NATIONAL CENTER Series 3 

For HEALTH STATISTICS Number 2 

ANALYTICAL STUDIES 

PROP~RW OF ~~ : 

PUBLICATIONS13MNCH 

EDITORIAL LIBMY Recent


Mortality Trends in


Chile


A study of the trend of the death rate in Chile 

with consideration of sex, age, and cause groups 

and selected socioeconomic factors. 

Washington, D.C. April 1964 

U.S. DEPARTMENT OF 

HEALTH, EDUCATION , AND WELFARE Public Health Service 

Anthony J. Ce Iebrezze Luther L. Terry 

Secretary Surgeon General 
See inside of back cover 

for catalog card. 

Public IIealth Service Publication No. 1000-Series 3-No. 2 

For sale by the Superintendentof Documents, U.S. Government Printing Office 

Washington, D.C., 20402 - Price 30 cents 
NATIONAL CENTER FOR HEALTH STATISTICS 

Forrest E. Linder, Ph. D., Director


Theodore D. Woolsey, Deputy Director


Oswald K. Sagen, Ph. D., Assistant Director


(for Professional Relations)


Walt R. Simmons, M. A., Statistical Advisor


Alice M. Waterhouse, M. D., Medical Advisor


James E. Kelly, D.D.S., Dental Advisor


Louis R. Stolcis, M. A., Executive Officer


OFFICE OF HEALTH STATISTICS ANALYSIS


Iwao M. Moriyama, Ph. D., Chief


DIVISION OF VITAL STATISTICS


Robert D. Grove, Ph.D., Chief


DIVISION OF HEALTH INTERVIEW STATISTICS


Philip S. Lawrence, SC.D., Chief


DIVISION OF HEALTH RECORDS STATISTICS


Monroe G. Sirken, Ph. D., Chief


DIVISION OF HEALTH EXAMINATION STATISTICS


Arthur J.-”-Mcuoweu, ‘“ u_nel ““ “ 

DIVISION OF DATA PROCESSING 

Sidney Binder, Chief 

Public Health Service Publication No. 1000-Series 3-No. 2 
PREFACE


This is the second in a series of analytical studies of the 

Office of Health Statistics Analysis designed to ascertain causes 

underlying the change in mortality trend in a number of countries 

in recent years. 

These studies are part of a program of the Office to encourage observation and interpretation of national trends by contracts with responsible investigators in various countries, in 

order to provide clues for comparison with findings in the United 

States and other countries. For the most part the change in trend 

is observable in countries of low mortality. However, Chile is one 

of the countries of higher mortality where the same phenomenon 

is apparently occurririg. In an effort to find the reasons for the 

leveling off of the death rate in Chile, a contract was made with 

Dr. Hugo Behm, Professor of Biostatistics, School of Public 

Health, University of Chile, who directed the project. 

Dr. Clara E. Councell of the Office of Health Statistics 

Analysis edited the research report for publication. 
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CONTENTS


Preface


Summary


Introduction


Mortality Trends by Sex and Age, 1933-60--------------------------


Trend of Total, Male, and Female Death Rates


Trend of Mortality by 5-Year Age Groups


Trend of Mortality for Each Age Group bySex


Mortality Trends for Selected Causes


Selected Causes With Breakpoints in Trend


Tuberculosis


Other Infective and Parasitic Diseases


Gastritis, Duodenitis, Enteritis, and Colitis


Influenza, Pneumonia, andBronctitis


Selected Causes With NoBreakpoints


Accidents, Poisonings, andViolence


Certain Diseases of Early Infancy -------------------------------


Malignant Neoplasms


Vascular Lesions Affecting Central Nervous System


Other Causesof math


Effect of Selected Causes on the Crude Death Rate -----------

Mortality Trends for Selected Causes by Age Groups


Under 1 Year of Age-------------------------------------------


1-4 Years of Age----------------------------------------------


S-14 Years of Age---------------------------------------------


15-24Years ofAge ---------------------------------------------


25-34 Years of Age--------------------------------------------


35-44 Years ofAge ---------------------------------------------


45 Years and Over ---------------------------------------------


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CONTENTS—Continued 

Mortality Trends by Sexand Age Groups 

Medical, Social, and Economic Factors Related to Mortality Trends---

Bibliography 

Wtailed Tables 

Appendix --------------------------------------------------------

Population 

~aths 

Mortality Trends for Selected Causes 

Cardiovascular Diseases


Certain Diseases of Early Infancy


Gastritis, Duodenitis, Enteritis, and Colitis


Other Causes


SYMBOLS 

Data not available 

Category not applicable . . . 

Quantity zero -

Quantity more than O but less than 0.05---- 0.0 

Figure doesnot meet standards of * reliabilityor precision 

15 

15 

20 

21 

31 

31 

31 

32 

32 

33 

33 

34 
RECENT MORTALITY TRENDS IN CHILE


The following reseorch report wos prepared by i-fugo &llrn, M. D., M. P. H., Professor of 5iostotistics, School of Public Health, 

University of Chile; ond Albino Bocaz, Hector Gutierrez, Adela Legarreta and Luis Marchant, Staff Members, Department of Biostatistics, Schaol of Public Heolth. The methodology, findings, nnd conclusions are thase of the investigators. 

SUMMARY 

The trend of mortality rates by sex and age 

has been studied in Chile for the years 1933 

through 1960 and for selected causes by sex and 

age for 1937 through 1959. .’lle crude dea.ti rate 

which declined steadily from. 1933 to 1953 has 

since leveled off for males and “females. The rate 

is 12.3 per 1,000 population in 1960. The change 

in trend occurred almost exclusively for the population under 50 years of age. The breakpoint was 

followed by a relatively constant rate, a slight increase, or a decline at a lower rate. A comparison of death rates by sex showed that between the 

ages of 20 and 50 years the interruption in the 

downward trend of mortality occurred 1 or 2 

years earlier for males than for females. Analysis by cause showed that the notable decline in 

mortality for the period 1937-53 was due largely 

to fewer deaths from a group of diseases of infective etiology (i.e., pneumonia, tuberculosis, 

gastritis and related diseases, and other infective 

diseases). Since 1953, these diseases had less of 

an average absolute decline (tuberculosis and gastritis, duodenitis, enteritis, and colitis) or a clear 

increase (influenza, pneumonia, and bronchitis). 

On the other hand, the diminishing relative importance of these groups 

progressive emphasis to 

showing little change or 

trend such as accidents, 

vascular lesions affecting 

tem, and certain diseases 

diseases also contributed 

total crude death rate. 

as causes of death gave 

the causes with rates 

a slightly increasing 

malignant neoplasms, 

central nervous sysof early infancy. These 

to the leveling of the 

About one-third of all deaths were under 1 

year of age when the change in trend seemed to 

be related to diminishing efficient control of mortality due to malnutrition and enteric and respiratory infections. Between 15 and 34 years of age, 

the trend of the total rate was influenced by the 

change in direction of mortality from tuberculosis and pneumonia, both important causes of death 

with declines interrupted in 1953. For older age 

groups, the weight of mortality from accidents and 

degenerative diseases became more important. 

Differences in trend by sex showed a more rapid 

decline in tuberculosis mortality for females and 

a more marked increase for males in death rates 

due to accidents and malignant neoplasms. 

The major findings were: (1) leveling of the 

death rate had occurred since 1953 for both sexes 

in all age groups under 50; (2) the decline in mortality from 1937 to 1953 was due largely to a decrease in death rates for infective diseases, while 

in recent years the decline has slowed or rates 

have increase~ and (3) other causes of death with 

long-term constant or slightly increasing trend 

have become progressively important. It was concluded that health programs, even though continuing to expand, have not been able to provide adequate services for a large segment of thepopulation with poor socioeconomic conditions. 

INTRODUCTION 

In areas of the world where vital records 

have been available over a long period of years, 

death and infant mortality rates have shown a 

general downward trend from the earliest re1 
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corded data. Significant improvements in mortality rates were made in many countries after 

the close of World War II, particularly for the 

younger age groups. In a number of countries, 

as in Chile, after a period of rapidly declining 

mortality, there has been a deceleration in the 

rate of decline of the crude death rate and infant 

mortality rate at varying years since 1950. The 

purpose of this study was to describe characteristics of changes in the mortality trend in Chile 

during the period 1933-60 and to study the possible 

relation of medical care, level of living, and other 

socioeconomic indicators to these changes. 

MORTALITY TRENDS 

BY SEX AND AGE, 1933-60 

Trend of Total, Male, and 

Female Death Rates 

In recent years, an important change in mortality trends has occurred. An analysis of infant 

mortality showed that beginning in 1953 the decline in this death rate was interrupted and there 

was an increase in the rate for several geographic 

areas of the country. 1 The crude mortality rate 

showed a marked and approximately linear decline for the period 1933-53 with an annual average reduction of 0.64 per 1,000 population. Mortality for that period declined from 26.0 to 12.4 

per 1,000 population or approximately 50 percent. 

After 1953, mortality leveled off at an average 

rate of 12.5 per 1,000 population (table 1 and 

fig. 1)0 

The significance of this change is evident if 

the mortality for 1960 is estimated on the basis 

of regression for 1933-53. The expected rate was 

8.6 and the observed rate was 12.3, which means 

that 28,024 of the total 93,625 deaths registered in 

1960 would not have taken place if the previously 

described trend had continued. 

The leveling of death rates in recent years 

occurred in Chile at high levels as may be seen 

l~=hm u-: ,\lor~a[j&d jnfantil y nivel de uida. Santiago de 

Chile. Edi’ciones de la Universidad de Chile. 1962. 

29 

28 I I 

,,,,,,,,,,,,, Bolh Sezes 

1[1

‘“~ 

1:33 ’35 1940 ‘45 1950 ’53 ’55 19m 

YEAR 

Figure 1. Totalcrude death rate and death rates by sex: Chile, 

1933.60 

by a comparison with U.S. rates for the same 

year. Fo; 1959 the rates were as follows: 

Chile 

Crude death rate (per 

1,000 population) 12.7 

Infant mortality rate 

(per 1,000 live 

births) 1~~.~ 

Neonatal 

Postneonatal 77:0 

Tuberculosis (per 

100,000 population) 56.1 

Other infective and 

parasitic diseases 

(per 100,000 population) 44.4 

United 

States 

9.4 

26.4 

19.0 

7.4 

6.5 

6.2 

2 
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An analysis of the mortality trend by sex 

showed a similar pattern of change, and the breakpoint was situated around 1953. The death rate 

for males was always higher than that for females, 

and the difference in rates between males and females tended to be proportionally greater because 

of a slightly greater decline in female mortality. 

The respective regression equations were: 

1933-1953 

Total y = 25.83 - 0.64 x 

Male ----------------- y = 26.72 - 0.63 x 

Female y = 24.96 - 0.64 X 

1953-1960 

Total y = 12.67 - 0.03 X 

Male ----------------- y = 13.67 - 0.01 X 

Female y= 11.78 - 0.08 X 

Trend of Mortality by 5-Year Age Groups 

An overall picture of the courseof mortality 

for each 5-year age group is shown in figure2. 

The relative reduction in the rates was generally 

greater for the younger age groups, except for 

under 1 year of age. On the other hand, itcanbe 

observed that the declining trend ofmortalitywas 

broken for all ages under 50 years—the pointof 

change being between 1953 and 1956. After these 

years, mortality increased, leveled off, or decreased its rate of decline. 

