Periodic Reporting for period 1 - MU-MED (Measuring and Understanding Mortality, its Exposures, and its Determinants in developing countries)
Reporting period: 2022-09-01 to 2024-08-31
In most low- and middle-income countries (LMICs), data on all-cause mortality are deficient. In addition to public discussion, healthcare decision-making, and policy responses, this constrains scientific understanding of levels, trends, and distribution of mortality (by gender, socioeconomic status, or other key markers of heterogeneity). This project focused on improving mortality estimation in India, the most populous country in the world, and a country with poor population health. The focus was on methodological innovation, using novel data, and investigating inequalities. This research was even more urgent given the paucity of data during the pandemic in most LMICs.
This project provided an assessment of the impact of the COVID-19 pandemic in India, using data collected at regular intervals by the demographic and health surveys. It established that this data was high-quality, and helped provide the first empirical estimates of life expectancy declines during the pandemic in India. It found large impacts of the pandemic – overall life expectancy declined by 2.6 years between 2019 and 2020. The project was also the first to establish that these declines in life expectancy were unequally distributed – female life expectancy declined more than male life expectancy, and marginalized groups experienced greater reductions in mortality. These results point out that pandemics can worsen existing social inequalities in health and mortality in LMICs. They also point to the possibility of measuring mortality reliably in LMIC settings, and in particular highlight the strengths of large-scale surveys that include mortality questions.
In related goals, the project provided methods for mortality estimation using data that asks households to report on recent deaths of household members. The project also assessed if longitudional data collection efforts which track mortality of adults between survey waves can help measure mortality. The outcome for both exercises was yes. In the context of the pandemic, the project also helped assess the reliability and completeness of civil registration data.
These goals are important for society because reducing mortality and improving health are fundamental human objectives. They are included in the sustainable development goals. Similarly, advancing methodologies and data science approaches that can help monitor mortality in low and middle income countries can help guide policy priorities and public discussions.
This project provided an assessment of the impact of the COVID-19 pandemic in India, using data collected at regular intervals by the demographic and health surveys. It established that this data was high-quality, and helped provide the first empirical estimates of life expectancy declines during the pandemic in India. It found large impacts of the pandemic – overall life expectancy declined by 2.6 years between 2019 and 2020. The project was also the first to establish that these declines in life expectancy were unequally distributed – female life expectancy declined more than male life expectancy, and marginalized groups experienced greater reductions in mortality. These results point out that pandemics can worsen existing social inequalities in health and mortality in LMICs. They also point to the possibility of measuring mortality reliably in LMIC settings, and in particular highlight the strengths of large-scale surveys that include mortality questions.
In related goals, the project provided methods for mortality estimation using data that asks households to report on recent deaths of household members. The project also assessed if longitudional data collection efforts which track mortality of adults between survey waves can help measure mortality. The outcome for both exercises was yes. In the context of the pandemic, the project also helped assess the reliability and completeness of civil registration data.
These goals are important for society because reducing mortality and improving health are fundamental human objectives. They are included in the sustainable development goals. Similarly, advancing methodologies and data science approaches that can help monitor mortality in low and middle income countries can help guide policy priorities and public discussions.
The work performed on this project consists of papers on mortality estimation and understanding the impact of the pandemic on life expectancy.
Work already published consists of the paper, “Large and unequal life expectancy declines during the COVID-19 pandemic in India in 2020”, which came out in the journal Science Advances in early 2024. The paper was widely covered in both international and Indian media and generated a lot of commentary. According to altmetric, the paper was in the top 5% of all outputs scored by altmetric, and picked up by as many as 41 news outlets. The paper was also presented at Nuffield college, University of Oxford; annual meeting of the Population Association of America (2023); and New York University Abu Dhabi. The paper documents that data from the demographic and health surveys in India measured mortality reliably – baseline age-specific mortality in 2019 in the DHS was similar to overall levels according to the United Nations Population Division’s World Population Prospects. Substantively, the paper found large declines in life expectancy in India between 2019 and 2020, suggesting that the pandemic had substantial impacts on mortality even before the deadlier second wave of COVID-19 driven by the delta variant in 2021. The project also found unequal impacts – declines in life expectancy among females were larger than declines among men, and declines among marginalized social groups of Indian society were larger than among more privileged social groups. Finally, the project helped establish that infection-fatality ratio from COVID-19 can be higher in LMIC settings than those observed in high income countries. Other work performed during the project and currently under review includes papers on maternal mortality estimation in India and the risk of mortality associated with widowhood. This work was also presented at scientific conferences, including at the European Population Conference 2024.
