STUMP » Articles » Mortality with Meep: Dominican Republic and Raw Death Rates » 20 June 2019, 07:29

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Mortality with Meep: Dominican Republic and Raw Death Rates  

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20 June 2019, 07:29

Well, I guess this is still going on. My prior post: Mortality with Meep: How Many Deaths Before it’s No Longer a Coincidence?

I saw this tweet this morning:


Well. That’s true, but….

You probably won’t die on your Dominican Republic vacation: study

Americans are more likely to die on native soil than in the Dominican Republic, a new study reveals.

The US State Department reported Tuesday that statistics indicate the threat to tourists in the Caribbean country — which is under siege by almost daily reports of mysterious deaths and illnesses — might be overblown, according to NBC News.

For American tourists, the death rate is about 7.04 per every 1,000 people for the last decade through 2018. To compare, the overall death rate back in the US was 8.49 per 1,000, the report said.

Furthermore, the findings suggest that reports of the country seeing an increase in American tourists dying from unnatural causes may be overplayed.

“We have not seen an uptick in the number of US citizen deaths reported to the department,” a department official told NBC News.

Fine, so the NY Post links to NBC News. Let’s see what that piece says.

No, the Dominican Republic hasn’t suddenly become more dangerous

The State Department has tallied all deaths of U.S. citizens abroad from so-called unnatural causes since 2007. Compared with the seven Americans who have died so far this year, 15 died through June in both 2011 and 2015 of causes like auto accidents, suicides, homicides and drownings. In 2009, 14 Americans died through June. In 2016, the number was 13.

Those numbers don’t include deaths from natural causes like those that are suspected in some of the recent cases; overall death totals are likely to be even higher.

“We have not seen an uptick in the number of U.S. citizen deaths reported to the department,” a State Department official told NBC News on Tuesday.

…..
Reports of mass outbreaks of illnesses, however, are not uncommon in the Dominican Republic and other parts of the Caribbean. A single message board on the travel site TripAdvisor, for example, runs to 11 pages of people reporting problems with or asking about the safety of bootleg and unregulated alcohol in the Dominican Republic, one of the avenues investigators are exploring to explain the current illnesses.

The CDC, meanwhile, warns would-be tourists that drinking the country’s tap water can open them to risk of hepatitis A, typhoid and cholera. The agency is currently warning travelers about an increase in report of rabies in Punta Cana; last year, the Zika virus was a big concern.

The non-profit International Association for Medical Assistance to Travellers even devotes a section on its website to “travelers’ diarrhea” in the Dominican Republic.

Okay, I think that’s enough to comment on.

But first…

INTERLUDE: TRAVEL ADVICE FROM MEEP

Back in the 90s, Stu & I went to Cancun for a week (in August… and I can tell more about that later) to one of those all-inclusive resorts. We had a good time, not least because very few Americans go to Cancun in August (THERE’S A REASON FOR THAT.)

Of course, the drinks at the resort were overpriced, as was whatever they put in the room minibar.

So we went to Walmart.

No, not Walmart in the U.S. The Walmart in Cancun. We took the local bus to Walmart, which was chock full of reasonably priced tequila, beer, etc, and brought it back by bus to our room. We also bought bottled water. I think we also bought chips & salsa, but I can’t remember. Stu was having trouble as he was still a vegetarian at that point, and he thought the beans at the resort were being fried in lard.

Now, we were both fairly young at that point, so we were able to tote a lot.

Also, it looks like there’s neither Walmart nor Target in the DR, but there are other similar stores. Support local retail!

Anyway, we spent only a moderate amount on booze, had a great time surrounded by Mexican and German families, and managed to not get tanned or burnt because we wore long-sleeved cotton coverups & big hats.

Meep’s advice: get your booze at Walmart when you go on these trips.

Also, don’t go to Cancun in August unless you REALLY like heat and sun.

RAW DEATH RATES VS. AGE-ADJUSTED DEATH RATES

First, I want to note the correction on the NBC News piece:

CORRECTION (Wednesday, June 19, 5:20 p.m. ET): A previous version of this article incorrectly compared the annual death rate of Americans in the United States to the rate of recent deaths of Americans in the Dominican Republic. The comparison did not take into account that most Americans in the country are tourists who are not there for a year; the passage has been removed.

Remember in my previous post, I had to reduce the ~2 million visitors down to an exposure base that was appropriate. Taking the raw number of deaths and dividing by 2 million is not appropriate.

That said, let’s look at this bit, from the NY Post:

For American tourists [to the Dominican Republic], the death rate is about 7.04 per every 1,000 people for the last decade through 2018. To compare, the overall death rate back in the US was 8.49 per 1,000, the report said.

This is not really an appropriate comparison.

Those are the overall death rates, it looks like. Not the age-adjusted death rates.

Because the issue here is that the age distribution of those visiting the Dominican Republic are nothing like the age distribution of those living in the U.S.

To begin with, far fewer people over age 80 are going to the DR than live in the U.S. They have a fairly high mortality rate, and most Americans die in their 80s.

On the other side, not as many small children are being taken to the DR than live in the U.S. The mortality rate for people under age 20 is fairly low. Maybe that balances out the 80-year-olds also not being there…. but probably not.

The appropriate way to compare is to adjust it by age, as if they have the same age distribution. That is, compute age-adjusted death rates.

Here is a primer on how to calculate age-adjusted death rates. And here is another. There is more than one way to calculate age-adjusted death rates.

The point, though, is that because age is such a huge driver in the difference between raw death rates (that is, just calculating # of deaths / total population), one needs to set the populations against the same “standard” age distribution… and the standard age distribution is somewhat arbitrary.

So you even have to be careful about comparing age-adjusted death rates between different data sets, as they may use different standard age distributions.

BACK TO THE PR PROBLEM: IT’S NOT ABOUT NUMBERS


The problem for the Dominican Republic is purely public relations right now. Comparing numbers like death rates is not going to convince anybody who is deciding on a location to vacation at.

There’s this bit:


But nobody really has a bias for thinking that somebody is going around murdering Americans in the Dominican Republic.

Let’s think of something that’s far more endemic: antivaxxers. They will not be convinced by numbers. It’s purely emotional reaction at this point.

Truth is one of my highest values, and I have a bias of digging into my assumptions. I am particularly aware of cognitive biases.

But that’s not how most people are (and I wouldn’t even argue that’s how most people should be. I don’t dig into every damn thing myself because it gets exhausting. Somebody needs to make the donuts and not spend time questioning everything.)

So they need to find some good emergency communications people, because this ain’t cutting it.

I agree that the numbers themselves don’t show a problem, but the problem is no longer about the numbers.

I have no recommendation on this score, because this really isn’t something I have expertise about. I can only tell the “you probably won’t die” is not a good message to convey. “Most people survive!” is not any better.

DO BETTER.


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