Mortality in Saudi Arabia 1950-2010: Trends and Causes

By: Dr. Mohammed AlgabbaniDepartment of Geography

King Saud UniversityAAG Annual Meeting, Los Angeles

April 13, 2013

Study Objectives

o This is a general descriptive study aiming to: 1. Shed light on mortality trends in Saudi Arabia(1950-

2010 ) and its impact on some population characteristics.

2. Discuss major death causes in comparison with selected countries.

o Comparing Saudi Arabia mortality over time and with other countries is of value as it:

1. shows how much progress was made with regards to one determinant of population health and

2. reveals Saudi Arabia position relative to other countries in this regards.

Why Study Mortality

o Mortality is a good indicator of:• the health of the population of a country ,• their socioeconomic status • and quality of life in general.

o Thus it is important that all death cases and causes are recorded in detail and carefully analyzed to reveal trends and changes over time and suggest actions.

o One of the problems facing researchers is getting recent and precise data about any problem or topic about Saudi Arabia.

o Because of scarcity of data depicting mortality trends and revealing death causes, this study data is obtained mainly from World Health Organization (WHO), as well as from Saudi Arabia Ministry of Health annual reports, national population censuses and , and other data sources such as World Bank, US Population Reference Bureau, Wikipedia, and Index Mundi.

Data

Saudi Arabia’s Death Trends

o Mortality in Saudi Arabia has declined with improved health care, wide spread immunization, safe drinking water, improved sanitary condition, better nutrition , good housing ,and rise in income and other socioeconomic variables.

o For example between 1980 and 2012 Saudi Arabia's Human Development Index (HDI) rose by 1.3% annually from 0.575 to 0.782 today, which gives the country a rank 57 out of 187 countries, placing Saudi Arabia above the regional average.(UN Human Development Indicators 2012).

Fig.1.Saudi Arabia Human Development Index: Health, Education and Income

Fig.2 Saudi Arabia Human Development Index: Trends 1980 – present

o In the past mortality rates was high, crude death rate 24.3/1000 in 1950.

• Though the absolute number of deaths increased with population growth, today on the contrary, death rates (Table1 .Fig.1) are considered one of the lowest in the world ( crude: 3.8/1000 in 2010).

• Saudi Arabia rank is 184 out of 192 countries.

Saudi Arabia Mortality History in Brief

Table 1. Saudi Arabia’s Crude Death Rate 1950-2010/1000

Period CDR

1950 24.3

1960 21.9

1965 19.6

1970 16.7

1975 13.4

1980 10

1985 7.5

1990 5.8

1995 4.9

2000 4.5

2005 4.1

2010 3.8

Fig.3. World Crude Death Rate 2010

Table.2 Saudi Arabia Infant Mortality Rate 1950-1010Period IMR

1950 204.3

1960 183.1

1965 162.6

1970 139.2

1975 106.6

1980 78.2

1985 57

1990 42.3

1995 30.2

2000 22.2

2005 19.4

2010 18.5

Fig.4. World Infant Mortality Rate 2010

Fig. 5. World Maternal Mortality Rate 2010

Saudi Arabia Mortality History in Brief

oInfant mortality rates have decreased rapidly than for the other age groups, which has fallen from 204.3/1000 live birth to 18.5/1000 live birth (1950-2010), oSaudi Arabia rank is 112 out of out of 121 countries.oMaternal mortality declined from 44 in 1990 to 24/per 100,000 live birth in 2010.o Saudi Arabia rank is 135 out of 183.

Impact of Mortality Decline on Population Growthand Age Structure

o Decline in mortality and a relatively high rate birth rate resulted in :

1. Increase in young age group, those below 15 years old. This increase has an impact on dependent group ratio and future population growth rates. (age pyramid figure.) 30% of the population under 14 years old.

2. Decline in fertility rate . With increased infant survival rate (and other factors such as work and education ) , fertility dropped from 6.5 1950 to 2.8 2010). Saudi Arabia rank 66 out of 190 countries.

