HL

Biology IA Anthony Hans Jan 2016

Investigation Regarding the Correlation Between

HDI and Mortality Rates due to Stroke
Research Question

What is the correlation between HDI and mortality rate due to stroke (measured in number of deaths per
100,000 of population), in countries with a HDI of above 0.75?

Background Research

Stroke is a cardiovascular disease that involves a lack of blood flow to the brain (National Stroke
Association, n.d.). This can occur in several ways: hemorrhagic strokes occur when a weak blood vessel
in the brain leaks, or if an aneurysm (a localized swelling of a blood vessel) bursts inside the brain; an
embolic stroke occurs if a plaque or clot fragment formed elsewhere in the body, travels up the brain and
blocks a small blood vessel there; and a thrombotic stroke is caused by a clot that formed inside one of
the brain’s blood vessel. All deprive sections of the brain from receiving sufficient oxygen, resulting in the
death of the brain’s neurons. Collectively, all of the different types of strokes kill six million individuals
per year worldwide (World Heart Foundation, 2016).

Figure 1: Diagram showing a hemorrhagic stroke involving an aneurysm

Stroke, and other diseases such as coronary heart disease and Alzheimer’s disease, are non-
communicable; that is, they are not transmitted from person to person, as infectious diseases carried by
viruses or bacteria are (World Health Organization, 2015). Instead, they are caused due to risk factors,
such physical inactivity or smoking. For this reason, advances technology and civil engineering which has
helped in preventing and curing transmissible diseases (examples being vaccines limiting the effect of
bacterial/viral diseases, and proper sewage treatment improving public hygiene and therefore health)
ALL TEXTS BELONG TO OWNERS.
TAKEN FROM WWW.INTERNALASSESSMENTS.WORDPRESS.COM
2

may not necessarily work to slow the growing prevalence of non-communicable diseases, which are not
caused by transmissions.

In this investigation, HDI (human development index) will be used as the metric by which development is
measured. This is an index incorporating education, GNI per capita, and healthcare, using various
indicators to measure each component and therefore the overall HDI (Human Development Report,
2015). An HDI value of 0.75 or higher can therefore be a reasonable indicator of a developed country.

Although certainly not as prominent as other non-communicable diseases, such as coronary heart
disease or cancer – both of which are the leading causes of death in most developed countries – stroke is
by no means insignificant. Even if a stroke attack does not claim the lives of its victims, the devastation it
so often causes to the afflicted and their families are hugely paralyzing. Therefore, I have devoted this
investigation to the study of stroke’s prevalence, in hopes of better understanding it in the larger picture.

Therefore, this research aims to determine the impact of human development on the number of
mortalities caused by strokes; where human development is measured by HDI, and the number of
mortalities is taken per annum and per 100,000.

Hypothesis

It can be predicted there is a negative correlation between the HDI of a country and the number of lethal
stroke cases there.

This is because when very high HDI countries are concerned, strokes are more easily treatable with
advanced healthcare, allowing stroke patients a higher recovery rate. Therefore, despite a higher life
expectancy and more people suffering from strokes, highly developed countries might be able to treat
strokes more easily than other diseases such as cancer or coronary heart disease, hence reducing the
mortality rate due to strokes

Therefore, the hypotheses for statistical testing are as follows:

Null Hypothesis: HDI has no impact on the mortality rate due to stroke.
Alternative Hypothesis: HDI will have a negative correlation on the mortality rate due to stroke

ALL TEXTS BELONG TO OWNERS.

TAKEN FROM WWW.INTERNALASSESSMENTS.WORDPRESS.COM
 3

Materials

l Microsoft Excel (used for all calculations and data processing)

l HDI database (for this, the Human Development Reports published by the UN will be used, which
may be found in this link: http://hdr.undp.org/en/data)
l WHO database on mortalities due to cerebrovascular diseases (may be found in this link:
http://www.who.int/healthinfo/global_burden_disease/estimates/en/index1.html, note that the
death estimates for 2000 and 2012 is used)
l World Bank database on total population (may be found in this link:
http://databank.worldbank.org/data/home.aspx)
Data from these sources are chosen for two reasons: reliability (as the UN and World Bank can be
considered as reliable and trustworthy sources for such data due to the nature of their organization), and
a lack of other databases.

Methodology & Trial Investigation

The following trial investigation was conducted with a selection of seven nations, which can also be
used to demonstrate the methodology of this investigation. These countries are: Austria, Denmark,
Germany, Greece, Hungary, Portugal, and Spain. These countries are chosen as they are all European
OECD nations, and therefore should have reasonably similar cultural and economic status, reducing the
possible impact of unrelated outside factors such as lifestyle habits or dietary preferences. The
correlation should therefore be reasonably strong, demonstrating that this investigation will work.

