MINISTRY OF HEALTH OF THE REPUBLIC OF MODOVA

NICOLAE TESTEMITANU STATE UNIVERSITY OF MEDICINE AND PHARMACY

OF THE REPUBLIC OF MOLDOVA
Nicolae Testemitanu
Department of Social Medicine and Health Management

Olga Penina, Elena Raevschi

OVERVIEW OF DEMOGRAPHY
Methodological Recommendations for the Course in Social Medicine & Health Management
for Medical Students

CHISINAU 2015

[CZU 616-058+614.2] (076)

P50

Recommended to printing by Central Methodology Council of Nicolae Testemitanu State

University of Medicine and Pharmacy , minutes nr. 1 of 15.10.2015

Author:
Olga PENINA

PhD, Nicolae Testemitanu Department of Social Medicine and

Health Management, Nicolae Testemitanu State University of
Medicine and Pharmacy
Elena RAEVSCHI PhD, MPH, associate professor, Nicolae Testemitanu Department of Social
Medicine and Health Management, Nicolae Testemitanu State University of
Medicine and Pharmacy
Resposible Editor:
Dumitru TINTIUC Head of the Department of Social Medicine and
Health Management Nicolae Testemitanu, University of
Medicine and Pharmacy Nicolae Testemitanu
PhD, professor

Reviewers:
Gheorghe PALADI Academician, PhD, professor, Department of Obstetrics and Gynecology,
Nicolae Testemitanu State University of Medicine and Pharmacy
Galina BUTA

PhD, associate professor, School of Public Health, Nicolae Testemitanu State

University of Medicine and Pharmacy

Methodology recommendations Overview of Demography are intended for the course Social
Medicine and Health Management. The booklet focuses on the basics of demography with a special
attention paid to the demographic analysis of mortality as the principle tool for population health
research. The paper is prepared in accordance with the discipline syllabus and includes a series of
practical exercises with regard to the analysis of the main demographic processes (mortality, fertility
and migration) and population structure by sex and age. The booklet is recommended both for medical
students (Faculty Medicine 2) for their homework and lecturers of the course Social Medicine and
Health Management.

Contents
PART I. INTRODUCTION TO DEMOGRAPHY.................................................................................................... 4
1.

Definition of demography ................................................................................................................... 4

2.

Demographic states, events and processes ........................................................................................ 4

3.

The basic demographic equation (balancing equation) ...................................................................... 5

4.

Natural increase, net migration and population growth .................................................................... 6

5.

Demographic rate................................................................................................................................ 7

6.

Four basic demographic rates ............................................................................................................. 8

7.

Crude rate of natural increase, crude rate of net migration and population growth rate ................. 8

8.

Other demographic measures............................................................................................................. 9

9.

Data sources ........................................................................................................................................ 9

10.

International Classification of Diseases and Causes of Death....................................................... 11

Practical exercises on Part I Introduction to Demography .................................................................... 12

Control questions on Part I Introduction to Demography ..................................................................... 13
PART II. POPULATION STRUCTURE BY SEX AND AGE .................................................................................... 15
1.

Population pyramid ........................................................................................................................... 15

2.

Interpretation of the shape of population pyramid .......................................................................... 15

3.

Population pyramids in developing and developed countries.......................................................... 16

4.

Types of population pyramid ............................................................................................................ 17

5.

Dependency ratio .............................................................................................................................. 18

Practical exercise on Part II Population Structure by Sex and Age ........................................................ 18

Control questions on Part II Population Structure by Sex and Age ....................................................... 19
PART III. ANALYSIS OF MORTALITY................................................................................................................ 20
1.

Types of death rates .......................................................................................................................... 20

2.

Specific death rates ........................................................................................................................... 20

3.

Age-standardized death rates ........................................................................................................... 21

4.

Special death rates: perinatal and infant death rates....................................................................... 22

5.

Life expectancy and life tables .......................................................................................................... 24

Practical exercises on Part III Analysis of Mortality ............................................................................... 25

Control questions on Part III Analysis of Mortality ................................................................................ 25
Bibliography .................................................................................................................................................. 26
3

PART I. INTRODUCTION TO DEMOGRAPHY

LEARNING OBJECTIVES:
- to understand the difference between demographic states, events and processes
- to be able to use the basic demographic equation
- to understand the basic demographic measures, including demographic rates
- to calculate the basic demographic rates
- to calculate crude rate of natural increase, crude rate of net migration and crude growth rate
- to understand the main data sources
- to know about the International Classification of Diseases and Causes of Death

1. Definition of demography
The word Demography is a combination of two Greek words literally meaning description of the
people. It was first used in 1855 by the Belgian statistician Achille Guillard in his book Elements of
Human Statistics or Comparative Demography.
There are various definitions of demography. Broadly speaking, demography is the study of
human populations (McFalls, 1998). Demographers use the term population to denote the collection
of persons alive at a specified moment in time who meet certain criteria. Thus, they may refer to
Population of the Republic of Moldova on January 1, 2015 or Population of males with higher
education from the Republic of Moldova on January 1, 2015.
Demography studies the structure of a population (by sex, age, education, etc.) and
demographic processes.