Straight linesof regressionwere drawnfreehand to determine whethertherehad beenabreakpoint around 1953. Ifso, linear regressions were 

adjusted in the respective agegroupsfortheperiod immediately before and after the yearof 

change. For the remainingagegroups, regression 

lines showed no breakpoint. It is evident that the 

year in which the breakpoint was situated wasapproximated. For the adjustment, some values 

which occasionally disturbed the general trend 

were substituted—for example, the increasedaccident mortality of 1939 due to an earthquake. 

In 1;33, the beginning of the period under 

study, the death rates for persons under 50years 

of age continued to be high until 1938-40. The 

abrupt increase for the year 1939 resulted from 

deaths causedby the earthquake. Inmanyofthese 

age groups, a rapid decline which had started 

earlier for some of the other age groups then 

began. 

The course after 1939 presented different 

characteristics according to age. For all ages 

under 50 years and also for theage.groups 55-59 

and 8S and over, an evident interruption of the 

favorable mortality trendwasobserved. Forsome 

age groups the change usually occurred during 

1953-54, but for others it did not occur until 

1955-56. 

For the agesunder lyearand 5-9years, the 

breakpoint was followed by an increase inmortality. For the age groups l-4,10-14, 20-24,25-

29,40-44,45-49, and85 yearsand over,the trend 

showed little change for recent years. Finally, at 

ages 15-19, 30-34, 35-39, and 55-59 years, the 

rates continued descending but with an absolute 

mean reduction lower than that for the preceding 

period. 

In contrast with this course, no significant 

changes in the trend of mortality for the older 

age groups were observed during 1953-56. The 

rates continued to decline slowly for ages 50-54 

and for ages between 60 and 79 years. For the 

age group 80-84 years,thelevelingoccurredfrom 

approximately 1940. 

Asummary of the trend for the groups which 

had achangein 1953-56, separated into twoperiods according to the presumable breakpoint, is 

indicated below. 

Period I


Age Regres-


Years sion


slope


Under 1---- 1936-53 -7.74 

1-4-------- 1933-53 -1.15 

5-9-------- 1933-56 -0.18 

1o-14------ 1940-55 -0.17 

15-19 1944-53 -0.47 

20-24 1938-56 -0.44 

25-29 1939-53 -0.45 

30-34 1933-47 -0.26 

-0.561 

Period II


Esti­


mated Regres­


break- sion


point slope


1953 1.22


1953 -0.05


1956 0.07


1955 -0.01


1953 -0.09


1956 0.01


1953 -0.03


( 1947-54 

35-39 1938-54 -0.41 

1954 

1954 

-0.10 

-0.18 

40-44 1933-53 -0.37 1953 -0.07 

45-49 1933-53 -0.46 1953 -0.06 

55-59 1933-54 -0.54 1954 -0.23 

85+-------- 1935-53 -4.78 1953 -0.48 

3 
13-

\ 

RATE PER 1,000 POPULATION 

300 -

Under I


203 -

1001 1 1 1 I I I I t 1 , ! ! 1 I I 1 1 1 1 1 I 1 I ! I 1 I


I933 ’35 1940 ’45 1950 ’53 ’55 1960


40


r


I-4


30


20
h 

I
 \ 10


9


8 , I 1 I 1 , , I , I I I I t t I , !


I e33 ’35 1940 ’45 1950 “53 ’35 1960


II 1 1 I , 1 t ! I I , , , t I , t , 1 , f [


1933 35 1940 ’45 1950 “53 ’55 I 960


4-

10-14


3 -


2 -

[1 I I I ! I t I I , , I I 0 , , 1 , , 1 1 , t , 1


1933’35 1940 ’45 1950 ’53 ’55 [960


YEAR 

RATE PER 1,000 POPULATION 

8-

7
 15-!9


6 -


5 -

4 -


3 -

2 -

~ 

1933 ’35 1960


12~ 

20-24


9 -


8 -

7 -

6 -

5 -

4 -

3 -

21 I , I , , , , , , 1 , I


1933’35 1940 ’45 1950 ‘53 ’35 1960


12-


10 - 25-29 

9 -

8 -

7 -

6 -

5 -

4 -

;,I 1950 1960


.-

30-34
 10-

9 -

s -

T -

6 -


5 -


4 t ,


[933 ’35 1940 ‘45 1950 ’53 ’55 1960


YEAR 

Figure 2. Death rotes by age: Chile, 7933.60 

4

RATE PER 1,000 POPULATION


15


35-39


10 -


Y ­


B -


7 -


6 -


5 I , I , I 1 I I 1 ! , I I 1 I I t ! , , 1 1 I ,


I!333 ’35 1940 ‘45 1950 ’53 ’55 1960


I


Is - 40–44 

14 -

12 -

10 -

9 -

B -

7


1933 ’35 1940 ’45 1950 ’53 ’55 1960


‘;~1933 ’35 1940 ’45 1950 ’53 ’55 1960


30-


25 - 50-54 

20 -

15 -

101 1 1 I 1 I t I I I , t ! 1 I I I 1 , I , I t , I ,


1533 ’35 1940 ’45 1950 ’52 ’55 1960


YEAR 

RATE PER 1,000 POPULATION


50


60-64
 40 -

30 -

20 I , ! I , I I I , ! t I ! , , , 1


1933 ’35 1940 ’45 1950 ’53 ’55 1960


,o~ 

1933 ’35 1940 1950 1960


Ilor 

75-79
 I 20


100 -

90 -


80 I t 1 1 1 I ! t I ! t 1 r


1933 ’35 1940 ’45 1950 ’53 ’55 1960


80-84


200


I 80 -


I 50 -


1201 I 1 1 I 1 1 t , 1 I ! 1 I r ! t ( 1 1 I t 1 I I I ! 1


I 933 ’35 1940 ’45 1930 ’53 ’55 1960


.loo~ 

85+


I 50 I , I I 1 , , , t I ! 1 1 I r , 1 , I t t r I 1 1 I


1933 ’35 1940 ’45 1950 ’53 ’55 1960


YEAR 

Ftgure 2. Death rates by age: Ch;le, 1933-60- Con finued 

5

�

These age groups contributed 82 percent of Trend of Mortality for Each 

the deaths in 1937, 70 percent in 1953, and73 Age Group by Sex 

percent in 1960. This explains why these age 

groups, which presented a remarkable leveling Mortality for both males and females genoff immortality in recent years, have determined erally followed a similar course for the majority 

the change in the crude rate. Moreover, due to of age groups, with the usual pattern of higher 

the high infant mortality that prevailed in the rates for males. There was an exception for the 

country (119.6 per 1,000 live births in 1960), the age groups 10-14, 15-19, 20-24, and 25-29 years, 

course of the rates during the first year of life where death rates for females were similar or 

had a strong influence on the total rate; deaths at higher than those for males at the beginning 

this age (under 1 year) were 34,003 in 1960—36 of the study period. However, the downward 

percent of the total 93,625 deaths. trend was more marked for females and did 

700 t I 7’JL 

600 1,/+, ~1= 

~, l. fl.enz., Pne.mO.!. and bronchitis 

500 \+ 

L’*,-,w 400 

\+ 

S,-, f 

A. 

~ 

Certain diseoses of early i“fmcy 

.*. 

200 ;H2:73’’l,300[I.,.,..
 100 ,,, Other infective diseases 

90 -

80 -

70 - Accidenfs, 

poisonings 

60 - and violence 

50 - �4** �+ + �6*. #~*-@ 40 - Voscular Ie*io”s 

30-

20 -

10 1 t I I 1 , 1 1 ! 1 I 1 t ! , , 1 I 1 I 1 10 1 1 , I 1 , , 1 t , , I 1 , , I I , 

1937 1940 ’45 1950 ’53 ’55 ’59 1937 1940 ’45 1950 ‘ 53 ’55 ’59 

YEAR YEAR 

Figwc3. Deafh rates by cause: Chile, 1937.59 
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not level off until 1955-56, while the death 

rates for males leveled off earlier. Thus, mortality for females exceeded that for males at 

ages 10-19 until the years 1948-49 and at ages 

20-29 until 1942-43. An explanation ofthese differences canbe found in the analysis ofcausesof 

death for these ages. 

For ages 20-49 years the breakpoint usually 

occurred in differentyear sformalesand females; 

death rates for males generally leveled offlor 

2years ear~ier than those for females. 

The differences in the levels of mortality 

between males and females were proportionally 

smaller at ages from 1 year to around middle 

age, Nevertheless, differences for all age groups 

tended to increase during the period 1933-6L 

In general, there was a marked excess of mortality for males after age 40 except for the 

group 80- 84; female mortality was higher at 

85 years and over. 

MORTALITY TRENDS 

FOR SELECTED CAUSES 

Deficiencies in certification of causes of death 

in Chile as well as irregularities in the application of the International Classification imposed 

some restrictions on the analysis of death by 

cause. For example, in spite of its numerical importance, the group of cardiovascular diseases 

was not included because of inconsistencies in 

statistics. Other causes of numerical importance 

were included in the group of other causes of 

death because the quality of cause certification 

precluded separate analysis. 

Age 

Death rates per 100,000 population for different groups of causes are shown in table 2. Groups 

of causes shown in figure 3 were selected for their 

numerical importance and the quality of basic 

data. These groups comprise 68 percent of the 

deaths in 1937 and 69 percent of those in 1959. 

The breakpoint shown by the crude death rate 

occurred in 1953. For the causes which had 

changes before and after this year (discussed as 

Period I and Period II, respectively), linear regressions were adjusted excluding some points 

with obvious accidental departures from the general trend. In the case of tuberculosis and gastritis, duodenitis, enteritis, and colitis the trend 

showed a break in 1948 and 1949, respectively. 

The group of certain diseases of early infancy presented irregularities, and because linear adjustment was not satisfactory, a parabola was used. 

For groups that had no obvious changes during the 

period 1937-59, only one regression line is shown. 

Rates read from the regression lines for 

1937, 1953, and 1959 have been discussed including those which changed the relative importance 

of various causes in relation to the total rate. 

Various deficiencies of the basic data added an 

error factor which could not be estimated to the 

regression coefficients and rates so determined. 

The effects of applying different revisions of the 

International Classification have not been analyzed 

since the error factors that have been discussed 

exceed by far the disparities resulting from use 

of the different revisions. 

Rates by cause for all ages have not been adjusted by age and sex because an analysis was 

made by age groups. The percentage distributions 

of the enumerated population by age and sex according to the censuses of 1940 and 1952 were as 

follows : 

1940 1952 

Male Female Male Female 

Total 100.0 100.0 100.0 100.0 

Under lo------------------------------- 37.8 36.5 38.3 36.4 

15-49 50.6 51.1 49.0 50.1 

50-64 8.4 8.6 9.0 9.2 

65-I------------------------------------- 3.2 3.8 3.7 4.3 

7 
SELECTED CAUSES


WITH BREAKPOINTS IN TREND


Tuberculosis 

For the period 1937-48 the decline was small 

(45 points), with an average annual reduction of 

3.6. In 1948 a first change in slope was observed 

and the leveling off was accelerated to an armual 

decline of 27.6 per 100,000 population with a decrease of 217 in 1948 to 75 in 1953. Thus, the relative importance of tuberculosis decreased from 

11 percent to 6 percent of all deaths in 1953. 

Another change in the trend took place in this 

year—the decline became slight and similar to 

that for 1937-48. 

Other Infective and Parasitic Diseases 

In Period I an important reduction occurred 

in this group of causes (b = -5.8), and the rates 

dropped from 129 to 38. There was an evident 

break in 1953 with a slight increase afterwards; 

the group produced 3 to 4 percent of all deaths 

in Period II. 

