Age patterns of mortality and cause-of-death structures in Sweden,Japan, and the United States

This paper uses a new standard model of adult mortality to compare the mortality patterns of Swedes, Japanese, and U.S. whites between 1950 and 1985. It examines changes in the age patterns of mortality and the cause-of-death structures within the populations. and the relationships between those two factors. As Japan has reached a level of mortality similar to that in Sweden, the age patterns of mortality in the two populations have become more similar despite distinct differences in causes of death. The United States has a cause-of-death structure similar to that of Sweden, but the age pattern of mortality is very different. High mortality in the middle age range in the United States results in approximately a one-year loss of life expectancy at age 45 in comparison with Sweden.     

An international comparison of excessive adult mortality

Abstract Empirical expressions derived by Coale and Demeny accurately characterized the relationships among death rates of different age groups for each sex during an extended period of time in Western nations. However, the relationships have changed in recent years, as the mortality of older persons has increasingly exceeded the level expected on the basis of these expressions. The recent disruption is relatively small for females and may be due to very rapid declines in maternal mortality. Among males, the change has been quite pronounced, and it is suggested that increases in cigarette consumption are largely responsible.     

Evaluation of estimates of underenumeration in the census and the age pattern of mortality,philadelphia, 1880

The schedule of mortality by age for Philadelphia's 1880 population classified by sex and race showed aberrations from Coale and Demeny West, South, and North model life tables. Deviations from standard age patterns of mortality were especially pronounced for the black population. The question addressed in this paper is whether the alternative age patterns of mortality are produced by underenumeration in the 1880 census or by actual variations in the age-specific mortality experience. The conclusion was reached that the underenumeration of the urban population, especially the blacks, exceeds estimates for the national population. In addition, the results indicated that the black population faced risks of dying that genuinely differed from standard age patterns. An attempt to use a Brass logit model to generalize the black mortality experience met with success for females but not for males.     

Population Variation in Cause of Death: Level,Gender, and Period Effects

The trends in 13 cause of death categories are examined with respect to expectation of life, sex differences, and period effects while misclassification of cause of death is controlled. The results suggest that as mortality declines, 1) the increasingly U-shaped age pattern of mortality is a period effect associated with the infectious diseases, 2) the risks of both overall infectious and degenerative causes of death decline, and 3) infectious disease mortality declines more in males, while degenerative disease mortality declines more in females. Finally, the model shows that some contemporary populations are approaching the .limits of reduction in mortality during infancy, childhood, and young adulthood. Past declines in the degenerative diseases, however, suggest that mortality may continue to decline.     

Underlying and multiple causes of death related to smoking

Although smoking has been linked to various causes of death, there is no systematic account of the underlying and multiple cause-of-death distributions associated with various smoking statuses. We analyze such patterns by age and gender for the USA in 1986. Our study is based on a one-percent random sample of decedents 25 and over in the USA for whom survey data from informants were linked to death certificate data. Smoking is related to several underlying causes of death, the most common being circulatory diseases. Lung cancer is less prevalent than circulatory diseases or other cancers among ever smokers. Multiple medical conditions are common for both smokers and nonsmokers, but particular combinations vary among persons with different smoking statuses. Former smokers who quit soon before death and were under frequent medical care are most likely to have had lung cancer. Amount of smoking is tied to variations in cause-of-death patterns. Differences by age and gender are not substantial, although other cancers appear frequently for both smokers and non-smokers among women. The distribution of medical causes of death for ever smokers is not radically different from that of never smokers. However, differences in cause patterns are seen when smoking statuses are detailed by amount of smoking and timing of quitting. These similarities and differences in cause patterns must be related to the fundamental fact that the average smoker will die earlier than the average nonsmoker. Such findings should especially influence programs for diseases whose links to smoking have been underestimated.     

The use of model life tables to estimate mortality for the United States in the late nineteenth century

This paper seeks to extend our knowledge about mortality in the late nineteenth century United States by using census mortality data for older children and teenagers to fit model tables. The same method can also be used with partially underregistered death data. The most commonly used model tables, the Coale and Demeny West Model, apparently do not adequately depict the changing shape of mortality over the period 1850--1910. An alternative model life table system is presented, based on the Brass two parameter logit system and available reliable life tables from the period 1850--1910. The two parameter system must be reduced to a one parameter system by means of estimated relationships between the parameters so that the fitting procedure can be used. The resulting model system is, however, heavily dependent on the experience of northern, industrial states, especially Massachusetts.     