2. Demographic states, events and processes

People constituting a population can be described by certain characteristics, i.e. people are being in
certain demographic states. Examples of demographic states include: being alive, living alone or
together with a partner, being married or divorced, living in a country of origin or in a host country, etc.
Demographic event is a transition from one demographic state to another. Examples of
demographic events include: death (i.e. a transition from the state of being alive to the state of being
dead), birth, migration, marriage, divorce, motherhood, etc.
The concept of event is based on assumption that there is a specific moment in time at which this
event occurs (e.g., we know the exact day, month and year of death).
Demographic events can be repeatable (can occur more than once) and non-repeatable (can
occur only once).
Examples of non-repeatable demographic events are as follows. Death is a non-repeatable
demographic event since it occurs only once. Birth by rank (order) of event is also a non-repeatable
demographic event, since a woman can give a birth to the first child, to the second child etc. only once.
Other examples of non-repeatable demographic events include: marriage by rank of event (e.g., first
marriage, second marriage, etc.), divorce by rank of event, etc.
4

Examples of repeatable demographic events include: birth without fixing the rank of event (i.e.
all births a woman had during her life), divorce without fixing the rank of event (i.e. all divorces a
woman or a man had during her/his life) etc.
Demographic process is a sequence of the same demographic events. There are five demographic
processes: fertility, mortality, migration, nuptiality and divorce (see Table 1).
Table 1. Five demographic processes with the corresponding demographic events
Demographic process
Fertility
Mortality
Migration
Nuptiality
Divorce

Demographic event
Birth
Death
In-migration (or immigration)
Out-migration (or emigration)
Marriage
Divorce

Thus, mortality as a demographic process consists of demographic events named deaths. Fertility
as a demographic process is a sequence of demographic events named births, etc.
Demographers distinguish three main demographic processes: mortality, fertility and migration
because these three processes can influence directly on population size (population number).
Nuptiality and divorces are NOT considered to be the main demographic processes, since they do not
have a direct impact on population size, though they can influence fertility.

3. The basic demographic equation (balancing equation)

Let us consider the population of a country (Figure 1). There are two ways of entering a population:
birth and in-migration (immigration). Likewise, there are only two ways of leaving a population: death
and out-migration (emigration).

Figure 1. Graphic presentation of a balancing equation

The size of population at any given moment in time t ( ) is the size of the initial population at
time 0 ( ) plus the number of births (
) and in-migrations ( ) between time 0 and t and minus the
number of deaths (
) and out-migrations (
) between time 0 and t. This equation is often referred
to as the basic demographic equation, or sometimes, as the demographic balancing.

It says that a countrys population size can only change because of three types of events: births,
deaths and migration (in-migration and out-migration). These three events are known as components
of population change.
For example, to calculate the size of the population on January 1, 2015, to the size of the
population on January 1, 2014 we need to add the number of births and in-migrations registered in
2014 and subtract from it the number of deaths and out-migrations registered in 2014:
Population on January 1, 2015 =
Population on January 1, 2014
+ Births in 2014
- Deaths in 2014
+ In-migrations in 2014
- Out-migrations in 2014

4. Natural increase, net migration and population growth

The quantity Births minus Deaths is known as natural increase. If the number of deaths exceeds
the number of births, we say about negative natural increase or natural decrease.
Natural increase = Births - Deaths
The quantity In-migration minus Out-migration is known as net migration.
Net migration = In-migration - Out-migration
Population growth consists of two components: natural increase and net migration:
Population growth = Natural increase + Net migration
Thus, the size of population at a given moment in time can be defined as the size of initial
population plus natural increase plus net migration:
Population on January 1, 2015=
Population on January 1, 2014
+ Natural increase in 2014
+ Net migration in 2014
If we know the size of population at a given moment in time, the size of the initial population
and natural increase, we can find net migration as follows:
Net migration in 2014 =
Population on January 1, 2015