Gastritis, Duodenitis, Enteritis, and Coliti5 

As for tuberculosis, there was a decline of 

relative importance (b = -5.9) for this group during the first period (1937 -49), lowering the rate 

from 200 to 138. This favorable trend accelerated 

in 1949-53, when the average annual decline 

reached 25.8 and there was a gain of 103 points. 

A change in 1953 resulted in leveling off-these 

causes contributed only 3 percent of the total 

mortality as compared with 9 percent of all deaths 

in 1937. 

Influenza, Pneumonia, and Bronchitis 

Although this group of causes presented great 

irregularities in the magnitude of rates, it is evident that there was a steady decline in Period I 

(b = -20.7) with a considerable drop in rates from 

.567 to 249. Around 1952-53, a substantial change 

was produced in the trend which then showed an 

increase (b = +4.9). This breakpoint is important 

because this group of causes contributed more 

than one-fifth of all deaths even after the reduction described. 

8 

SELECTED CAUSES 

WITH NO BREAKPOINTS 

Accidents, Poisonings, and Violence 

Disregarding 1937-39, mortality from this 

group of causes showed little change and increased only from about 72 (based on the 1940-

59 regression line) to 79 per 100,000 population 

in the 23 years of observation. Due to the decline 

of deaths from other causes, its proportion of 

total deaths rose from 3 to 6 percent. 

Certain Diseases of Early Infancy 

Important deficiencies existed for this group 

of causes. In the first period, there was a slight 

drop in the rates—from approximately 232 per 

100,000 population in 1937 to 185 in 1953. Beginning with 1953, a new level of mortality was 

registered with great irregularities and a slight 

tendency to increase; these anomalies of the 

curve wer’e probably due to different criteria for 

classification. This group of causes showed no 

continuing decline and probably contributed about 

16 percent of all deaths. 

Malignant Neoplasms 

Mortality from these causes showed an uninterrupted and slight increase (b = +1.5) from 

1937-59, which carried the rates from 6S to 98 

per 100,000 population. In 1959 malignant neoplasms were responsible for 8 percent of the total 

deaths. 

Vascular Lesions Affecting 

Central Nervous System 

Selected as an indicator of the course of mortality for all cardiovascular diseases, the curve 

caused by this group of causes indicated a slight 

increase from 1937 through 1959 with rates of 42 

and 59, respectively. 

Other Causes of Death 

Deaths in this group reached almost one-third 

of the total. These data do not permit adequate 

analysis because of deficiencies in certification 

or rates of low magnitude, but it should be noticed 

that this heterogeneous group also had a tendency 

to decline until 1953 with later leveling off. 
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EFFECT OF SELECTED CAUSES 

ON THE CRUDE DEATH RATE 

The data collected, with all its limitations, 

showed that the important decline in the crude 

mortality rate for the period 1937-53 was fundamentally related to the decrease in mortality 

from a certain group of diseases of infective 

etiology. The total decrease was 1,061 per 100,000 

population, to which these causes contributed as 

follows: 

Declime 

in rate 

per 100,000 

Percent

of 

decline population 

Influenza, pneumonia, and 

bronchitis 318 30.0 

Tuberculosis 187 17.6 

Gastritis, duoclenitis,enteritis, and


colitis 165 15.6


Other infective 

and parasitic 

diseases 91 8.6 

These causes showed atotal reductionof 761 

points for this period, which represents 72percent of the decline inthe crude rate between 1937 

and 1953. Furthermore, this was an important 

group of causes, comprising 50 percent of all 

deaths registered in 1937. Mortality from tuberculosis and gastritis, duodenitis, enteritis, and 

colitis had an intermediate breakpointin PeriodI 

during 1948-49, after which the decline inthese 

rates was greatly accelerated. In factbetweenthe 

years 1948-49 and 1953, the death rates forthese 

causes dropped 245 points with b = -27.6 for 

tuberculosis and b = -25.8 for gastritis, duodenitis, enteritis, and colitis. 

The most important fact after 1953 was the 

changing trend for this group of causes. Tuberculosis was the only cause that had a continuous 

but slow rate of decline (b = -3.7) which comprised only a small part of the total mortality 

(4 percent). The groups of infective diseases–influenza, pneumonia, and bronchitis and gastritis, 

ciuodenitis, enteritis, and colitis—increased 

slightly, and in 1959 they were responsible for 30 

percent of all deaths. 

On the other hand, the causes of death which 

had a stationary or slightly increasing course 

made up a larger portion of the crude death rate 

due to a great extent to the important decline in 

mortality from the group of causes just mentioned. Deaths attributed to accidents, neoplasms, 

diseases. of early infancy, and vascular lesions 

affecting the central nervous system constituted 

35 percent of the deaths in 1959; the latter cause 

was included as an indicator of the upward trend 

of the total deaths from cardiovascular diseases. 

The causes of death with stationary or increasing 

course during 1937-59 indicated a second factor 

that contributed to the leveling off of total mortality since 1953. 

MORTALITY TRENDS FOR SELECTED 

CAUSES BY AGE GROUPS 

In analyzing the course of mortality by cause 

for different age groups, consideration was given 

to those in which a recent break in the decline of 

the rates had been observed. The analysis was restricted to ages for which information alxmt causes 

of death was available for at least 60 percent of 

deaths. 

Under 1 Year of Age 

Unfortunately, it was impossible to make an 

analysis of the trend of causes of death at this 

age, which contributed approximately one-third of 

all deaths in Chile, because of deficiencies in the 

specification of these causes in the basic data and 

problems of classification. 

In considering the numerical importance of 

the group in determining the course of the crude 

mortality rate, figure 4 was reproduced from a 

study 2 which showed the course of neonatal and 

postneonatal mortality for 1930 and 1960. The 

rates were calculated per 1,000 live births with 

a correction for underregistration of births. 

As is well known, most of the deaths during 

the first 28 days of life are related to pregnancy 

and birth. For the rest of the first year of life, 

2Behm, H., op. cit. 

9 
------------------

--------

--------------

------------------

--------

--------------

-----------------

300 

I I 

:~ 

1930 ’35 [940 ’45 1950 ’55 1960 

YEAR 

Figure 4. Infant mortality rates: Chile, ~930-60 

extensive clinical and epidemiological evidence 

indicated that mortality occurred principally from 

malnutrition and enteric and respiratory infections. 

A study 3 of deaths at 1-11 months with medical certification for 1957-59 gave the following 

distribution of the principal causes of death: 

Percent 

Influenza, pneumonia, and 

bronchitis 33.0 

Gastritis, duodenitis, enteritis, and colitis 29.7 

Nutritional maladjustment---- 16.2 

Other infective and parasitic diseases 6.4 

As shown in figure 4,therewas adifference 

between the fluctuating rates of decline in the 

31bid. 

mortality trend for the two age groups. Forneonatal mortality, the decline initiated in 1934 was 

extended until 1956 with an averageannualreduction of 3.0 per 1,000 live births, carrying the 

rates from approximately 100 to35, From 1956 

the rates leveled off. On the other hand, thedecline in mortality at l-llmonthswas lessmarked 

(b = -2.9) and was interrupted in1953; the rates 

declined from approximately 120 to 70 during 

1936-53. After 19531ateinfant mortalityincreased 

(b = +2.1), so that the rate for1960(84.5 per 

1,000) wassimilar totheone existing in Chilean 

1950. 

The break in the course of infant mortality in 

Chile must be attributed to thepersistenceof high 

mortality from malnutrition and enteric andrespiratory infections. 

For all of the following age groups, theregressions had 1940 as the point of origin due to 

the fact that during 1937-39 there were disturbing 

factors in the trend of some causes. In contrast 

with the analysis of causes for all ages, consideration is given here to the breakpoints for each 

group of causes in such a way that they do not 

coincide with the year of change of the total agegroup rate. The summary tables refer to the years 

1940 and 1959 and to the year in which the breakpoint was registered for the total age group. Intermediate points were added for tuberculosis and 

gastritis, duodenitis, enteritis, and colitis when 

an additional breakpoint was obvious. When the 

the same group of causes had a disparity in the 

point of union of both lines of regression, a mean 

of both predicted values was used for the summary table. 

1-4 Years of Age 

The selected causes that have been analyzed 

accounted for 67 to 74 percent of all deaths in this 

age group (table 3 and fig. 5). The total death rate 

declined by 1,690 points between 1940 and 1953, 

including the following: 

Decline Percent of


in rate total rate


Influenza, pneumonia, and bronchitis 559.0 33.1 Gastritis, duodenitis, enteritis, and colitis 444.2 26.2 

Other infective and parasitic diseases 157.9 9.3 

Tuberculosis 150.9 8.9 

10 
---------

--------------

---------------

---------

---------

--------------

--

This means that 78 percent of the total decline in 

the death rates from 1940 to 1953 forages 1-4 

years was attributed to these four groups of 

causes. The leveling off from 1953 appeared to be 

associated especially with the change in the trend 

for influenza, pneumonia, and bronchitis with a 

decline in the downward trend from 1940-53 

(b = -44.4) to 1953-59 (-3.7); this group contributed 41 percent of the deaths in this age 

group. Death rates for gastritis, duodenitis, enteritis, and colitis leveled off, and deaths from 

infective and parasitic diseases increased 

(b . +6.5). In 1959 these three groups of causes 

were responsible for 65 percent of all deaths at 

ages 1-4 years. 

Tuberculosis showed a great decline between 

1948 and 1953 (b = -23.5). After 1953 the slight 

reduction was of no significance since it caused 

only 1.8 percent of total deaths in 1959. 

5-14 Years of Age 

The rate for all causes had a change in trend 

for this age group in 1955; the average annual reduction for the periods 1940-55 and 1955-59 was 

14.4 and 0.2, respectively, as shown in table 4. 

Table 4 and figure 5 are based on the mortality trend of five groups of selected causes of 

death that accounted for approximately 64-72 percent of all deaths for this age group. The total 

death rate showed a decline of 221 points between 

1940 and 1955 to which the causes listed below 

contributed: 

Decline Percent in rate 

Tuberculosis 78.9 35.7 

lnf luenza, pneu ­ monia, and bronchitis 58.2 26.3 

Other infective 

eases 29.2 13.2 

Gastritis, duode - nitisj enteritis, 

and colitis 5.9 2.7 

and parasitic disThe decline of the first three groups was of 

decisive importance— contributing 62 percent of 

the deaths registered in1940 for this age group. 

Mortality from gastritis, duodenitis, enteritis, 

and colitis though in decline did not contribute to 

any large extent to the total death rate (2 percent). 

The leveling off of mortality in 1955 at ages 

5-14 years was determined in its greater part by 

the trend of mortality horn influenza, pneumonia, 

and bronchitis and other infective and parasitic 

diseases, which no longer declined but had a rising trend. Both groups registered 44 percent of 

all deaths in 1959. Only tuberculosis continued to 

decline though at a lower rate, and its weight in 

the trend of mortality for this age group was relatively small. On the other hand, deaths from accidents totaled 21 percent of all deaths in 1959, 

and the level of mortality from this cause has remained unchanged. For this reason therefore 

deaths from accidents are an important factor of 

change in the total death rate. 

15-24 Years of Age 

For this age group, the rates for mortality 

had a breakpoint situated approximately in 1954. 

The decline registered up to that year was more 

rapid between 1948 and 1954 than in preceding 

years. It has been possible to analyze the causes 

that accounted for 61-75 percent of the deaths as 

can be seen in table 5 and figure 5. 

The decline in the total death rate between 

1940 and 1954 was 517 points, with an average 

annual decline of 21 points for 1940-48 and 58 

points for 1948-54. This decline was clearly aresult of the decrease in mortality from tuberculosis, which contributed 44 percent of the deaths 

in this age group in 1940. The differences between 

the rates for 1940 and 1954 for the selected 

causes are listed below. 