Firstly, data regarding the population, human development index, and population will be obtained from
their respective databases for the years 2000 and 2012 (the only years when the WHO has presented
data regarding causes of mortality on their website):

Table 1: Raw data showing the estimated death counts due to stroke, population and the HDI of
selected countries in the specified years
Estimated death counts due to
Human Development Index Population
Country stroke (in '000s of deaths)
2000 2012 2000 2012 2000 2012
Austria 0.836 0.884 8.8 5 8,011,566 8,429,991
Denmark 0.862 0.921 5.2 3.6 5,339,616 5,591,572
Germany 0.855 0.915 82.4 59.9 82,211,508 80,425,823
Greece 0.799 0.865 22.9 20.7 10,805,808 11,045,011
Hungary 0.769 0.823 18.8 13.3 10,210,971 9,920,362
Portugal 0.782 0.827 22.8 12.8 10,289,898 10,514,844
Spain 0.827 0.874 36.6 29.6 40,263,216 46,773,055
ALL TEXTS BELONG TO OWNERS.
TAKEN FROM WWW.INTERNALASSESSMENTS.WORDPRESS.COM
4

To calculate death rates, the estimated death counts due to stroke can be divided by the population. This
is the death rate due to stroke per person; to find the more conventional death rate per 100,000
population, the number can be multiplied by 100,000.

Sample calculations: Austria’s death rate due to stroke per 100,000 population in 2000

𝐸𝑠𝑡𝑖𝑚𝑎𝑡𝑒𝑑 𝑑𝑒𝑎𝑡ℎ 𝑐𝑜𝑢𝑛𝑡
𝐷𝑒𝑎𝑡ℎ 𝑟𝑎𝑡𝑒 𝑝𝑒𝑟 𝑝𝑒𝑟𝑠𝑜𝑛 =
𝑇𝑜𝑡𝑎𝑙 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛

8.8
=
8011566

= 0.001098412

𝐷𝑒𝑎𝑡ℎ 𝑟𝑎𝑡𝑒 𝑝𝑒𝑟 100,000 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 = 𝐷𝑒𝑎𝑡ℎ 𝑟𝑎𝑡𝑒 𝑝𝑒𝑟 𝑝𝑒𝑟𝑠𝑜𝑛 × 100,000

= 0.001098412 × 100,000

= 109.8

(Note that the final result is in 1 decimal place, as the data found on death counts is also in 1 decimal
place.)

Table 2: Processed data showing the mortality rates caused due to strokes
Mortality rates due to
Mortality rates due to stroke per person stroke per 100,000
Country
population
2000 2012 2000 2012
Austria 0.001098412 0.000593120 109.8 59.3
Denmark 0.000973853 0.000643826 97.4 64.4
Germany 0.001002293 0.000744786 100.2 74.5
Greece 0.002119231 0.001874149 211.9 187.4
Hungary 0.001841157 0.001340677 184.1 134.1
Portugal 0.002215765 0.001217327 221.6 121.7
Spain 0.000909018 0.000632843 90.9 63.3

From here, it is a simple matter of averaging the death rates and HDI for both years, then comparing the
two values for correlation:

ALL TEXTS BELONG TO OWNERS.

TAKEN FROM WWW.INTERNALASSESSMENTS.WORDPRESS.COM
 5

Table 3: Average mortality rates per 100,000
population due to stroke and HDI of selected
countries of during the years 2000 and 2012
Average mortality
Average human
rate due to stroke
Country development
per 100,000
index
population
Austria 0.860 84.6
Denmark 0.891 80.9
Germany 0.885 87.4
Greece 0.832 199.7
Hungary 0.796 159.1
Portugal 0.804 171.7
Spain 0.851 77.1

Chart 1: the relationship between HDI and

mortality rates due to stroke per 100,000
population in trial nations
250.0
Death rate due to stroke per 100,000 population

200.0

150.0

100.0

50.0

0.0
0.780 0.800 0.820 0.840 0.860 0.880 0.900
Human development index

The investigation will follow exactly the same method, except with a larger number of countries.