- Population on January 1, 2014

- Natural increase in 2014
6

If we know the size of population at a given moment in time, the size of initial population and
net migration, we can find natural increase as follows:
Natural increase in 2014 =
Population on January 1, 2015

- Population on January 1, 2014

- Net migration in 2014

Taking into account that the sum of natural increase and net migration is equal to population
growth, we can calculate the size of population at a given moment in time, as the sum of the size of
initial population and population growth.
Population on January 1, 2015= Population on January 1, 2014 + Population growth in 2014
Thus, population growth can be defined as the size of population at a given moment minus the size of
the initial population.
Population growth = Population on January 1, 2015 Population on January 1, 2014

5. Demographic rate
Each component of population change (births, deaths, migration) can be expressed as an absolute
number, or more commonly, as annual rate. Each rate has numerator, denominator and multiplier.

Numerator includes the number of demographic events of a specific type (births, deaths, inmigrations, divorces etc.) in a given time period (e.g., during one calendar year).
Denominator includes the number of people at risk of experiencing that type of event in the
given time period. Denominator of annual rate is the size of mid-year population (the size of a
population estimated for the middle of a year). Mid-year population may be calculated as the mean of
the population at the beginning of one year and at the beginning of the next year (usually, beginning of
a year is January 1).
For example, to calculate the mid-year population for the year 2014, we need to calculate the
mean of the population on January 1, 2014 and the population on January 1, 2015:

Demographic rates are ordinarily calculated per 1,000 persons, i.e. the multiplier is equal to 1,000.
However, for certain types of demographic rates the multiplier can be 100,000 or even 1 million. The
use of multiplier makes the demographic rate more readable.

6. Basic demographic rates

There are four basic demographic rates:
1. Crude birth rate (CBR)

2. Crude death rate (CDR)

3. Crude rate of in-migration (CRIM)

4. Crude rate of out-migration (CROM)

7. Crude rate of natural increase, crude rate of net migration and population growth
rate
Natural increase, net migration and population growth can be expressed not only in absolute
numbers but also as rates. Each component can be defined in two ways as follows.
Crude rate of natural increase (CRNI)
a)

b)

Crude rate of net migration (CRNM)

a)

b)
Population growth rate (PGR)
a)

b)

8. Other demographic measures

Besides rates, demographers can also use other demographic measures such as ratio, proportion and
probability.
Ratio: any number divided by any other number.
For example, to calculate sex ratio in the population, we need to divide the number of men by the
number of women in the population.
Proportion: special type of ratio in which the numerator is included in the denominator.
For example, we can calculate the proportion of population at age 60 years and over in the population.
To do this, we need to divide the number of people aged 60 years and over by the total number of the
population. Proportion is often expressed as percentage (multiplied by 100).
Probability: the ratio of the number of demographic events (births, deaths, etc.) to the population at
the beginning of the year. Demographic rate and probability differ by denominator. If a rate has the
mid-year population as a denominator, then a probability has the population at the beginning of a year
(January 1) as a denominator.

9. Data sources
In order to calculate rates, data are required on both the number of events occurring within a given
time period and the population exposed to the risk of experiencing those events. How are these data

obtained? Normally, there are three main sources of data. These are population censuses, vital
registration and surveys.
Population censuses
Census is the most common method used to find out the population size. Census is the enumeration of
all the individuals comprising the population within an area at a specific time (Census Day). In the
census, data are collected from the entire population at specified time; in contrast to other surveys, in
which information is collected only from a small part of residents, and conclusions regarding general
population are made on the basis of this information.
Most countries have regular censuses, taken usually every 10 years, in which everyone resident
in the country at a particular time period is counted and asked to reply to questions about sex, age,
marital status, occupation etc.
Almost every country has had at least one census, and even in the developing countries, regular
censuses are now quite usual. The only country never to have conducted a census is Chad. In the
Republic of Moldova, after the World War II, the Population Census was conducted in 1959, 1971,
1979, 1989, 2004, 2014. In Israel, after WW II the census was carried out sex times: in 1948, 1961,
1972, 1983, 1995 and 2008.
A few advanced industrialized countries, such as the Netherlands and Germany, have
abandoned censuses. This is because they have population registers (for example, requiring everyone
to register with local government when they move to another house). These countries are thus
obtaining information on their population from the continually updated population and other registers
rather than from censuses.
In some cases, certain population subgroups are especially difficult to reach. Censuses are also
susceptible to misreporting by respondents. In particular, the elderly tend to overstate their age,
divorced men tend to report that they are single (never married). In addition, especially at older ages,
there is a tendency to give ones age to the nearest five years (e.g., age 80, 85, 90, etc.), causing the
phenomenon known as age heaping. For these reasons, especially when undertaking analyses
involving small populations, it is necessary to take care when interpreting results.
Vital registration system
Vital registration provides data about demographic events themselves (i.e. about deaths, births,
divorces, marriages). In developed countries, it is usually a legal requirement to register the birth of
every child, each deaths, and all marriages and divorces.
Vital registration of death exists in about 70 countries worldwide. In a few others, such as India
and China, there are surveillance systems covering some parts of the population.
At the time of registration, other details may be collected. Death/birth certification is usually
based on a standard certificate that varies from country to country and includes a range of different
characteristics of the deceased/new-born and parents. For example, when the birth of a child is
registered, information about the mothers occupation and marital status is asked for.
Surveys
Although census and vital registration can provide much of the data which demographers need, there
are occasions when additional, more detailed information is required. For example, in England and
Wales, neither census nor vital registration system ask questions about how many children a woman
has already had. Gaps in the data can be filled by carrying out special surveys.
10