Decline Percent in rate 

Tuberculosis 285.7 55.2 

Influenza, pneu - monia, and bronchitis 71.6 13.8 

Other infect ive and 

parasitic diseases 37.9 7.3 

It is evident, moreover, that the course of 

mortality from tuberculosis produced the change 

described for the total rate for 1948. Beginning 

II 
--

RATE PER 100,000 POPULATION RATE PER 100,000 POPULATION 

1,200 - 4oo~ 

[,000 

900 -

lnflUE.ZO, pneumonia ond bronchitis I-4 300 - T. L. f.. iosis 15-24 

800- 700 -

6W - 200 -

500 - -+ 

400 -

\ [J ,00 ~n#’ 

300 - ~ [Ai 

90 -

200 -

#-,@*\ 

\ % 8-T* “l%tiv. dmmses \ 

Gas,trifts, 

enteritis, 

d.oden if is, 

and colitis 

80 - Accid.ta!., 70 - poisoning. 

,** *.%,, ,.4 %, 60 ~ ..%,, � and violence ,. 

;,,*****’ % ,<.s * 

b 50 3 

$*+*’ s*@4*,,,\ ,. 

\ 88 “ t,+. -, 

\ ..-,4*% Tuberculosis #t 40 -

1, 49. -,4 \ 

[00 - # 8 

90 - ~!$.,+ b \

- # 30 - s9.m 

80 - “j L~~ %, 

70 - Olher \, 

20 - infect!ve diseoses * 

10 

9 

8-

7 

6 I 

1937 1940 ’45 1950 ’53 ’55 ’59 1937 1940 ’45 I 950 ’33 ‘55 ’59 

200 -

900 

5-14 800 25-34 

,o~ :~ 

700 E 

600 

I00 - Tub.(c.l.asis 500 

90 I 

400 - Tuberculosis 70 - , 

300 -

an~ bronchitis 

200 

30 -

a � 88 

j f’ 

20 - 100 -

90 -

80 -

70 ~ 

$ 

60 84


50 -8, \ In fluenzo,


* �9m..-*+* pnewno”ia 

40 - \ and bronchitis t 

6 - 30 - infective diseases 8-*. 

5 - % %-+ Gastritis, duoden,t, s * 

4 - enter if is, and colitis 20 - -t 

Other 8 

t 

*, 3 -

\ 

\m*, 

+ 

2 - 10 - \ 

9 - \ 

timm- 8 -

7 -

6 -

II 1 1 1 , I 1 r 1 , 1 I 1 t I I 1 I 5 , , 1 t , I 1 1 I 

1937 1940 ’45 1950 ’53 ’53 ’59 1937 1940 ’45 1950 ’53 ’55 ’59 

YEAR YEAR 

Figure 5. Death rates for selected causes by age: Chile, 1937-59 

12 
---

--

---

� 

Ku: pER Ioo, ooo POPULATION RATE PER 100,000 POPULATION 

1,200 -

400 

111M,t Tuberculosis

35-44 I ,000 -

900 -

800- 55-64 

300 ~n#nl#~l#l,,,,,,,, nllllnnfll#,, +,,**,*,,,* 700 and bronchitis 

+++ 600 - , Influenza, %,,,w 500 - Neoplosms 200 $~ pneumom. +.$ Accide”!s, and broncl.ltls ++ 400 - j! 

at ! $@%,q,,..fci l-s “%,,,,,,,,,,,, “, 

Tuberculosis 

100 

90 \ 

Bo * 200 -

~~i~ ~Q ;. � 

‘;-~-~* -*
* 40 $ 

\ 

30 *--U** 

\ 

\, ; 

-\ 20 ‘~, Other infective diseases ~ \ ,6** 

�** 

**** 10 [ 

L______lo~

1937 1940 ’45 1950 ’53 ‘ 55 ‘ 59 1937 1940 ’45 1950 ’53 ’55 ’59 

[,500 3,000 -

r 

I 45-54 65+ 1,020 2,000 and bronchitis 

Yoo 

800 

700 1 

600} 

500 - I ,000 -

900 -

400 800 - __.d 

Tuberculosis 700 - #Neopla,m. 

600 -

500 

200 - 400 1 

IOJ -

;: ~ 

70 -’, . lnfluenzo, 

Go _ *# �+ pneumonig •4*-~* and Wcnchitis 50 - ++ * 

40 

30 60 

-\ 50 

20 Other Infective diseases ‘--+*N 40 

*v4~\ 

1 \ 

� 0-- 30 [ 

,Jl 

1537 1940 ‘45 1950 ’53 ’55 ’59 

,o~ 1937 1940 ’45 1930 ’53 ’55 ’59 

YEAR YEAR 

Figure 5. Death rates for selected couses by age: Ch! /e, 7937-59- Continued 
---------

--------------

--

---------

--------------

--

with 1954, however, the total rate leveled off following the course of mortality from influenza, 

pneumonia, and bronchitis, which contributed 14 

percent of all deaths. Mortality from accidents 

became increasingly important as a consequence 

of the decline of tuberculosis, and in 1959 was 

responsible for 32 percent of all deaths at ages 

15-24 years. Although the decline of mortality 

from tuberculosis was greatly moderated (for 

1948-53, b = -41.6 and from 1953, b = -5.6), this 

cause was not an important factor in determining 

the total mortality as it contributed only 12 percent of the total deaths in 1959. 

25-34 Years of Age 

In this age group analysis was restricted 

since the causes which had been brought under 

study amounted to only 63 percent of the total 

deaths for that group in 1940 and only 55 percent 

in 1959 (table 6 and fig. 5). However, the general 

results were consistent with findings for the 15-

24 age group. For the total rate, the breakpoint 

was in 1953. The rate of decline for the first period accelerated during 1948 so that for the period 

between 1940 and 1948, the mean annual decline 

was 29.5; it increased to 64.3 in 1948-53. In 

the following years, there was an evident leveling 

off with b = -5.3. Tuberculosis was responsible 

for 36 percent of all deaths at these ages at the 

beginning of the period under study. It was the 

rapid decline of this rate after 1948 that caused 

the breakpoint described for that year in the rate 

for all causes. Within a decline of 551 points in 

the general death rate for the years 1940-53, the 

weight of the following cause groups was: 

Decli,ne Percent in rate 

Tuberculosi,s 262.1 47.6 

Influenza, pneu - monia, and bronchitis 76.2 13.8 

Other infective and 

parasitic diseases 37.0 6.7 

These three groups of causes contributed half 

of the deaths for the age group 25-34 years in 1940 

and were responsible for 68 percent of the difference in the rate between 1940 and 1953. 

The leveling off of mortality for this ag,: 

group was related to a similar leveling off of tu.. 

berculosis after 1953. In 1959 tuberculosis stik 

caused one out of every six deaths at these ages, 

and therefore its change of trend was of particular importance— for 1948-53, b = -39.6; for 1953-

59, b = -3.4. 

Mortality from accidents was stationary during the whole period, but became progressively 

important through the decline of deaths of infectious etiology. In 1959 the accident group was responsible for 26 percent of the deaths in this age 

group. 

35-44 Years of Age 

As shown in table 7 and figure 5 the causes 

studied contributed only 54-60 percent of the total 

deaths for this age group. This percentage would 

have been higher if vascular lesions affecting the 

central nervous system had been considered in 

showing the trend of all deaths from cardiovascular diseases. 

The total rate for this age group had an interruption in its declining trend about 1954. Out 

of a total decline of 520 points in the general 

death rate between 1940 and 1954, the different 

causes contributed as follows: 

Decline Percent in rate 

Tuberculosis 217.7 41.9 

Influenza, pneu - monia, and bronchitis 98.1 18.9 

Other infective and 

parasitic diseases 43.3 8.3 

All together these causes were responsible 

for 69.1 percent of the total decline. Just as in 

the age group 25-34 years, the change in the trend 

for all causes was connected with the break in the 

decline of these causes, especially of the first 

two, which in 1954 caused 23 percent of the total 

deaths for the age group 35-44 years. 

On the other hand, the causes which showed 

a stationary or slightly increasing trend during 

the whole period 1940-59 (accidents, malignant 

neoplasms, and vascular lesions affecting central 

14 
nervous system) comprised at least 30 percent of 

the deaths since 1954 and afforded another contribution to the leveling off. 

45 Years and over 

The course of mortality by cause was not 

analyzed for these age groups. The only identified 

group of causes which presented any change during the period under study was influenza, pneumonia, and bronchitis. Death rates for tuberculosis tended to level off, but its importance as a 

cause of death in these more advanced ages was 

greatly reduced. Consequently, the pattern had 

a stationary trend or a slight decline which was 

not interrupted during the period 1953-55 as was 

that for the younger age groups, (fig. 5). 

MORTALITY TRENDS


BY SEX AND AGE GROUPS


For age groups 10-14,15-19, and20-24 years, 

mortality for females—which exceeded that for 

males from 1933 until about 1949—later showed a 

larger decline and eventually reached a lower 

level than that for males as in the other age 

groups. 

Mortality of males and females due to all 

causes and tuberculosis and maternal mortality 

for females are shown in figure 6 for ages 15-24 

years. It is clearly seen that the more favorable 

trend for females was due to the fact that tuberculosis was an important cause of death in 1937 

(42 percent of total deatlm), with a higher rate 

for females than for males but with a more 

marked decline, In fact, the point at which the declining mortality rate for females crosses the 

rate for males corresponds with that of 1948, 

when the notable decrease in mortality from tuberculosis began. 

The course of maternal mortality was a contributory element; the rates for this cause 

b dropped from 94.4 to 25.4 per 100,000 population 

bmveen the years 1937 and 1955 with subsequent 

leveling off. 

Trends of the rates for selected causes by 

sex at ages 25-34, 35-44, and 45-54 are also 

shown in figure 6. The main difference between 

mortality for males and that for females was that 

the leveling off of the rates was shown earlier 

for males than for females with a difference of 1 

to 2 years in the corresponding breakpoints. A 

study of these figures showed that this difference 

was a result of the following factors: (1) Tuberculosis mortality, which remained an important 

cause of death for this age group, had a prolonged 

downward trend for females 1 or 2 years longer 

than did the corresponding trend of male mortality; (2) accidents, which were more important 

as a cause of death for males than for females, 

had for males, as a rule, a rise in trend; (3) for 

ages 35-44 and 45-54, mortality due to malignant 

neoplasms had a greater tendency to increase for 

males than for females, especially for the last 5 

years. 

It is evident that the decline of maternal mortality contributed to the rapid decline of female 

mortality during 1937-53. This factor did not 

affect the breakpoint of the total female rate, however, since maternal mortality had already leveled 

off around 1955 and was of little importance to 

the total mortality for that sex. 

MEDICAL, SOCIAL, AND 

ECONOMIC FACTORS RELATED 

TO MORTALITY TRENDS 

Since mortality is an index of the health 

problems of a community and these are interrelated with multiple economic and social factors of the development of the population, it is 

necessary to give an idea of the conditions that 

existed and are now prevailing in Chile; Ample 

evidence exists that levels of living in Chile are 

low in extensive groups of its population and that 

the country is still in an underdeveloped stage. 

The Chilean economic development, according to 

the Corporacio@n de Fomento de la pyod~ccio”n; is 

characterized by slow growth and instability. 

From the period 1925-29 to 1956-60 the per capita 

value of goods and services produced has increased 1.3 percent per year, while the population 

has increased 1.8 percent and more recently up 

to 2.5 percent. In foreign commerce the country 

is still dependent on mineral exports. Capital investment is low, and the gross investment represents only 10 percent of the value of goods and 

services produced. 

