Geographical Review of Japan Vol. 62 (Ser. B), NO. 1, 1-13, 1989

Spatial Patterns of Major Mortality Causes in

M. M. Azlz*

Abstract

The paper examines the spatial patterning of the three major causes of mortality in Kuwait . Since the population of Kuwait is composed of two well-identified communities: Kuwaitis and non-Kuwaitis , the distribution of deaths will be affected by different social, economic and demographic charac teristics of both groups. Mortality rates are calculated per 100,000 of the total population according to the international classification of death causes. The major groups of mortality causes are: neoplasms , diseases of the circulatory system, and accidents and injuries, which are responsible for nearly two-thirds of the to tal deaths in Kuwait. Of all the causes, diseases of the circulatory system cause the highest rate of death. Accidents and injuries come second, followed by neoplasms . Mortality rates from all causes are higher among Kuwaitis than among non-Kuwaitis . Rates are also higher in most cases among males of both communities than females . The highest figures of mortality, however, are those recorded in the Capital including the township of Kuwait , and , which is densely populated by foreign immigrants . Immigrants tend to suffer from accidents and injuries.

Key words: Kuwait, non-Kuwaiti, mortality rates , cardiovascular diseases, noeplasms, ac cidents, risks of death.

exerting influence on distribution patterns. Such I. INTRODUCTION factors, however, will not be dealt with in this study, since it is more concerned with the spa Only a few population geographers have shown tial aspects of disease. The population of Kuwait interest in mortality studies. Most of the work is composed of almost totally different commu remains the concern of medical geography as it nities: Kuwaitis and non-Kuwaitis.3) Spatial var is regarded as an important sub-discipline of iations of disease will undoubtedly reflect the population geography. However, the main con many different characteristics of both popula tribution of medical geographers has been aimed tion groups and identify the causal relationships at the analysis of spatial differentiations of cause correspondingly. specific mortality and their relationships with so Mortality rates are calculated per 100,000 of cial, economic, demographic and environmen total population as in the following table. The tal conditions.1) Since every disease shows seventeen major groups of death causes identi spatial variations, analysis of the relationships fied by the international classification are adopt between diseases and various conditions may ed and regrouped into three principal groups for provide an explanation to mortality causes and the purpose of this study.4) These are: ne distribution.2) oplasms, diseases of the circulatory system, and This paper is being prepared esentially to re accidents and injuries, which are responsible for veal the spatial patterns of major causes of dis nearly two-thirds of total deaths in Kuwait. ease in Kuwait. It tries to identify and recognise The study is based primarily on vital health and the spatial distribution of diseases in administra population data issued by the Ministries of tive units of the country. Analysis of various Health and Planning in Kuwait, in addition to causes can help to determine different variables international sources. Basic data on death causes

* Department of Geography , University of Kuwait, Kuwait.

 2 M. M. AZIZ

Figure 1. of Kuwait

Table 1 Mortality Rates in Kuwait by Major Causes of Death, Governorate, Nationality, and Sex, 1985 (Deaths per 100,000 persons in specified governorate)

Basic Data from: a) State of Kuwait, Ministry of Planning, Central Directorate of Statistics (1981): Bulletin of Vital Statistics: Births and Deaths 1980, Kuwait, pp. 110-124, Tables 38 a, band c. b) (1987), Bulletin of Vital Statistics: Births and Deaths 1985, Kuwait, Table 2. c) (1986): General Census of Population 1985, Vol. I, Kuwait, p. 6, Table 2. M=male, F=female, T=total Spatial Patterns of Major Mortality Causes in Kuwait 3

have only been recently compiled on the basis of - Kuwaitis differs to a great extent. Young people administrative units.5) Only in the census year less than 15 years of age comprise about half of of 1985 have such data become available, and the total Kuwaiti population. Meanwhile the they will be used in this paper.6) same age group comprises only about 29% of the It may be useful to mention the following non-Kuwaitis.7) In addition, adults comprise general aspects before discussing the three major less than half of the Kuwait community, com causes: pared with nearly 70% of the non-Kuwaitis. 1. Diseases of the circulatory system acquire The same can be said about sex composition, the highest mortality rates of the two remaining where males comprise nearly 50% of both age groups at both national and regional levels. Next groups for Kuwaitis, but among the non-Kuwaiti comes the 'accidents and injuries' group, and population they represent only a quarter of the finally the neoplasms. under 15 age group, and three-quarters of the 2. Mortality rates for almost all causes of death adult group.8) Such differences can be seen in are twice to three times higher among the Ku all parts of the country. waitis than the non-Kuwaitis. This can be at 4. Because of the peculiar age and sex compo tributed mainly to the fact that the majority of sition of the non-Kuwaitis, it is clear, generally, immigrants or non-Kuwaitis is composed of that female mortality rates for many causes ex adults (15•`59), and also to differing social and ceed those of males, whereas among the Kuwai economic characteristics of both communities, tis the opposite is true. with particular reference to such parameters as 5. Since environmental conditions are almost following: different languages, cultures, tradi similar in all parts of the country, they are not tions, educational standards, occupational struc expected to have different areal impacts on dis tures, housing conditions, and average earnings. ease causation.9) 3. Age composition of the Kuwaitis and non