Surveys may be divided into two types.

In a prospective study, a defined group of people is followed for a number of years, and the
dates at which events of interest occur to them are noted.
In a retrospective study, a sample of people is interviewed at a single point in time, and asked
questions about the dates at which events of interest happened to them.

10. International Classification of Diseases and Causes of Death

Cause of death is recorded using a classification developed by the World Health Organization (WHO),
the International Classification of Disease and Causes of Death (ICD).
The first classification of diseases and causes of death was adopted in 1893 (ICD-0) and since
that it was regularly updated, usually every 10 years, to take account of changing patterns of disease,
such as the emergence of AIDS. Most countries, including Moldova, adopted the tenth revision of the
ICD in the late 1990s.
The 10th revision of International Classification of Diseases and Causes of Death
The International Classification of Diseases and Causes of Death (ICD) is divided into a series of
chapters, such as Chapter II for Neoplasmsor Chapter IV for Endocrine, nutritional and metabolic
diseases (Table 2). In the tenth revision of ICD, each individual disease is given a unique four-digit
alphanumeric code. For example, cancer of the stomach is C16, which can be subdivided to give more
precise localization (C16.2 is cancer of the body of the stomach).

Table 2. Chapters of the 10th revision of the International Classification of Diseases and Causes of
Death
Chapter

Codes

Title

I
II
III

A00-B99
C00-D48
D50-D89

IV
V
VI
VII
VIII
IX
X
XI
XII
XIII
XIV
XV
XVI
XVII
XVIII

E00-E90
F00-F99
G00-G99
H00-H59
H60-H95
I00-I99
J00-J99
K00-K93
L00-L99
M00-M99
N00-N99
O00-O99
P00-P96
Q00-Q99
R00-R99

Certain infectious and parasitic diseases

Neoplasms
Diseases of the blood and blood-forming organs and certain disorders involving the
immune mechanism
Endocrine, nutritional and metabolic diseases
Mental and behavioural disorders
Diseases of the nervous system
Diseases of the eye and adnexa
Diseases of the ear and mastoid process
Diseases of the circulatory system
Diseases of the respiratory system
Diseases of the digestive system
Diseases of the skin and subcutaneous tissue
Diseases of the musculoskeletal system and connective tissue
Diseases of the genitourinary system
Pregnancy, childbirth and the puerperium
Certain conditions originating in the perinatal period
Congenital malformations, deformations and chromosomal abnormalities
Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere
classified

11

Chapter

Codes

Title

XIX
XX
XXI

S00-T98
V01-Y89
Z00-Z99

Injury, poisoning and certain other consequences of external causes

External causes of morbidity and mortality
Factors influencing health status and contact with health care

International form of death certificate

Figure 2 represents the international death certificate, as recommended by the tenth revision of the
ICD. Part I of the death certificate is subdivided into the information about the immediate (direct) (line
a), the intermediate (lines b and c) and the underlying (line d) cause of death.
The second part (II) of the certificate provides additional information on diseases diagnosed
simultaneously at the moment of death, which are not believed to contribute directly to the fatal
outcome. The certificate should also contain information about the time passed between the onset of
the disease and the death.