The average income per capita, approximately 500 dollars per year, has a very uneven 

15 
Rate per 100,000 population Rafe per 100,000 pop.! oti.an 

400 � 9*. --* . . . . . ..-. 

Zrxl -

~ ;== \ Tuberculosis ���� Accidents, �* poisonings 

~nd .iole”ce \l Tuberculosis ‘b100 - 100 -~ %+ 

: :-

70 - ‘b~bh+ 

90 

80 

70 

-

-

-

; 

:; 

$ 

* 

*---. * [ 

“’””b 

60 - %, 60 - :; Maternal ‘W”%.+ --*-Q%’, 

50 - Maternal ‘* 50 -;; \ 

\ 11 40 - �*A, 40 1

t ;m 

30 -

1’ I I 

101 ! t I t , , ! I 1 ! ! I I I 1 I I 1 1 I [0 I I t , 1 t I I 1 r I I I 1 I t I 1 ! I I I I937 1940 ’45 1950 ’53 ’55 ‘ 59 1937 1940 ’43 1950 “53 ’35 ’59 

4oo - Tuberculosis 400 -

300 *+. - .* 35-44 300 -

P 

200-

‘\ *-H,-* i poisonings \ 

8 \ 

*9=--W and violence % :; Accidek, \ I 00 - :: % ICQ - II poisonings $%Tubarculos, s 

90 - ‘% ‘% Tuberculosis 90 - II and violence 

80 - :; ‘% % 80 -11 “=S 

70 -II �*@**. -. **ti..,e, 70 -:; ‘+ 

%- i 60 -;; Mnternal % 60 - %*4 **.-.4-*.*6 :; 

% 50 -:} 50 -;: * 

. 

# A ,~~, 

40 -~ 

;1 

i

I Ill 

30 # ; Accidents, poisonings and violence so:- , Accidw,fs, poisonings and violence 

�*. 

%, %, +9. ~ 4’ 

& ‘ ‘--.**--**+* \ � --%w# Q 

$ %, * dfi~, / +J’ 

20 \ 0’+,4++’ 20 - \ -*.** ; ,$ 

1 1 , I I 01 

1, I # I , I , I I , I ! , 1 [0 I , I I ,

V

, I I t I I 1 , 1 , I 

100 ,+ 35-44 

: I ‘\4@’-’+4”*+”+*9’’*” fi’”””fi’”””-’ . 

1“ Neoplosms 

401 1 1 t 1 ! # I r I ! r I I I I 1 1 f t 1 I I 1001 t 1 I 1 1 1 I , 1 1 I 1 I , , I f , , I I 

1937 1940 ’45 1950 ’53 ’55 ’59 1937 1940 ’45 [950 ’53 ’55 ’59 

YEAR YEAR 

Figure 6. Death rotes for selected causes by age and sex: Ch;le, 1937.38 

16 
distributicm—3 percent of the population receive 

2S percent of the national income, while 55 percent of the population get only 16 percent. The 

Scvuicio National de Salud estimates that 80 percent of a workman’s salary is necessary for his 

food consumption. This means that a large part 

of the working class is unable to solve its subsistence problem. 

Agriculture is technically backward and the 

land is very unequally distributed—22 percent of 

the landowners possess 72 percent of the cultivated ground. Hence agricultural production is inadequate, and in recent years the import of agricultural products which could be produced at home 

has reached the amount of 50 million dollars 

yearly. 

The remarkable growth of the population is 

characterized by urbanization, with great increases in the larger cities. Population of the 

southern zone of Santiago, for example, has increased 110 percent between 1952 and 1960. To 

this a serious lack of housing is added; since 

1~52 it has increased by 10 percent while the total 

population has increased by 23.5 percent. Forty 

percent of the population have no proper water 

supply, and this percentage increases to 80 percent in the rural areas. Sewerage is lacking for 

45 percent of urban houses; and 50 percent of the 

rural population have no excreta disposal system. 

The illiteracy rate is about 20 percent. It is 

estimated that 250,000 school-age children do not 

attend school. Out of those beginning grammar 

schools, only 36 percent reach the sixth grade. 

Skilled labor is scarce in spite of the advancement made in technical training. In spite of all 

this, the national manufacturing industry, favored 

by the protectionism following the 1930 crisis, 

has experienced a great upsurge, and its production has been four times as much during the last 

20 years, thus affording 26 percent of total production. Important achievements have been made 

in steel, electric power, and oil. 

The principal agencies in charge of medical 

and preventive care for the population joined together to form the Sevvicio National de Salttd in 

1952, This service is responsible for: (1) protection and promotion of health for the total population; (2) free medical care for the 70 percent of 

the population that constitute the laboring classes 

and their families and medically indigent groups; 

and (3) diverse economic compensations for sickness, inability to work, and so forth. 

As to the work performed by the SeYvicio 

National de Salud, available information shows 

that: (1) the number of registered services given 

has shown a continuing increase (table 8 and fig. 

7); (2) the proposed aims have not been fully accomplished due to a shortage of human, material, 

and budget resources; as a result there was no 

professional care for 44 percent of the births 

which occurred among the working class during 

1957; (3) owing to the same reasons the quality 

and availability of medical care are not satisfactory; and (4) levels and quality of medical care 

in the various provinces vary, with an excessive 

concentration of resources in the larger cities. 

Very adverse conditions prevail among 27.6 perRATIO 

200 

190 

180 Ndmnd Income 

t mr c.oita b 

moz �$: Medical certific. tmn l“” , . 

... ~,$,,,h$ of dea+h 

-.. 

%*..*” 

[ 

901 , 

193:. ’35 1940 ’45 1950 ’55 ’55 19 

YEAR 

Figure 7. Selected economic, educational, and medical-care indicators: Chile, 1933-60 

17 
cent of the population living in a group of provinces that are chiefly rural, with low levels of 

living, fewer medical resources, and serious 

health problems where infant mortality varies 

between 107 and 151 per 1,000 live births, 

These facts can be used in the interpretation 

of data shown in the descriptive part of this study. 

The remarkable decline of mortality in this 

country between 1933 and 1953 must be related to 

success in the partial control of excessive mortality of infective etiology. This success was due 

chiefly to the use of effective therapeutic means 

such as sulfa drugs and antibiotics and to health 

activities (particularly for children) organized as 

health programs even before the creation of the 

Sewicio Nacionul de Salud in 1952. These programs included not only medical care but also 

preventive and health promotion measures. 

Though the programs did not cover the whole 

population, they reached large population groups, 

chiefly in the urban areas. 

A good example of this is shown by the slight 

decline in the rate for tuberculosis mortality during 1937-48. During those years a great number 

of tuberculosis hospitals had already been built, 

and there was an organized fight against the disease which included case finding and treatment 

for many patients. Mortality from this cause 

shows a stronger decline since the use of streptomycin began in 1948, and it was thus possible to 

greatly reduce the fatality and shorten the treatment period.’ 

The leveling off of mortality from the group 

of causes registered in the years 1953-55, which 

determined the leveling of the total death rate 

curve, seems to be related to several factors. 

Health programs have failed to achieve an efficient level and have failed to cover the total population. Areas where medical care has been very 

limited and mortality very high have become a 

handicap for the continuation of the decline of the 

total death rate of the country. For example, the 

group of predominantly rural provinces mentioned have infant mortality rates surpassing by 

75 percent the mortality of the province of Santiago which has many more resources. In some 

of these areas with no medical care, the infant 

mortality rate reaches 150 to 200 per 1,000 live 

births. 

However, the interruption in the decline of the 

general mortality is also found in places like Santiago. This fact suggests a second element in this 

problem of general mortality in that direct medical activity is more and more restricted in its 

effect on all diseases which are more directly 

related to the socioeconomic conditions of the 

population and to the environment. Such is the 

case of respiratory and digestive infections; 

other infective and parasitic diseases, including 

lxberculosis; and malnutrition—all closely connected in their origin with the level of living of 

the people. 

Figure 6 shows the course of some economic, 

educational, and medical care indices for the period 1933-60. The economic index is the national 

income per capita. The educational level is measured by the percentage of the school-age population registered in the schools. Medical indices 

are the percentage of deaths with medical certification of the cause of death and the number of 

hospital discharges per 1,000 population. There 

are several causes of error in these series as 

shown by some of their irregularities. But when 

compared with other statistical information and 

when taken as gross indices, they represent adequately the course of some components of the 

level of living and of the medical care provided 

in Chile. 

The indices show a sustained advancement for 

the whole period during which death rates have 

been declining. While they show that health services provided have continued increasing even 

after 1954, the per capita income since 1953 tends 

to level and even to decrease. This is the period 

when no further progress is registered in the 

health control of the country. 

Recently Ristori et a,?.4 have published an 

epidemiological report on measles in Chile showing an increasing mortality rate that is currently 

five times as great as that in 1953. Their report 

points out the increasing frequency of fatal pulmonary and laryngeal complications which occur 

chiefly during the first year of life. They think 

that this trend is most likely related to malnutrition, which is so frequent at that age, and exposwre to cold weather with early infection made 

possible by unfavorable living conditions, especii~~toric., ~occardo, H., Rxgo?io, J. M., ~d Armiio, R: 

ttkfe~cal i~poxtance of measles in Chile. ” Amen”can ]~u~al U/ 

Diseases o/ Children 10~236-2cfl, iifarch 1$)62. 

18 
--------------------------------- ------------------------------- -------- -------- --------- --

ally overcrowding. This situation is made worse 

by the rapid growth of the big city populations. 

So measles-a benign disease in advanced 

areas-has come to be associated with 50 percent of the 1960 mortality from acute infective 

diseases in children, and its death rate was as 

high as 438.8 per 100,000 population under 1 year 

of :Igc’. 

In spite of the great efforts in food control, 

sanitation, and immunization, the incidence rate 

of typhoid fever registered in Santiago Province 

WJS 70.6 per 100,000 in 1959. By correcting the 

Type of mortality 

I 

In fant 

Neonatal 

Postnecmatal 

These figures show clearly that even though 

the medical care provided is correlated with a 

reduction of infant mortality, the low level of living of the working class determines a high mortality compared with that of the higher socioeconomic strata. This is particularly evident for 

mortality at ages 1 to 11 months, which depends 

more directly on the socioeconomic condition of 

th~?family group in which the child was born. For 

the country as a whole, the infant mortality rate 

was 119.6 per 1,000 population in 1960 in spite of 

the Seruicio hkzcional de Sakd devoting 27 per­

\ cent of its budget, 23 percent of its hospital beds, 

and 48 percent of its outpatient department services to maternal and child health programs. 

Progress achieved in the past in the control of 

mort;llity of infective etiology has given way to a 

l~>vc’lingoff at high endemic levels. This is because 

as a result of the conditions of underdevelopment 

in Chile: (1) the health programs have been unable 

to provide efficient and complete care for the whole 

popul:ltion and (2) the low level of living among 

l;lrge groups of the population leads to unfavorable 

hculth conditions which still prevail. 

underreporting of cases, the estimated rate might 

be twice as high. 

Especially illustrative are the results of research on infant mortality according to social 

classes. 5 The professional care provided at birth 

either by a physician or a registered midwife 

was used as an index to the health care received 

during the first year of life. Social class was 

established by the occupational status of the father. 

Both items were obtained from the birth and the 

death certificates; the results are summarized 

in the following table: 

Rates per 1,000 live births 

157 102 57 

49 28 21 

108 74 36 

In addition to existing conditions, the earthquake of May 1960 destroyed the South Central 

Zone. In this area levels of living were already 

low and the earthquake produced extensive material damages, making the health problems still 

worse. There was also the influenza epidemic of 

1957 which affected the mortality rate for certain 

age groups (fig. 5). 