Figure 2. Mortality Rates for Neoplasms among Kuwaitis Per 100,000 persons 4 M. M. AZIZ

Figure 3. Mortality Rates of Neoplasms among Non-Kuwaitis Per 100,000 persons

higher among males than females of both popu II. NEOPLASMS10) lation groups. Population age and sex structure in addition to other factors may explain such Death records show that this group is the third differences. It seems that almost all types of ne most important cause of death among the seven oplasms have been involved in deaths in Kuwait. teen groups after heart diseases and accidents. Nevertheless more than 27% of them are caused This means that these diseases cause eleven out by those of digestive organs. The Kuwaitis and of every hundred deaths among the country's to the males of both groups are the major victims tal population. of these diseases, where deaths constitute 63% Figures for the past fifteen years do not show and about 80% of total deaths respectively. a significant change in the threat of these diseases Deaths from such diseases in the Capital gover to health in Kuwait, despite the slight increase norate however, comprise only about 15% of to and decrease among the Kuwaitis and non tal deaths in all the governorates of Kuwait. Kuwaitis respectively, and their position in the Malignant neoplasms of lymphatic and hae list of death causes.11) matopoietic organs are the second and third most The rates of mortality in 1985 at governorate important causes of death in this governorate. level differ clearly from those for total popula They each are responsible for more than 30% of tion. Death rates in two governorates outnum total deaths. More than three-quarters of the vic ber the national rates, while those in the other tims are Kuwaitis and female deaths comprise two are lower (Figs. 2 and 3). The highest figures about two-thirds of total losses. These two causes can be seen in the Capital governorate, where of death in the Capital governorate account for they exceed the national figures by more than ten more than 12070 of their total deaths in the deaths. Moreover, death rates among Kuwaitis country. exceed those for immigrants by three times.12) Mortality rates in are The risk of death from such diseases is also much lower than those in the previous gover- Spatial Patterns of Major Mortality Causes in Kuwait 5

norate and in Kuwait as a whole. Figures for its ter group the rates are similar for both sexes.14) Kuwaiti inhabitants are almost twice those for Neoplasms of digestive organs prove again to non-Kuwaitis. Mortality levels for both popula be the prime cause of death here as in other tion groups and sexes are the nearest among the places, where about 30% of total deaths in this governorates to those for the total population in governorate are due to this cause. Kuwaitis com the country.13) prise about two-thirds of all deaths due to this Distribution of deaths on sub-causes shows disease, while males of both communities com that neoplasm of digestive organs is once more prise about 55% of them. Nevertheless, this considered the major risk. It is responsible for governorate has only a 15% share of the total the death of one person in every four that die mortality from this cause. in this governorate. For the first time, the majori Neoplasms of the respiratory organs is the se ty of the victims (55%) are non-Kuwaitis. This cond largest cause of death with a figure of 21%. may be due to the fact that Hawalli has the old nearly two-thirds of total deaths are among est concentration of immigrants in Kuwait and Kuwaitis, and almost all recorded incidents are they all enjoy similar living conditions compared among males. with other governorates. Besides, about two Ahmadi's contribution to total deaths in the thirds of the victims are men, and deaths from country is small, with only a 16% share. Remain this disease in Hawalli comprise about half of ing death cases in Ahmadi are caused by ne its total deaths in the country. oplasm of the genito-urinary organs and those The second most important cause is lymphat of bone, skin and breast. ic neoplasm, which claims one in every five The second highest death figures in Kuwait are deaths caused by all the neoplasms. Two-thirds those recorded in Jahra. They are clearly higher of the total deaths are among non-Kuwaitis too, than those for total population, but lower among while about 70% of them are males. It seems that its Kuwaiti citizens than among all Kuwaitis in this neoplasm represents a major threat, for it the state. Death rates among immigrants on the claims about 56% of all deaths in Kuwait. Ne other hand, are the highest, whether compaed oplasms of both respiratory and genito-urinary with total immigrant deaths in the country or organs represent almost equally the third most those in other governorates.15) serious danger. The share of each cause is about Neoplasm of digestive organs comes at the top 15% of total deaths and more than half of them of the list of causes once again with a share of are non-Kuwaitis. Male victims constitute more more than 24% of all death causes. More than than 80% of respiratory deaths and about 60% 82% of deaths caused by this neoplasm are of genito-urinary deaths. Deaths attributed to Kuwaiti and two-thirds of the total deaths from these two causes in this governorate account for it are males. In spite of this Jahra has less than more than 45% of their total deaths in the a 20% share of the total number of deaths from country. this disease in the country. Records show that the remaining daths are dis The second highest number of deaths is caused tributed among other causes, particularly ne by neoplasms of the lymphatic and genito oplasms of unspecified sites and those of bone, urinary organs with a figure of 19%. Neoplasms skin and breast. Each of these two causes is of the lymphatic organs in Jahra cause 24% of responsible for about 45% of its total deaths. the total deaths from this disease in the coun The lowest mortality rates for neoplasms in try, while neoplasms of the genito-urinary organs Kuwait are those recorded in Ahmadi gover in Jahra cause 20% of the total deaths from it norate, whether for its total population, or for in the country. both sexes. They are not more than two-thirds Other causes are only of little significance. of those for the whole country. But like other According to death victims they have almost the governorates they are higher among Kuwaitis same impact here as in previous governorates. than among non-Kuwaitis, and among the lat 6 M . M. AZIZ