Figure 2. The international death certificate on causes of death as recommended by the tenth revision of
the International Classification of Diseases and Causes of Death

Practical exercises on Part I Introduction to Demography

Exercise 1.
The size of population on January 1, 2014 is 5000 persons. In 2014, 150 deaths, 100 births, 50 inmigrations and 60 out-migrations were registered. Calculate the size of population on January 1, 2015,
natural increase, net migration and population growth in 2014 using the balancing equation.
12

Exercise 2.
The size of population on January 1, 2014 is 5000 persons. On January 1, 2015, the size of population is
4940 persons. In 2014, 150 deaths and 100 births were registered. Using the balancing equation find
the net migration in 2014.
Exercise 3.
The size of population on January 1, 2014 is 5000 persons. On January 1, 2015, the size of population is
4940 persons. In 2014, 50 in-migrations and 60 out-migrations were registered. Using the balancing
equation find the natural increase in 2014.
Exercise 4.
The size of population on January 1, 2014 is 5000 persons. On January 1, 2015, the size of population is
4940 persons. Calculate the population growth and population growth rate in 2014.
Exercise 5.
The size of population on January 1, 2014 is 5000 persons; the size of population on January 1, 2015 is
5500 persons. In 2014 year, 100 births and 150 deaths were registered. Calculate the crude rate of
natural increase.
Exercise 6.
The size of population on January 1, 2014 is 5000 persons; the size of population on January 1, 2015 is
5500 persons. In 2014 year, 100 births and 150 deaths were registered. Calculate the crude rate of
natural increase; crude birth rate and crude death rate. What can you say about the natural increase?
Exercise 7.
The size of population on January 1, 2014 is 5000 persons; the size of population on January 1, 2015 is
5500 persons. In 2014 year, 600 in-migrations and 50 out-migrations were registered. Calculate crude
rate of net migration; the crude rate of in-migration and crude rate of out-migration.

Control questions on Part I Introduction to Demography

1. What are demographic state, event and process?
2. Name five demographic processes.
3. What are the three main demographic processes? How are they called?
4. What do we use the balancing equation for?
5. What components do we need to calculate the size of a population at a given moment?
6. What is natural increase and when it can be negative?
7. What is net migration?
8. What are the components of population growth?
9. What is demographic rate? What are numerator and denominator of demographic
rate?
10. Name four basic demographic rates. How do you calculate them?
11. What are the two ways to calculate crude rate of natural increase?
12. What are the two ways to calculate crude rate of net migration?
13. What are the two ways to calculate population growth rate?
14. What is the difference between demographic rate and demographic probability?
13

15. What is census? What do we need it for?

16. What is age heaping?
17. What does the vital registration system provide us with?
18. When do we need to carry out a demographic survey? What types of demographic
survey do you know?
19. What is the current revision of the International Classification of Diseases and Causes of
Death (ICD)? How many chapters does it have?
20. What type of code is used in the 10th revision of ICD?
21. How many parts have the international form of death certificate by cause? How many
lines has the first part?

14

PART II. POPULATION STRUCTURE BY SEX AND AGE

LEARNING OBJECTIVES:
- To be able to interpret the shape of population pyramid
- To know typical characteristics of population pyramid for developing and developed countries
- To know different types of population pyramid and their characteristics
- To calculate dependency ratio
Demography studies structure and processes of the population. The size and structure of population is
influenced by three main demographic processes: fertility, mortality and migration. The most studied
aspects of population structure are sex and age.

1. Population pyramid
Age and sex structure of population in a specific country is illustrated by the use of population
pyramid. Population pyramid is a bar graph showing the number or proportion of people at each age
by sex for a given population. The horizontal axis shows population either in absolute numbers or as
percentage. The vertical axis lists age groups. The left side of the pyramid shows the population
distribution of males. The right side shows the population distribution of females. (Fig. 3)

Figure 3. Population pyramid of India in 2000 (in millions)

2. Interpretation of the shape of population pyramid

The shape of the population pyramid can inform us about:
1. Crude birth rate and crude death rate
2. Life expectancy at birth (i.e. a number of years a new-born is expected to live)
3. Specific events happened to people living in a particular country
Width of the base of the population pyramid can inform us about crude birth rate of the population.
A wide base indicates a higher number of children in a population and hence a higher crude birth rate.
A narrow base indicates a lower number of children and a lower crude birth rate.
Width of the top of the population pyramid can inform us about life expectancy at birth of the
population, i.e. a number of years a new-born is expected to live. A narrow top of the population
15

pyramid indicates that few people survive till older age groups and life expectancy is low. A wider top
reflects a larger number of older people in a population and a longer life expectancy.
The shape of the sides of the population pyramid can inform us about crude death rate of the
population. Concave sides indicate a high crude death rate. Convex sides indicate a low crude death rate
(see Figure 4).
Irregularities in the sides of the population pyramid can inform us about specific events happened
to people living in a country.
A bump (bulge) in the sides of the population pyramid indicates either the period of immigration or
a baby boom (unexpected growth in the number of births) occurred earlier. On the contrary, indents in
the sides of the population pyramid show either a higher than usual death rate (because of war,
famine) or the period of emigration.