It is quite possible that the general conditions 

described above may be similar to those of other 

countries but in different degrees of underdevelopment, and the relatively better death-registration information available in Chile has made it 

possible to describe it statistically. 

In this respect, all the evidence gathered 

provides an exciting challenge to remove the fundamental causes of an excessive and avoidable 

mortality. It also shows the need for planning 

health activities as a part of the social and economic development of the country. 

5Behm, H., op. cit. 

19 
BIBLIOGRAPHY


Behm, H., and Legameta, A.: Bases paca un programa de mejoramiento de la certificacifkr de la causa de muerte. Inforrne al 

Comit6 National de Estad~sticas Wale. y %.nitarias, 1958. 

Behm, H., and Montoya, C.: La mortalidad del niiio en Am&ica. 

Relatn al VII Congreso M{dico-%cial Psnamericano. Santiago de 

Chile. hfarzo 1962. 

Bravo, L. et al.: Problemas de la salud pfiblica y sus relaciones 

cnn el desarrollo econ6mico de Chile. Revi sta de Medicina Preventive y Social 1:7-21, Enero-Junio 1961. 

CabeIlo, O., and Cibotti, R.: Programaci6n de salud y desarrollo 

econ6mico. Cuaderrms Mfdico-%rcislcs, Marza 1962. 

Colegio Medico de Chile: Deparramento de Salud Pilbli ca. Primem.s Jornadas M&lico-Sociales, 1958. 

Corporaci6n de Fomento de la Pro ducci6n: Program@. national de 

desarrollo econrfmico. 1951-1970. 

Direcci6n de Estadi-stica y Censos. Demograf~a. 1956, 1957, and 

1958. 

Direcci6n de Estad[stica y Censos. E!olet~n de Estadfsricas Dem& 

grifficas. 1960. 

Hanruy, E.: Educacitfn elemental, anulfabetismo y desarmllo econ6mico. Santiago de Chile. EditoriaI Universitazia. 19~0. 

National Office of Vital Statistics. Vital Statistics of the United 

States 1959, Volume I. 

Pinto Santa Cruz, A.: Chile, un caso de desarmllo frustrado. San. 

tiago de Chile. Editorial Universitaria. 1959. 

San Martin, H.: Problems mfdico social del nifio: la poblaci6n 

callampa, el consultorio infantil y la comtmidad; el ambietrte de 

viola del niiio cbileno. Co-relatn al W Congreso Wdico-.%cial 

Panamericano. Santiago de Chile. hfarzn 1962. 

Servicio National de Esta&Ostica y Censos: Demograf~a y Asistencia Social. 1933 to 1951. 

Servicio Nscional de Estadfstica y Censos: Demugraffti. 1952 tn 

1955. 

Servicio National de Salud: Defunciones y Cwtsas de ‘.luertc. 

19s9 and 1960. 

United Nstions: Demographic Yeatbook. 1959. 

United Nations: Economic Survey of Latin America. t.l<xico, D. F. 

1959. 

United Nations: Report on the T’orld Social Situation. New York 

1957. 

000 

20 
Table l..


2.


3.


4.


5.


6.


7.


8.


DETAILED TABLES 

Death rates by sex: Chile, 1933-60-----------------------------------------------


Trend of mortality from selected causes: Chile, 1937-59--------------------------

Trend of mortality from selected causes for ages 1-4 years: Chile, 1,940-59-------

Trend of mortality from selected causes for ages 5-14 years: Chile, 1940-59------

Trend of mortality from selected causes for ages 15-24 years: Chile, 1940-59-----

Trend of mortality from selected causes for ages 25-34 years: Chile, 1940-59-----


Trend of mortality from selected causes for ages 35-44 years: Chile, 1940-59-----


Selected economic, educational, and medical-care indicators: Chile, 1933-60------


Page


22


23


24


25


26


27


28


29


21

--------------------------------------------------------

--------------------------------------------------------

--------------------------------------------------------

--------------------------------------------------------

--------------------------------------------------------

Table 1. Death rates by sex: Chile, 1933-60


[Rates p2r 1,000 population] 

Year Both sexes


l933-------------------------------------------------------- 26.0


l934-------------------------------------------------------- 25.7


l935-------------------------------------------------------- 23.9


l936-------------------------------------------------------- 24.0


l937-------------------------------------------------------- 22.7


l938-------------------------------------------------------- 23.1


l939-------------------------------------------------------- 22.9


1940 21.3


1941 19.4


l942-------------------------------------------------------- 19.9


l943----------------4--------------------------------------- 19.3


l944-------------------------------------------------------- 18.9


l945-------------------------------------------------------- 19.3


l946-------------------------------------------------------- 16.6


l947-------------------------------------------------------- 16.1


l948-------------------------------------------------------- 16.7


l949----+--------------------------------------------------- 17.3


1950 15.0


1951 15.0


l952-------------------------------------------------------- 13.0


l953-------------------------------------------------------- 12.4


l954-------------------------------------------------------- 12.8


l955-------------------------------------------------------- 13.0


l956-------------------------------------------------------- 12.1


l957-------------------------------------------------------- 12.9


l958-------------------------------------------------------- 12.2


l959-------------------------------------------------------- 12.7


1960 12.3


Male Female


27.3 24.6


26.6 24.8


24.6 23.3


24.8 23.2


23.6 21.8


24.1 22.2


23.7 22.1


22.0 20.6


20.2 18.7


20.8 19.0


20.1 18.6


20.1 17.9


20.6 18.0


17.7 15.5


17.0 15.2


17.7 15.7


18.6 16.2


16.2 13.8


16.2 13.9


13.9 12.1


13.2 11.7


13.9 11.8


14.2 11.8


13.3 11.0


13.9 11.9


13.3 11.1


13.8 11.5


13.4 11.1


22

--------

Table 2. Trend of mortality from selected causes: Chile, 1937-59


[l{at@.
 per100,000 pop.lntion aa read from regression lines. Rat. for 1953 corresponds	 to line fittej to years 1953-59. Relative imptanc. of each cause group shown as percentage 

oftotaltato]


~n::::ve Gastritis, Influenza, Accidents, Certain


diseases Year All causes1 Tuberculosis and duodenitis, pneumonia, poisonllgs , Neoplasm of ~arly 

parasitic enteritis, and 

diseases and colitis bronchitis violence infancy 

1937----------- 2,328 262


1953----------- 1,267 75


1959----------- 1,247 52


1937----------- 100 11


1953----------- 100 6


1959----------- 100 4


1933-53-------- -63,8 . . . 

1937-48-------- ... -3.6


1937-49-------- ... ...


Rate


129 200 567 

38 35 249 

48 44 278 

Percent 

6 9 24 

3 3 20 

4 4 22 

Regression slope


. . . . . . . . . 

. . . . . . . . . 

.. . -5.9 . . . 

1937-53-------- ... ..0 -5.8 ... -20.7 

1937.59-------- ... ... ... ... ... 

1940-59, ... ... ... ... ... 

1948-53-------- ... -27.6 ... ... ... 

1949-53-------- ,.. ... ... -25.8 ... 

1953-59-------- -3.4 -3.7 +1.6 +1.5 +4.9 

272 65 232


... ... 185


79 98 204


3 3 10


... ... 15


6 8 16


. . . . . . . .. 

. . . . . . .. . 

. . . . . . . . . 

. . . . . . . . . 

. . . +1.5 . . . 

+0.3 ... . . . 

... ... . . . 

... ... . . . 

... ... . . . — 

Vascular


lesions


affecting


central


nervous


system


42


...


59


2


...


5


. . . 

. . . 

. .. 

.. . 

+0.8 

. .. 

. .. 

.. . 

. . . 

23 

NIITE: I!rsnkpaln& for the f.llowlng C.US.S are: Tulmrculosi., 217 (1948k and gastritis, duodenitis, enteritis, and colitis, 138 (1949). 

lPvrcontngo ,wwumulntionof oausos with ndoquate dlngnostic information on causes of desth: 1959, 69; 1953, . . .; and 1937, 68. 

%thnnted hy li140. 69rogmsionIino, 
Table 3. Trend of mortality from selected causes for ages 1-4 years: Chile, 1940-.s9 

[Rates per10C,OOO population asreadfromregression lines]

Year 

1940----------------------

1953----------------------

1959----------------------

1940----------------------

1953----------------------

1959----------------------

1940-48-------------------

1940-50-------------------

1940-53-------------------

1948-53-------------------

1950-59-------------------

1953-59-------------------

All causesl 

2,607.9 

917.6 

903.9 

100.0 

100.0 

100.0 

... 

... 

-131.9 

... 

... 

-6.5 

Other 

infective I

Tuberculosis and 

parasitic 

diseases 

Rate 

183.1 259.5 

32.2 101.6 

16.1 140.7 

Percent 

7.0 10.0 

3.5 11.1 

1.8 15.6 

Regression slope 

-5.5 . . . 

... -16.1 

... . . . 

-23.5 . . . 

... +6,5 

-2.7 . . . 

Gastritis, 

duodenitis, 

enteritis, 

and colitis 

546.2 

102.0 

74.1 

20.9 

11.1 

8.2 

. . . 

. . . 

-32.4 

. . . 

. . . 

-0.7 

Influenza, 

pneumonia, 

and 

bronchitis 

. 

934.(1 

375.[) 

370.t, 

35./1 

4(3.() 

41.0 

. . . 

. . . 

-44.4 

. . . 

. . . 

-3.’7 

NOTE Breakpoints forthefollowing causesars:Total (1953); tuberculosis (1948and 1953); other infective and parasitic diseases (19501; 

gastritis, duodenitis, enteritis, and colitis (1953); and influenza, pneumonia, and bronchitis (1953). 

lpercentage accumulation of causes with adequatediagnostic information on causes of death: 1959, ~6.FJ; 1953, 66.6; 1940, 73.7. 

24 
Table 4. Trend of mortality from selectedcauses for ages 5-14 years: Chile, 1940-59 

[Rates per 100,000 population w readfromregression lines]

Other


infective Gastritis, Influenza, Accidents,


duodenitis, pne:~dnia, poison&gs,
 Year All causesl Tuberculosis and enteritis,
 parasitic and colitis bronchitis violence
 diseases


1940-------


1955-------


1959-------


1940-------


1955-------


1959-------


1940-48----


1940-55----


1940-56----


1940-59----


1948-53----


1953-59----


1955-59----


1956-59----


364.3 93.5


143.4 14.6


137.71 5.8


100.0 25.7


100.0 10.1


100.0 4.2


. . . -3.2 

-14.4 . . . 

. . . . . . 

. . . . . . 

. . . -9.0 

. . . -2.2 

-0.2 . . . 

. . . ,.. 

Rate


42:5


13.3


20.1


Percent


11.7


9.3


14.6


Regression slope


. . . 

-1.9


...


...


...


...


+1.9


...


8.5 91.3 27.7


2.6 33.1 28.2


1.0 41.1 28.4


2.3 25.0


1.8 23.1 19.7


0.7 29.8 20.6


... ... . . . 

... ... . . . 

... -3.6 . . . 

-0.4 ... +0 .03 

... ... ...


... ... ...


... ... ...


... +3.0 ...


NOTE: Breakpoints for the following causes arw Total (1955); tuberculosis (1948 and 1953); other infective and parasitic diseases (1955~ 

and influenza, pneumonia, and bronchitis (1956). 

Ipercentagecaumula~ion of~au~e~ with adequate ~iawostic
 information on CaUSeS of death 1959, 6!).9; 1955, 64.& 1940, 7!?.3. 

