Diverging Trends in Female Old‐Age Mortality: The United States and the Netherlands versus France and Japan

In the most advanced countries, child mortality and adult mortality under age 65 years have fallen so low that further improvement in life expectancy relies almost completely on the decline of mortality at older ages. This phenomenon is particularly pronounced among women, who are far ahead of men in survival rates. Thus, to project the future of life expectancy, this study focuses on trends in female life expectancy at ages 65 and older. Four countries are selected for this analysis: the United States, Netherlands, France, and Japan. It is particularly interesting to understand why American and Dutch trends in female old‐age mortality have been diverging from those in France and Japan for two decades. It is shown here that most of the divergence derives from the fact that decline in cardiovascular mortality is more and more offset by increases in other causes of death in the United States and the Netherlands, while the other two countries are more successful in reducing mortality from all causes at increasingly older ages. This latter phenomenon could represent a new stage of the health transition.     

Three measures of longevity: Time trends and record values

This article examines the trend over time in the measures of “typical” longevity experienced by members of a population: life expectancy at birth, and the median and modal ages at death. The article also analyzes trends in record values observed for all three measures. The record life expectancy at birth increased from a level of 44 years in Sweden in 1840 to 82 years in Japan in 2005. The record median age at death shows increasing patterns similar to those observed in life expectancy at birth. However, the record modal age at death changes very little until the second half of the twentieth century: it moved from a plateau level, around age 80, to having a similar pace of increase as that observed for the mean and the median in most recent years. These findings explain the previously observed uninterrupted increase in the record life expectancy. The cause of this increase has changed over time from a dominance of child mortality reductions to a dominance of adult mortality reductions, which became evident by studying trends in the record modal age at death.     

The contribution of a history of heavy smoking to Scotland's mortality disadvantage

Scotland has a lower life expectancy than any country in Western Europe or North America, and this disadvantage is concentrated above age 50. According to the Human Mortality Database, life expectancy at age 50 has been lower in Scotland than in any other developed country since 1980. Relative to 15 developed countries that we have chosen for comparison, Scotland's life expectancy in 2009 at age 50 was lower by an average of 2.5?years for women and 1.6?years for men. We estimate that Scottish women lost 3.6?years of life expectancy at age 50 as a result of smoking, compared to 1.4?years for the comparison countries. The equivalent figures among men are 3.1 and 2.1?years. These differences are large enough for the history of heavy smoking in Scotland to account both for most of the shortfall in life expectancy for both sexes and for the country's unusually narrow sex differences in life expectancy.     

European perspectives on healthy aging in women

Using data from the 1994 European Community Household Panel, we compare active life expectancy differentials at age 65 years between women and men in 12 European countries. We seek to explain the extent to which differences are a reflection of gender differentials in life expectancy at 65 years or reflect differences in active life expectancy earlier in life. Considerable variation in the gender differentials in both total and active life expectancies at age 65 years exist within Europe, with some countries experiencing 20% lower life expectancy at age 65 years for men compared to women. Some evidence was found to suggest that gender differentials in active life expectancy may continue from younger ages through to later life.     

Divergence in Age Patterns of Mortality Change Drives International Divergence in Lifespan Inequality

In the past six decades, lifespan inequality has varied greatly within and among countries even while life expectancy has continued to increase. How and why does mortality change generate this diversity? We derive a precise link between changes in age-specific mortality and lifespan inequality, measured as the variance of age at death. Key to this relationship is a young–old threshold age, below and above which mortality decline respectively decreases and increases lifespan inequality. First, we show for Sweden that shifts in the threshold’s location have modified the correlation between changes in life expectancy and lifespan inequality over the last two centuries. Second, we analyze the post–World War II (WWII) trajectories of lifespan inequality in a set of developed countries—Japan, Canada, and the United States—where thresholds centered on retirement age. Our method reveals how divergence in the age pattern of mortality change drives international divergence in lifespan inequality. Most strikingly, early in the 1980s, mortality increases in young U.S. males led to a continuation of high lifespan inequality in the United States; in Canada, however, the decline of inequality continued. In general, our wider international comparisons show that mortality change varied most at young working ages after WWII, particularly for males. We conclude that if mortality continues to stagnate at young ages yet declines steadily at old ages, increases in lifespan inequality will become a common feature of future demographic change.     

How Long Do We Live?

Period life expectancy is calculated from age‐specific death rates using life table methods that are among the oldest and most widely employed tools of demography. These methods are rarely questioned, much less criticized. Yet changing age patterns of adult mortality in countries with high life expectancy provide a basis for questioning the conventional use of life tables. This article argues that when the mean age at death is rising, period life expectancy at birth as conventionally calculated overestimates life expectancy. Estimates of this upward bias, ranging from 1.6 years for the United States and Sweden to 3.3 years for Japan for 1980–95, are presented. A similar bias in the opposite direction occurs when mean age at death is falling. These biases can also distort trends in life expectancy as conventionally calculated and may affect projected future trends in period life expectation, particularly in the short run.     