New insights into the Far Eastern pattern of mortality

Some of the highest levels of excess mortality of males found anywhere in the world were present in several Far Eastern populations during the 1960s and 1970s but have progressively disappeared since that time. This study uses cause-of-death data to determine the diseases responsible for the existence and attenuation of these sex differences in Hong Kong, Singapore, and Taiwan. The results indicate that respiratory tuberculosis is the single most important underlying cause of the existence and attenuation of the pattern, that the role of liver diseases is not clear cut, and that other causes (such as cardiovascular diseases) are also important. A review of numerous risk factors yields no compelling reason why these populations experienced such large sex differences in mortality. However, it seems likely that public health and biomedical improvements (particularly those related to the reduction in mortality from tuberculosis) played a critical role in the attenuation of the Far Eastern mortality pattern.     

‘Incorrect,loose and coarse terms’: classifying nineteenth-century English-language causes of death for modern use. An example using Tasmanian data

This paper outlines a cause-of-death classification system applicable to nineteenth-century English-language death data. Consisting of 32 categories, this system combines aspects of William Farr’s nosology, developed in nineteenth-century Britain, and the modern International Classification of Diseases. It is sufficiently broad for meaningful categories to be created for analytical purposes, but specific enough for particular cause-of-death trends and patterns to be traced. Individual-level death registration data from the British colony of Tasmania, 1838–1899, are used to demonstrate the application of this classification system. The paper describes the history of recording causes of death in nineteenth-century Tasmania and discusses several problems particular to nineteenth-century cause-of-death data. The benefits and disadvantages of three existing nosologies, Farr’s, Preston’s and the International Classification of Diseases, are considered with reference to nineteenth-century data. The final sections outline the data and method, and discuss an application of the classification system developed for cause-specific child mortality in nineteenth-century Tasmania.     

Mortality in England and Wales from 1848 to 1947

This is a survey of the changing causes of death in England and Wales during the past 100 years. Based on the published mortality statistics of the General Register Office the framework of the survey is a series of specially prepared tables of death rates by sex, age and cause of death for the periods 1848–72, 1901–10, 1921, 1931, 1939 and 1947. Adjustments were made wherever necessary to compensate for changes in medical nomenclature and in the statistical classification of disease.

After allowance has been made for the changing age structure of the population, the male death rate at all ages in 1947 was 42% of the rate in 1846–50, and the female rate 35 %. Maximum improvement was among girls aged 5–9 years, whose death rate in 1947 was 9% of the rate 100 years before.

In 1848–72 the group to which were allocated the largest proportion of the deaths at all ages were the infectious diseases with one-third of the total; and these were followed by the respiratory, nervous and digestive diseases. In 1947, on the other hand, diseases of the circulatory system came first with rather more than one-third of the total at all ages, and these were followed by cancer.

Changes in proportionate mortality rates from various causes have been examined at successive ages from infancy to old age. There was a decline in proportionate mortality from the infectious diseases other than tuberculosis, but increased mortality from tuberculosis in the younger age groups and from violence, circulatory diseases and cancer.

The trends of absolute mortality from the various causes were also studied. The reduction in total mortality was such that whereas there were half a million deaths of civilians registered in England and Wales in 1947, the total would have been over a million had the death rates of 1848–72 still prevailed.

The article concludes with a brief review of the factors responsible for the changes that have taken place.     

Relative Trends In Mortality From Related Respiratory and Airborne Infectious Diseases

Poor living conditions and inadequate diet were undoubtedly major contributors to high infectious disease death rates in Britain during the nineteenth century, but improvements were not necessarily the precondition for mortality decline. Evidence of consistent improvements is far from conclusive, while different trends for different diseases have to be explained. Scarlet fever and whooping cough death rates did not decline until the last few decades of a century in which measles mortality was continuing high Respiratory and gastro-intestinal complications are frequently involved in conditions of overcrowding and poverty. Death rates for recorded respiratory diseases themselves reveal a downturn at the end of the century, but respiratory tuberculosis mortality declined throughout and smallpox was virtually eliminated through vaccination measures. The interrelated nature and aetiology of these diseases has implications for changes in mortality, while population variables and other transmission factors including social behaviour patterns are probably crucial for an understanding of historical and contemporary trends.     