25


7.6 
Table 5. Trend of mortality from selected causes for ages 15-24 years: Chile, 1940-59 

[Rates
per100,000 population as read from regression lines] 

1 

Other


infective Influenza,


and pneumonia,


and
 parasitic


diseases bronchitis


Accidents,


pois~$ngs,


violence


Year All causesl Tuberculosis


Rate


49.4


11.5


6.6


Percent


6.4


4.5


2.8


1940----------------------


1954----------------------


1959----------------------


1940----------------------


1954----------------------


1959----------------------


1940-48-------------------


1940-55-------------------


1940-59-------------------


1948-53-------------------


1948-54-------------------


1953-59-------------------


1954-59-------------------


1955-59-------------------


775.3 341.1


257.9 55.4


235.0 27.4


100.0 44.0


100.0 21.5


100.0 11.7


107.0 79.9


35.4 76.8


33.0 75.5


13.8 10.3


13.7 29.8


14.0 32.1


... . . . 

-5.1 . . . 

... -0.2


... ...


... ...


... ... 

... ,.. 

+0.2 ... 

Regression slope


-21.0 -7.0 . . . 

... . . . -2.7 

... . . . ... 

... -41.6 ... 

-58.0 . . . ... 

... -5.6 ... 

-6.3 . . . ... 

... . . . -0.4 

NOTE: Breakpoints for thefollowing causes me: Total(1948 and1954); tuberculosis
 (1948and 1953); other infective and parasitic dis.

eases (1955); and influenza, pneumonia, and bronchitis (1955). 

lpercentage accumulation of causes with adequate diagnostic information on causes of death: 1959, fiO.6; 1954, 69.5; and 1940, 74.5. 

26

Table 6. Trend of mortality from selected causes for ages 25-34 years: Chile, 1940-59


[Ratesper100,000pqxdaticm
 asreadfrommgmseicmlirres]


I


Other


infective Influenza, Accidents,


All causesl Tuberculosis and pneumonia, poisonings,
 and and
 Year


1940----------------------


1953----------------------


1959----------------------


1940----------------------


1953----------------------


1959----------------------


1940-48-------------------


L940-53-------------------


1940-56-------------------


1940-59-------------------


1948-53-------------------


1953-59-------------------


1959-59-------------------


parasitic
 2-.–--–- – bronchltie


Rate 

989.4 355.0 49.9 121.8 

438.0 92.9 12.9 45.6 

400.8 68.0 7.9 41.2 

Percent 

100.0 35.9 5.0 12.3 

100.0 21.2 3.0 10.4 

100.0 17,0 2.0 10.3 

Regression slope 

-29.5 -6.6 . . . . . . 

... . . . -2.8 . . . 

... . . . ... -5.9 

... . . . ... ... 

-64.3 -39.6 ... ... 

-5.3 -3.4 -0.8 ... 

... . . . ... +1.6 

violence


98.9


102.6


104.3


10.0 

23.4


26.0


. . . 

. . . 

. . . 

+0.3


...


...


...


NOTE: Breakpoints forthefollowing causes are: Total, 1948and 1953;Tuherculosk,1948 and 19fi8;
influenza, pneumonia, and bronchitis, 1!lfi6; and other infective and parasitic diseaees, 1953. 

Ip,,rconbga accumulation of ~ause~ with adequate diagnostic infonrration on causes of death: 1959, 55.% 1958, 58.0; and 1940, 83.2. 

27

--------

--------

--------

--------

-----

Table 7. Trend of mortality from selected causes for ages 35-44 years: Chile, 1940-59


[Rates per100,000populatkm
asmad frommgmsskn lines]


—. 

Vascular


lesions


affecting


central


nervous


system


35.}


3(J.~


24.)


2.)


4.~


3,1


,.. 

+.2 

. . . 

. . . 

. . . 

. . . 

-1.2


...


.,.


Other


infect ive


Year All caueesl Tuberculosis and


Influenza, Accidents,


pneumonia, poisonings, Neoplasms
 and and
 parasitic


diseases


II I 

bronchitis violence


Rate


161.0


62.9


71.8


Percent


13.0


8.7


11.0


1940


1954--------


1959


1940


1954--------


1959


1940-48-----


1940-53-----


1940-54-----


1940-56-----


1940-59-----


1948-54-----


1953-59-----


1954-59


1956-59-----


1,240.4 318.3


720.2 100.6


651.5 94.2


100.0 25.7 

100.0 14.0 

100.0 14.5 

. . . -5.2 

. . . ... 

-36.4 ... 

... ... 

... ... 

... -30.8 

... ...


-11.5 -2.4


... ...


57.3


14.0


10.1


4.6


1.9


1.5


94.4


111.8


118.0


7.6


15.5


18.1


...


...


...


...


+1.2


...


...


.,.


...


64.9


73.3


76.3


5.2


10.2


11.7


. . . 

. . . 

. . . 

. . . 

+0.6 

...


...


...


...


Regression slope


. . . . . . 

-3.3 . . . 

... . . . 

... -7.0 

... ...


... ...


-0.8 ...


... ...


. . . +5.0 I 

NOTE!: Breakpoints forthefollowing
 causesara Total, 195.4 Tuberculosis, 1948 and 195* other infective and parasitic diseases, 1053: influenza, pneumoni~ , 

and bmnc~]tis, 1956; and vascular lesions affecting central nervous system, 1953. 

lperce”tage ~cc”m”lation of CaUSS.8wjfi adequate diagnostic information on causes of death: 1959, 60.5; 1954, 54. @ and 1940.59.0. 

28 
-----------------

-----------------

-----------------

-----------------

-----------------

-----------------

-----------------

-----------------

Table 8. Selected economic, education 1, and medicsl-care indicators: Chile, 1933.60


Naticma1 income Percentage school-age Percentage of medical


per capital population registered certification of cause Hospita 1 discharge per


at schoo12 of deathz 1,000 population.2


Year


Escudos Ratio Percent Ratio Percent Ratio Percent Ratio 

1933-----------------


1934-----------------


1935-----------------


1936-----------------


1937-----------------


1938


1939-----------------


1940


1941-----------------


1942-----------------


1943-----------------


1944-----------------


1945-----------------


1946-----------------


1~47-----------------


1948


19.49


1950-----------------


1951-----------------


1952


1953-----------------


1954-----------------


1955


1956


1957-----------------


1958-----------------


195’3-----------------


1960


NI1’m; 1!13:1 Oq”ala 100, 

284 100 45.: 10( 48.: 10( 48.5 100.0 

318 112 46.( 10: 460~ 9; 51.: 105.9 

325 114 48.! 10; 45.< 9: 52.; 107.7 

330 116 50.( 11( 46.[ 9; 54.i 110.8 

350 123 50,[ 11: 47.1 9[ 54.L 111.2 

344 121 51.[ Ill 47.: 9[ 55.: 113.5 

352 124 49.[ 11( 49.[ 102 58.2 119.0 

363 128 53.1 11; 58.< 12C 61.4 125.6 

400 141 53.! llf 62.( 12E 61.3 125.4 

359 126 53.L Ilt 67.C 132 63.3 129.4 

407 143 52.1 11: 65.C 13: 63.7 130.3 

416 146 52.L 116 65.C 13: 65.2 133.3 

448 158 51.2 11: 67.C 139 67.5 138.0 

452 159 51.7 114 66.0 137 68.7 140.5 

394 139 51, i 114 71.8 149 70.2 143.6 

441 155 53.2 117 71.4 148 73.0 149.3 

433 152 54.? 120 67.0 139 74.5 152.4 

444 156 54.9 121 66.5 138 71.5 146.2 

449 158 54.3 120 68.1 141 73.2 149.7 

492 173 56.5 125 67.2 139 73.4 150.1 

509 179 59.1 130 69.1 143 77.4 158.3 

549 193 60.1 133 69.6 144 79.4 162.4 

533 188 60.6 134 70.6 146 80.6 164.8 

517 182 60.9 134 71.2 147 79.3 162.2 

538 189 62.4 138 70.3 146 81.4 166.5 

530 187 72.0 149 81.1 165.8 

515 181 71.1 147 76.4 156.2 

510 180 84.6 173.0 

lIPm lI1!w W bawd on da~ provided by tho Cconomi. Commission, LatitI Americrq for 1940-6C estimate of Crxpormi6n de Ikmemnde1.Pmdwci&. Figures refer t.escudoscd


IUIW.(1ddlw = 1.05:1owudm). 

knfarmnti.n lake.n fmin Dirocci6n de Esladiltioa y ceIIsos YLW.rbooks. 

29 
APPENDIX


POPULATION 

The official data available at the Direcci&z 

de Estadz%tica y Cemsos were midyear estimates 

of the total population by sex for each year from 

1.933 to 1960, and population distribution by sex 

and age from censuses taken in 1930, 1940, and 

1~52, as well as preliminary results of the 1960 

census. 

Inasmuch as these censuses showed imperfections, age pyramids were adjusted to correct 

for underenumeration (especially for ages under 

4 years) and for preferences in declarations of 

age. On the basis of these corrected figures, midyear populations for each census year were estimated and apportioned by the above-mentioned 

official estimates. For the period 1933-51, the 

population by age and sex was obtained by simple 

linear interpolation of the corrected censuses. 

Estimates by age groups and sex for 1953-60 

were based on the corrected census of 1952 and 

the corresponding live births (previously corrected for omission) and deaths. 

DEATHS 

Three institutions participate in the production of Chilean vital statistics: The Se?wicio de 

Registro Civil, which is the information collecting body, and two agencies with processing functions—the Di~ecci6n de Estad<stica y Censos and 

the Sew’cio Nacionul de Salud. 

The Servicio de Registro Civil has about 420 

local offices which cover the national territory. 

Compulsory death registration has been in effect 

for many years in Chile (the law dates from 1884) 

and is believed to be almost complete. The mortality information collected in the local offices of 

the SeYvicio de Registvo Civil is sent as individual statistical reports to the central processing 

agencies. The three institutions which make up 

the system agreed upon the text and design of the 

death certificate which is in accordance with the 

recommendations of the United Nations. The data 

in the statistical report are taken from the medical death certificate, which has agreed with international recommendations since 1953. 

The numbers of deaths utilized in this study 

were officially published by the Di~ecci6n de 

Estadz%tica y Censos, with the exception of those 

for the year 1960; the only available data for this 

year were supplied by the Se?wicio iVacional de 

Salud. Preference was also given to official data 

because they were offered in longer statistical 

series and with better detailed classification. 

Although the vital statistics system provides 

complete information under most headings, several deficiencies exist concerning statistics for 

causes of death. Such deficiencies can be attributed to various factors. Not all the deaths are 

accredited by a medical certificate. The percentage of medical certification in Chile reached 72 

percent in 1958. This figure varies in the different regions of the country—95 percent in Santiago 

Province, where the capital of the country is situated, and only 31 percent in Chiloe, a province 

with a large rural population. For the cases with 

no medical certification, the law demands assurance of the death IYom two lay witnesses. 

These witnesses usually do not have sufficient 

knowledge to give adequate information on the 

cause of death. 

Medical certification of causes of death is 

not always correct. Different studies carried out 

in Chile have shown errors due to the fact that 

31 
-----------------

----------------

--------- -------------------

-------------

----- ------------- ---------------

--------------- ------------

. 

the certifying doctor does not always follow official recommendations.~ 

The rules employed for the codification and 

classification of causes of death have changed 

during the course of years. Up to 1949, the 

Divecci6n de Estadiktica Y Censos applied the 

Fifth Revision of the International Statistical 

Classification. From 1950 to 1952, a national classification was used, and only in 1953 was there a 

return to the International Classification (Sixth 

and Seventh Revisions). 