Another article, “Widow and Widower Mortality in India: A Research Note.” is fortcoming in the journal Demography. It uses longitudinal data from India Human Development Survey to estimate mortality associated with widowhood. It provides the first assement of the mortality impact of widowhood status using longitudinal data from low and middle income settings. It also helps assess the relative advantages of using longitudional survey data for mortality estimation.
Another article, "Indirect effects of the COVID-19 pandemic: A cause-of-death analysis of life expectancy changes in 24 countries, 2015 to 2022. was pulished in PNAS nexus 4. It uses causes of death data from multiple countries to examine how the pandemic impacted direct and indirect mortality by cause. It helps understand how the cause of death profiles changed across multiple countries.
Another article“Externalities of polluting cooking fuels, gender, and adult cognitive health in Low- and Middle-Income countries” was published in the prestigous journal American Journal of Epidemiology. It examines local and household level exposures to environmental harms from pollution and adult cognitive health.
It provides the first assessment of local impacts of polluting fuel use for adult cognitive health, and clarifies mechanisms that cause gender differences in adult cognitive health
Work already published consists of the paper, “Large and unequal life expectancy declines during the COVID-19 pandemic in India in 2020”, which came out in the journal Science Advances in early 2024. The paper was widely covered in both international and Indian media and generated a lot of commentary. According to altmetric, the paper was in the top 5% of all outputs scored by altmetric, and picked up by as many as 41 news outlets. The paper was also presented at Nuffield college, University of Oxford; annual meeting of the Population Association of America (2023); and New York University Abu Dhabi. The paper documents that data from the demographic and health surveys in India measured mortality reliably – baseline age-specific mortality in 2019 in the DHS was similar to overall levels according to the United Nations Population Division’s World Population Prospects. Substantively, the paper found large declines in life expectancy in India between 2019 and 2020, suggesting that the pandemic had substantial impacts on mortality even before the deadlier second wave of COVID-19 driven by the delta variant in 2021. The project also found unequal impacts – declines in life expectancy among females were larger than declines among men, and declines among marginalized social groups of Indian society were larger than among more privileged social groups. Finally, the project helped establish that infection-fatality ratio from COVID-19 can be higher in LMIC settings than those observed in high income countries. Other work performed during the project and currently under review includes papers on maternal mortality estimation in India and the risk of mortality associated with widowhood. This work was also presented at scientific conferences, including at the European Population Conference 2024.
Another article, “Widow and Widower Mortality in India: A Research Note.” is fortcoming in the journal Demography. It uses longitudinal data from India Human Development Survey to estimate mortality associated with widowhood. It provides the first assement of the mortality impact of widowhood status using longitudinal data from low and middle income settings. It also helps assess the relative advantages of using longitudional survey data for mortality estimation.
Another article, "Indirect effects of the COVID-19 pandemic: A cause-of-death analysis of life expectancy changes in 24 countries, 2015 to 2022. was pulished in PNAS nexus 4. It uses causes of death data from multiple countries to examine how the pandemic impacted direct and indirect mortality by cause. It helps understand how the cause of death profiles changed across multiple countries.
Another article“Externalities of polluting cooking fuels, gender, and adult cognitive health in Low- and Middle-Income countries” was published in the prestigous journal American Journal of Epidemiology. It examines local and household level exposures to environmental harms from pollution and adult cognitive health.
It provides the first assessment of local impacts of polluting fuel use for adult cognitive health, and clarifies mechanisms that cause gender differences in adult cognitive health
This project has led to significant progress beyond the state of the art in mortality estimation in low- and middle-income countries, as well as an understanding of its determinants. First, the project establishes the validity and reliability of approaches that ask question on recent deaths of household members, particularly in the south Asian context. This can help guide future efforts to collect mortality data, and provides updated approaches to use already collected data. Second, the project finds large inequalities in mortality by social status and social class in India – these inequalities can be observed across the life course. This has implications for public discussions as well as public policy – and requires societal as well as policy responses. Third, the project advances knowledge on demography and public health aspects of low and middle income countries, which is patchy. Finally, the project empirically documents the impact of the pandemic in India – such studies have been limited in the context of low and middle-income countries, where most estimates rely on extrapolations.