persons

added or subtracted from a population as a result of the
combined effect of immigration & emigration

Definition of key words:

Urbanization refers to mass migration of rural population
into urban centers resulting in increasing the urban
population & growth of cities

Population Growth Rate (%/ year) is the rate at which a

given population is expected to increase in a given period of

time.

Population Doubling Time refers to the time that would

take for a population to double. Because the population

increase is on the compound interest formula, a 1% per year
increase would cause the population to double in about 70
years. If the population is increasing at 3% per year, than
the doubling time will be 23.3 years

Definition of key words:

Population Pyramid is a pictorial presentation of the age-sex
composition of a population

Replacement Level Fertility (or Zero population growth) is activated

when a couple has two births during their reproductive life, just
enough to replace themselves. At a community scale, the replacement level
is considered when there are, on the average, 2.1 births per woman, to
compensate for child deaths

Momentum of Population Growth is the characteristic of population

growth when a sharp decline in births does not bring in an immediate
reduction in natural increase

There are four ways in which the number of people in an

area can change during two time periods t 0 & t1
Pt1 = Pto + (B D) + (IM OM)
B = number of live births to mothers in the area
D = number of residents died
IM = number of persons moving into the area fro permanent
residence
OM = number of persons moving out of the area to live elsewhere
Thus the population of an area may change due to natural
reasons (B D) known as natural increase or due to
migration (IM OM) known as net-migration. Subsequently:
Population Growth = Natural Increase + Net Migration

While characteristic is an attribute of an individual ( e.g. male,

young, healthy, employed etc), composition is a property of a
group of people. It describes how the total given population is
constituted (e.g. 51% males, 20% below age 5, 85% healthy 7&
30% employed etc).
Dependency Ratio is an index summarizing an age
distribution. Strictly, this is the ratio of population who are
economically not active to those who are economically active.
However, due to the difficulties in defining economic activity in
many countries, especially when international comparisons
are made, a ratio of age group is used instead:

Population Composition (Contd)

Dependency Ratio
= Children + Elderly X 100
Working Age
= Pop below 15 + 65 & above X 100
Pop 15 64 years
Dependency Ratio of Pakistan = 95.1
Dependency Ratio of UK
= 66.5
Sex Ratio: The overall sex ratio is simply the ratio of males to females
in the population & is calculated by taking the number of males in a
population & dividing it by the number of females in the same population
Sex Ratio = Number of Males X 100
Number of Females

Demographic Cycle
World history suggests that every nation passes through
a demographic cycle. The stages are:

1. High Stationary Stage: characterized by

rate and high death rate

high birth

2. Early Expanding: The death rate begins to decline

while birth rate remains unchanged

3. Late Expanding: The death rate declined still further

and birth rate tend to fall

4. Low Stationary Stage: Low birth and low death rates

5. Declining Stage: birth rate is lower than the death rate
and population starts declining

 Old Balance: (High fertility & High Mortality)

A large supply of births was necessary to compensate for
the large number of deaths. MMR & IMR extremely high
New Balance: (Low fertility & Low Mortality)
Represents an improved condition of human efficiency &
health, with fewer deaths considerably less efforts
required to bring a generation to maturity. Production of
agricultural & industrial commodities is greater & life style
is more comfortable
Imbalance: (High Fertility & Low Mortality)
In between old & new balance is the period of rapid natural
increase. This growth is helpful for under-populated
nations. Too fast growth of population leading economic,
social & political chaos ( being faced by numerous
developing countries including Pakistan)

Birth Rates Death Rates

Natural
Increase

Example
Europe prior to 15th
century, most other
developing countries till
the 19th century

High

High

Zero to
very slow

High

Declining

Slow

Europe 17th century,

India 1930s 40s

High

Low

Rapid

Europe 18th century,

Pakistan 1970s

Declining

Low

Slow

Europe 19th century, East

Asian countries in the mid
20th century

Low

Low

Zero or
very slow

Europe, Japan & USA

The Demographic Transition

in Developed and Developing Countries

Vital Statistics Rates, Ratios, and

Proportions
Three rates used in vital statistics:
Crude rates - computed for an entire population
Specific rates - consider differences among
subgroups, computed by age, race, sex or other
variables.
Adjusted (standardized) rates - to make valid
summary comparisons between two or more
groups with different age (or other) distributions.

Measures of Mortality
Each rate is a measure of the relative frequency of
deaths that occurred in a given population over a
specific time period (time at risk).
Population size is usually defined as the population
at midyear (July 1).
These measures estimate the population at risk
(a+b)/time(t) of one year. If this convention cannot
be met, then the calculation should really be
considered a proportion rather than a rate.

Measure of Mortality:
Annual Crude Death Rate
Universally used as generalized indicator of a
populations health.
May not be truly reflective without accounting for
age, race, or sex.
Example:
State, Yr - population: 5000; deaths: 25
Crude Death Rate = (25/5000)
= 5 deaths per 1000 population per year

Measure of Mortality:

Age-Specific Death Rate

Defined as the number of deaths in a specific age
group in a calendar year, divided by the population
of the same age group on July 1 of that year, the
quotient multiplied by 1000.