caused by infectious diseases, neoplasms and ac III. DISEASES OF THE CIRCULATORY cidents collectively. SYSTEM16) Regional patterns show uneven distribution of mortality. Rates in all governorates but one are This group of diseases represents the major risk lower than the national average (Figs. 4 and 5). to health in Kuwait. Its role has also been in The highest figures are those recorded in the creasing with the passage of time. In 1970 it was Capital governorate, where about four deaths of the fourth most important cause according to the every 10 are caused by heart disease. The same total number of death causes. This means that is true for the male population, as figures for fe about 14% of total deaths were due to cardiovas males are less than half those of males. cular diseases. After only 5 years in 1975 this The impact of various sub-causes of this group group came at the top of the death cause list and varies greatly. In this governorate about 57% of claimed more than 18% of all deaths in the total deaths are due to ischaemic heart diseases. country.17)It continued to be the leading health Both Kuwaitis and immigrants are almost equally threat in 1980, and with an enormous increase. subject to these risks, but most deaths (82%) oc It was now responsible for the deaths of three cur among males. out of each ten victims of the two communities Another 19% of total deaths are due to hyper in Kuwait. tensive diseases. Two-thirds of them are Kuwait The situation is almost unchanged in 1985, is, but unlike ischaemic heart diseases, more than with a slight increase of mortality among the 60% of the victims are females. However, deaths Kuwaitis. The number of deaths among males by such diseases constitute only about 14% of during the above period was higher than among all cases in Kuwait. females. Although the cerebrovascular diseases came The number of deaths caused by heart disease third as a cause of death, their share of total mor in Kuwait in 1985 almost equals the number tality in the governorate is only about 10%.

Figure 4. Mortality Rates for Circulatory System Diseases among Kuwaitis Per 100,000 persons Spatial Patterns of Major Mortality Causes in Kuwait 7

Figure 5. Mortality Rates for Circulatory System Diseases among Non - Kuwaitis Per 100,000 persons

Kuwaitis and males prove to be the most vulner it constitutes more than 54% of all deaths in the able sections of the population. country. The remaining small numbers of deaths are due Cerebrovascular disease is the third main to other causes of minor importance such as cause, accounting for 13% of all deaths. The rate those of pulmonary circulation and other un of deaths is almost equal between the Kuwaitis specified diseases of the circulatory system. and the non-Kuwaitis, and also between the sex The dangers of heart disease seem to be lesser es. In spite of this, however, half of the total in the governorate of Hawalli. Only three out of deaths from this disease in the country occur in every 10 deaths in 1985 in Hawalli were due to Hawalli. heart disease. These deaths were only about 10% The remaining deaths in this governorate are of heart disease deaths in the country as a whole. caused by other diseases of the circulatory sys Non-Kuwaitis, unlike in previous governorates, tem, especially pulmonary and other unspecified constitute aoout 57% of the victims. Male mor diseases. tality constitutes about two-thirds of them. It seems that the lowest death figures are in Ah About half of the deaths are the victims of madi governorate. This is clear from the fact that ischaemic heart diseases. Two-thirds of them are only a quarter of the total deaths in this gover non-Kuwaitis, and three quarters of deaths are norate are caused by heart disease. 55% of these males. The seriousnes of the diseases is explained deaths are Kuwaitis, and only less than one-third by its high contribution to the total mortality of of the victims are female. the governorate, which exceeds 37%. The ischaemic group of diseases is also the Hypertension is the second cause, which claims leading cause of death here. It causes half of the another 23%, over half this figure being record total circulatory system deaths. Non-Kuwaitis ed among the immigrant settlers. Here again, as comprise about 45% of these deaths. Female in the Capital governorate, females are the main mortality from this disease is four times higher target of this illness. But unlike the first cause than that of males in Ahmadi. However, deaths 8 M . M. AZIZ

