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Monday, April 24, 2017
Joseph Chamie is an independent consulting demographer and a former director of the United Nations Population Division.
- The number of deaths worldwide in 2015 was approximately 57 million. Those deaths represent 0.78 percent of the world’s population of 7.3 billion. In comparison, 140 million births occurred in 2015, resulting in a global population increase of 83 million people.
The major causes of death worldwide are ischemic heart disease, stroke, lower respiratory infections and chronic obstructive lung disease (Figure 1). Those four key diseases have remained the world’s top killers during the past decade.
Two-thirds of all deaths are due to non-communicable diseases, in particular cardiovascular diseases, cancers, diabetes and chronic lung diseases. As has been the case throughout recent years, cardiovascular diseases are the number one cause of death in the world, accounting for nearly one-third of all deaths.
The critical behavioral risk factors for heart disease, stroke and lung diseases are unhealthy diet, physical inactivity, excessive alcohol consumption and tobacco usage. The use of tobacco, in particular smoking, is responsible for the death of about 1 in 10 adults worldwide.
Communicable diseases together with maternal, neonatal and nutrition conditions account for close to one-quarter of all deaths. The deadly infectious diseases include lower respiratory infections, HIV/AIDS, diarrheal diseases, malaria and tuberculosis.
While progress has been achieved in reducing maternal deaths, maternal mortality rates continue to be high. Nearly 830 women die daily due to complications of pregnancy and childbirth. Rates are especially high in some African countries, such as Chad, Mali and Somalia, where a quarter or more of the deaths among women of reproductive ages are from maternal causes relating to pregnancy and childbirth.
For children under age 5, the major causes of death are prematurity, pneumonia, birth asphyxia and birth trauma, and diarrheal diseases. In 2012 approximately 4 in 10 deaths of children under age 5 years took place within 28 days of birth, with prematurity responsible for 35 percent of those deaths.
Injuries are responsible for nearly one-tenth of all deaths. Road traffic injuries in particular take approximately 3,500 lives each day, placing it among the ten leading causes of death. Among people aged 15 to 29 years the major cause of death is road traffic injuries. And approximately 75 percent of all road traffic deaths are among males. One of the most important risk factors in road traffic fatalities is alcohol consumption.
While more than half of deaths worldwide occur after age 65, the age distributions of deaths vary greatly by development level. In Japan, for example, 60 percent of deaths occur after age 80. Child mortality under age 5 years claims 0.26 percent of all deaths and the chances of a Japanese child not reaching age 5 is about 1 in 333.
In contrast, in Nigeria nearly 60 percent of deaths occur below age 30. Child mortality under age 5 years accounts for 37 percent of all deaths and the chances of a Nigerian child not reaching their fifth birthday is approximately 1 in 8.
Major causes of death also vary considerably by socio-economic conditions. The top four causes of death in low-income countries in 2012 were lower respiratory infections, HIV/AIDs, diarrheal diseases and stroke. In high-income countries, in contrast, the top four killers were ischemic heart disease, stroke, trachea bronchus/lung cancers, and Alzheimer’s and other dementia (Figure 2).
Suicide, another important cause of death, was responsible for over 800,000 deaths in 2012 or about 1.4 percent of all deaths worldwide. Due to religious, social and legal pressures, the incidence of suicide tends to be under-reported or not reported at all in some cases.
In 2012 three-fourths of all reported suicides took place in low- and middle-income countries. The most suicide-prone countries were Guyana, North Korea, South Korea, Sri Lanka, Lithuania, Suriname and Mozambique.
Males are nearly twice as likely as women to take their own lives. Suicide rates were highest among those aged 70 years and over. However, among young people aged 15 to 29 years suicide is the second leading cause of death worldwide.
Intentional homicide accounts for almost half a million deaths annually, or 0.8 percent of all deaths. In 2012 no less than 437 thousand people were murdered with men making up about 80 percent of homicide victims and 95 per cent of perpetrators.
More than half of all homicide victims are under 30 years of age, with children under the age of 15 accounting for 8 per cent of all homicides. Close to 15 per cent of all homicides is the result of domestic violence with women making up 70 per cent of those fatalities.
Some of the highest homicide rates are in Central and South American countries, such as Belize, El Salvador, Guatemala, Honduras and Venezuela, where rates range from 40 to 90 deaths per 100,000 population. Among the high-income countries, such as Germany, Japan, United Kingdom and the United States, homicide rates are comparatively low, less than 5 deaths per 100,000 population.
The number of deaths in war and civil conflict account for approximately 0.3 percent of all deaths globally. The body count from the top twenty deadliest wars in 2014, according to the Project for the Study of the 21st Century, was 164 thousand.
The four deadliest conflicts in 2014 were Syria (76 thousand), Iraq (21 thousand), Afghanistan (15 thousand) and Nigeria (12 thousand). Those and other conflicts experienced significant increases in casualties over the previous year.
The proportion of all deaths due to terrorism is about 0.06 percent. In 2014 the death toll from terrorism was approximately 33 thousand, compared to about 18 thousand in 2013. Nigeria had the largest increase in terrorist fatalities with about 7,500 deaths in 2014, an increase of more than 300 percent over 2013.
Terrorist attacks and deaths are highly concentrated geographically. Five countries – Afghanistan, Iraq, Nigeria, Pakistan and Syria – accounted for nearly 80 percent of terrorism fatalities in 2014.
Iraq stands out as the worst affected country from terrorism, having the highest number of terrorism incidents and fatalities ever recorded by a single country. Approximately 30 per cent of all deaths in 2014 were the result of terrorist attacks.
The number of deaths due to executions in 2014 was no less than 607. While 22 countries carried out executions in 2014, three of them − Iran, Iraq and Saudi Arabia – were responsible for more than 70 percent of recorded executions.
The number of executions is an underestimate as some countries underreport or do not report executions. In particular, the number does not include China, where statistics on the death penalty are a state secret.
Finally, as death is the inevitable outcome for everyone, the issue of the preferred or best ways to die often arises. People typically report that they prefer to die peacefully at an old age, at home in bed. Most wish to avoid a painful, lengthy and burdensome end of life.
Many would like to pass away quietly, comfortably and unbothered at an advanced age, preferably in their sleep. Others desire to die suddenly and painlessly after living an active, disability-free life. The Japanese have referred to this as “Pin Pin Korori” (ピンピンコロリ), the wish to live a long and happy life followed by sudden death rather than prolonged frailty or illness.
Some, perhaps even many, choose not to reflect upon death and end of life decisions. As one American comedian glibly remarked, “I’m not afraid to die, I just don’t want to be there when it happens.”
Ignoring one’s unavoidable demise, however, is unwise and unhelpful. Talking about the end of life, writing down one’s wishes and sharing those decisions with others makes one’s passing away less difficult, stressful and unsettling for family, friends and caregivers.