Estimating indirect mortality impacts of armed conflict in civilian populations: panel regression analyses of 193 countr
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RESEARCH ARTICLE
Open Access
Estimating indirect mortality impacts of armed conflict in civilian populations: panel regression analyses of 193 countries, 1990–2017 Mohammed Jawad1* , Thomas Hone1, Eszter P. Vamos1, Paul Roderick2, Richard Sullivan3 and Christopher Millett1
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 1118 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 allcause 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. Keywords: Conflict, War, Health, Mortality
* Correspondence: [email protected] 1 Public Health Policy Evaluation Unit, Imperial College London, 3rd Floor, Reynold’s Building, St Dunstan’s Road, Hammersmith, London W6 8RP, UK Full list of author information is available at the end of the article © 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 a
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