from ischaemic diseases here amount to only Hypertensive and cerebrovascular diseases are 15% of the country's total number of deaths the second biggest sub-cause with a joint figure from circulatory system ailments. of 40%. 80% of deaths from these causes are The second biggest cause in this group is hyper Kuwaitis, and for every four female deaths, there tension with a figure of 19%. Of these deaths, are six male. three-quarters are Kuwaitis. Female mortality is Less important causes of death in this gover unusually lower than that for males here. Deaths norate are the pulmonary and other circulatory from hypertension in Ahmadi account for only system diseases. 13% of the total deaths from it in the country. Ceeebrovascular diseases are only of minor im IV. ACCIDENTS AND INJURIES18) portance here, as are other unspecified causes of death. According to death records, this group has Finally, Jahra governorate had the second been regarded as one of the leading causes of highest mortality rates from heart diseases in death in Kuwait for some time. In 1970 nearly 1985. They caused two out of every ten deaths 20% of all deaths in Kuwait were caused by ac in the governorate. For every non-Kuwaiti that cidents. This figure rose to about 30% in 1975. died, four Kuwaitis were victims, and for every In 1980 it became the second major cause of four female deaths, there were six males. death in Kuwait after heart diseases.19) Of the sub-causes, ischaemic disease seems to Although the situation remained almost un be the major one. They were responsible for changed in 1985, there has been a slight increase about 35% deaths. 80% of them are Kuwaitis in death tolls. The mortality rates were clearly and 70% are male. Jahra's contribution to the much higher among the Kuwaitis and the males total number of deaths from ischaemic diseases of both population segments in 1985. But the ab in the country is the lowest, with a figure of only solute figures show that non-Kuwaitis are the 11%. biggest sufferers, because of the wide range of

Figure 6. Mortality Rates for Accidents and Injuries among Kuwaitis Per 100,000persons Spatial Patterns of Major Mortality Causes in Kuwait 9