Unfortunately for the purposes of this study, 

the change of classification in 1953 occurredprecisely when the mortality trend was changing. In 

spite of efforts to obtain comparability in the 

study of causes, difficulties which could not be 

overcome caused elimination from the study of 

some important groups of causes (e.g., cardiovascular diseases). This group was limited to 

vascular lesions affecting central nervous system 

because it did not apparently show distortion in 

classification. 

The changes of classification criteria have 

still another origin in the diversity of criteria 

used by different officials in applying the rules 

throughout the years. 

Quality of basic information is different for 

various groups of causes. For example, hypertension has 98-percent medical certification in 

contrast with other diseases which show 20- to 30-

percent certification. This fact brought about the 

decision to select groups of causes with more 

than 50-percent medical certification. This reduced the study of specific causes to a portion 

comprising around 68 percent of the total number of deaths; discarded causes were grouped in 

a residual category. Moreover, some causes 

originally selected had to be separately grouped 

or eliminated because their trend revealed irregularities brought about by changes of criteria 

previously mentioned. 

‘iPereda, E.: “ Estudio de la exactitud de 10S datos estadfsticos de causas de de funci6n y 10S procedimientos para per fecci o’­

narlos. ”A medical student’s report to Facultad de !Jedicina. Universidad de Chile. 1956. (unpublished) 

!khm, H., Reyes, A., Taucher, E., and Zenteno, T.: “Problems de rromenclatura en la clasificaci6n de las defuncio”nespor 

trastornos nutritivos del Iactant e.” Comunicaci6n al Seminarin Icternacional de Clasificaci6n de Enfermedades. Caracas, Venezuela. 

1957. 

The percent of medical certification of cause~ 1 of death in 1959 for the groups under study is the 

following: 

Total 

Tuberculosis 

Other infective and 

parasitic diseases 

Neoplasms


Vascular lesi,ons CNS--------


Influenza, pneumonia,


and bronchitis


Gastritis, duodenitis,


enteritis, and colitis


Maternal deaths


Early infancy


Accidents, poisonings,
 and violence


All other causes


Percent 

71.1 

82.3 

72.6 

83.5 

85.5 

47.7 

81.3 

80.8 

73.1 

95.7 

73.7 

In order to have an additional check onthc 

trend of causes of death, these were studied fothe provinces of Santiago and Valparaiso, which 

have more reliable information because of thei]. 

higher percentage of medical certification with 

fewer defective certificates. These twoprovinces 

register 35 percent of the total deaths in the 

country. This analysis revealed that the trendof 

the causesof death whichhave been studied follolv 

the general trend observed in the country as it 

whole. 

MORTALITY TRENDS 

FOR SELECTED CAUSES 

Cardiovascular Diseases 

This group was to include items B22, 24,25, 

26, 27, 28, and 290fthe Abbreviated Listof th? 

International Classification of Diseases (Sevent’1 

Revision, 1955); rheumatic fever was exclude~ 

because of its infrequency and low medical cer. , 

tification as a cause of death. The trend ofth,; 

group showed little change, with arate ofabout 

220 per 100,000 population for 1937-50 followei 

by a decline until 1954, when rates leveled off. 

This course does not agree with the expecteli 

trend of mortality from cardiovascular diseases 

in Chile. 

32 
A similar situation was observed when the 

trend was studied for the same causes of death 

in the provinces of Santiago and Valparafso, 

where basic data are of better quality. The analysis of the course of the components of the group 

showed that although mortality produced by vascular lesions affecting the central nervous system (B22) has a slight and sustained increase in 

ICK37-59, the other disease entities showed the 

same irregularities as described in the group 

rate. Furthermore, the figures produced by the 

SCYuicto National de Salud and the Direcci6n de 

Estadikticu y Cemsos were checked with each 

other and several inconsistencies were found. 

Most of these differences were related to changing’ criteria in the application of the International 

Classification and the use of a national classification during the years 1950-52. 

Consequently, this group, in spite of its numerical importance, had to be excluded from the 

study. Data referring to the deaths included in 

B22 had fewer irregularities and might be considered as an index of mortality from cardiovascular diseases. 

Certain Diseases of Early Infancy 

(B42,43, and 44) 

For the country as a whole as well as in the 

provinces of Santiago and Valpara<so, the curve 

for this group showed a slow decline in the rates 

of about 50 points up to 1950; a progressive increase was observed afterwards. This trend had 

no relation to the general curve of total infant 

mortality in spite of the fact that it was an important cause of this mortality. In order to and yze this disagreement, the three components 

were studied separately. Birth injuries, postnatal 

asphyxia, and atelectasis (B42) showed a slight 

increase which did not appear to be real because 

the proportion of births under professional care 

had been increasing during this period. Infections 

of the newborn (B43) showed a sudden increase in 

1Q50 which coincided with a decrease of similar 

magnitude in the group of other diseases peculiar 

to early infancy (B44). Evidently this was due to 

modifications in the criteria applied in classifying under these headings, which, nevertheless, 

would not affect the total of the group. 

Changes of criteria in codification which 

might explain the anomalous course of the total 

curve for 1955 have been analyzed in a study 

carried out at that time. ~ This study showed that 

an important part of acute enteric infections, 

diagnosed as “dyspepsia” by pediatricians, was 

e?:roneously attributed to B44. On the other hand, 

deaths from gastritis, duodenitis, enteritis, and 

colitis (B36) presented a marked decline beginning in 1949, which can be only partially explained by the introduction of antibiotics at that 

time. On the basis of the factors previously discussed, it seemed probable that part of this decline was due to the fact that deaths actually belonging to group B36 have been assigned to “nutritional maladjustment” (category 772), and thus 

mortality classified in group B44 had been artificially increased. 

For the purpose of comparison, data originating with the Sewwicio National de Salud were 

studied, resulting in a curve which generally revealed a trend similar to that of the Di}-ecci6n de 

Estadiktica y Censos. 

Since the available information had several 

sources of error, it was obvious that only rough 

changes should be described. Nevertheless, the 

overall picture of mortality was consistent with 

other evidence. 

Gastritis, Duodenitis, Enteritis, 

and Colitis (B36) 

The curve for this group showed an initial 

level of approximately 200 deaths per 100,000 inhabitants, a rate which remained more or less 

stable up to 1945. Beginning with this year, an 

irregular decline was initiated, and it was especially stressed in the years 1951 and 1953, after 

which little change was evident. The level of this 

last period was a rate of about 40 per 100,000 

population. The knowledge of the health conditions 

of the country especially in relation to deficient 

7Behm, Reyes, T aucher, and Zenteno, op. cit. 

33 
sanitation and high infant mortality rate, a part 

of the latter being due to this group of causes, 

made the accuracy of the actual rate doubtful. 

The comparative study of these data with 

those of the Semicio Nacioml de Salud showed 

an important difference in the number of deaths. 

Classification rules were followed more carefully at the SeYvicio Nacionul de Salud for this 

group of causes, suggesting that their figures 

presented a truer picture. Unfortunately, the 

series published by this service were too short 

for this study. However, there was evident level0 

ing off of the trend in recent years at a rate of 

approximately 80 per 100,000 population. 

Other Causes 

This heading covered the remaining group:: 

of causes, some of which had numeric importance’ 

but the quality of cause certification did not per-. 

mit analysis. This group amounted to 32 percen: 

in 1937 and 31 percent in 1959 and was anothe]! 

factor which limited analysis of causes of deatl 

in Chile. 

00 

34 * us. GOVERNMENTPRINTING OFFICE; 1s84 o-7z2-Y4* 
OUTLINE OF REPORT SERIES FOR VITAL AND HEALTH STATISTICS 

Public Health Service Publication No. 1000 

SERIES 1-4. GENERAL SERIES. Prugram descriptions, methodological research, and analytical studies of vital mrd health statistics. 

Earlier repcmts of this kind have appeared in “Vital Stati sti cc-Special Reports” and in “Health Statistic fmm the National Health Survny, ” Series 

A and D, PHS Publication No. 584. 

Series 1:	 Programs and collection procedures.– Reports which describe the general programs of the National Center for Health Statistics and 

its offices and divisions, data collection methods used, definitims, and other material necessary for understanding Of the tichnical characteristics of published dh. 

Series 2:	 Data evaluation and methods research. -Studies of new statistical methodology including: experimnntnl tests of new survey methods, studies of vital statistics collection methods, new analytical techniques, Objective evaluations Of reliability Of cOllected data, 

contributions to statistical thsnry. 

Series 3: Analytical Studies.-Tbis seriee comprises reports presenting analytical or interpretive studies based on vital and health statistics. 

Series 4:	 Documents and committee re pm ts. - Final reports of major committees concerned with vital and health statistics and documents 

such as recommended model vital registration laws and revised birth and death certificates. 

SERIES 10-12. DATA FROM THE NATIONAL HEALTH SURVEY 

Earlier reports of the kind appearing in Series 10 have been issued as “Health Statistics fmm the National Health Survey, ” Series B and C, PHS 

Publication No. 584. 

Series 10: Statistics on illnese, accidental injuries, disability, use of hospital, medical, dentnl, and other services, and ether health-related 

topics, based on data collected in the continuing National Health Interview Survey. 

Series 11: Data fmm the Health Examination Survey bas~ On the direct examination, testing) and measurement ‘f natiOnal samP1es ‘f ‘he 

population of the United States, including the medically defined prevalence of specific diseases, and distributions of the population with respect tm varioue physical and physiological measurements. 

Series 12: Data from tbe Health Records Survey relating ta the health characteristics Of persOns in institutions, and 011 hOspital, medical 

nursing, and personal care received, baeed on naticmal samples of establishments providing these services and samples Of the 

residents of patients, or of records of the establishments. 

SERIES 20-23. DATA FROM THE NATIONAL VIT.4L STATISTICS SYSTEM 

Earlier repnrts of this kind have been issued in “Vital Statistics-Special Reports. ” 

Series 20: Various reports On mOrtality, tabulations by cause Of death, age, etc., time series of rates, data fOr geOgr@phic areas, States, 

cities, etc.—other than as included in annual nr monthly reports. 

Series 21: Data on natality such as birth by age of mother, birth order, geographic areas, States, cities, time series Of rates! etc. -compiletions of data not included in the regular ,_– annunl vOlumes Or mOn~lY reWrts. 

Seriee 22: Data on marriage and divorce by various demographic factors, geographic areas, etc.–other than that included in annual or monthly 

reports. 

Series 23: Data fmm the program of sample surveys related to vital records. The subjects being covered in these surveys are varied including topics such as mortality by socioeconomic classes, hospitalization in the last year of life, X-ray exposure during pregnancy, 

etc. 

Catalog Card 

. 

Recent mortality trends in Chile 1 study of the trend of the death rate in Chile 

ulth cmnsidwation of sex, age. and cause groups and selected s~cioec~nomi(: factOrs 

\!ashi” KtO~, [1.S, Dep~t”, e”t of Health, Fd”cati on, and Welfare, Public Health !%r~i~~. 

1!164. 

3+ p. diacrs. , tables. 27cm. (/,.s \’]tal a“d lIealth StaLi -tics, Series 3. “o. 2) 

[~ S. Public Health Service, Puhliral]on no 1000, Series 3, no. ?. 

1. liortality Statistics ~hile. 2 Chilr Statistics, \ ital. 1. Title. (Series. 

$er]rs: U.S. Public Health %r~irc Publication no. 1000, Series 3, no. 2) 

Cataloged by Department of Health, I“ducacion, and Welfare Library.