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Death in Indonesia: Estimating All-Cause Mortality, Cause-Specific Mortality

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Death in Indonesia: Estimating All-Cause Mortality, Cause-Specific Mortality Death in Indonesia: estimating all-cause mortality, cause-specific mortality, and fatal burden attributable to smoking and air pollution Sarah Wulf Hanson A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy University of Washington 2019 Reading Committee: Theo Vos, Chair Laura Dwyer-Lindgren Emmanuela Gakidou Christopher J. L. Murray Program Authorized to Offer Degree: Global Health ©Copyright 2019 Sarah Wulf Hanson University of Washington Abstract Death in Indonesia: estimating all-cause mortality, cause-specific mortality, and fatal burden attributable to smoking and air pollution Sarah Wulf Hanson Chair of Supervisory Committee: Theo Vos Department of Health Metrics Sciences Indonesia is a populous, diverse country that has not been well studied in terms of health. This analysis addresses that knowledge gap in three aims by first, estimating the number deaths in Indonesia by province, year, age, and sex; second, developing a cause list based on cause of death assignment accuracy and estimating cause-specific mortality by province, age, and sex in 2014 according to that cause list; and third, comparing four methods to attribute deaths to risk factors that can be measured by fine particulate matter concentration. The first aim adapted existing demographic techniques used by the Global Burden of Disease study to estimate subnational all-cause mortality over time by age and sex in Indonesia. Province-level life tables were generated from survey data about household deaths given the lack of a vital registration system in Indonesia and included in the analysis, along with all available data for population, education, income, child mortality, and adult mortality. The second aim consists of two parts. First, an analytical cause list was generated based on the accuracy of cause of death assignments in physician-certified verbal autopsy data. Second, this cause list was applied to all available physician-certified verbal autopsy data in Indonesia in order to estimate cause- specific mortality by province, age, and sex in 2014 using small area estimation methods. The third aim compares four methods of calculating attributable burden to risk factors related to fine particulate matter—ambient air pollution, household air pollution, active smoking, and secondhand smoke—for fatal health outcomes that have an established relationship between fine particulate matter exposure level and risk ratio of the outcome. Acknowledgments This work would not have been feasible or finished without the support shown me by so many people along the way. I would like to thank the Institute for Health Metrics and Evaluation and University of Washington for their financial and intellectual support: in particular, the IT and Data teams for their ever-ready help and humor, Admin and Ops for a corner office for our fledgling years when the PhD program began, and the UW libraries for faithfully fulfilling my many obscure article requests. I also thank my collaborators at the National Institute for Health and Research Development in Indonesia led by Dr. Soewarta Kosen, who welcomed me into their office, shared tea and stories and data with me, and convinced me to taste durian. Terima kasih banyak Pak Alo, Endah, dan kolega- kolega saya yang luar biasa. I give my deep gratitude to my committee for their loyal support and feedback throughout my dissertation process and for setting and maintaining a high bar. To Laura Dwyer-Lindgren, for her expertise in small area estimation and encouragement. To Chris Murray, for inspiring and facilitating my choice of studying burden of disease in Indonesia and for his keen methodological insights. To Emmanuela Gakidou, for creating this program and leading us students and candidates through the PhD process with grace and understanding. To Bob Mugerauer, for his kindness and invaluable perspective on facing difficulties during a PhD. And to Theo Vos, for his patient commitment, care, and guidance through the long years, interruptions, periods of slow progress, and many chapter drafts. I am grateful to my colleagues both near and far. To my early officemates David Phillips, Grégoire Lurton, and Roy Burstein for inspiring laughter and curiosity at our intellectual hours, and to Joe Dieleman for inspiring the practice. To my close friends and all my fellow PhD students, for their support, optimism, and encouragement along the way. To the FacebookTM group “PhD and Early Career Researcher Parents” for the shared experiences, commiseration, encouragement, and companionship among researcher parents across the world. And to my church community, whose love and care exemplify that of Jesus. I am indebted to the coffee shops within walking distance, where I have spent countless days writing code, debugging code, staring into space, creating too many figures and tables, sipping coffee, drafting and redrafting chapters, holding back tears, holding back jubilation, and reminding myself to stretch and drink some water occasionally. Special gratitude is reserved for Bruce Johnson, whose willingness to put another’s life before his own in the face of danger will always remind me of the goodness and grace of God, without whom I would likely not be here today. I am so grateful to my family. To my brothers Ben and Adam, their wonderful families, my extended family, and my family-in-law for the love, interest, and care they have all shown as they cheered me on to the final submission. To my mother for sacrificing many weeks to care for us during times of need, and to my father for his corresponding sacrifices at home; I would not have finished without you and am humbled by your gift. I thank Graeme, who has only ever known me as a PhD student but who has always seen me as much more than that. Thank you for loving me apart from what I do and for also loving what I do. Your humility, selflessness, kindness, and humor inspire me daily, and I can’t wait to watch Survivor with you tonight. Luke and baby M, thank you for letting me be your mom. That is my greatest joy. Though you won’t remember this time, know that you have inspired me to, as my dad says, “study hard, eat well, sleep lots, and play some.” I pass this advice on to you, with plenty of play as your study. Death in Indonesia: estimating all-cause mortality, cause-specific mortality, and fatal burden attributable to smoking and air pollution Sarah Wulf Hanson, MPH [email protected] ADVISOR: Theo Vos, MD, MSc, PhD Professor, Health Metrics Sciences, University of Washington READING COMMITTEE: Laura Dwyer-Lindgren, PhD Assistant Professor, Health Metrics Sciences, University of Washington Emmanuela Gakidou, MSc, PhD Professor, Health Metrics Sciences, University of Washington Senior Director of Organizational Development and Training, Institute for Health Metrics and Evaluation Christopher J.L. Murray, MD, DPhil Chair and Professor, Health Metrics Sciences, University of Washington Director, Institute for Health Metrics and Evaluation GRADUATE STUDENT REPRESENTATIVE: Robert Mugerauer, PhD Professor, Urban Design and Planning, University of Washington Professor, Architecture, University of Washington Director, PhD in the Built Environment Program Contents Introduction ......................................................................................................................................1 Chapter 1: Age-specific and sex-specific all-cause mortality in 34 Indonesian provinces, 1990-2015 .....4 Introduction .................................................................................................................................................. 5 Methods ........................................................................................................................................................ 6 Overview ................................................................................................................................................... 6 Geographic units and time period estimated ........................................................................................... 7 Data source summary ............................................................................................................................... 8 Births and population numbers .............................................................................................................. 19 Education covariate ................................................................................................................................ 21 Lag-distributed income covariate ........................................................................................................... 26 Child mortality 5q0 .................................................................................................................................. 31 Adult mortality 45q15 ............................................................................................................................... 35 Age-specific mortality rate estimation ................................................................................................... 39 Under-5 deaths ................................................................................................................................... 39 Over-5 deaths ...................................................................................................................................... 41 Fatal discontinuities ...............................................................................................................................
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