Figure 7. Mortality Rates for Accidents and Injuries among Non-Kuwaitis Per 100,000persons risks they expose themselves to in their search for juries inflicted by other persons and accidental better earnings (Figs. 6 and 7). falls. Another reason for the major role of accidents In Hawalli 70% of accident victims are from in the death toll is the large number of privately the immigrant community. For every eight male owned cars, which are the , most important deaths there are only two female deaths. means of transport in Kuwait. Public transport Road accidents are the biggest cause of death does not contribute much to the death toll. The in this governorate. 60% of accident deaths are risks of death by accident are biggest in places due to road accidents. The number of non where old settlements of both Kuwaitis and im - Kuwaiti victims is twice that of the Kuwaitis, and migrants are located. male deaths outnumber female deaths by four In the Capital about 16% of total deaths are to one. Unlike the Capital, this governorate con due to accidents. Nearly two-thirds of the vic tributes 30% to the number of road accident tims are immigrants, and for every nine males deaths in Kuwait. Other kinds of accidents play that die through accidents, there is only one fe a secondary role, but the most important are ac male death. cidents of fire and flame, misadventure during Of the 10 sub-causes of accidents, transport ac medical care, accidental falls, and other unspeci cidents are the leading cause of death. Half of fied accidents. the total accident deaths in the governorate are Unlike in Hawalli, where the lowest mortality caused by them. For every three Kuwaitis that rates are recorded, those in Ahmadi are the die in accidents, seven non-Kuwaitis die. On the highest. 20% of all deaths here are caused by ac other hand, it seems that the Capital's contribu cidents. Ahmadi's share of total accident deaths tion to the total number of road accidents in is only two-thirds that of Hawalli. Another Kuwait is small, with a figure of only 8%. The difference between the two is that the risks of remaining proportion of deaths is attributed to accidents are almost equally divided between the other types of accidents such as homicide, in two distinct communities. In spite of this, males 10 M . M. AZIZ remain the principal target, and about nine of ber of transport deaths in Kuwait, which is a little them die for every one female. less than Ahmadi's contribution. Transport accidents are again the major cause Later effects of accidents are the next biggest of death, but to a more serious degree here than cause of death, and are of the same significance in former governorates. Six out of every 10 as in Ahmadi. Other accidents have only a deaths due to accidents are attributed to road ac negligible role in the total death figures. cidents. Both sections of population are exposed equally to the dangers of traffic accidents. The V. CONCLUSION male/female ratio of 9 to 1 confirms the high risks that the people here are facing. This is prob This study tries to identify and recognize the ably because Ahmadi is the governorate where spatial distribution of the three major causes of most of the industrial and agricultural activities, mortality in the four governorates of Kuwait. and the largest current housing schemes are lo They are: diseases of the circulatory system, ne cated. It also has common borders with Saudi oplasms, and accidents and injuries. Nearly two Arabia, where there are many more oil installa thirds of total deaths are due to these causes, but tions and work opportunities. Therefore, large mortality rates for both Kuwaiti and non numbers of people move everyday on its roads, Kuwaiti communities are not similar. which can be considered the busiest in the Diseases of the circulatory system seem to be country. the major killer in the country. They are respon Later effects, which can be clearly related to sible for more than 30% of all deaths. Regional road accidents, are the second biggest cause of patterns show uneven distribution of mortality. death. They cause two of every 10 accident The highest figures are recorded in the Capital deaths, and almost all victims are male. The re governorate. In this governorate about two maining small proportion of deaths are due to thirds of total deaths are due to ischaemic heart other accidents, particularly those of fall and diseases. Both Kuwaitis and non-Kuwaitis are fire. equally subject to these diseases and most deaths Mortality figures in Jahra seem to be the se occur to males. The lowest death figures are in cond lowest of all the governorates. Accidents where more than half of cause less than one-fifth of all deaths in this them are Kuwaitis, of whom two-thirds are governorate. However, Kuwaiti and male victims females. outnumber non-Kuwaiti and female victims by Mortality brought about by acidents and in four to one respectively. The high incidence of juries has been regarded as one of the leading death here is due to circumstances similar to Ah causes of death for some time. In 1985 it became madi governorate. the second major cause of death in Kuwait . Mor Jahra occupies the northernmost part of the tality rates are clearly much higher among the country close to the Iraqi and Saudi Arabian male Kuwaitis and non-Kuwaitis. But the abso borders. Many of its residents usually travel to lute figures show that non-Kuwaitis are the big the nearby in the Capital gover gest sufferers because of the wide range of risks norate, where the largest business district is they are exposed to in their search for better located. earnings. More than 60% of accident deaths are It is not surprising, therefore, that transport due to transport accidents only. Almost all vic accidents claim about two-thirds of total deaths, tims are males, and two-thirds of the mortalities which is a higher figure than for Ahmadi gover occur among those who are under 50 years of norate. For every seven Kuwaitis that die in road age. accidents here, there are less than three non The risks of death are biggest in the old settle Kuwaiti victims. When compared with Ahmadi's ments of both Kuwaitis and non-Kuwaitis . The figures, this shows a significant increase. Males highest mortality rates are recorded in Ahmadi, continue to be the main victims, as they comprise while the lowest in Hawalli. about 90% of total road deaths. This gover Neoplasms represent the third major cause of norate contributes about 20% to the total num death. They claim about 11% of total deaths in Spatial Patterns of Major Mortality Causes in Kuwait 11

