Iranian Journal of Public Health 2018. 47(6):794-802.

Influence of Key Health Related Indicators on Adult Mortality: Result from UN Member Countries
Chhabi Lal RANABHAT, Myung-Bae PARK, Chun-Bae KIM, Chang-Soo KIM, Hyoung-Sun JEONG, Sang Baek KOH, Sei-Jin CHANG



Background: Adult mortality is associated with different demographic and behavioral risk factors including approaches to health care financing. Adult mortality rate significantly reflects the effectiveness of public health-related program and intervention. The aim of this study was to find strength of association between key health's related indicators and adult mortality rate.

Methods: This cross-sectional study used 5 sets of data combined into one from different organizations of 193 countries using record linkage theory. Eleven key health-related indicators were taken as independent variables and adult mortality of male and female were dependent variables from 2010 to 2013. Average mortality for male and female was shown by means and standard deviations, raw association by Pearson correlation and strength of association by hierarchical linear regression.

Results: The average adult mortality rate (AMR) of male was 0.209±0.106 and of female, 0.146 ±0.105 in years. In raw correlation, almost all health indicators were associated with AMR of male and female. In regression analysis, Universal Health Coverage (UHC) significantly reduced (male ~0.43, female ~0.30) adult mortality, in contrast, population growth significantly increased (male ~ 0.37, female ~0.43). Alcohol consumption per year increased AMR in male by 0.41 (P<0.01) and vaccination coverage (DPT 3) significantly reduced the AMR (0.26) in female.

Conclusion: It is necessary to extend the UHC in remaining countries and still a need to control the population where there is high population growth. Effectively control of alcoholic drink in male and full coverage of vaccination in childhood mitigates adult mortality. The UHC is ambitious goal for SDG and special attention should be provided nationally and globally




Adult mortality rate, Health indicators, Universal health coverage, Record linkage

Full Text:



Yamano T, Jayne TS (2004). Measuring the impacts of working-age adult mortality on small-scale farm households in Kenya. World Development, 32(1): 91-119.

Case A, Ardington C (2006). The impact of parental death on school outcomes: Longitudinal evidence from South Africa. Demography, 43(3): 401-20.

Evans DK, Miguel E (2007). Orphans and schooling in Africa: A longitudinal analysis. Demography, 44(1): 35-57.

Ainsworth M, Dayton J (2003). The impact of the AIDS epidemic on the health of older persons in northwestern Tanzania. World Development, 31(1): 131-48.

Kautz T, Bendavid E, Bhattacharya J, Miller G (2010). AIDS and declining support for dependent elderly people in Africa: Retrospective analysis using demographic and health surveys. BMJ, 340: c2841:1-6.

Chao L-W, Pauly M, Szrek H et al (2007). Poor health kills small business: Illness and microenterprises in South Africa. Health Aff (Millwood), 26(2): 474-82.

Rajaratnam JK, Marcus JR, Levin-Rector A et al (2010). Worldwide mortality in men and women aged 15–59 years from 1970 to 2010: A systematic analysis. Lancet, 375(9727): 1704-20.

World Bank (2013). Mortality rate, adult, male (per 1,000 male adults).

World Bank (2013). Mortality rate, adult, female (per 1,000 female adults).

Sartorius B, Kahn K, Collinson MA et al (2013). Dying in their prime: Determinants and space-time risk of adult mortality in rural South Africa. Geospat Health, 7(2): 237-49.

Gregg EW, Cheng YJ, Saydah S et al (2012). Trends in death rates among US adults with and without diabetes between 1997 and 2006: Findings from the national health interview survey. Diabetes Care, 35(6): 1252-7.

Hill K (2003). Adult mortality in the developing world: What we know and how we know it: UN.

Rogers RG, Crimmins EM (2011). International Handbook of Adult Mortality: Springer Science & Business Media.

Norman R, Matzopoulos R, Groenewald P, Bradshaw D (2007). The high burden of injuries in South Africa. Bull World Health Organ, 85(9):695-702.

Pilav A (1999). Health status indicators and the importance of their use in daily practice. Med Arh, 53(3 Suppl 3):51-3.

Schirnding Yv (2002). Health in Sustainable Development Planning: The Role of Indicators. Geneva: World Health Organization.

Saikia N, Bhat PM (2008). Factors affecting adult mortality in India: An analysis of National Family Health Surveys of 1992-93 and 1998-99 (NFHS I and II). Demography India, 37(2): 291-302.

Ram U, Jha P, Gerland P et al (2015). Age-specific and sex-specific adult mortality risk in India in 2014: Analysis of 0.27 million nationally surveyed deaths and demographic estimates from 597 districts. Lancet Glob Health, 3(12): e767-75.

Naghavi M, Wang H, Lozano R et al (2015). Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet, 385(9963): 117-71.

Misganaw A, Mariam DH, Araya T (2013). Association of socioeconomic and behavioral factors with adult mortality: Analysis of data from verbal autopsy in Addis Ababa, Ethiopia. BMC Public Health, 13: 634-45.

Setel P, Kitange H, Alberti K, Moshiro C (1998). The policy implications of adult morbidity and mortality in Tanzania: From data analysis to health policy—preliminary experiences. Global Forum for Health Research (Forum 2).