3. Population pyramids in developing and developed countries

The shape of the population pyramid in a developed country, like France or Germany, differs from
the shape of the population pyramid in a developing country, like Nigeria or Kenya (Figure 3).

Figure 4. Population pyramid in a typical developing country (on the left) and a developed county (on the
right)
In a typical developing country, the width of the population pyramid is wide, which indicates a
high proportion of children in a population and hence high crude birth rate. The population pyramid of
a developing country has a narrow top indicating low proportion of older people and low life
expectancy. The sides of the population pyramid are concave showing high death rates in a population.
In a typical developed country, the width of the population pyramid is narrow, which means a
small number of children and low crude birth rate. The population pyramid of a developed country is
wider at the top, which indicates a larger proportion of the elderly and higher life expectancy. Finally,
the sides of the population pyramid in a developed country are convex because death rates among the
population are low.

16

Table 3. Main characteristics of population pyramid for a typical developing and developed countries
Characteristic of
population pyramid
Width of the base
Width of the top
Shape of the sides

Developed country

Developping country

Narrow (= low crude birth rate)

Wide (= high life expectancy)
Convex (= low crude death rate)

Wide (= high crude birth rate)

Narrow (= low life expectancy)
Concave (= high crude death rate)

4. Types of population pyramid

Three types of population pyramid can be distinguished: expansive, stationary and constrictive (Figure
5).
Expansive type of population pyramid has a triangular form. The expansive type of the population
pyramid has larger numbers or percentages of younger age groups and each successively older group
is represented by a smaller bar. Crude birth and death rates are high, life expectancy is short.
Population growth is rapid. This type of the population pyramid is characteristic of developing
countries like Kenya, Nigeria, and India.
Stationary type of a population pyramid has the form of a box. The stationary type of a population
pyramid is characterized by relatively equal numbers or percentages for almost all age groups
involved. Certainly, in the oldest age groups, the figures are smaller. This model reflects nations with
relatively very even sex and age population distribution. Population growth is slow or neutral. This
type of population pyramid is characteristic of some developed countries like France or USA.
Constrictive type of population pyramid has the form of a cup. This type of population pyramid has
lower numbers or percentages of younger age groups. Crude birth rate is very low and life expectancy
is high. Population growth is negative. This type of population pyramid is characteristic of such
developed countries as Germany or Italy.

Figure 5. Expansive, stationary and constrictive types of the population pyramid

17

5. Dependency ratio
Dependency ration shows how many young people (under 15 years old) and older people (65 years old
and over) depend on people of working age (15-64 years old).

For example, Pakistan, which is a developing country has 41% of its population under 15 years
old, and 4% over 65 years old. This makes 55% (=100-(41+4)) between the ages of 15 and 65.

New Zealand, a developed country, has 23% of its population under 15, and 12% over 65. This makes
65% between 15 and 64. Thus, in New Zealand the dependency ratio is 53.8.
Countries that have a high dependency ratio have more people who are not of working age, and fewer
who are working. The higher the number, the more people need to be looked after.

Practical exercise on Part II Population Structure by Sex and Age

Exercise 1. Look at the population pyramid of Haiti (2011) and characterize its shape. What is its type?
What are crude birth and death rates and life expectancy at birth in this country? What is the
population growth in this country?

Exercise 2. Look at the population pyramid of Bahrain (2011). How can one explain the bump (bulge) in
the side of the pyramid on the left (males)? In what age groups is it observed?

18

Exercise 3. Look at the population pyramid of Monaco. What is crude birth rate and life expectancy at
birth in this country? What is the type of the population pyramid? What is the population growth in
this country?

Exercise 4. According to the results of the Population Census conducted in Israel in 2008, the total
population is 7,404,250 persons. The number of children under 15 years old is 2052460 and the
number of older people over 65 years is 721,100. Calculate the dependency ratio.

Control questions on Part II Population Structure by Sex and Age

1.
2.
3.
4.
5.
6.
7.
8.
9.

What is population pyramid?

What can the shape of the population pyramid inform us about?
How can the base of the population pyramid inform us about crude birth rate?
How can the top of the population pyramid inform us about life expectancy at birth?
How can the sides of the population pyramid inform us about crude death rate?
What do bulges (bumps) in the sides of the population pyramid indicate?
What do indents in the sides of the population pyramid indicate?
What types of population pyramid do you know?
What are the characteristics of population pyramid typical for a developing and developed
country?
10. What is dependency ratio?