Kuwait. The highest figures can be seen in the 3. M. neoplasm of respiratory and intrathoracic Capital governorate, where death rates among organs. Kuwaitis exceed those for immigrants by three 4. M. neoplasm of bone, connective tissue, skin and times. Death risks are also higher among males breast. 5. M. neoplasm of genito-urinary organs. than females of both communities. Although all 6. M. neoplasm of other and unspecified sites. types of neoplasms have been recorded, more 7. M. neoplasm of lymphatic and haematopoietic than 27% of them are due to those of digestive tissue. organs. The males of both Kuwaitis and non 8. Benign neoplasm. Kuwaitis are the major victims. 9. Carcinoma in situ. 10. Other and unspecified neoplasm. (Received Aug. 9, 1988) 11) a. AZIZ, M. M. (1987): Cause-Specific Mortality (Accepted Jan. 10, 1989) in Kuwait: A Study in Medical Geography, Vol. I, 1970-75, University of Kuwait, That Al- Salasil, Kuwait, p. 65 (in Arabic). Notes and References b. AZIZ, M. M. (1987): Cause-Specific Mortality in Kuwait: A Study in Medical Geography, Vol. 1) CURSON, P. H. (1986): "Mortality Patterns in the II, 1980-85, University of Kuwait, Al-Qabas Modern World," in PACIONE, M. (ed.): Population Press, Kuwait, p. 211 (in Arabic). Geography. Progress and Prospect, Croom Helm, 12) Although this is the location of the capital city of London, p. 97. the state and the oldest inhabited area of the coun 2) PACIONE, M. H. (ed.) (1986): Medical Geography: try, Kuwaitis represent only about 36% of the total Progress and Prospect, Croom Helm, London, p. 3. population here. Source: op. cit. 7), p. 2, Table 1. 3) Non-Kuwaitis are immigrants of different national 13) This governorate, in contrast to the Capital, ities who reside in Kuwait for various reasons. In represents the oldest residential area for non-Kuwaiti 1985 non-Kuwaitis composed about 60% of total immigrants. Kuwaitis, therefore, are considered only

population. a small minority or about 27% of the governorate's 4) United Nations, World Health Organization (1977): total population, ibid., p. 4, Table 1. Manual of International Statistical Classification of 14) Unlike previous governorates, Kuwaitis here consti Diseases, Injuries and Causes of Death, Vol. 1, Gene tute about half of its total population, ibid., p. 5, va, pp. 101-144. 259-282, and 473-546. Table 1. 5) The State of Kuwait is divided into the following 15) People from eastern and northern parts of the Ara major administrative units or governorates: the Cap bian Peninsula have been attracted to the Jahra Oa ital, Hawalli, Ahmadi, and Jahra. They in turn are sis for a long time, and Kuwaiti citizens constitute divided into about 80 smaller units of various sizes. more than 76% of the total population, ibid., p. 5, These governorates also vary in area and population Table 1.

(Fig. 1). 16) This group includes the following sub-causes: 6) A general census of population is usually carried out 1. Rheumatic fever and rheumatic heart diseases. in Kuwait every five years. The first one took place 2. Hypertensive diseases. in 1957, followed by six more in the years: 1961, 3. Ischaemic heart diseases. 1963, 1970, 1975, 1980, and 1985. 4. Diseases of pulmonary circulation and other 7) State of Kuwait, Ministry of Planning, Central Direc diseases. torate of Statistics (1986): General Census of Popu 5. Cerebrovascular diseases. lation 1985, Vol. I, Kuwait, p. 6, Table 2. 6. Other diseases of the circulatory system. 8) Ibid., p. 6. 17) a. State of Kuwait, Ministry of Planning, Central 9) The State of Kuwait is located in the north Directorate of statistics (1979): Bulletin of Vi westernmost corner of the Arabian Gulf in south tal Statistics, Births and Deaths 1970-1978 , west Asia, between 28.45-30.05•‹N and Kuwait, pp. 47-55, Tables 23a, b and c. 46.30-48.30•‹E. It covers an area of nearly 18,000 b. Aziz, M. M., op. cit., 11)-b, p. 122. km2 with a population of two milions. As a rule, 18) This group includes the following sub-causes: Kuwait is an arid hot country. Modern Kuwait has 1. Transport accidents. been witnessing spectacular economic, social, urban 2. Accidental poisoning. and demographic changes, since the beginning of the 3. Misadventures during medical care and abnor oil era in 1950. mal reactions. 10) This group includes the following sub-causes: 4. Accidental falls. 1. Malignant neoplasm of lip, oral cavity, and 5. Accidental causes by fire and flames. pharynx. 6. Other accidents including late effects . 2. M. neoplasm of digestive organs and 7. Drugs and medicaments causing adverse effects . peritoneum. 8. Suicide and self-inflicted injury. 12 M . M. AZIZ

