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Try out PMC Labs and tell us what you think. Learn More. The non-confidential information used in this publication, was compiled in accordance with the Information Act of of the Republic of Fiji but which DAMU has no authority to independently verify. The Data Analysis Management Unit of the Ministry of Health and Medical Services cannot and does not represent that the data was appropriate for this publication, or endorse or support any conclusions that may be drawn from the use of the data.

Fiji, a Pacific Island nation ofcensushas experienced a prolonged epidemiological transition. This study examines trends in mortality and life expectancy LE in Fiji by sex and ethnicity over —, with comparisons to published estimates.

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The LE gap between populations, or within populations over time, is examined using decomposition by age. Period trends are assessed for statistical ificance using linear regression. DASRs — were lower for i-Taukei 9. In —17, LE years for males was: i-Taukei Compared to international agency reports, —17 empirical LE estimates males Based on empirical data, LE in Fiji has minimally improved over —, and is lower than some international agencies report. Adult mortality was higher in Indian than i-Taukei men, and higher in i-Taukei than Indian women.

Exclusion of stillbirths resulted in IMRs lower than ly reported. Differing mortality trends in subgroups highlight the need to collect census and health data by ethnicity and sex, to monitor health outcomes and inform resource allocation. Comprehensive, timely measures of mortality and accurate asment of causes of death are fundamental in understanding the health of a population and effectively allocating health resources [ 1 ]. Measures of mortality may be calculated directly from data collected and collated locally, with corrections for biases, or from modelling techniques [ 2 ].

are most accurate if based on complete local deaths and denominators from recently measured populations. Fiji has experienced demographic and epidemiological transitions since the mid-twentieth century, with reductions in infectious diseases leading to mortality decline, increased life expectancy LE and population growth, followed by fertility reduction.

Fiji sex looking for a park

Increased proportional mortality from cardiovascular and other non-communicable diseases NCDs in adults is considered to have contributed to the plateau in LE in Fiji since the mids [ 34 ]. Free, or low cost, public health care, funded through taxation, is provided by: three divisional tertiary caretwo specialist and 17 sub-divisional hospitals; 84 health centres with a medical officer or nurse practitioner ; and 98 nursing stations [ 8 ].

Government funding of health services in Fiji was amongst the lowest of PICs at 2. Cross-sectional studies have shown that Indians have a higher prevalence of hypertension [ 11 ] and type 2 diabetes mellitus T2DM at a lower body mass index BMI than i-Taukei [ 12 ]. Accurate and timely mortality measures based on local empirical data are required to monitor the success of these initiatives. No fee is levied for timely registration of births or deaths, however the requirement for in-person attendance by a family member at the BDM office to complete the legal registration process may create a barrier to completion.

DAMU birth and death records have been assessed as more complete than the civil register [ 1617 ]. The causes of death are quite different between the two halves of the adult age range, and consequently examination of mortality in 15— and 35—year age ranges will better inform targeting of preventative health interventions. The gap, or lack thereof, in LE between populations, or over time within a population, is the sum of positive and negative contributions of age-specific mortality [ 19 ].

Decomposition of the LE gap can identify specific age groups or segments of the population as targets for mortality reduction interventions. When accurately measured, these indicators facilitate monitoring of progress towards Sustainable Development Goal SDG three: ensuring healthy lives and well-being at all ages. BySDG 3. This study estimates age-specific all-cause mortality and LE trends by ethnicity and sex in Fiji over — to assess the extent to which the ly reported plateaux in LEs during — [ 3 ] has persisted, and compares these estimates with published data from other sources.

Age-specific mortality rate contributions to LE are also assessed. In this population-based study, mortality rates by age group, sex and ethnicity are calculated to estimate adult mortality and LE using the hypothetical cohort method [ 21 ]. All deaths occurring in Fiji between January and December and reported to the Fiji MoHMS were analysed according to date of death DoD including deaths recorded in occurring in Whilst the tools used for recording details of deaths changed during —, the process for reporting deaths did not. The NHN is a unique identification used to track and record any interaction of a person with the health system in Fiji, and can be used for confirmation of demographic information, such as age, sex and ethnicity during data entry from the MCCD into electronic systems.

of deaths by sex, summarised by age groups, per triennia bi-Taukei and Indian, Fiji — During the s a separate form was used for recording stillbirthsbut its use was discontinued in Up to foetal deaths ICD P95 per year 0—2. These deaths, clearly identified as stillbirths P95, DoB and DoD identicalwere removed prior to all analyses. Deaths with unknown age were proportionately redistributed.

These comprised 2. During June—December an additional deaths were recorded in the MoHMS database with a DoD between January—December ; mortality data from earlier years were essentially complete at the time of extraction in June Records with the same death certificateDoD, DoB, cause of death, sex and ethnicity were considered duplicates and were removed. The highest of duplicated records occurred in ; de-duplication reduced the deaths by 0. Population denominators are from Fiji Censuses. Populations by ethnicity by 5-year age group and sex were published by the FBoS following the [ 6 ] and Fiji Censuses [ 25 ].