19

PART III. ANALYSIS OF MORTALITY

LEARNING OBJECTIVES:
- To know different types of mortality rates
- To be able to calculate sex-, age- and cause- specific death rates
- To know the meaning of age-standardization of death rates
- To know the international definition of live-birth and still-birth
- To be able to calculate different types of infant and perinatal death rates
- To have idea about life expectancy at birth and life tables

1. Types of death rates

There are four types of death rates:

1.
2.
3.
4.

Crude death rates

Specific death rates (by sex, age, cause of death)
Age-standardized death rates (or age-adjusted death rates)
Special death rates: infant death rate, perinatal death rate, maternal death rate

Crude death rates are explained in Part 1 Introduction to Demography. Further, we shall study other
types of death rates.

2. Specific death rates

Crude death rates are calculated for the whole of the population. However, death rates can be
computed for different subgroups of the population. These death rates are named specific death rates.
For example, one can calculate death rates for different age groups of the population. These death rates
are named age-specific death rates. Then, cause-specific death rates can be computed for different
causes of death. One can also compute death rates by sex, age and causes of death. In this case, they say
about sex-, age- and cause-specific death rates.
Age-specific death rates

Cause-specific death rates

Sex-, age- and cause-specific death rates

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Example: calculation of age-specific death rates from cancer of the lung and bronchus by sex in England
and Wales
Number of deaths from cancer of the lung and bronchus by age and sex in England and Wales
25-34
35-44
45-54
55-64
65-74
75-84
85+
Males
6
132
884
3101
5799
5935
1522
Females
14
110
668
1753
3367
4116
1249

Mid-year population by age and sex in England and Wales ( in thousands)

25-34
35-44
45-54
55-64
65-74
Males
3679.3
3932.7
3350.5
2859.5
2065.4
Females
3681.8
3994.2
3409
2939.1
2324

75-84
1200.2
1783.7

85+
285
727.5

Let us calculate age-specific death rate for males at age 45-54:

Number of deaths in 2002: 884
Number of mid-year population: 3350.5

Thus, specific death rate from cancer of lung and bronchus among males aged 45-54 in England and
Wales in 2002 is 26.38 per 100000 persons. Cause-specific death rates are usually calculated per
100000 persons.
In the same way, one calculates specific death rates for other sex- and age-groups. The final results are
presented in the table below.
Age-specific death rates from cancer of lung by sex in England and Wales (per 100,000)
25-34
35-44
45-54
55-64
65-74
75-84
Males
0.16
3.36
26.38
108.45
280.77
494.50
Females
0.38
2.75
19.60
59.64
144.88
230.76

85+
534.04
171.68

3. Age-standardized death rates

When we want to compare total mortality between two points in time in one population or two
different populations, the use of crude death rate leads to incorrect results. It is explained by the fact
that crude death rates are strongly influenced by age structure of population. For example, one
population may have a higher proportion of elderly individuals than the other. Thus, in Pakistan, which
is a developing country, the proportion of the older population aged 65 years old and over is 4%, while
in New Zealand, which is a developed country, this proportion is 12%.
Age-standardization of crude death rates is a special procedure that eliminates the effect of
differences in population composition with respect to age from crude death rates.

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Let us study an example that illustrates this problem. At the top of the Figure below, you can
see crude mortality rates per 100,000 persons (population) for men and women. The graph suggests
that rates are quite similar for the two sexes. At the bottom of the Figure, you can see the same data,
now adjusted for differences in the age structure. This shows that for women rates have consistently
been much lower than those for men. This is because the female population has a higher proportion of
elderly people than the male population and consequently a higher number of deaths.

In males and females Crude death rates

have almost the same values

In females Age-standardized death rates

are much lower than for males

Figure 6. Crude death rates and age-standardized death rates by sex in England and Wales (per 100000)
The procedure of age-standardization of death rates itself is explained in the course Biostatistics and
Research Methodology.