9. Homicides and injuries purposely inflicted by GILBERT, A. and GUGIER, J. (1982): Cities, Poverty and other persons. Development: Urbanization in the Third World, Ox 10. Other violence. ford University Press, Oxford and N. Y. 19) op. cit., (m) p. 141. CLICK, J. B. (1982):"The Spatial Organization of Cancer Mortality" A. A. A. G., 72-4, 471-481. GRAY, M. (1979): Man Against Disease, Oxford Univer Other References sity Press. GROSS, F., PISO, Z., STRASSER,T. and ZANCHETTI,A. ABDUL-HALIM, R. E. (1985):"Some observations on (1984): Management of Arterial Hypertension. cancer bladder in Saudi Arabia", Emirates Medical W. H. O., Geneva. Journal, 3, 203-206. HELLEN, J. A. (1986):" Medical Geography and the AL-ADNANI, M. S. (1984) "Cancer in Southern Iraq", Third World, in M. H. PACIONE(ed.), op. cit. (2), pp. Journal of Kuwait Medical Association, 18, 81-87. 284-323. AZIZ, M. M. (1986):"Natural Increase Differentials in HOWE, G. M. (1976):" Environmental Factors in Dis Kuwait", Journal of the Gulf and Arabian Peninsu ease", in J. LENIHANand W. FLETCHER(eds.) Health la, University of Kuwait, No. 48, 15-51 (in Arabic). and Evironment, Blackie, London. BARRETT, F. A. (1986):"Medical Geography: Concept HOWE, G. M, and LORAINE, J. A. (eds.) (1974): En and Definition" in M. H. PACIONE (ed.), op. cit. (2), vironmental Medicine, Heinemann Medical, London. 1-34. HOWE, G. M. and PHILLIPS, D. R. (1983):"Medical Ge BARTLEY, M. (1988):"Unemployment and Health: ography in the United Kingdom, 1945-1982", in N. Selection of Causation-A False Antithesis Sociolo D. MCGLASHAN and J. R. BLUNDEN(eds.), Ge gy of Health and Illness," A Journal of Medical So ographical Aspects of Health, Academic Press, Lon ciology, 10-1, 41-67. don, pp. 33-52. BHARDWAJ,S. M. (1978):"Some Directions in Applied HUW, R. J. (1981): A Population Geography, Harper Medical Geography: Third World Perspective," in J. and Row, London. W. FRAZIERand B. J. EPSTEIN (eds.), Applied Geog JAMES, G. D., YEE, L. S., HARSHFIELD,G. A. and DICK raphy Conference, State University of New York, pp. ERING,T. G. (1986):"Sex Differences in Factors Af 318-330. fecting the Daily Variation of Blood Pressure", Social BROWNIES, A. A. (1972):"Modeling the Geographic Science and Medicine, 26-10, 1019-1023. Epidemiology of Infectious Hepatitis," in N. D. KANNEL, W. B. and THOMAS, J. T. (1986): Incidence, MCGLASHAN(ed.), Medical Geography, Methuen and Prevalence and Mortality of Cardiovascular Diseases Co., London, pp. 279-300. in the Heart, Arteries and Veins" in J. W. HURST CLARKE, J. I. (1984): Geography and Population: Ap (ed.), The Heart, McGraw-Hill Publishing Co., N.Y., proaches and Applications, Pergamon, London. pp. 557-565. CLIFF, A. D. and HAGGETT, P. (1986):"Disease Diffu KARVONEN, M. and MIKHEEV, M. I. (eds.) (1986): sion" in M. H. PACIONE (ed.), op. cit. (2), 84-125. Epidemiology of Occupational Health, W. H. O., CUMPER, G. (1983):"Economic Development, Health Regional Publication, No. 20, Copenhagen. Services and Health," in K. LEE and A. MILLS (eds.), KEMP, I., BOYLE, P., SMANS, M. and MUIR, C. (eds.) The Economics of Health in Developing Countries, Ox (1985): Atlas of Cancer in Scotland 1975-1980, Inci ford University Press, pp. 23-42. dence and Epidemiological Perspective, W. H. O., DINMAN, B. D. (1988):"Alumina-Related Pulmonary IARC, Publications No. 72, Lyon. Disease", Journal of Occupational Medicine, 30-4, KVALE, G. and HEUCH, I. (1988):"Lactation and 328-335. Cancer Risk: Is There a Relation Specific to Breast EKMAN,P. (1986):"Prostate Cancer-To Treat or Not Cancer?" Journal of Epidemiology and Community to Treat?", Emirates Medical Journal, 4-2, 90-94. Health, 42-1, 30-37. ELL-BUSHARA,S. (1980):"The Distribution of Popula MAYER, J. D. (1986):"Ecological Associative Analy tion and Medical Facilities in Saudi Arabia, Erdkunde, sis", in M. H. PACIONE(ed.), op. cit. (2), pp. 64-83. 34-3, 215-218. MCCRACKEN, K. W. (1981): Analysing Geographical Fox, D. J. (1972):"Patterns of Morbidity and Mortal Variations in Mortality: Age-Specific and Summary ity in Mexico City", Geographical Review, LXII-2, Measures," Area: 13, 203-210. 151-185. MEAKE, M. S. (1977):"Medical Geography as Human Fox, A. J. and GOLDBLATT,P. O. (1982): Longitudinal Ecology: the Dimension of Population Movement," Study: Socio-Demographic Mortality Differentials, Geographical Review, 67-4, 379-394. HMSO, London. PETER, J. (1988):"Dietary Factors in Benign Breast Dis FRENCH, G. E. and HILL, A. G. (1971): Kuwait, Urbani ease," The Cancer Bulletin, The University of Texas, zation and Medical Ecology. A Geomedical Study, 40-1, 44-50. Springer, Berlin. PRIOR, P. (1988):"Long-term Cancer Risk in Alco GERALD, F. R. (1979): Applied Medical Geography, holism," Alcohol and Alcoholism, 23-2, 163-171. John Wiley and Sons, Washington. PYLE, G. F. (1979): Applied Medical Geography, John Spatial Patterns of Major Mortality Causes in Kuwait 13