The hospitals and population growth: The voluntary general hospitals, mortality and local populations in the English provinces in the eighteenth and nineteenth centuries part 2

Summary In the second part of this article the number and nature of hospital cases treated in the light of physical, medical and surgical limitations are examined. Each hospital's records of treatment are summarised and discussed. Whether or not the hospitals were able to tackle successfully some of the major diseases and causes of death and thereby exert a positive influence in reducing mortality rates is then considered. Two main conclusions are drawn. First, that the hospitals had a positive role to play within their patient catchment areas, but that this was insufficient to affect national mortality trends decisively. Secondly, the hospitals' influence was of greater importance before the mid-nineteenth century. Despite advances in medical knowledge and techniques, population pressure, overcrowding and the growing incidence of serious cases in hospitals coupled with outbreaks of 'hospital diseases' meant that the results of hospital treatment may have become less impressive. But even then, mortality levels in the hospitals were low and the hospitals did not merit their reputation of being 'gateways to death' or as institutions 'which positively did harm'.     

Stabilization,birth waves,and the surge in the elderly*

Substantial regularities characterize the transition to stability that follows a shift from one set of vital rates to another. The new vital, rates interact with the population's initial age composition and generate birth waves whose amplitude and attenuation depend on the ratio of ultimate to initial growth and on the new pattern of stable net maternity. A greater change in growth and a later stable net maternity pattern produce larger fluctuations in the number of births. Stabilization begins at the youngest ages and proceeds upward. Sixty years after the shift, the birth waves have largely disappeared and the proportion under age 15 approximates the stable level implied by the new rates. Those patterns are manifest in the stabilization of both observed and Coale‐Demeny model stable populations.

When fertility falls, the new stable population has a larger fraction at all ages above (approximately) 30, with greater changes characterizing the extremes of life. Fifteen years after the fall, there is a trough in the number at ages 0–14. Sixty years after the fall, when the largest pre‐decline cohort is age 60–74 and the smallest post‐decline cohort is age 45–59, there is a surge in the relative size of the elderly population. Thus after two generations, the birth waves produced by a rapid decline in fertility accentuate the effects of population aging.     

Famine,Disease, and Mortality Patterns in the Parish of Borshevka,Russia, 1830–1912

Scholars have projected a dismal image of nineteenth-century, rural Russia as a society repeatedly punctuated by crop failures, famine, starvation, and epidemics of famine-related diseases. But there has been no rigorous attempt, using appropriate methods, to assess the nature of demographic crises in Russia and their contribution to overall mortality and population growth. The pattern of mortality evident in the parish under examination is distinguished by an extremely high incidence of infant, diarrhoeal diseases and childhood, infectious diseases. This unfavourable disease environment and resulting high rates of infant and early childhood mortality were more closely related to fertility levels, household size, housing conditions, and weaning practices than to annual or seasonal food availability and the nutritional status of the population. In a disease-driven society, the susceptibility to infection and the force of infection can, to a considerable extent, be determined by demographic factors, familial norms, and climatic constraints.     

Famine, disease, and mortality patterns in the parish of Borshevka, Russia, 1830-1912

Scholars have projected a dismal image of nineteenth-century, rural Russia as a society repeatedly punctuated by crop failures, famine, starvation, and epidemics of famine-related diseases. But there has been no rigorous attempt, using appropriate methods, to assess the nature of demographic crises in Russia and their contribution to overall mortality and population growth. The pattern of mortality evident in the parish under examination is distinguished by an extremely high incidence of infant, diarrhoeal diseases and childhood, infectious diseases. This unfavourable disease environment and resulting high rates of infant and early childhood mortality were more closely related to fertility levels, household size, housing conditions, and weaning practices than to annual or seasonal food availablity and the nutritional status of the population. In a disease-driven society, the susceptibility to infection and the force of infection can, to a considerable extent, be determined by demographic factors, familial norms, and climatic constraints.     

A model of the age patterns of births by parity in natural fertility populations

This research develops a convolution model to express the age patterns of fertility at each birth order in natural fertility populations in terms of six parameters, directly representing the proximate determinants of fertility, and a series of parity level indicators. The parity level indicators at each birth order are simply the proportions of women in a cohort who will eventually have births at each birth order it the age‐related fecundity decline is controlled. The Coale‐McNeil nuptiality model is adopted to represent the age pattern of first marriage rates and the natural fertility schedule employed in the Coale‐Trussell fertility model is incorporated to adjust age effects. The fast Fourier transform is used in solving the model numerically. It proves that the model is able to provide excellent fits to fertility for rural Chinese women in the 1950s.     

