The measurement of adult mortality has also proven to be difficult in Asia. Mortality data simply did not exist in most Asian countries until the mid to late 20th century (Zhao 2011). Data from only 11 Asian populations contributed to the development of the United Nations Model Life Tables for Developing Countries in the early 1980s (United Nations 1982). Since then, the frequency of censuses increased but Asia is still lagging behind in terms of data quality. Demographic and health surveys have also played an important role and managed to fill some of the data gaps. In addition, as in the African region, the UNPD and the WHO have made considerable efforts to evaluate and adjust available data and correct for underreporting and enumeration errors.
The first three plots in Figure 10a, b present adult mortality estimates for males in Asian countries that fall within our classification criterion. These are based on estimates from the World Population Prospects (solid lines). The corresponding regions are Southern Asia, South East Asia, and a few countries in Central and Western Asia.
For countries in these regions, the estimates of the probability 45q15 in the WPP are only available for the period 1995-20103. Data on sibling survival have only been collected in Afghanistan, Nepal, Bangladesh, Cambodia and Timor-Leste. The corresponding estimates appear with dashed lines.
3 Estimates are available from 1980 onwards for countries for which an explicit modeling of HIV/AIDS is made by the UNPD, as is the case in most African countries.
Figure 10a, b. Trends in the probability of male dying between ages 15 and 60, by region, from the 2010 Revision of the World Population Prospects and DHS sibling histories.
A number of countries, mostly in the Southern and Central region, have experienced either a slow decline or no remarkable change in the level of adult mortality in the period 1990-2005, as portrayed by these most recent estimates by the UN. Such countries are Afghanistan, Pakistan, India, Turkmenistan, and Uzbekistan. Afghanistan is the country where life expectancy was estimated at 47 years in 2005-2010 according to the 2010 Revision of the World Population Prospects, faring as the lowest life expectancy at birth in Asia (United Nations 2011b). But there are large uncertainties around these mortality estimates. In the recently released 2012 Revision of the WPP, mortality rates for Afghanistan have been revised downwards, with life expectancy reaching 58 years in 2005-2010. This revision was based on the 2010 Afghanistan Mortality Survey (AMS), in which low levels of child and adult mortality were reported. For example, the trend in adult mortality inferred from sibling data collected in this survey are presented in Figure 10a, b. These estimates should not be taken at face value, however, as several indicators point to poor data quality, such as very high sex
ratios of reported siblings and a large fraction of deaths reported as having occurred exactly 10 years prior to the survey. In addition, approximately 13 percent of the population was not surveyed because of security or other issues.
In order to shed light on the heterogeneous cause-of-death structure that is characteristic of Asia, the percent distribution of adult deaths by cause is displayed in Figure 11 to Figure 12 for both sexes, based on the 2008 WHO estimates of deaths due to diseases and injury (World Health Organization 2011). Adult deaths (15-59) were disaggregated by cause according to the major ICD-10 groupings (World Health Organization 1992) i.e. communicable, non-communicable, and injury deaths. Deaths from “infectious and parasitic diseases” were extracted from communicable diseases to understand their role in the countries under study. HIV and AIDS, and tuberculosis-related deaths were also isolated from the subgroup “infectious and parasitic diseases”
to show their weight in the countries under study.
In general in high mortality Asian countries, factors that have contributed to these high adult mortality trends are wars, social unrest, the collapse of the USSR, the spread of HIV and AIDS and, to a certain extent, a low level of socio-economic development.
In Southern Asia (Figure 11), although these countries are still in the later stage of the epidemiological transition, the high levels of adult mortality can be attributed to non-communicable diseases, although communicable diseases as a whole (including infectious and parasitic diseases) still account for a large share.
Figure 11. Distribution of adult deaths by major cause (%), Southern Asia Authors’own calculations based on WHO 2011 data.
In South-East Asia (Figure 12), communicable diseases -- particularly infectious and parasitic diseases – prevail, with Timor-Leste and Cambodia showing a large burden
0 20 40 60 80 100
Afghanistan Bangladesh Bhutan India Nepal Pakistan
Communicable diseases Infectious and parasitic diseases exc. HIV/TB HIV/TB
Noncommunicable diseases Injuries
due to HIV and TB-related adult deaths. Cambodia and Lao People’s Democratic Republic also exhibit a large share of adult deaths due to non-communicable diseases. A significant burden from injury deaths is present in Myanmar.
Figure 12. Distribution of adult deaths by major cause (%), South-East Asia Authors’ own calculations based on WHO 2011 data.
In Central and Western Asia (Figure 12), adult deaths from non-communicable diseases represent the major killer, according to WHO estimates. Countries that belong to this group are Azerbaijan, Tajikistan, Turkmenistan, Uzbekistan and Yemen. HIV and AIDS, and TB-related deaths occupy the largest share in Tajikistan.
0 20 40 60 80 100
Cambodia Lao People's Democratic
Republic Myanmar Timor-Leste
Communicable diseases Infectious and parasitic diseases exc. HIV/TB HIV/TB
Noncommunicable diseases Injuries
Figure 13. Distribution of adult deaths by major cause (%), Central and Western Asia Authors’own calculations based on WHO 2011 data.