In part I the senior author reported on the causes of death of women of reproductive ages in Seoul, as obtained by a review of medical records in eleven principal hospitals. Although there are some advantages since more medical detail can be found in the records of hospital deaths, results thus obtained can hardly be considered to represent the pattern of deaths in the general population..
In order to complement the shortcomings of data from medical records the alternative approach of studying the death certificates of women of reproductive ages was attemped. All death certificates of women between the ages of 15 and 50 at the time of death which were submitted to Dong (district) offices in Seoul for burial or cremation permits were reviewed. Following transcription of all items from the death certificates, relatives of the dead were traced and interviewed by female interviewers between May 1968 and July 1958 using a specially prepared questionnaire.
From among 1900 death certificates 690 cases were interviewed. Of the remaining, 1,210 cases, 380 cases were accidental deaths which were omitted intentionally from interview, 801 cases could not be located because of out-migration or inadequate addresses and 29 cases were not interviewed for other reasons.
The interviewers contacted a disproportionatey simaller number of the survivors of women aged 15-19 and 20-24 than among the overall group of 1,900 deaths (Table 1). Proportionately 2.4°,0 less of the 15-19 year old´s survivors and 4.8% less of the 20-24 year old´s survivors were located and interviewed. In addition the age goup 45-49 was over-represented with a higher proportion of interviews actually performed (22.6%) than in the general group. Therefore the results obtained from the cases interviewed could be generalized to all deaths. somewhat more precisely if an adjustment for this uneven non-response were made, however this is awkward.
Results obtain ed from 1, 900 death certificates and the survey based on 690 cases interviewed are summarized as follows:
1. Leading causes of death among women in the reproductive ages based on 1, 900 death cetificates are tuberculosis 16.3%, suicide 15.2%, cancer i1%, lesions affecting central nervous system 8.8°0, and maternal death 6.7% (Table 2). Similarity in the pattern for leading causes of death was also found among those interviewed except. for accidental death which was intentionally omitted from the interview.
2. As to age at death, age 45-49 years old constitutesl8. 8% of the total deaths, age 20-24 15.1% and age 15-19 9.6%, the lowest of all (See Table 2).
3. The leading cause of death is tuberculosis which maintains the first order of frequency among women from ages 25 to 39 years old, the second order of death is suicide, 15.2% of the total, which is the most frequent cause of death for women aged 15-24 years and the second most frequent for women 25-34 years of age. Cancer, the third most frequent cause of death overall, becomes the second most frequent with advancing age at 45-49 years old. About one third of deaths due to cancer occur between ages 45-49. Maternal death is fifth in the order of frequency overall (6.7% of total) becoming third in the order of frequency in the age range 20-34 years.
3. Results of interviews reveal that in the lower economic class tuberculosis and renal disease are relatively more prominent, whereas in the upper economic class frequency of cancer and maternal death are somewhat higher (Table 3).
4. As shown in Table 4, 63.9% of the total cases died at home, 25.4% at general hospitals, and 2.9/o at private clinics. When cross tabulated with age at death, the proportion of deaths at home increases with advancing age: about one half of women aged less than 24 died at home while 76.8% of those between 45 and 49-died at home.
5. 58.1% of all death certificates were issued by physicians at private cynics, 33.4% by those at general hospitals and 6.1% by herb doctors. (See Table 5)
6. Interview data showed 46.5% to have seen physicians at general hospitals, 33.6% to have gone -to private clinics, and 9.4% to -have recieved no medical attention prior´ to. their deaths. In shart, 22.9% of the total did. not recieve any medical care prior to death. (Table 5)
7. As seen in Table 6, there was no marked seasonal variation in the occurence of death except that a relatively higher proportion occurred during winter, 28.2% In winter, suicide and heart disease often caused death, whereas in spring tuberculosis, cancer and lesions affecting the central nervous system were relatively more frequent. Material death was most frequent in summer.
8.. Complications of pregnancy and labor reported on death certificates comprised 6.7% of the total deaths reported. A further breakdown is shown in Table 7.
The three major causes of maternal death are hemorrhage, toxemia of pregnancy and puerperal infection in the order of frequency. Among those interviewed, which represented 69% of all cases reported in death certificates, 17 cases of death due to induced abortion were elicited by interview. This far surpasses the 12 cases reported on death certificates. Furthermore, 27 cases were found who died sometime after induced abortion (without specifying its relation to cause of death).
During the interview it was found that 57.176 of total maternal deaths were seen or treated at general hospitals, and 29.5/o were seen at private clinics prior to their death. The proportion of deaths. due to abortion constituted about one fourth of maternal deaths. Since the proportion of deaths reported within the year of death is estimated at 42.2% of the actual number of deaths in Seoul, analysis based on death certificates is seemingly incomplete at the present. There is however, no way for this study to improve upon the collection of death data. The leading causes of death of women of reproductive age are tuberculosis, suicide, cancer, and cardiovascular accidents. These vary with changes of age as shown in Table 8.
The first cause of death for age 25-29 is maternal death which reflects the necessity of improving medical care for young mothers in Korea. For ages 30-34 tuberculosis is the most frequent cause of death in Seoul and renal disease for age´s 15-39. Thus, the leading, causes of death for women in their late 20´s and 30´s are infectious ,diseases which are preventable and curable in the majority of cases, whereas in Japan and the United States the pattern is quite different from Korea.
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