PLOS ONE2013-11-01 1:37 AM

Mortality in Iraq Associated with the 2003–2011 War and Occupation: Findings from a National Cluster Sample Survey by the University Collaborative Iraq Mortality Study 2003-2011伊拉克战争引起的死亡:伊拉克死亡研究项目的大学合作组通过国内群体抽样研究所得的发现

Abstract Background Previous estimates of mortality in Iraq attributable to the 2003 invasion have been heterogeneous and controversial, and none were produced after 2006. The purpose of this research was to estimate direct and indirect deaths attributable to the war in Iraq between 2003 and 2011. 背景 之前关于2003年入侵伊拉克所引起的死亡评估鱼龙混杂且互有矛盾,而且在2006年之后便不再有新的研究成果。本文的研究目的在于评估2003-2011年伊拉克战争所引起的所有直接和间接的死亡。 Methods and Findings We conducted a survey of 2,000 randomly selected households throughout Iraq, using a two-stage cluster sampling method to ensure the sample of households was nationally representative. We asked every household head about births and deaths since 2001, and all household adults about mortality among their siblings. We used secondary data sources to correct for out-migration. From March 1, 2003, to June 30, 2011, the crude death rate in Iraq was 4.55 per 1,000 person-years (95% uncertainty interval 3.74–5.27), more than 0.5 times higher than the death rate during the 26-mo period preceding the war, resulting in approximately 405,000 (95% uncertainty interval 48,000–751,000) excess deaths attributable to the conflict. Among adults, the risk of death rose 0.7 times higher for women and 2.9 times higher for men between the pre-war period (January 1, 2001, to February 28, 2003) and the peak of the war (2005–2006). We estimate that more than 60% of excess deaths were directly attributable to violence, with the rest associated with the collapse of infrastructure and other indirect, but war-related, causes. We used secondary sources to estimate rates of death among emigrants. Those estimates suggest we missed at least 55,000 deaths that would have been reported by households had the households remained behind in Iraq, but which instead had migrated away. Only 24 households refused to participate in the study. An additional five households were not interviewed because of hostile or threatening behavior, for a 98.55% response rate. The reliance on outdated census data and the long recall period required of participants are limitations of our study. 方法与发现 我们在伊拉克全境随机抽取了2000户进行了一项调查,应用群体抽样分析两步法以确保所抽取的样本能够代表全国。从2001年起,我们记录每家户主的出生和死亡日期,以及家庭中所有成年人的氏族成员的出生和死亡日期。我们使用辅助数据源来校正因人口迁出引起的数据问题。自2003年3月1日起至2011年6月30日,伊拉克粗略计算得出的死亡率为4.55 每 1,000 人每年(95%不确定区间3.74-5.27),比26个月的战争期间的死亡率还高0.5,就是说,大约405,000(95%不确定区间48,000–751,000)的额外死亡是因为这场战争冲突。战争高峰期(2005-2006)死亡风险女性上升0.7,男性上升2.9。我们认为60%的额外死亡直接由暴力导致,另40%由基础设施的崩塌或其它间接的战争相关因素导致。我们采用第二手数据来源以估算移民出国人员的死亡率。这些计算显示我们少算了至少55,000个死亡人数,他们本来应该由仍然在伊拉克有家庭的家庭申报的,但是他们却移民了。只有24户家庭拒绝参加此项调查。另外5户家庭因表现出了敌意和恐吓行为而未能见面谈话,因此这项调查的回应率为98.55%。对过期人口普查数据的使用以及过长的反馈周期,都使得这项研究存在一定的局限性。 Conclusions Beyond expected rates, most mortality increases in Iraq can be attributed to direct violence, but about a third are attributable to indirect causes (such as from failures of health, sanitation, transportation, communication, and other systems). Approximately a half million deaths in Iraq could be attributable to the war. 结论 在正常死亡之外,大多数死亡人数的增加都可被归因为直接暴力,但有三分之一归因于间接因素(如健康、卫生、交通、传媒等系统)。伊拉克大约50万人的死亡应该归因于这场战争。

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