MONDAY, 14 JANUARY 2008
Violence-Related Mortality in Iraq from 2002 to 2006
Iraq Family Health Survey Study Group
Yet another study has been published in an international medical journal of the rates of violent deaths in Iraqis since the occupation.
This time it is the American The New England Journal of Medicine’s turn (printed copy due to be published 31st January 2008).
I am not sure how much, if any interest this study will generate, but after all the fuss that followed the original Lancet study from Burnham et al it was only a matter of time before something like this was published.
For those interested I will summarise the findings, show you the tables, and highlight a few points I picked up when I scanned this paper.
The period studied is from 2002 to 2006, and the authors are the Iraq Family Health Survey Study Group or IFHS (who describe themselves as relevant federal and regional ministries in Iraq in collaboration with the WHO).
The study presents data collected by questionnaire conducted in 9354 households, covering 61,636 individuals, and 1325 deaths.
Not surprisingly it proved difficult for teams to visit all intended households, and the highest rates of non-visited households are in precisely the areas most likely to have seen the highest violent death rates.
Of the 1086 originally selected clusters, 115 (10.6%) were not visited because of problems with security. These clusters were located in Anbar (61.7% of the unvisited clusters), Baghdad (26.9%), Nineveh (10.4%), and Wasit (0.8%).
However the authors then compensate for this by utilising data from the Iraq Body Count; a source they state “underestimates the death toll, but probably over-estimates the rates in Baghdad”.
Data from the Iraq Body Count were used to compute ratios for death rates in Anbar and Baghdad, as compared with the three provinces that contributed more than 4% each to the total number of deaths reported for the period from March 2003 through June 2006.
The main conclusion of this study is that the overall death rate per 1000 person-years was 5.31 (95% CI 4.89-5.77) and violent death was 1.09 (95% CI 0.81-1.5).
Although there is an acknowledgement that underreporting of deaths is usual, and one cause is the dissolutions of the household after death of a member, the estimated 62% completeness of reporting is thought by the authors to be an underestimation.
The application of the growth balance method, with the use of the age distribution of deaths in the population obtained from the household roster, indicates that the level of completeness in the reporting of death was 62%. However, this estimation needs to be interpreted with caution, since a basic assumption of the method — a stable population — is violated in Iraq
In a table showing the cause of death by sex and age before and after the occupation
the authors comment that:
Overall, the proportion of deaths from injuries increased from 10.5% before the invasion to 23.2% after the invasion. The increase was most dramatic among men between the ages of 15 and 59 years, among whom deaths from injuries increased from 31.2% before the invasion to 63.5% after the invasion and became the leading cause of death in this age group.
I think what is just as significant if not more so is in this table is the absolute numbers of death due to communicable disease (infections) and reproductive (death during pregnancy or delivery), these rose four-fold, in children and women, and doubled in those over the age of sixty, accounting for an excess of 917 deaths, compared to the excess of 240 violent deaths.
The adjusted rate of death per 1000 person-years increased significantly, from 3.19 (95% CI, 2.67 to 3.82) to 6.36 (95% CI, 5.78 to 7.02); the increases were seen in all age groups but were most prominent in men between the ages of 15 and 59 years. Mortality from nonviolent causes was significantly higher per 1000 person-years in the post-invasion period (4.92; 95% CI, 4.49 to 5.41) than in the pre-invasion period (3.07; 95% CI, 2.61 to 3.63)
The highest mortality rates were in central and southern Iraq as compared to Kurdistan, and in males aged 15-59 years.
And finally the group compare these results with the two other sources of data.
The estimated number of violent deaths over the three years from this study is 150,000 deaths (or between 104,000 and 223,000) and lies somewhere between the “underestimates” of the Iraq Body Count (46,000 deaths), and the “over-estimated” Burnham (The Lancet study) data (650,000 deaths) for the same time period.
All three sources agreed on the low mortality in Kurdistan. Of all the violent deaths occurring in Iraq, the proportion in Baghdad was 54% in the IFHS, 60% in the Iraq Body Count, and only 26% in the study by Burnham et al.
The IFHS data indicate that every day 128 persons died from violence from March 2003 through April 2004, 115 from May 2004 through May 2005, and 126 from June 2005 through June 2006. The Iraq Body Count numbers were 43, 32, and 55 civilian deaths per day for the same periods. In the study by Burnham et al., there was a much higher rate of death from violence and a sharp increase during the 3-year period, with 231, 491, and 925 deaths per day, respectively. There was greater agreement regarding mortality from nonviolent causes between the IFHS study (372 deaths per day) and the study by Burnham et al. (416 deaths per day).
POSTED BY 3EERAQIMEDIC AT 00:00 4 COMMENTS
saminkie said...
Thank you 3eeraqimedic for this summary of that study...it was sad but important to know...
17 January 2008 09:08
Bruno said...
The omission of Anbar and the most violence stricken areas of Baghdad etc will seriously skew the results, IMO. IBC greatly underestimates mortality, and indeed, can only do so given that it is a passive reporting system based on news reports in a war that has been described as the most dangerous war for reporters ever.
18 January 2008 07:07
3eeraqimedic said...
Dear Sami
"It was SAD but important" an Iraqi looks at the study and sees, a terrible loss of precious lives, thousands of damaged families, and a fragile country losing a large section of its young men.
I have been reading the "foreign" comments on this study and almost everone is analysing from the "ha ha Lancet was wrong angle" or studyng the authors affiliations. I guess it is denial or deflection of responsibility.
Take care
18 January 2008 08:07
3eeraqimedic said...
Dear Bruno
Long time no "see"
I intentionally emphasised the point of missing clusters, and even the "Iraqi ministry personnel" who collected this data state that the IBC underestimates rates.
But ultimately no matter what studies show for some people this occupation would have been as much "worth it" as the sanctions previously.
18 January 2008 08:17
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