Early-life conditions and adult mortality decline in Dutch cohorts born 1812–1921

Mounting evidence suggests that early-life conditions have an enduring effect on an individual’s mortality risks as an adult. The contribution of improvements in early-life conditions to the overall decline in adult mortality, however, remains a debated issue. We provide an estimate of the contribution of improvements in early-life conditions to mortality decline after age 30 in Dutch cohorts born between 1812 and 1921. We used two proxies for early-life conditions: median height and early-childhood mortality. We estimate that improvements in early-life conditions contributed more than five years or about a third to the rise in women’s life expectancy at age 30. Improvements in early-life conditions contributed almost three years or more than a quarter to the rise in men’s life expectancy at age 30. Height appears to be the more important of the two proxies for early-life conditions.     

Period‐Based Mortality Change: Turning Points in Trends since 1950

We investigate a major turning point in mortality trends at adult ages that occurred for many low‐mortality countries in the late 1960s or early 1970s. We analyze patterns of total and cause‐specific mortality over the past 60 years using data from the Human Mortality Database and the World Health Organization. We focus on four broad categories of causes of death: heart diseases, cerebrovascular diseases, smoking‐related cancers, and all other cancers. We use a two‐slope regression model to assess the timing and magnitude of turning points in mortality trends over this era, making separate analyses by sex, age, and cause of death. The age pattern of temporal changes is given particular attention. Our results demonstrate convincingly that period‐based factors were very significant in the onset of the “cardiovascular revolution” in the years around 1970. In general, although cohort processes cannot be ruled out as a driver of mortality change in recent decades (especially for mortality due to smoking‐related cancers), the evidence reviewed here suggests that period factors have been the dominant force behind the mortality trends of high‐income countries during this era.     

Educational Inequality in Adult Mortality: An Assessment with Death Certificate Data from Michigan

Education was added to the U.S. Standard Certificate of Death in 1989. The current study uses Michigan’s 1989–1991 death certificates, together with the 1990 Census, to evaluate the quality of data on education from death certificates and to examine educational differences in mortality rates. With log-rates modeling, we systematically analyze the variability in educational differences in mortality by race and sex across the adult life cycle. The relative differences in mortality rates between educational levels decline with age at the same pace for all sex and race categories. Women gain a slightly greater reduction in mortality than men by reaching the secondary-education level, but a modestly smaller reduction by advancing beyond it. Blacks show a reduction in predicted mortality rates comparable to whites’ by moving from the secondary to the postsecondary level of education but experience less reduction than whites by moving from the primary to the secondary level. Thus, the secular decline in mortality rates that generally accompanies historical improvements in education might actually be associated with an increase in the relative differences between blacks’ and whites’ mortality. We discuss limitations of the data and directions for future research.     

Age patterns of mortality for older women: an analysis using the age-specific rate of mortality change with age

"In this paper we propose a mortality measure that seems useful in analyzing age patterns of death rates. The measure, which will be denoted by k(x), indicates the proportional increase or decrease with age in the risk of death at a given age x, and is called the age-specific rate of mortality change with age." Estimations are presented for women in 10 countries. "Eight of the selected sets of data are for developed nations in the 1960s and 1970s, and the other two sets of data, for Taiwan, 1931-35, and for Germany, 1910-11, represent relatively high mortality. For France and West Germany, three different periods are included for an investigation of cohort effects on the observed age patterns." Other mathematical models of age-specific mortality rates are discussed and compared. (SUMMARY IN FRE)     

A Turning Point in Gender Bias in Mortality? An Update on the Number of Missing Women

Amartya Sen started a debate about gender bias in mortality by estimating the number of “missing women,” which refers to the number of females of any age who have presumably died as a result of discriminatory treatment. Depending on the assumptions made, the combined estimates for countries exhibiting the presence of such gender bias varied between 60 and 107 million. As new population data have become available for these countries, this article examines whether the number of “missing women” has changed in the past decade. The combined estimate of the number of missing women has risen in absolute terms but has fallen slightly in relation to overall population. Considerable improvement is evident in West Asia, North Africa, and parts of South Asia, while only small improvements have occurred in India and a deterioration took place in China. Analyses of the underlying causes of gender bias in mortality suggest that improvements are largely related to improved female education and employment opportunities and rising overall incomes, while deterioration is mostly attributable to the rising incidence of sex‐selective abortions.     

