IRUS Total

Estimating indirect mortality impacts of armed conflict in civilian populations: panel regression analyses of 193 countries, 1990-2017

File Description SizeFormat 
s12916-020-01708-5.pdfPublished version1.04 MBAdobe PDFView/Open
Title: Estimating indirect mortality impacts of armed conflict in civilian populations: panel regression analyses of 193 countries, 1990-2017
Authors: Jawad, M
Hone, T
Vamos, E
Roderick, P
Sullivan, R
Millett, C
Item Type: Journal Article
Abstract: Background Armed conflict can indirectly affect population health through detrimental impacts on political and social institutions and destruction of infrastructure. This study aimed to quantify indirect mortality impacts of armed conflict in civilian populations globally, and explore differential effects by armed conflict characteristics and population groups. Methods We included 193 countries between 1990 and 2017 and constructed fixed effects panel regression models using data from the Uppsala Conflict Data Program and Global Burden of Disease study. Mortality rates were corrected to exclude battle-related deaths. We assessed separately four different armed conflict variables (capturing binary, continuous, categorical and quintile exposures) and ran models by cause-specific mortality stratified by age groups and sex. Post-estimation analyses calculated the number of civilian deaths. Results We identified 1,118 unique armed conflicts. Armed conflict was associated with increases in civilian mortality - driven by conflicts categorised as wars. Wars were associated with an increase in age-standardised all-cause mortality of 81.5 per 100.000 population (β 81.5, 95% CI 14.3-148.8) in adjusted models contributing 29.4 million civilian deaths (95% CI 22.1-36.6) globally over the study period. Mortality rates from communicable, maternal, neonatal, and nutritional diseases (β 51.3, 95% CI 2.6-99.9), non-communicable diseases (β 22.7, 95% CI 0.2-45.2) and injuries (β 7.6, 95% CI 3.4-11.7) associated with war increased, contributing 21.0 million (95% CI 16.3-25.6), 6.0 million (95% CI 4.1-8.0), and 2.4 million deaths (95% CI 1.7-3.1) respectively. War-associated increases in all-cause and cause-specific mortality were found across all age groups and both genders, but children aged 0-5 years had the largest relative increases in mortality. Conclusions Armed conflict, particularly war, is associated with a substantial indirect mortality impact among civilians globally with children most severely burdened.
Issue Date: 10-Sep-2020
Date of Acceptance: 14-Jul-2020
URI: http://hdl.handle.net/10044/1/81420
DOI: 10.1186/s12916-020-01708-5
ISSN: 1741-7015
Publisher: BioMed Central
Start Page: 1
End Page: 11
Journal / Book Title: BMC Medicine
Volume: 266
Copyright Statement: © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
Sponsor/Funder: Medical Research Council
Keywords: Conflict
11 Medical and Health Sciences
General & Internal Medicine
Publication Status: Published
Online Publication Date: 2020-09-10
Appears in Collections:Faculty of Medicine
School of Public Health

This item is licensed under a Creative Commons License Creative Commons