The Contribution of Health Care and Other Interventions to Black–White Disparities in Life Expectancy, 1980–2007

Black–white mortality disparities remain sizable in the United States. In this study, we use the concept of avoidable/amenable mortality to estimate cause-of-death contributions to the difference in life expectancy between whites and blacks by gender in the United States in 1980, 1993, and 2007. We begin with a review of the concept of “avoidable mortality” and results of prior studies using this cause-of-death classification. We then present the results of our empirical analyses. We classified causes of death as amenable to medical care, sensitive to public health policies and health behaviors, ischemic heart disease, suicide, HIV/AIDS, and all other causes combined. We used vital statistics data on deaths and Census Bureau population estimates and standard demographic decomposition techniques. In 2007, causes of death amenable to medical care continued to account for close to 2 years of the racial difference in life expectancy among men (2.08) and women (1.85). Causes amenable to public health interventions made a larger contribution to the racial difference in life expectancy among men (1.17 years) than women (0.08 years). The contribution of HIV/AIDS substantially widened the racial difference among both men (1.08 years) and women (0.42 years) in 1993, but its contribution declined over time. Despite progress observed over the time period studied, a substantial portion of black–white disparities in mortality could be reduced given more equitable access to medical care and health interventions.     

Losses of Expected Lifetime in the United States and Other Developed Countries: Methods and Empirical Analyses

Patterns of diversity in age at death are examined using e ^†, a dispersion measure that equals the average expected lifetime lost at death. We apply two methods for decomposing differences in e ^†. The first method estimates the contributions of average levels of mortality and mortality age structures. The second (and newly developed) method returns components produced by differences between age- and cause-specific mortality rates. The United States is close to England and Wales in mean life expectancy but has higher life expectancy losses and lacks mortality compression. The difference is determined by mortality age structures, whereas the role of mortality levels is minor. This is related to excess mortality at ages under 65 from various causes in the United States. Regression on 17 country-series suggests that e ^† correlates with income inequality across countries but not across time. This result can be attributed to dissimilarity between the age- and cause-of-death structures of temporal mortality reduction and intercountry mortality variation. It also suggests that factors affecting overall mortality decrease differ from those responsible for excess lifetime losses in the United States compared with other countries. The latter can be related to weaknesses of health system and other factors resulting in premature death from heart diseases, amenable causes, accidents and violence.     

The Epidemiologic Transition Revisited: Compositional Models for Causes of Death by Age and Sex

For decades, researchers have noted systematic shifts in cause‐of‐death patterns as mortality levels change. The notion of the “epidemiologic transition” has influenced thinking about the evolution of health in different societies and the response of the health system to these changes. This article re‐examines the epidemiologic transition in terms of empirical regularities in the cause composition of mortality by age and sex since 1950, and considers whether the theory of epidemiologic transition presents a durable framework for understanding more recent patterns. Age‐sex‐specific mortality rates from three broad cause groups are analyzed: Group 1 (communicable diseases, maternal and perinatal causes, and nutritional deficiencies); Group 2 (noncommunicable diseases); and Group 3 (injuries), using the most extensive international database on mortality by cause, including 1,576 country‐years of observation, and new statistical models for compositional data. The analyses relate changes in cause‐of‐death patterns to changing levels of all‐cause mortality and income per capita. The results confirm that declines in overall mortality are accompanied by systematic changes in the composition of causes in many age groups. These changes are most pronounced among children, for whom Group 1 causes decline as overall mortality falls, and in younger adults, where strikingly different patterns are found for men (shift from Group 3 to Group 2) compared to women (shift toward Group 2 then Group 3). The underlying patterns that emerge from this analysis offer insights into the epidemiologic transition from high‐mortality to low‐mortality settings.     

Why do people die in famines? Evidence from three island populations

There is surprisingly little consensus about what people die of during famines. In this paper, the causes of the increases in mortality during the Greek famine of 1941-43 are examined. The focus of the study is three island populations: Syros, Hios, and Mykonos. Death registration for these islands was not disrupted during the famine and the records give cause for death, certified by a doctor. Archival material and hospital records are utilized to assess public health during the famine. The findings point to the overwhelming importance of starvation for increased mortality during the famine and the virtual absence of either significant epidemics of infectious diseases or a breakdown in the public health system. The paper concludes by comparing the findings for the Greek famine with those for other famines. A model that attempts to explain the different courses that famine mortality can take is proposed.