Death in Indonesia: estimating all-cause mortality, cause-specific mortality, and fatal burden attributable to smoking and air pollution

Thesis (Ph.D.)--University of Washington, 2019Indonesia 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