Pensola TH, Martikainen P (2003). Cumulative social class and mortality from various causes of adult men. J Epidemiol Community Health, 57(9): 745-51.

Rogers RG, Everett BG, Saint Onge JM, Krueger PM (2010). Social, behavioral, and biological factors, and sex differences in mortality. Demography, 47(3): 555-78.

Bostock S, Steptoe A (2012). Association between low functional health literacy and mortality in older adults: Longitudinal cohort study. BMJ, 344: e1602:1-10.

Clark D, Roayer H (2013). The effect of education on adult mortality and health: Evidence from Britain. Am Econ Rev, 103(6): 2087-120.

Ranabhat CL, Kim CB, Park MB, Acharaya S (2017). Multiple disparities in adult mortality in relation to social and health care perspective: Results from different data sources. Global Health, 13(1): 57-65.

Moreno-Serra R, Smith P (2011). The effects of health coverage on population outcomes: a country-level panel data analysis. Washington, DC: Results for Development Institute.

Schmidt S, Power M, Bullinger M, Nosikov A (2005). The conceptual relationship between health indicators and quality of life: results from the cross‐cultural analysis of the EUROHIS field study. Clin Psychol Psychother, 12(1): 28-49.

De Andrade LOM, Filho AP, Solar O et al (2015). Social determinants of health, universal health coverage, and sustainable development: Case studies from Latin American countries. Lancet, 385(9975): 1343-51.

Dunn HL (1946). Record Linkage. Am J Public Health Nations Health, 36(12): 1412-6.

Jutte DP, Roos LL, Brownell MD (2011). Administrative record linkage as a tool for public health research. Annu Rev Public Health, 32: 91-108.

World Bank (2015). Data.

World Health Organization (2014). Global Health Observatory (GHO). World Health Organization.

World Health Organization (2010). WHO Global Information System on Alcohol and Health (GISAH). Geneva.

Stuckler D, Feigl AB, Basu S, McKee M (2010). The Political Economy of Universal Health Coverage. Background paper for the global symposium on health systems research, World Health Organization, Geneva.

Yang YC, McClintock MK, Kozloski M, Li T (2013). Social isolation and adult mortality: The role of chronic inflammation and sex differences. J Health Soc Behav, 54(2): 183-203.

Suzuki E, Kashima S, Kawachi I, Subramanian S (2012). Social and geographic inequalities in premature adult mortality in Japan: A multilevel observational study from 1970 to 2005. BMJ Open, 2(2): e000425:1-11.

Galor O (2012). The demographic transition: Causes and consequences. Cliometrica (Berl), 6(1): 1-28.

Bongaarts J (2009). Human population growth and the demographic transition. Philos Trans R Soc Lond B Biol Sci, 364(1532): 2985-90.

Gribble JN (2012). World Population Data Sheet 2012. Washington, DC: Population Reference Bureau.

Moreno-Serra R, Smith PC (2012). Does progress towards universal health coverage improve population health? Lancet, 380(9845): 917-23.

Ranabhat CL, Kim CB, Singh DR, Park MB (2017). A comparative study on outcome of government and co-operative community-based health insurance in Nepal. Front Public Health, 5: 250:1-9.

Plunk AD, Syed‐Mohammed H, Cavazos‐Rehg P et al (2014). Alcohol consumption, heavy drinking, and mortality: Rethinking the J‐Shaped curve. Alcohol Clin Exp Res, 38(2): 471-8.

Ranabhat CL, Kim CB, Park MB, Bajgai (2018) J. Impact of Spiritual Behavior on Self-Reported Illness: A Cross-Sectional Study among Women in the Kailali District of Nepal. J of Lifestyle Med. 8(1):23.

Rehm J, Baliunas D, Borges GL et al (2010). The relation between different dimensions of alcohol consumption and burden of disease: An overview. Addiction, 105(5): 817-43.

Majer JM, Rodriguez J, Bloomer C, Jason LA (2014). Predictors of HIV-risk sexual behavior examining lifetime sexual and physical abuse histories in relation to substance use and psychiatric problem severity among ex-offenders. J Am Psychiatr Nurses Assoc, 20(2): 138-46.

Burnhams NH, Parry C, Laubscher R, London L (2014). Prevalence and predictors of problematic alcohol use, risky sexual practices and other negative consequences associated with alcohol use among safety and security employees in the Western Cape, South Africa. Subst Abuse Treat Prev Policy, 9: 14:1-10.

Aaby P, Ravn H, Roth A et al (2012). Early diphtheria-tetanus-pertussis vaccination associated with higher female mortality and no difference in male mortality in a cohort of low birthweight children: An observational study within a randomised trial. Arch Dis Child, 97(8): 685-91.

Aaby P, Benn C, Nielsen J et al (2012). Testing the hypothesis that diphtheria–tetanus–pertussis vaccine has negative non-specific and sex-differential effects on child survival in high-mortality countries. BMJ Open, 2(3): e000707.


  • There are currently no refbacks.

Creative Commons Attribution-NonCommercial 3.0

This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.