Investigation and Results

The database used in obtaining HDI information divides countries based on four categories: very high
HDI countries (countries with a HDI above 0.8 as of 2014), high HDI countries (between 0.7 to 0.8),
medium HDI countries (between 0.55 to 0.7) and low HDI countries (below 0.55). Therefore, the
ALL TEXTS BELONG TO OWNERS.
TAKEN FROM WWW.INTERNALASSESSMENTS.WORDPRESS.COM
6

countries categorized as having a “very high HDI” will be used in this investigation, as relatively few of
them have a HDI below 0.75 during 2000 (which is the minimum HDI used for this investigation, as
stated in the research question). As there are relatively few countries in this category – only 49 – and a
few of them either lack data (such as Liechtenstein) or have a population that is relatively small (such as
Singapore or Hong Kong), random sampling is not necessary; only 18 of these countries have sufficient
data, an HDI that is consistently above 0.75 and a population size greater than 10 million since 2000, so
these 18 countries shall be used.

The results are as follows:

Table 4: Raw data showing the HDI, death counts due to stroke and total population of nations
with HDIs above 0.75 on the years 2000 and 2012
Death count due to
Human development
stroke (in '000s of Total population
Country index
deaths)
2000 2012 2000 2012 2000 2012
Argentina 0.762 0.831 27.4 28.2 19,153,000 22,728,254
Australia 0.898 0.932 12.2 11.0 37,057,453 42,095,224
Belgium 0.874 0.889 8.6 7.4 10,251,250 11,128,246
Canada 0.867 0.910 15.5 13.5 30,769,700 34,751,476
Chile 0.752 0.827 7.4 8.4 15,170,387 17,388,437
Czech Republic 0.821 0.867 16.9 10.4 10,255,063 10,510,785
France 0.848 0.886 40.9 34.4 60,912,498 65,659,790
Germany 0.855 0.915 82.4 59.9 82,211,508 80,425,823
Greece 0.799 0.865 22.9 20.7 10,805,808 11,045,011
Italy 0.829 0.872 67.3 58.7 56,942,108 59,539,717
Japan 0.857 0.888 132.1 120.6 126,843,000 127,561,489
Korea 0.821 0.893 41.6 27.8 22,840,218 24,763,353
(Republic of)
Netherlands 0.877 0.920 12.5 8.8 15,925,513 16,754,962
Poland 0.786 0.838 66.8 64.5 38,258,629 38,063,164
Portugal 0.782 0.827 22.8 12.8 10,289,898 10,514,844
Spain 0.827 0.874 36.6 29.6 40,263,216 46,773,055
United 0.865 0.901 62.1 46.3 58,892,514 63,700,300
Kingdom
United States 0.883 0.912 169.3 133.6 282,162,411 314,102,623

ALL TEXTS BELONG TO OWNERS.

TAKEN FROM WWW.INTERNALASSESSMENTS.WORDPRESS.COM
 7

Table 5: Processed data showing the mortality rate caused by stroke in the selected nations in 2000 and
2012
Mortality rate due to stroke per
Mortality rate due to stroke per person
Country 100,000 population
2000 2012 2000 2012
Argentina 0.001432383 0.001241697 143.2 124.2
Australia 0.00032908 0.00026096 32.9 26.1
Belgium 0.000840013 0.000661172 84.0 66.1
Canada 0.000503748 0.000387472 50.4 38.7
Chile 0.000490413 0.000482589 49.0 48.3
Czech Republic 0.001647081 0.000988891 164.7 98.9
France 0.00067176 0.000524081 67.2 52.4
Germany 0.001002107 0.000744576 100.2 74.5
Greece 0.002114838 0.001870679 211.5 187.1
Italy 0.001182507 0.000985131 118.3 98.5
Japan 0.001041133 0.000945319 104.1 94.5
Korea (Republic of) 0.001819974 0.00112458 182.0 112.5
Netherlands 0.000787218 0.000522311 78.7 52.2
Poland 0.001745275 0.001693969 174.5 169.4
Portugal 0.00221199 0.001213221 221.2 121.3
Spain 0.000909327 0.000632348 90.9 63.2
United Kingdom 0.001054875 0.000726532 105.5 72.7
United States 0.000600084 0.000425269 60.0 42.5

Table 6: the average HDI and mortality rates due to stroke during the
years 2000 and 2012
Mortality rate due to
Average human
Country stroke per 100,000
development index
population
Argentina 0.796 133.7
Australia 0.915 29.5
Belgium 0.881 75.1
Canada 0.889 44.6
Chile 0.790 48.7
Czech Republic 0.844 131.8
France 0.867 59.8
Germany 0.885 87.3
Greece 0.832 199.3
Italy 0.850 108.4
Japan 0.872 99.3
Korea (Republic of) 0.857 147.2
Netherlands 0.899 65.5
Poland 0.812 172.0
Portugal 0.804 171.3
Spain 0.850 77.1
United Kingdom 0.883 89.1
United States 0.897
ALL TEXTS BELONG TO OWNERS.
51.3
TAKEN FROM WWW.INTERNALASSESSMENTS.WORDPRESS.COM
8