Determinants of Regional Variations in Infant Mortality in Rural India

An analytical framework is specified for understanding the determinants of infant mortality. It distinguishes between factors at three levels – village, household and individual – and arranges them in ascending order with respect to their proximity to infant mortality. Village and household-level factors are assumed to influence infant mortality indirectly by influencing at least one of the six individual-level factors. The present analysis of the data aggregated at the state level clearly demonstrates the importance of both medical and non-medical factors for explaining the observed regional differences in infant mortality in rural India. The percentage of births attended by trained medical personnel and poverty, are the two important determinants of regional variations in neo-natal mortality; and the village-level availability of medical facilities and the extent of triple vaccination are the two important determinants of post-neo-natal mortality. The influence of adult women's literacy on infant mortality is explained by better medical care at birth, and preventive and curative medical care during the post-neo-natal period. Medical factors have been shown to be slightly more important than non-medical factors. This suggests that it might be possible to reduce the high level of infant mortality currently prevalent in many states in India by simple preventive medical interventions.     

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.     

Mortality in Vietnam, 1979–1989

Little is known about past and present mortality in Vietnam, as the first official data on mortality have only recently become available from censuses taken in 1979 and 1989. Using these data, I estimate Vietnamese mortality during the intercensal period using two techniques that rely on age-specific growth rates from two successive age distributions. Intercensal emigration and differential completeness of census enumeration associated with massive outflows of refugees in the wake of the Vietnam War; population-redistribution policies, and a highly mobile population represent important sources of bias for the estimation of intercensal mortality. I incorporate several strategies to minimize bias from these sources and to select the method that is least sensitive to errors associated with them. Life expectancy at birth estimated for the 1979–1989 intercensal period is 61.4 years for males and 63.2 for females. These results suggest a trend of declining mortality between the 1970s and the 1980s and add solid empirical evidence to the debate over whether mortality in Vietnam has been deteriorating or improving.     

'Between one and three million': towards the demographic reconstruction of a decade of Cambodian history (1970-79)

Estimates of mortality in Camabodia during the Khmer Rouge regime (1975-79) range from 20,000 deaths according to former Khmer Rouge sources, to over three million victims according to Vietnamese government sources. This paper uses an unusual data source - the 1992 electoral lists registered by the United Nations - to estimate the population size after the Khmer Rouge regime and the extent of "excess" mortality in the 1970s. These data also provide the first breakdown of population by single year of age, which allows analysis of the age structure of "excess" mortality and inference of the relative importance of violence as a cause of death in that period. The estimates derived here are more comparable with the higher estimates made in the past. In addition, the analysis of likely causes of death that could have generated the age pattern of "excess" mortality clearly shows a larger contribution of direct or violent mortality than has been previously recognized.     

Children’s educational attainment,occupation, and income and their parents’ mortality

Using data from Finland, this paper contributes to a small but growing body of research regarding adult children's education, occupation, and income and their parents' mortality at ages 50+ in 1970–2007. Higher levels of children's education are associated with 30–36 per cent lower parental mortality at ages 50–75, controlling for parents' education, occupation, and income. This association is fully mediated by children's occupation and income, except for cancer mortality. Having at least one child educated in healthcare is associated with 11–16 per cent lower all-cause mortality at ages 50–75, an association that is largely driven by mortality from cardiovascular diseases. Children's higher white-collar occupation and higher income is associated with 39–46 per cent lower mortality in the fully adjusted models. At ages 75+, these associations are much smaller overall and children's schooling remains more strongly associated with mortality than children's occupation or income.     

Suicide mortality in Australia, 1970–1991

This paper contains results of a study into changes in rates of suicide in Australia in the 1970s and 1980s. The study found that there was a significant divergence of suicide mortality rates between males and females, with male rates increasing in the last twenty years and female rates showing a general decline. The increase in male rates was highest at ages under 30 and over 80 years of age. The differences in rates between marital status groups have remained large. The study also analysed birthplace differentials in suicides and included some data from overseas countries for comparisons.     

Population trends and differentials in countries of the ESCAP region

The total population of the ESCAP region reached 2.4 billion in 1979, up from 2 billion in 1970. 6 of the 10 largest countries are in the region: China, India, Indonesia, Japan, Bangladesh, and Pakistan. East Asia contains 1.1 billion; Middle South Asia contains 923 million; Eastern South Asia, 354 million; and Oceania, 22 million. The crude birth rate for the total region dropped by 5 points from 1970-9; the crude death rate dropped by 2 points, resulting in a decline in the annual growth rate of .3 percentage points, from 2.1% in 1970 to 1.8% in 1979. Overall, the total fertility rate decreased by 15% from 4.8 to 4.1. The total fertility rate in Australia fell 33% from 2.8 to 1.9 and in New Zealand from 3.0 to 1.9, or 37%. Generally fertility is lower in urban areas than in rural with some exceptions. A strong negative relationship between level of education and fertility exists in all countries of Asia and the Pacific, however, the parity of women with some primary education exceeds that of women with no schooling. Life expectancy at birth for both sexes in the region increased from 55.1 years in 1970 to 58.7 years in 1979, or by 7%. The highest life expectancy is in Japan at 75.2 years. The infant mortality rate in the ESCAP region in 1979 was estimated to be 78/1000. World Fertility Survey data indicate that the mean age of first marriage is generally very low but gradually increasing.     

