MORTALITY FROM EXTERNAL CAUSES IN COLOMBIA'S FIVE LARGEST CITIES: 2000-2024
Author(s)
Nelson Alvis-Guzman, MPH, PhD, MD1, Nelson José Alvis Zakzuk, MSc2, Kevin Enrique Gamero Tafur, Sr., MSc3, Nelson Rafael Alvis Zakzuk, Jr., MBA4.
1Professor, Universidad de la Costa - ALZAK Foundation, Barranquilla, Colombia, 2University of Sao Paulo, Sao Paulo, Brazil, 3Pharmaser, Cartagena, Colombia, 4ALZAK Foundation, Cartagena, Colombia.
1Professor, Universidad de la Costa - ALZAK Foundation, Barranquilla, Colombia, 2University of Sao Paulo, Sao Paulo, Brazil, 3Pharmaser, Cartagena, Colombia, 4ALZAK Foundation, Cartagena, Colombia.
OBJECTIVES: Describe and compare mortality trends from external causes in Colombia's five largest cities from 2000 to 2024, estimating age-standardised mortality rates (ASMR), years of life lost (YLL), and segmented trend inflection points.
METHODS: Descriptive longitudinal analysis of non-fetal mortality microdata from DANE (external cause deaths; ICD-10 Chapter XX, codes V-Y). ASMR were calculated by direct standardisation using the WHO World Standard Population. YLL were estimated with the GBD 2019 IHME standard life table (life expectancy at birth = 86.02 years), without temporal discounting, expressed per 1,000 total and per 1,000 working-age inhabitants (15-64 years). Joinpoint regression was applied to the annual ASMR series.
RESULTS: Of the 5.6 million total deaths, 954,150 were due to external causes, and 602,338 of those occurred in the five main cities. All five cities showed markedly divergent trajectories. Medellín recorded the greatest absolute reduction (ASMR: 2.07 to 0.59 per 1,000; −71.6%), with the steepest decline concentrated in 2000-2005 (annual percent change [APC]: −19.2%, p<0.05) and a sustained downward trend thereafter (APC: −3.92%/year, p<0.01). Cali maintained persistently high rates with no significant trend since 2005 (APC: −0.01%, p=0.98), retaining the highest working-age YLL in 2020-2024 (71.48/1,000). Cartagena de Indias was the only city with a statistically significant post-2018 acceleration (APC: +9.99%/year, p<0.01), surpassing Medellín in working-age YLL by the final quinquennium (54.85 vs. 34.60/1,000). Bogotá and Barranquilla showed significant recent rebounds (APC: +2.81% and +3.27%, respectively, p<0.01) after earlier reductions. The apparent convergence of ASR by 2024 masked opposing dynamics: continued reductions in Andean cities versus rising rates in Caribbean cities.
CONCLUSIONS: External cause mortality trajectories in Colombia’s five largest cities reflect local security conditions and socioeconomic determinants rather than uniform national trends. Cartagena’s post-2018 escalation and Cali’s persistent plateau require priority public health action targeting violence prevention and road safety
METHODS: Descriptive longitudinal analysis of non-fetal mortality microdata from DANE (external cause deaths; ICD-10 Chapter XX, codes V-Y). ASMR were calculated by direct standardisation using the WHO World Standard Population. YLL were estimated with the GBD 2019 IHME standard life table (life expectancy at birth = 86.02 years), without temporal discounting, expressed per 1,000 total and per 1,000 working-age inhabitants (15-64 years). Joinpoint regression was applied to the annual ASMR series.
RESULTS: Of the 5.6 million total deaths, 954,150 were due to external causes, and 602,338 of those occurred in the five main cities. All five cities showed markedly divergent trajectories. Medellín recorded the greatest absolute reduction (ASMR: 2.07 to 0.59 per 1,000; −71.6%), with the steepest decline concentrated in 2000-2005 (annual percent change [APC]: −19.2%, p<0.05) and a sustained downward trend thereafter (APC: −3.92%/year, p<0.01). Cali maintained persistently high rates with no significant trend since 2005 (APC: −0.01%, p=0.98), retaining the highest working-age YLL in 2020-2024 (71.48/1,000). Cartagena de Indias was the only city with a statistically significant post-2018 acceleration (APC: +9.99%/year, p<0.01), surpassing Medellín in working-age YLL by the final quinquennium (54.85 vs. 34.60/1,000). Bogotá and Barranquilla showed significant recent rebounds (APC: +2.81% and +3.27%, respectively, p<0.01) after earlier reductions. The apparent convergence of ASR by 2024 masked opposing dynamics: continued reductions in Andean cities versus rising rates in Caribbean cities.
CONCLUSIONS: External cause mortality trajectories in Colombia’s five largest cities reflect local security conditions and socioeconomic determinants rather than uniform national trends. Cartagena’s post-2018 escalation and Cali’s persistent plateau require priority public health action targeting violence prevention and road safety
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EPH227
Topic
Economic Evaluation, Epidemiology & Public Health, Health Policy & Regulatory
Topic Subcategory
Public Health
Disease
Injury & Trauma