Wiley and Sons, Washington. Geneva.- PYLE, G. F. (1976):"Introduction: Foundations to Med (1978): Arterial Hypertension, Technical Report ical Geography," Economic Geography, 52-2, Serires, No. 628, Geneva. 95-102. -(1985): Blood Pressure Studies in Children, ROOTMAN, I. and MOSER, J. (1984): Guidelines for In Technical Report Series, No. 715, Geneva.- vestigating Alcohol Problems and Developing Ap (1959): Hypertension and Coronary Heart Dis propriate Responses, W. H. O., Offset Publication No. ease: Classification and Criteria for Epidemiological 81, Geneva. Studies, Technical Report Series, No. 168, Geneva.- SURESH, S. A. (1987):"A Comparative Study of Cancer (1982): Prevention of Conorary Heart Disease, in North-West India and Saudi Arabia," The Second Technical Report Series, No. 678, Geneva.- U. A. E. Cancer Conference, p. 76. (1983): Primary Prevention of Essential TROYER, H. (1986):"Review of Cancer Among Four Hypertension, Technical Report Series, No. 686, Religious Sects: Evidence that Life-Styles are Distinc Geneva.- tive Sets of Risk Factors," Social Science and Medi (1964): Rehabilitation of Patients with Cardi cine, 26-10, 1007-1017. ovascular Diseases, Technical Report Series, No. 270, United Nations, World Health Organization (1962): Ar Geneva.- terial Hypertension and Ischaemic Heart Disease: (1962): Road Traffic Accidents: Epidemiology, Preventive Aspects, Technical Report Series, No. 231, Control and prevention, Geneva.

ク ウ ェー トにおけ る主 な死 亡原 因 の地域 パ ター ン

M. M.ア ジ ズ*

本 研 究 は ク ウ ェー トにお け る3大 死 亡 原 因 を 地 域 的 に る。 特 に循 環 器 系 疾 病 に よる死 亡 率 は 高 く,次 い で事 故 考 察 した もの で あ る。 ク ウ ェ ー トの人 口は,ク ウ ェー ト 傷害,腫 瘍 の順 で あ る。 人 と非 ク ウ ェー ト人の2つ の 明瞭 に 異 な る コ ミュ ニテ ィ ク ウ ェー ト人の 間 の死 亡率 は非 クウ ェー ト人の そ れ よ か ら成 り立 って お り,両 グル ー プの 社 会 的,経 済 的,人 りも高 い 。 ま た,両 コ ミュ ニテ ィ と も,女 子 よ り男子 の 口学 的 性 格 は 死 亡 の分 布 に 大 き く影響 し てい る。 方 が 死 亡 率 が 高 い 。地 域 的 に は,ク ウ ェー ト市を 含 む 首 死 亡 率 は,死 因 に 関 す る国 際 的 分 類 に よ り10万 人 ご と 都 地 区 と ジ ャハ ラ地 区 で 特 に 高 い 。 移 民 は,事 故 傷 害 に に 算 定 した 。 主 な 死 因 は 腫 瘍,循 環 器 系 疾 病,事 故 傷 害 か か りやす い 。 の3つ で,こ れ ら で全 国 の死 亡 の3分 の2近 くを 占め

* ク ウ ェ ー ト大 学 文 学 部 地 理 学 教 室 ク ウ ェ ー ト国 ク ウ ェ ー ト市