Youth lost to homicides: disparities in survival in Latin America and the Caribbean

Abstract

IntroductionThe homicide rates among young men in Latin America and the Caribbean (LAC) are the highest in the world. It is not clear how this has impacted the life expectancy in these countries. This research has two purposes: (1) to quantify the impact of homicides on the mortality gap between LAC and high-income countries over recent years and (2) to assess the changes in homicide impact in overall survival over time.MethodsCauses of death data were extracted for 23 countries in the LAC and 15 European countries (average European union-15 [EU-15]), using UN, UNODC, WHO, HMD and IHME databases for the period 2005–2014. The contribution by homicide deaths to the change in life expectancy, over time and as a difference between two populations, was quantified using decomposition methods.ResultsThe contribution by homicide mortality to changes in life expectancy levels differed widely across the examined LAC countries. In Honduras, homicide mortality accounted for 1.75 (95% CI 1.64 to 1.86) and 6.30 (95% CI 6.07 to 6.53) years lower life expectancy than in the EU-15 countries for women and men, respectively. Contrary to this, homicide was just accountable for less than a couple of months of life expectancy differences between Chile and EU-15. Jamaica had the largest reduction in homicides and its impact increased life expectancy over time by almost half a year for men. However, Mexican men and Honduran women have experienced increases in mortality by homicide, which decreased their life expectancy by more than a quarter of a year between 2005 and 2014.ConclusionsExcess mortality related to homicides in young people accounted for major changes in life expectancy in the LAC region. Furthermore, reducing excess mortality due to homicides is a crucial goal to further increase longevity towards levels of low-mortality countries. These reductions might prevent homicides spreading to other parts of Latin America. Decision and policy-makers in LAC need to address this immediately, and investing in the young population needs to be given a high priority.

The contribution of age structure to the international homicide decline

“…Several of the largest countries of Latin America, such as Brazil, Mexico and Venezuela, have experienced considerable increases in their homicide rates over recent decades, despite an ageing of their populations (S9 Fig). While this study does not directly investigate the reasons for high homicide rates in Latin America, many countries in the region experience inordinate levels of inequality, organized crime, economic downturn, and other sources of social and political instability [74,75]. The example of Latin America suggests that heightened levels of criminogenic forces such as these can overpower the pacifying influence of an ageing population.…”

“…Consequently, perceptions of police corruption are greater and the ability of police to control and provide security are lower in Latin America compared to Western countries [85], further incentivizing the use of violence for the resolution of private conflicts. In short, many Latin American countries are characterized by a preponderance of severe criminogenic factors including high rates of economic inequality, poverty, abundance of firearms, drug-trafficking, organized crime, government ineffectiveness, and others [74,75,84,85,87]. Accordingly, while demographic factors may be key in explaining many of the social changes in the region, population aging may be insufficient to produce a distinguishable change on homicide trends in the presence of multiple other criminogenic disadvantages.…”

The adult mortality profile by cause of death in 10 Latin American countries (2000–2016)

“…Another critical obstacle to reducing adult mortality in Latin American countries is external causes. Poverty, social inequality, economic instability, and drug trafficking sustain high levels of violent mortality (14,15,18,35). In recent decades, various endeavors have helped reduce poverty and alleviate social inequalities in Latin America.…”

“…Another striking feature of the mortality pattern in Latin America, especially in Brazil, Colombia, Ecuador, and Mexico, has been the increasing number of deaths from violence and accidents since the 1980s. These levels are still high in many countries, and there is a concentration of these deaths among young adult males (3,11,(13)(14)(15)(16)(17)(18). Frenk et al (18) argue that the mortality from these causes in Latin American countries is independent of the epidemiological transition and is strongly associated with political instability, economic inequality, social segregation, and drug trafficking.…”

Uneven state distribution of homicides in Brazil and their effect on life expectancy, 2000–2015: a cross-sectional mortality study

“…Violence and homicides in Brazil present a considerable public health challenge. 1 With a risk of mortality from homicides 10 times that of most developed countries and it being the leading cause of death among young adults, 2 3 recent improvements in population health attributable to ongoing public health interventions and pushes towards universal health coverage are in jeopardy. [4][5][6][7] On average, Brazilians live 20 years longer than half a century ago.…”