Table 3 Saudi Arabia Crude Birth Rate/1000

Period CBR

1950 47.9

1960 47.6

1965 47.6

1970 46.9

1975 46.4

1980 44.1

1985 42.7

1990 38.3

1995 33.5

2000 29.7

2005 24.7

2010 22.1

Fig 6. World Birth Rate 2010

3. Slow but steady increase in elderly. •Decline in mortality as well as fertility resulted a relative incease in aging in population. •A marked increases in life expectancy over the last 60 years.( Men life average expectancy (71.9) which is lower than that of women (75.9 ( Table , Fig.).•Average life expectancy was 44.7 in 1960 (Saudi Arabia rank is 114th), became 73.9 in 2010 ( Saudi Arabia rank 78th). •The proportion of elderly( 65 years and over) represents 3% of total population 65 years and over: •Saudi Arabia rank 151 out of 182.

Impact of Decline in Mortality on Population Growthand Age Structure

Table 4 Fertility: Selected Countries 2010Country Total fertility (per woman)I

Argentina 2.2

Australia 1.9

Canada 1.7

Egypt 2.7

Germany 1.4

Iran 1.7

Japan 1.4

Malaysia 2.6

Saudi Arabia 2.8

Singapore 1.3

South Africa 2.5

Turkey 2.1

United States 2.1

Fig.7. Total fertility Per Woman Selected Countries 2010

Fig.8.Saudi Arabia Population Pyramid 1950-2100

Pop. 3.2m Pop. 26.3m

Table 5. Saudi Arabia Life Expectancy 1960-2010

Table 6.Life Expectancy Selected countries 2010

Country Life expectancy at birth (years)

Argentina 75

Australia 82

Canada 81

Egypt 71

Germany 80

Iran 73

Japan 83

Malaysia 73

Saudi Arabia

74

Singapore 82

South Africa

54

Turkey 75

United States

79

Fig 9. Life Expectancy at Birth (years) Selected Countries 2010

Fig.10. Average World Life Expectancy At Birth 2010

Fig11. Percentage of Population Aged 65 or Older 2010

Fig 12. Saudi Arabia Demography 1950-2100

Leading Causes of Death in the pasto In the past the dominant death causes were

Infectious diseases such as malaria, tuberculosis ,flu, diphtheria ,and cholera . Today Saudi Arabia still has these diseases, about 13% of death cases, but they became secondary causes of death .. For example:

malaria infected cases dropped from 274 in 2006 to only 69 in 2011, and no death cases were reported for these two years.

tuberculosis, 98 cases were reported in 2006 and just 80 cases in 2011. Death due to tuberculosis only 4 as of 2011 data.

cholera accounted for 14 cases of death in 1970 and none since then.(MOH).

Table 7. Mortality All causes (ages 30-70) Selected Countries (2010)

Country Mortality (ages 30-70, per 100 000 population) -

Argentina 533

Australia 278

Canada 320

Egypt 805

Germany 362

Iran 600

Japan 281

Malaysia 663

Saudi Arabia 664

Singapore 326

South Africa 2259

Turkey 550

United States

460

Fig.13. All Causes Mortality Rate(Ages 30-70)/100,000 Population Selected Countries 2010

Table 8 Communicable Diseases Mortality Rate 2010 Selected Countries

Country Mortality (per 100 000 population)

Argentina 87

Australia 18

Canada 23

Egypt 76

Germany 21

Iran 82

Japan 40

Malaysia 185

Saudi Arabia

86

Singapore 66

South Africa 983

Turkey 53

United States

34

Fig 14. Communicable Diseases Mortality Rates 2010(Per 100,000 Population)

Leading Causes of Death At Present

o At present 87% of death cases are attributable to non-communicable diseases such as heart diseases, hypertension , diabetes , stroke, and cancer , and external causes (accidents and poisoning).

o Five diseases, Heart, hypertension , diabetes , traffic accidents ,and stroke, and accounted for 65.4% of recorded deaths in 2010 which totaled 82380 cases.

