Decadal transition of adult mortality pattern at Ballabgarh HDSS: evidence from verbal autopsy data

Sanjay Kumar Rai, Arti Gupta, Rahul Srivastava, Mohan Bairwa, Puneet Misra, Shashi Kant, Chandrakant S. Pandav

Mortality levels and patterns are significant indicators of population health, and are of importance to prioritize the goals of health systems and efficient resource allocation. We ascertained the decadal transition of mortality pattern in adult population aged 15 years and above during the years 2002-2011. All adult deaths aged 15 years and above during the years 2002 to 2011 were included in the study. Cause of death was ascertained by verbal autopsy tool for adults which is a validated questionnaire developed at Ballabgarh Health and Demographic Surveillance System (HDSS). Cause and age specific mortality, and mean age at death was determined for individual years. A total of 4,276 deaths (≥15 years) occurred in the Ballabgarh HDSS during the years 2002 to 2011. Of these, 96.8 % deaths were investigated using verbal autopsy tool. Of total deaths investigated, 60.6 % were males. Cardiovascular diseases (19.6 %) were the leading cause of death, followed by respiratory diseases (16.5 %). In the age group of 15-59 years, the most common cause of mortality was external causes of mortality (28.9 %). Most common cause of death was senility (20.8 %) in females, whereas cardiovascular diseases were commonest cause (19.6 %) in males. Road traffic injuries contributed 6.7 % deaths in males compared to 1.5 % in females. Over the years, the proportions of mortality due to cardiovascular diseases had increased (12.6 % to 18.8 %). Mortality proportions had decreased for infectious diseases (12.1 % to 9.5 %) and respiratory diseases (24.7 % to 10.9 %). Mortality due to neoplasms remained nearly stagnant (6.6 % to 6.4 %). Mean age at death due to cardiovascular diseases and neoplasm had increased from 57 years (95 % CI: 52.2-62.9) to 62 years (95 % CI: 59.2-65.4) and 58 years (95 % CI: 53.1-63.2) to 62 years (95 % CI: 57.0-66.7), respectively, during the decade. Mean age at death had decreased for road traffic injuries and infectious diseases from 41 years (95 % CI: 31.7-50.8) to 39 years (95 % CI: 34-43.4) and 53 years (95 % CI: 48.3-58.6) to 50 years (95 % CI: 44.1-55.8), respectively over the years. Mortality surveillance using verbal autopsy tool revealed a transition in cause specific deaths from respiratory diseases to cardiovascular diseases over the decade. The apparent epidemiological transition in the community demands reorientation of healthcare priorities.