4. Special death rates: perinatal and infant death rates

Perinatal deaths refer to deaths registered in the perinatal period (period around birth), while infant
deaths refer to deaths occurred during the first year of life. Before studying perinatal and infant
mortality, it is important to clarify the definitions of live-birth, still-birth and miscarriage.
According to World Health Organization (WHO) live-birth is a product of conception completely
ejected or extracted from the mother's body, regardless of the pregnancy duration, who after this
separation gives a sign of life (respiration, heart activity, beats of umbilical cord or muscular
contraction).
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Each country has its own national definition of live-birth, which is not always in accordance with
the WHO recommendations. In the Republic of Moldova (after 2008), babies born after 22 weeks of
gestation or weighing more than 500 gr who have any sign of life are considered to be live-born.
Still-birth or late foetal death is a product of conception completely ejected or extracted from the
mother's body after a pregnancy duration of at least 28 weeks who, after this separation, gives no sign
of life. In some countries statistical offices use the interval of 22 or 20 weeks of gestation.
Miscarriage or early foetal deaths is a product of conception that was completely ejected or
extracted from the mother's body after a pregnancy duration of less than 28 weeks of gestation and
after this separation gives no sign of life.
Deaths registered during the first 28 days after birth are named neonatal deaths. Deaths registered
during the first week (0-6 days) after birth are early neonatal deaths. Deaths registered between 8 and
28 days after birth refer to late neonatal deaths.
Still-births (late foetal deaths) and early neonatal deaths are named perinatal deaths. Still-births
and miscarriages (early foetal deaths) are named foetal (in utero) deaths.
Deaths registered between 29 days and one year after birth are called post-neonatal mortality.
Finally, infant deaths are deaths registered during the first year after birth. Infant deaths include
neonatal (early and late neonatal) deaths and post-neonatal deaths.

Figure 7. Representation of the perinatal period and the first year of life

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5. Life expectancy and life tables

Another way of looking at the health of a population is to ask how long people can expect to live. Life
expectancy is a commonly used summary measure. Life expectancy is usually reported as life
expectancy at birth, although you may come across life expectancy at, for example, age 15 or 45.
Life expectancy is calculated using life tables. The basic information used in life tables are age-specific
mortality rates. These are applied to a theoretical population, typically equal 100,000. Based on agespecific mortality rates, a number of life table functions are calculated. Table 4 shows an example of life
table for an imaginary country. The last column includes values of life expectancy indicated as for
different age groups (0-1, 1-4, 5-9, etc.). The first value in this column refers to life expectancy at birth.
Table 4. Example of a life table

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Practical exercises on Part III Analysis of Mortality

Exercise 1. The mid-year male population at the age of 20-24 is 58,000 persons. During a year, 120
deaths were registered in this age group, including 80 deaths from injury and poisoning, 20 deaths
from infectious diseases and 20 deaths from other causes of death. Calculate all possible specific death
rates.
Exercise 2. The size of female population in the age group of 65 years old and over on January 1, 2014 is
102300 persons and on January 1, 2015 it is 101,000 persons. In 2014, 800 deaths were registered in
this sex and age group, including 500 deaths from diseases of the circulatory system, 150 deaths from
neoplasms, 95 deaths from diseases of the respiratory system and 55 deaths from other causes of
death. Calculate all possible specific death rates.
Exercise 3. The total size of a mid-year population in 2014 is 650,800 persons, including 357,940
females and 292,860 males. In 2014, 7,200 deaths were registered, including 4,000 deaths in females
and 3,200 deaths in males. In this year, 6,500 live-births and 200 still-births were registered. Among
the total of deaths, 80 deaths were registered in the age group under one year, including 55 deaths
during the first week after birth. Calculate all possible crude, specific and special death rates.

Control questions on Part III Analysis of Mortality

1. What four types of death rates do you know?
2. What examples of specific death rate can you give?
3. What is the purpose of age-standardization of crude death rates?
4. In what cases the age-standardization of death rates is obligatory?
5. What are the international definitions of live-birth and still-birth?
6. What is the difference between still-birth and miscarriage?
7. What are the components of infant mortality?
8. What are the components of neonatal mortality?
9. What are the components of perinatal mortality?
10. What is the denominator of perinatal mortality rate?
11. What do we need to calculate life table for?

25

Bibliography
1. Andrew Hinde, 1998 Demographic methods. Arnold, 1998. 305 p.
2. Dumitru Tintiuc et al., Sntate Public i Management,Chiinu, CEP Medicina, 2007,
ISFEP Tipogr. Central, 896 p.
3. Joceline Pomerleau and Martin McKee, Issues in Public Health. Open University Press. 240
p.
4. Roger Detels, et al., Oxford Textbook of Global Public Health. Oxford University Press,
2015. 1854 p.
5. Samuel Preston, Patrick Heuveline, Michel Guillot, 2000 - Demography: Measuring and
Modeling Population Processes. 303 p.
6. Theodore H. Tulchinsky, Elena Varavikova, The New Public Health. Academic Press, 2009.
672 p.

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