Fig 15. Non-communicable Diseases Mortality Rate

( per 100, 000 Population)2010 Selected Countries

Table 9.Saudi Arabia’s Top 20 causes of Death 2010

Causes Deaths %Coronary Heart Disease 20,877 23.98Hypertension 10,656 12.24Diabetes Mellitus 5,870 6.74Road Traffic Accidents 5,233 6.01

Stroke 4,798 5.51Other Injuries 4,648 5.34Influenza & Pneumonia 4,166 4.79

Low Birth Weight 3,882 4.46Congenital Anomalies 2,545 2.92

Kidney Disease 2,540 2.92Suicide 1,512 1.74Drowning's 1,471 1.69Endocrine Disorders 1,404 1.61Falls 1,391 1.60Lung Disease 1,197 1.37Colon-Rectum Cancers 1,126 1.29

Lymphomas 950 1.09Diarrheal diseases 812 0.93Liver Disease 743 0.85Birth Trauma 730 0.84

Fig 16. Saudi Arabia Top 20 causes of Death 2010 %

Coronary Heart Disease

o Heart disease is the leading cause of death, accounting for almost fourth of all death cases in 2011.

o There were 20877 or 23.98% o coronary death cases in 2010o (180.58 per 100,000 of population).o Saudi Arabia rank is #32 . o Rise in death of cardiovascular disease is related to

physical inactivity and poor nutrition. Recent data indicates that total raised Cholesterol average 25 years+ is 6.9 for males and 8.6 for females.

Hypertension

o According to latest data, hypertension o death in Saudi Arabia were 10656 or 12.24% of total death in 2010 ( 109.84 per 100,000 of population) making it the second cause of death. o Saudi Arabia rank 4th in the world.

Cancero Cancer of all types is the third cause of death, accounted for 6629 death cases in 2010, representing 7.62% of total death cases and is estimated at 81 per 100,000 .o No of cancer patients increase annually by about

12,000 cases according to Officials at King Faisal Specialist Hospital where most cases are referred to and treated .

Table 10. Cancer Mortality 2010 (ages 30-70)/100,000 Population Selected Countries Country Cancer Mortality (ages 30-70, per 100

000 population)

Argentina 165

Australia 125

Canada 138

Egypt 130

Germany 150

Iran 111

Japan 119

Malaysia 141

Saudi Arabia 81

Singapore 126

South Africa 193

Turkey 163

United States 143

Fig 17. Cancer Mortality rate (ages 30-70)/100,000 Population Selected Countries

Major Types of Cancer Causing Death in Saudi Arabia (2010)

o Colon-rectum cancers 1126 cases or 1.29% of total death in 2011( 9.73 per 100,000 of population )Saudi Arabia rank is 72, Followed by,

o Lymphoma with 950 cases or 1.09% of total death,(SA rank 54) then,

o breast cancer accounted 706 or .81% of total death in 2011 ,(11.28 per 100,000 of population)rank 157 in the world, and

o lung cancer 607 or .70% of total death 5.42 per 100,000 of population). Rank # 143 in the world

o These four, out of the 14 cancer types, accounted for more than 51% of cancer death cases.

Diabetes oDiabetes is the fourth cause of death. Death cases numbered 5870 or 6.74% of total death in 2011, (58.97 per 100,000 of population). Which rank Saudi # 38 in the world out of 192 countrieso Saudi Arabia population actually is the first in the Arab World having diabetes.

Traffic Accidents

Road traffic accidents is the fifth leading cause of death in Saudi Arabia. It was responsible for 5,233 cases of death or 6.01 of total death in 2010. If death cases attributable to traffic accidents are

recorded precisely the number of death cases will be much higher than what the published data shows*.

_______________________________________ *Traffic accidents as a cause of death only written for cases in the site o location of the accidents while victims who die later in the hospitals the cause is of death is recorded under injuries.

Traffic Accidents

Over the past two decades Saudi Arabia has recorded 4 million traffic accidents, leading to 86,000 deaths and 611,000 injuries, 7 percent of which resulted in permanent disabilities). In 2012 the number of auto accidents were 544,179 averaging 1537 a day . Number of injured 39000 and the number of dead 7153, averaging 20 person daily. (Saudi Traffic Directory) 20% of the Ministry of Health hospitals beds are occupied by traffic accidents victims

Table 11. Mortality: Road traffic Deaths Selected Countries 2010

Country Estimated road traffic death rate (per 100 000 population)I

Argentina 12.6

Australia 6.1

Canada 6.8

Egypt 13.2

Germany 4.7

Iran 34.1

Japan 5.2

Malaysia 25

Saudi Arabia

24.8

Singapore 5.1

South Africa

31.9

Turkey 12

United States

11.4

Fig 18. Road Traffic Accidents Death(Per 100,000 population) Selected Countries

Fig. 19. World Traffic Death Rate

Stroke

o Stroke is the sixth cause of death, accounted in 2011 for 4798 or 5.51% of total death in Saudi Arabia o Saudi Arabia rank # 143 in the world out of 192

countries with regards this cause of death.