Chart 2: Scatter graph showing the relationship

between HDI and Mortality rate due to stroke in
countries with HDIs above 0.75
250.0
Mortality rate per 100,000 population caused by stroke

200.0

150.0

100.0

50.0

0.0
0.750 0.770 0.790 0.810 0.830 0.850 0.870 0.890 0.910
Human development index y = -803.25x + 787.78
R² = 0.37128

Here we can observe that there is one outlier with a mortality rate of 48.7 per 100,000 due to stroke, and
a HDI of 0.790 (the value found in the bottom left of the other data points on the graph); this belongs to
Chile. If this is taken out of consideration, we can see that the scatter graph forms a loose linear
correlation, as displayed on the graph. The linear correlation therefore allows the use of a Pearson’s
product-moment coefficient for statistical testing.

Statistical Testing

To conduct a Pearson’s correlation test, some values must be assigned: the variable X can be the
mortality rate due to stroke, whereas Y is the human development index, and N denotes the number of
countries. The total sum of each column is then found. Then, new columns for the values of XY, X2, and Y2
is needed. The result is as follows:


ALL TEXTS BELONG TO OWNERS.
TAKEN FROM WWW.INTERNALASSESSMENTS.WORDPRESS.COM
 9

Table 7: Pearson’s product moment correlation test on the results on table 5
N X Y XY X2 Y2
1 133.7 0.796 106.425 17875.7 0.634
2 29.5 0.915 26.993 870.3 0.837
3 75.1 0.881 66.163 5640.0 0.776
4 44.6 0.889 39.649 1989.2 0.790
5 48.7 0.790 38.473 2371.7 0.623
6 131.8 0.844 111.239 17371.2 0.712
7 59.8 0.867 51.847 3576.0 0.752
8 87.3 0.885 77.261 7621.3 0.783
9 199.3 0.832 165.818 39720.5 0.692
10 108.4 0.850 92.140 11750.6 0.723
11 99.3 0.872 86.590 9860.5 0.761
12 147.2 0.857 126.15 21667.8 0.734
13 65.5 0.899 58.885 4290.3 0.808
14 172.0 0.812 139.664 29584.0 0.659
15 171.3 0.804 137.725 29343.7 0.647
16 77.2 0.850 65.620 5959.8 0.723
17 89.1 0.883 78.675 7938.8 0.780
18 51.3 0.897 46.016 2631.7 0.805
Sum 1791.1 15.423 1515.333 219997.4 13.241

From here, the following equation is used to find the Pearson’s correlation value:
𝑛 𝑥𝑦 − ( 𝑥)( 𝑦)
𝑟=
(𝑛 𝑥 ! − ( 𝑥)! )(𝑛 𝑦 ! − ( 𝑦)! )
Utilizing this formula, the following result may be found:
18 1515.333 − (1791.1)(15.423)
𝑟=
18 219997.4 − 1791.1! 18 13.241 − 15.423!
𝑟 = −0.586
This value means that there is a reasonably strong negative correlation between the human development
index of a developed country, and the mortality rates caused by stroke. Furthermore, it is found that in a
Pearson’s correlation test, the critical value for a correlation with 17 degrees of freedom (found by the
number of trials, 18, minus 1), and a level of confidence of 0.05, is 0.482 (Statistics Solutions, n.d.). The r
value obtained from this investigation has a higher absolute value than this; therefore, we can reject the

ALL TEXTS BELONG TO OWNERS.

TAKEN FROM WWW.INTERNALASSESSMENTS.WORDPRESS.COM
10

null hypothesis and conclude with the alternative hypothesis, which states that HDI will have a negative
correlation on the mortality rate due to stroke.

Conclusion

To restate the research question: What is the correlation between HDI and mortality rate due to
stroke (measured in number of deaths per 100,000 of population), in countries with a HDI of
above 0.75?

This investigation has found that HDI has a negative correlation with mortality rate due to stroke in
developed countries, in a linear trend, supporting the hypothesis made earlier.A biological explanation
for this might be that strokes are easier to treat than other non-communicable diseases, such as cancer.
This means that, even though a greater proportion of people in developed countries will have been
exposed to more risk factors for strokes (such as trans fats, sedentary behavior, etc.), and advanced
healthcare system can still compensate by improving the chance of recovery, whereas another non-
communicable disease such as cancer is much more difficult to treat, and hence is more difficult to
compensate with good healthcare standards. This says nothing of the economic and social repercussions
of contracting strokes, even when one recovers, which is best reserved for another investigation.

