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Specific health problems
In 1987 Costa Rica had 2,790,600 inhabitants. Based on official projections, the 1992 population was estimated at 3,099,063, with an age structure as follows: 0-4 years of age, 12.8%; 5-14 years, 23.1 %; 15-64 years, 59.8%; 65 years or older, 4.3%. The population density increased from 50 inhabitants per kmē in 1984 to 60.7 in 1992. The Central region is home to 65% of the population, with a density of 230.1 inhabitants per kmē; in other regions of the country the population density ranges from 19 to 40 inhabitants per kmē. The population is 47% urban and 53% rural. Between 1960 and 1990 the urban population grew at an average annual rate of 3.9%.
The growth of the Central region has been largely the result of internal migration, although international migration has also played a part, particularly during the period 1975 to 1985, when three regions of the country registered net immigration (Central, Huetar Norte, Huetar Atlántica). There continue to be two main currents of migration: from small cities and rural areas to the country's principal urban centers, and from economically depressed rural areas where employment opportunities are limited and most of the land is owned by a few individuals to other rural areas in which development is taking place and the demand for workers is greater.
In 1989, 40,800 refugees were living in the country. By July 1993, the number had fallen to 31,875. In addition, there are an estimated 250,000 undocumented aliens.
The natural population growth rate for the period 1991-1992 was 2.26%. The total fertility rate decreased from 3.5 children per woman between 1980 and 1985 to 3.26 between 1985 and 1990. In 1991 the birth rate was 26.3 per 1,000 population, and life expectancy at birth for the period 1990-1995 was estimated at 75.2 years.
Birth and death records suffer from late registration of mortality, which is estimated at 2.8% for general mortality and 3% for infant mortality. No medical death certificate is issued for 24% of deaths in general, whereas only 2.8% of infant deaths lack medical certification.
The general mortality rate recorded in 1991 was 3.8 per 1,000 population and there were a total of 11,792 deaths. The infant mortality rate in 1991 was 13.9 per 1,000 live births. Deaths attributed to signs, symptoms, and ill-defined conditions made up 1.7% of the total.
In 1991 four major groups of causes accounted for 70% of all deaths: 29.4% were due to diseases of the circulatory system, 20% to malignant neoplasms, 10.5% to external causes, and 10.2% to diseases of the respiratory system, with rates of 11.2, 7.6, 4.0, and 3.9 per 10,000 population, respectively. Infectious and parasitic diseases, which in 1970 ranked as the leading cause of death and accounted for 20.5% of all deaths (a mortality rate of 13.6 per 10,000 population), in 1991 ranked 10th and were responsible for 2.8% of all deaths (a rate of 1.1 per 10,000 population).
general population in 1991 acute myocardial infarction was the
leading cause of death, accounting for 9.6% of all deaths. The
mortality rate from this cause increased from 2.6 per 10,000
population in 1970 to 3.7 in 1991. In second place was malignant
neoplasm of the stomach, which caused 5% of all deaths. The
mortality rate from this cause, 2.0 per 10,000 population, has
changed very little since 1970. The third leading cause of death
was other forms of chronic ischemic heart disease, at a rate of
1.6. Chronic airway obstruction ranked fourth, at a rate of 1.2,
and acute cerebrovascular disease and diabetes mellitus ranked
fifth and sixth, respectively, at rates of 1.2 and 1.0 per 10,000
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