Suicideo Though Islam prohibit self killing suicide death rates in Saudi Arabia have been rising though not disclosed because of social stigma.o Thus suicide death cases are above what is being published. o In 2011 suicide deaths numbered o 1512 or 1.74% of total death , o ( 5.92 per 100,000 of population )o Saudi Arabia rank 118 out of 192 countries.

HIV Aids death rates also are growing though not disclosed because of sensitivity of the issue. According to Ministry of health the total number of AIDS cases are 16334 cases in 2011.Saudi Arabia rank 171 out of 192 countries.

Fig 20. World HIV Prevalence

Table 12. Saudi Present Health Risk Factors

Factor Male% Female %

RAISED B GLUCOSE AGE 25+ 22 21.7

RAISED B. PRESSURE AGE 25+

32.9 28.7

OBESITY 29.5 43.35

TOBACCO USE AGE 15+ 24 1.0

• Factor that contributes to illness and death• Source: WHO.

Smoking

o Health official estimate the number of smokers to be around six millions or about 20% of the populationo Smoking is a major cause of mortality of lung cancer. .o Lung Cancers accounted for 1197 or 1.37% of total death( 12.67 per 100,000 of population )ranking Saudi Arabia 139 in the world.o .

Obesity

o According to a recent study round o 44% of Saudis are obese.o This might explain why diabeteso and hypertension death cases are high.o According to health statistics at least 20,000

people in Saudi Arabia die every year due to complications from obesity(MOH).

Fig 21. World Prevalence of Obesity

Premature Death o Although most deaths occur at an older age, a

significant number of deaths occur in younger people, defined as premature death, is due to certain death causes such as traffic accidents , suicide and AIDS, violence, and poisoning, which makes years of potential lost life level for Saudi Arabia high.

o Traffic accidents are the leading cause of death in males 16 to 36 years .

o Saudis in the age group (15-49 years old) makes up 83% of those infected by HIV/AIDS .

o Most of those who commit suicide are young.

Do Death Rate vary By region?o As data in Table 10 indicates, regions in the north

and south generally have higher total and infant death rates than other regions of the country.

o Bahah has the highest rate (4.9 deaths per 1000 population) of regions, followed by Hail, compared with 3.9 per 1000 person for the country.

o Tabouk had the lowest death rate (2.71 per 1000/person) followed by Madinah.

o Un expected Higher death rate in Riyadh and Makkah regions, me be explained by higher traffic death rate since these two regions have the highest traffic death rate in the country.

Fig.22 Regions of Saudi Arabia

Table 10. Saudi Arabia Regional Death Rate 2007Region Total

Population2007

Total Death

Death/1000 person

Rank Total infants

Total Infants Death

Death/1000infant

Rank

Riyadh 3999907 16650 4.20 6 94809 2087 22.01 3Makkah

3761931 14975 3.98 7 90010 1963 18.81 8

Madinah

1215514 3325 2.73 11 30925 518 16.75 11

Qaseem

864800 3045 3.52 8 19157 400 20.88 5

Eastern 2712367 8089 2.98 12 70468 1021 14.49 13Aseer 1490025 6435 4.30 5 41780 811 19.41 6Tabouk 635674 1683 2.71 13 19908 319 16.02 12Hail 474509 2141 4.51 2 9355 228 24.37 1Northern

253177 1132 4.47 4 5892 127 21.55 4

Jazan 1046402 3664 3.50 9 24654 422 17.12 10Najran 375463 1199 3.20 10 9856 181 18.36 9Bahah 336704 1659 4.90 1 7346 135 18.83 7Jouf 326891 1464 4.48 3 7693 171 22.23 2Total/country

17493364 65461 3.74 413853 8383 20.26

Source: Central Department of Statistics , Demographic Research, 2007.

Total Death By Region

Do Death Rate Vary By region?o As to infant death rate Hail and Jouf had the

highest , 24.37 and 22.23/1000 population respectively, compared with 20.28 for the country.

o Eastern and Tabouk regions had the lowest infant death rate, 14.49 and 16.02/1000 population respectively .

o What is not expected is lower death rate for Jazan, Madinah and Tabouk regions given their population characteristics and socioeconomic development achieved in these regions which suggest that these data are of inadequate quality.