This is supported by a study published on BioMed Central (Wu, Woo and Zhang, 2013); in this study, a
correlation between socioeconomic status and stroke is being tested, rather than HDI. However, these
two variables are reasonably similar as a measure of a population’s well-being, and can therefore be
assumed to be somewhat comparable. This study has claimed that, whereas an improvement in
socioeconomic status increased stroke mortality in less developed areas, the opposite is true for more
developed countries and regions, hence supporting this investigation’s findings.

Evaluation

A strength of this investigation is the strong reliability of the data used; since the countries used for this
investigation are relatively modernized and have populations larger than 10 million, it can be expected
that the data collected is not only accurate, but representative. There is also a sufficient range and data
collected to draw a conclusion from.

However, this investigation does have some issues:

ALL TEXTS BELONG TO OWNERS.
TAKEN FROM WWW.INTERNALASSESSMENTS.WORDPRESS.COM
 11

Table 8: Limitations of this investigation
Limitation Significance Possible improvement
Only the years This limits the reliability of each of the Data from other years may be
2000 and 2012 country’s data points, as only two samples collected directly from the various
were used, as are taken per country to form an average of country’s national health websites,
these are the the country’s mortality rate and HDI, which which may yield data from years
only years that may be non-representative. other than 2000 and 2012 for all
the databases nations.
had in common.
Sample size is This may have an effect on the statistical Countries with smaller population
rather small at testing, which therefore weakens the sizes can be considered – such as
18 countries. conclusion made drawn from the results. above 8 million, rather than 10
million.
The countries The countries in this investigation vary quite Other factors, such as population
used for the dramatically, from the largely urban UK to density, climate and GDP per capita
investigation the more sparsely populated Canada. This may also be considered and kept
had very few has led to a great amount of uncertainty in similar for the selected countries,
controlled the data (evident with an R2 value of less though this may limit the sample size.
variables. than 0.4).

When conducting this investigation again, the following changes may improve the results:
§ The larger nations may be separated into their constituent districts/states (for example, the US can
be separated into its 50 states, and whereas China’s national HDI may be relatively low, more
prosperous provinces/districts such as Shanghai or Tianjin can be investigated), and the data for
each region may be collected individually. This may dramatically increase the sample size of the
investigation – provided the constituents have a sufficiently large population size.
§ The overall social impact of stroke can be investigated alongside the mortality rate, using indicators
such as the average hospitalization time for stroke cases, or monetary costs of operations; this will
allow the investigation to better gauge the prevalence and significance of strokes.
§ Less prosperous countries can be investigated as well; this will lead to an investigation of stroke on
a much broader scope, which may reveal the trend between HDI and stroke-caused mortalities in
less developed nations.

ALL TEXTS BELONG TO OWNERS.

TAKEN FROM WWW.INTERNALASSESSMENTS.WORDPRESS.COM
12

Bibliography

World Health Organization, (2015). Noncommunicable Diseases – Fact Sheet. [online] Available at:
http://www.who.int/mediacentre/factsheets/fs355/en/

World Heart Federation, (2016). Stroke. [online] Available at:
http://www.world-heart-federation.org/cardiovascular-health/stroke/

National Stroke Association, (2017). Hemorrhagic Stroke. [online] Available at:
http://www.stroke.org/understand-stroke/what-stroke

National Health Service, (2015). What are cerebrovascular diseases? [online] Available at:
http://www.nhs.uk/conditions/cerebrovascular-disease/Pages/Definition.aspx

Human Development Reports, (2015). Human Development Data (1980 – 2015). [online] Available at:
http://hdr.undp.org/en/data

World Health Organization, (2017). Estimates for 2000 – 2012. [online] Available at:
http://www.who.int/healthinfo/global_burden_disease/estimates/en/index1.html

The World Bank, (2017). Explore. Create. Share: Development Data. [online] Available at:
http://databank.worldbank.org/data/home.aspx

Statistics Solutions, (n.d). Table of Critical Values: Pearson Correlation. [online] Available at:
http://statisticssolutions.com/table-of-critical-values-pearson-correlation/

Wu, S., Woo, S., and Zhang, X., (2013). Worldwide socioeconomic status and stroke mortality: an
ecological study. BioMed Central. [online]. Available at:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3695775/

Human Development Reports, (2015). Human Development Index (HDI). [online] Available at:
http://hdr.undp.org/en/content/human-development-index-hdi

ALL TEXTS BELONG TO OWNERS.

TAKEN FROM WWW.INTERNALASSESSMENTS.WORDPRESS.COM