Example:
Country, Yr - age group: 25-34 yrs; population: 5,000,000;
deaths: 200,000
Age-specific death rate= (200,000/5,000,000)
= 40 deaths per 1000 population per year for age
group 25-34

Measure of Mortality:

Cause-Specific Death Rate

Defined as the number of deaths assigned to a specific
cause in a calendar year, divided by the population on
July of that year, the quotient multiplied by 100,000
Example:
Country, Yr - cause: accidents; population: 5,000,000;
deaths: 4,000
Cause-specific death rate= 4,000/5,000,000
= 80 accidental deaths per 100,000 population per year

Measure of Mortality:

Proportional Mortality Ratio

Defined as the number of deaths assigned to a specific
cause in a calendar year, divided by the total number of
deaths in that year, the quotient multiplied by 100
Example:
Country, Yr - total deaths from all causes: 1,500,000; deaths from
cancer: 675,000
Proportional mortality ratio= 675,000/1,500,000
= 45% of total deaths per year from cancer

Measure of Mortality:

Infant Mortality Rate

Defined as the number of deaths of persons age 0-1 in
a calendar year, divided by the number of live births in
that year, quotient multiplied by 1000
Example:
State, Yr - live births: 325,000; infant deaths: 1,750
Infant mortality= 1,750/325,000
= 5.4 infant deaths per 1000 live births per year

Measure of Mortality:

Maternal Mortality Ratio*

Defined as the number of deaths assigned to puerperal
causes (i.e., childbearing) in a calendar year divided by
the number of live births in that year, the quotient
multiplied by 100,000.
Example:
Country, Yr - deaths due to puerperal causes: 275; live births:
1,750,000.
Maternal mortality ratio: 275/1,750,000
= 15.71 maternal deaths per 100,000 live births per
year

Measure of Mortality:

Neonatal Mortality Proportion

Defined as the number of deaths of neonates
(infants <28 days of age) in a calendar year,
divided by number of live births in that year, the
quotient multiplied by 1000
Example:
State, Yr - deaths at <28 days=2,750; live births: 325,000
Neonatal mortality proportion= 2,750/325,000
= 8.5 neonatal deaths per 1000 live births

Measure of Mortality:

Fetal Death Ratio

Defined as the number of fetal deaths in a
calendar years, divided by the number of live
birth in that year, the quotient multiplied by
1000.
Example:
State, Yr - fetal deaths: 2,450; live births: 525,000
Fetal death ratio = 2,450/525,000
= 4.7 fetal deaths per 1000 live births

Measure of Mortality:

Perinatal Mortality Proportion

Defined as the number of fetal plus neonatal deaths,
divided by the number of live births plus fetal deaths,
the quotient multiplied by 1000
Example:
State, Yr - fetal deaths: 3,250; neonatal deaths: 5,750;
live births: 475,000
Perinatal mortality proportion= (3,250+5,750/475,000+3,250)
= 18.8 perinatal deaths per 1000 fetal deaths plus live births

Measure of Fertility:

Crude Birthrate
Defined as the number of live births in a calendar year,
divided by the population at July 1 of that year, the
quotient multiplied by 1000
Example:
State, Yr - live births: 250,000; population: 30,000,000
Crude birthrate= 250,000/30,000,000
= 8.3 live births per 1000 population per year

Measure of Fertility:

General Fertility Rate

Defined as the number of live births in a calendar year,
divided by the number of women ages 15-44 at midyear,
quotient multiplied by 1000
Example:
Country, Yr - live births: 7,500,000; number of women ages 15-44:
35,000,000
General fertility rate= 7,500,000/35,000,000
= 214.3 live births per 1000 women ages 15-44 per year

Measure of Morbidity:

Incidence Rate
Defined as the number of newly reported cases of a
given disease in a calendar year, divided by the
population on July 1 of that year, the quotient multiplied
by either 1000, 100,000, or 1,000,000 (whatevers
convenient).
Example:
State, Yr - new cases of AIDS reported: 5,250;
population: 35,000,000
Incidence rate: 5,250/35,000,000
= 15 new AIDS cases per 100,000

Measure of Morbidity:

Prevalence Proportion
Defined as the number of existing cases of a given
disease at a given time, divided by the population at
that time, the quotient multiplied by 1000, 100,000, or
1,000,000 (whatevers convenient)
Example:
Country, Yr - number of men alive with AIDS: 3,750;
population: 15,000,000 men
Prevalence proportion= 3,750/15,000,000
= 25 AIDS cases per 100,000 men

Measure of Morbidity:

Case-Fatality Proportion
Defined as the number of deaths assigned to a given
cause in a certain period, divided by number of cases of
the disease reported during the same period, the quotient
multiplied by 100.
Example:
Country, Yr - report number of male AIDS cases: 45,000; deaths
from the disease: 37,000.
Case-fatality proportion: 37,000/45,000
= 82.2% mortality among reported cases of AIDS

Adjustment of Rates
(or, Rate Adjustment)
Adjusting, or standardizing, rates is used to make valid
comparisons between populations that may differ in
some significant way (i.e., age distribution).
Standardized rates have no meaning in isolation, since
adjusted rates are artificial.
Depending on type of data - there are two methods to
adjust rates - direct (preferred) and indirect.
The numerical values of the adjusted rates depend on
the choice of the standard population.