Reassessing the decline in parent-child old-age coresidence during the twentieth century

The share of the elderly living with an adult child decreased monotonically throughout the twentieth century, while the probability of reaching old age and the number of years lived in old age increased. As a result, the expected number of life-years lived with adult children while in old age may have increased, decreased, or stayed the same. I estimate that the number of life-years lived in old-age coresidence with adult children stayed roughly constant between 1900 and 1940, while the rate of coresidence declined. Life years lived in old-age coresidence then declined substantially between 1940 and 1990. Moreover, the number of life-years lived in old-age coresidence in 1990 would have been roughly half as great as it actually was had there been no improvements in mortality between 1900 and 1990. And if fertility had remained at its 1900 levels, life-years lived in old-age coresidence would have been about 45% higher in 1990 than it actually was. The results imply that analyses of the change in familial assistance to the elderly should also consider changes in mortality.     

Trends in U.S. adult chronic disease mortality, 1960–1999: age,period, and cohort variations

In this paper, I examine temporal changes in U.S. adult mortality by chronic disease cause of death and by sex over a 40-year period in the second half of the twentieth century. I apply age-period-cohort (APC) analyses that combine conventional approaches and a new method of model estimation to simultaneously account for age, period, and cohort variations in mortality rates for four leading causes of deaths, including heart disease, stroke, lung cancer, and breast cancer. The results show that large reductions in mortality since the late 1960s continued well into the late 1990s and that these reductions were predominately contributed by cohort effects. Cohort effects are found to differ by specific causes of death examined, but they generally show substantial survival improvements. Implications of these results are discussed with regard to demographic theories of mortality reductions, differential cohort accumulation of health capital and lifetime exposures to socioeconomic and behavioral risk factors, and period changes in diagnostic techniques and medical treatment.     

Changing Life Expectancy and Health Expectancy Among Russian Adults: Results from the Past 20 Years

The decade following the collapse of the Soviet Union was characterized by wide fluctuations in Russian mortality rates, but since the early 2000s, life expectancy has improved progressively. Recent upturns in longevity have promoted policy debates over extending the retirement age in the country. However, whether observed gains in life expectancy are accompanied by improving health remains to be addressed. Using data from the 1994–2014 Russian Longitudinal Monitoring Survey of the Higher School of Economics, this study investigates trends over 20 years in healthy life expectancy (HLE) and illness-free life expectancy (IFLE) for men and women at adult ages. Analyses using the Sullivan method show that men and women at adult ages have experienced large increases in health expectancies during the post-Soviet period. Increases in HLE exceeded increases in total life expectancy for both genders. Further, health expectancies have evolved over time through cycles of increases and decreases, just like life expectancy. These results suggest increases in good-quality years among men and women at working ages, offering support for changing the official retirement age. The extent of the change in the retirement age, however, needs to be carefully considered, given that, despite recent improvements, the health expectancy of the Russian population still remains low.     

A survey of population in the ESCAP region

In 1983, the ESCAP region added 44 million people, bringing its total population to 2600 million, which is 56% of the world population. The annual rate of population growth was 1.7% in 1983 compared to 2.4% in 1970-75. The urban population rose from 23.4% in 1970 to 26.4% in 1983, indicative of the drift from rural areas to large cities. In 1980, 12 of the world's 25 largest cities were in the ESCAP region, and there is concern about the deterioration of living conditions in these metropoles. In general, however, increasing urbanization in the developing countries of the ESCAP region has not been directly linked to increasing industrialization, possibly because of the success of rural development programs. With the exception of a few low fertility countries, a large proportion of the region's population is concentrated in the younger age groups; 50% of the population was under 22 years of age in 1983 and over 1/3 was under 15 years. In 1983, there were 69 dependents for every 100 persons of working age, although declines in the dependency ratio are projected. The region's labor force grew from 1100 million in 1970 to 1600 million in 1983; this growth has exceeded the capacity of country economies to generate adequate employment. The region is characterized by large variations in life expectancy at birth, largely reflecting differences in infant mortality rates. Whereas there are less than 10 infant deaths/1000 live births in Japan, the corresponding rates in Afghanistan and India are 203 and 121, respectively. Maternal-child health care programs are expected to reduce infant mortality in the years ahead. Finally, fertility declines have been noted in almost every country in the ESCAP region and have been most dramatic in East Asia, where 1983's total fertility rate was 40% lower than that in 1970-75. Key factors behind this decline include more aggressive government policies aimed at limiting population growth, developments in the fields of education and primary health care, and greater availability of contraception through family planning programs.     