Ethnicity data were not released following the census because of reservations concerning data quality [ 27 ]. Ethnicity projections published by FBoS in [ 7 ] were used to estimate the ethnic composition of the population; this projected an increase in i-Taukei, as a proportion of the total population, from Data on live births per year were available from the MoHMS for — by ethnicity, but not by sex.

In —17, To reduce variation from small event s and enumeration biases, live births, deaths, and populations over — were grouped by triennia, with the most recent period containing four-years —17 to avoid the potential of stochastic variation from analysis of single-year data. Comparisons involving LE hypothetical cohort method are not affected by differing age structures of populations. All other data from present analysis.

Published estimates for life expectancy by sex, Fiji — Infant mortality and under-five mortality rates, total, i-Taukei and Indian, Fiji — Deaths corrected for removal of stillbirths and duplicates. Births: average per year. Births by sex not available. CI confidence interval. U5M was lower in Indians than i-Taukei, with a narrowing gap during — Adult mortality, life expectancy, age standardised rates by age group, ethnicity, sex. Fiji — Over —, LE at birth increased in i-Taukei males 0.

For the total population, LE increased 1. Decomposition of differences in life expectancy between and 98 and —17, and between populations in — Total includes i-Taukei, Indian, others. LE: Life expectancy. Grey bars show the estimated LE deficit contributed by age-specific mortality of each 5-year age group to the LE gap between populations. Each panel displays the decomposition of the LE gap between the first entity and the second entity named by convention.

For females, the positive contributions to the LE improvement come from reduced mortality in most 5-year age groups but are offset by negative contributions in the 30— and 50—years age ranges, resulting in a smaller overall increase in LE compared to males.

Higher mortality in every 5-year-age group in the male population contributes to the LE gap between the sexes not shown in Fig. Published agency trends of LE at birth by sex are higher than from empirical data in this study Fig. Following the census, estimates of LE at birth for males was: studies reported declines in IMR from to —98, with larger declines in Indians compared with i-Taukei, resulting in similar IMRs for both ethnicities by —98 [ 3 ].

In this study, the IMR decline continued over —, with an interruption during —07, and stability since Changes in foetal death-recording practices and electronic mortality recording systems may have contributed to inclusion of foetal deaths in mortality data and artefactually elevated IMRs reported elsewhere. During — the stillbirth form was not in use, with stillbirths identified on a new MCCD only after Since live births are consistent with those in this study, differences are likely due to under-enumeration of infant deaths in the MoHMS HSR from late recording of deaths, after publication of annual reports.

Fiji sex looking for a park

For young adult women, the probability of death remained low, and similar for i-Taukei and Indians from to 98 to —17, however decomposition of the LE gap highlights higher mortality at 30—years for i-Taukei offset by higher mortality at 15—years for Indians.

The cause of death structure of these differences requires investigation. Trends in mid-age adult mortality over — differ by sex and ethnicity; reporting mortality only for the total population by sex, rather than by sex and ethnicity, obscures these divergences.

Explanations for differing mortality trends by sex and ethnicity in the 35—59 age group may reflect risk factor prevalence trends [ 42 ]. Decomposition of LE gaps between and 98 and —17 shows differing age contributions by sex and ethnicity.

Decomposition of the LE gap by cause of death will further inform contributions to these LE gaps. The LE plateau ly reported for both ethnicities and sexes in Fiji, based on analysis of death records to [ 3 ] has continued to For the total male population, LE increased more than in each ethnic group individually; the increase can be partially attributed to i-Taukei, with a higher LE, making up a larger proportion of the total male population in compared to However, the report includes an estimated population of , [ 37 ] based on projected average intercensal annual population increases of 1.

The use of these higher population estimates for calculating mortality rates would partly for the higher LE estimates than in the present analysis. Late registration of deaths is noted as a limitation in the Vital Statistics Report, [ 16 ] with deaths recorded forcompared with deaths here, due to late death registrations. This demonstrates a source of considerable inaccuracy that can arise from premature use of death data which is under-registered.

While LE estimated in this study from empirical death data are lower than estimated by GBD, both sources show stagnation in LE over recent decades. The MoHMS National Strategic Plan — targets ificantly increasing the of nurses, doctors and other health workers [ 41 ]. The top three causes of mortality as reported by the MoHMS remain diseases of the circulatory system, endocrine and metabolic conditions mostly diabetesand neoplasms [ 3738 ]. ificant increases in the prevalence of high blood pressure in both sexes and both ethnicities occurred between and [ 11 ].

T2DM prevalence [ 12 ] and incidence [ 13 ] also increased in Fiji between and Tobacco smoking in both sexes and ethnicities decreased over —, with most of the reduction occurring before for i-Taukei men, after which prevalence formed a plateau; whilst for Indian men the decline continued until [ 43 ]. Mortality and LE trends from cardiovascular disease, T2DM and lung cancer are the result of cumulated exposure to risk factors over decades; and based on reported trends in risk factors the current plateau in LE is expected to continue.

This analysis utilises more complete primary data than ly employed for published estimates of mortality and LE in Fiji and uses Fiji census data as denominators, which enumerated a smaller population than ly projected.

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