Infant Death By Region

Why death rates vary by region? o For explanation of regional variation in death rate ,

infant death rate data were analyzed using three variables ( % urban, family size and income level) .

o Correlation coefficient results showed that there were negative relationship between infant death rate and level of urbanization (- .84 ) , level of income (-.36)

o In other words regional infant death rate decreases with rise in level of urbanization and income .

o There was a positive relationship with family size (.67).

o There were negative relationship between Income and family size(.58); % urban and family size (.14). and positive relationship between income and level of urbanization (.57).

Conclusion/The Futureo Death is every body’s destiny and everyone has to die some

time, but many deaths occur prematurely and can be prevented.

o Physical inactivity or sedentary life, excess of calorie intake and obesity especially women will keep cardiovascular, diabetes, hypertension and cancer illnesses as main health problems causing rapid increase in death rate.

o Also, If the current rising number of traffic accidents is not curbed, there will be more tragedies as traffic accidents are expected to reach 4 millions a year by 2030.

o Respiratory diseases are likely to rise in main cities due to rise in dust and air pollution.

Conclusion/The Future• Some of the death cases presented in Saudi Arabia lies under

what is known premature deaths which can be prevented or reduced.

• Statistic by cause of death can be used as a guide to actions and interventions to reduce mortality attributed to these causes.

• Present death trends and causes requires intervention particularly in reducing obesity, smoking and traffic accidents. Thus efforts are needed to place a high priority on policies that promote physical activities and healthy diet .

Conclusion/The Future•Enforcement of traffic laws and improvement in road traffic safety are necessary to reduce deaths and injuries.

•Establishing health programs that promote health awareness that lead to early detection and screening of health problems such as cancers and in getting regular health checks for blood pressure, cholesterol and blood sugar.

• •Finally, death recording has to be improved by indicating the specific cause of death in the death certificate for research purposes of research , policies and programs.•Hopefully these suggestions eventually help in reducing death rates especially premature death cases .

References• Central Department of Statistics , Demographic Research, 2007.• CIA Fact Book , 2012.• Mundi Index.• Saudi Arabia , Traffic Directory, Annual Report 2011.

• Saudi Arabia , Ministry of Health, Annual Report, 2010.

• Saudi Arabia , Ministry of Economy and Planning, Population , Censuses, 2010.

http://www.who.int/research/en/ World Health Rankings Research and Features Sheetwww.saudiaramco.com/content/dam/.../StopTrafficAccidents.pdf United Nations, Department of Economic and Social Affairs, Population Division

(2011): World Population Prospects: The 2010 Revision. New York UN. Bulletin on Population AND Vital Statistics IN THE ESCWA New York, 2009. US Population Reference Bureau. 2011, world population data sheet . Washington,

DC: United Nations Population Division. (2009). World population prospects: The 2008 revision . New York,

Wikipedia World Health Organization, Global Health Observatory Data Repository. World Health Organization. (2010). World Health Statistics Report. August 16, 2010 World Health Organization , Saudi Arabia . Regional Office for the

Eastern Mediterranean Cairo,2006.

Fig.1 World Human Development Index 2013

Very high Low High Data unavailable Medium

Fig.2.World map indicating the Human Development Index 2012

0.900 and over 0.850–0.899 0.800–0.849 0.750–0.799 0.700–0.749

0.650–0.699 0.600–0.649 0.550–0.599 0.500–0.549 0.450–0.499

0.400–0.449 0.350–0.399 0.349 and under Data unavailable

Fig.3. Saudi Arabia Data Summary 2012

Statistics Value World Rank

POPULATION TOTAL 28,686,633 42

POPULATION GROWTH RATE 2.8 60

UNEMPLOYMENT 8.8 66

PER CAPITA INCOME/ GNP 24,020 44

CELLULAR PHONE SUBS/100 188 39

HOSPITAL BEDS/10000 32 89

NO OF PHYSICIANS/1000 1 101

Fig.4. Typical Saudi (Un Healthy) Diet

Fig.5 World Prevalence of Blood Pressure 2008

Fig.6. Prevalence Estimates of Diabetes 2025