Demography,Education, and Democracy: Global Trends and the Case of Iran

Reconstructions and projections of populations by age, sex, and educational attainment for 120 countries since 1970 are used to assess the global relationship between improvements in human capital and democracy. Democracy is measured by the Freedom House indicator of political rights. Similar to an earlier study on the effects of improving educational attainment on economic growth, the greater age detail of this new dataset resolves earlier ambiguities about the effect of improving education as assessed using a global set of national time series. The results show consistently strong effects of improving overall levels of educational attainment, of a narrowing gender gap in education, and of fertility declines and the subsequent changes in age structure on improvements in the democracy indicator. This global relationship is then applied to the Islamic Republic of Iran. Over the past two decades Iran has experienced the world's most rapid fertility decline associated with massive increases in female education. The results show that based on the experience of 120 countries since 1970, Iran has a high chance of significant movement toward more democracy over the following two decades.     

The Changing Shape of Soviet Mortality, 1958–1985: An Evaluation of Old and New Evidence

Changes in mortality in the Soviet Union have attracted the attention of both scholars and the popular media. After a hiatus of more than ten years, the government of the Soviet Union has released data on mortality for the 1980s, which allow assessment of recent changes. The new life table for 1984–85 shows that mortality of Soviet females has improved at ages below 45 and deteriorated above that age since the last age-specific mortality data were published in the early 1970s, while mortality of males has improved at ages below 25 and deteriorated above that age. At the same time, the official mortality rates for persons aged 60 and over in 1958–59, 1968–71, and 1984–85 are implausibly low. Poor-quality data at the older ages, particularly in rural areas and the less developed regions of the country, contributed to these low mortality rates of the old. As data quality has improved with time, the reported mortality rates at old ages have increased. Adjustment of the official data for error, especially above age 60, shows that whereas the reported value of e₀ for males fell by 1.5 years between 1958–59 and 1984–85, the actual value probably fell by no more than 0.5 years; the corresponding figures for females were a reported rise of one year, and an actual rise of at least two years. Examination of these Soviet data illustrates how important consideration of error in mortality statistics of the old can be in understanding mortality trends.     

The effect of piped water on early childhood mortality in Urban Brazil, 1970 to 1976

The effects of access to piped water on the trends in child mortality and on differentials by income class are analyzed using data on surviving children and other variables in samples of urban mothers aged 20–29 in 1970 and 1976. Path analytic regression techniques are used to test a recursive model linking the supply and demand for piped water to selected household and community level variables, and to examine their joint effect on child mortality. The model’s estimated parameters for 1970 and 1976 are used to analyze changes in mortality between the two dates. Increased maternal education accounts for a larger share of the mortality decline than any other single factor. Increased access to piped water also contributes to mortality decline, and such access helps to reduce the mortality differential between lower and higher income and education classes.     

Revised regional model life tables at very low levels of mortality

This paper presents and discusses new model life tables at very low mortality, which make use of age-specific death rates from the 1960s, 1970s, and 1980s. These life tables fit recorded death rates in very low mortality populations better than do the existing ones at expectations of life of 77.5 and 80 years. The old tables incorporate too-high mortality at the higher ages and in infancy and they incorporate regional differences that no longer exist. The new tables "close out" the mortality schedules above age 80 more realistically. The convergence of age patterns of mortality at very high life expectancies in populations that used to conform to different families is in itself of demographic interest. Some convergence may perhaps be expected. Sullivan (1973) found that, in Taiwan, the comparison of mortality at ages 1-5 to mortality at 5-35 in the late 1950s showed higher mortality at the younger ages relative to the ensuing 30-year age interval than was found in any of the models, including the South model, which has the highest relative mortality from ages 1-5 among the 4 regional patterns. Then, in the late 1960s, the relation of mortality at 1-5 to mortality at 5-35 in Taiwan fell to a position intermediate between the West and South tables. Sullivan found in data on mortality by cause of death a large reduction in mortality from diarrhea and enteritis, no doubt as a result of environmental sanitation. Mortality from these causes is concentrated among young children, and reduction in deaths from these causes would naturally diminish the excess mortality in this age interval. The East pattern, characterized by very high mortality in infancy (but not from 1-5), may be the result of the prevalence of early weaning or avoidance of breast feeding altogether in the populations characterized by this pattern. As health conditions have improved, evidenced by the overall design of mortality, these special factors are diminished or erased. Model life tables at these very low mortality levels have different uses from most applications of model life tables at higher mortality. The use of model tables to estimate accurate schedules of mortality when the basic data are incomplete or inaccurate is less relevant in this range of mortality levels.