European Perspectives on Healthy Aging in Women

SUMMARY

Using data from the 1994 European Community Household Panel, we compare active life expectancy differentials at age 65 years between women and men in 12 European countries. We seek to explain the extent to which differences are a reflection of gender differentials in life expectancy at 65 years or reflect differences in active life expectancy earlier in life. Considerable variation in the gender differentials in both total and active life expectancies at age 65 years exist within Europe, with some countries experiencing 20% lower life expectancy at age 65 years for men compared to women. Some evidence was found to suggest that gender differentials in active life expectancy may continue from younger ages through to later life.     

Decomposing change in life expectancy: A bouquet of formulas in honor of Nathan Keyfitz’s 90th birthday

We extend Nathan Keyfitz's research on continuous change in life expectancy over time by presenting and proving a new formula for decomposing such change. The formula separates change in life expectancy over time into two terms. The first term captures the general effect of reduction in death rates at all ages, and the second term captures the effect of heterogeneity in the pace of improvement in mortality at different ages. We extend the formula to decompose change in life expectancy into age-specific and cause-specific components, and apply the methods to analyze changes in life expectancy in Sweden and Japan.     

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.     

Lifespan Dispersion in Times of Life Expectancy Fluctuation: The Case of Central and Eastern Europe

Central and Eastern Europe (CEE) have experienced considerable instability in mortality since the 1960s. Long periods of stagnating life expectancy were followed by rapid increases in life expectancy and, in some cases, even more rapid declines, before more recent periods of improvement. These trends have been well documented, but to date, no study has comprehensively explored trends in lifespan variation. We improved such analyses by incorporating life disparity as a health indicator alongside life expectancy, examining trends since the 1960s for 12 countries from the region. Generally, life disparity was high and fluctuated strongly over the period. For nearly 30 of these years, life expectancy and life disparity varied independently of each other, largely because mortality trends ran in opposite directions over different ages. Furthermore, we quantified the impact of large classes of diseases on life disparity trends since 1994 using a newly harmonized cause-of-death time series for eight countries in the region. Mortality patterns in CEE countries were heterogeneous and ran counter to the common patterns observed in most developed countries. They contribute to the discussion about life expectancy disparity by showing that expansion/compression levels do not necessarily mean lower/higher life expectancy or mortality deterioration/improvements.     

African-american mortality at older ages: Results of a matching study

In this paper we investigate the quality of age reporting on death certificates of elderly African-Americans. We link a sample of death certificates of persons age 65+ in 1985 to records for the same individuals in U.S. censuses of 1900, 1910, and 1920 and to records of the Social Security Administration. The ages at death reported on death certificates are too young on average. Errors are greater for women than for men. Despite systematic underreporting of age at death, too many deaths are registered at ages 95+. This excess reflects an age distribution of deaths that declines steeply with age, so that the base for upward transfers into an age category is much larger than the base for transfers downward and out. When corrected ages at death are used to estimate age-specific death rates, African-American mortality rates increase substantially above age 85 and the racial “crossover” in mortality disappears. Uncertainty about white rates at ages 95+, however, prevents a decisive racial comparison at the very oldest ages.     

Trends in senescent life expectancy

The distinction between senescent and non-senescent mortality proves to be very valuable for describing and analysing age patterns of death rates. Unfortunately, standard methods for estimating these mortality components are lacking. The first part of this paper discusses alternative methods for estimating background and senescent mortality among adults and proposes a simple approach based on death rates by causes of death. The second part examines trends in senescent life expectancy (i.e., the life expectancy implied by senescent mortality) and compares them with trends in conventional longevity indicators between 1960 and 2000 in a group of 17 developed countries with low mortality. Senescent life expectancy for females rises at an average rate of 1.54 years per decade between 1960 and 2000 in these countries. The shape of the distribution of senescent deaths by age remains relatively invariant while the entire distribution shifts over time to higher ages as longevity rises.     

1994～2004年中国老年人的生活自理预期寿命及其变化

本文应用2004年和1994年国家统计局全国人口变动抽样调查中有关老年人生活自理能力的数据,采用Sullivan法对老年人的生活自理预期寿命进行了分析,并且比较了1994年到2004年生活自理预期寿命的变化。研究发现,2004年中国男性老年人平均有1.5年生活不能自理,女性老年人平均为2.5年。随着年龄的增长,中国老年人的生活自理预期寿命占余寿的比重也在逐渐下降。女性老年人的预期寿命比男性高,生活自理预期寿命在60~80岁也高于男性,但是85岁及以上女性的生活自理预期寿命低于男性,而且女性老年人生活自理预期寿命占余寿的比重在整个老年阶段均低于男性老年人。从10年间的变化看,中国老年人的预期寿命和生活自理预期寿命都有所增长,但是生活自理预期寿命在余寿中的比重反而下降了,而且随年龄的增长,下降得也越来越快,男性和女性均呈现同样的态势。就平均水平而言,健康状况改善的程度低于寿命的延长,高龄女性老年人在这个方面尤其处于劣势。     

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.     

Russian Mortality Crisis and the Quality of Vital Statistics

Mortality from ill-defined conditions in Russia has the fastest rate of increase compared to all other major causes of death. High proportion of deaths in this category is indicative for low quality of mortality statistics. This article examines the trends and possible causes of mortality from ill-defined conditions in Russia. During 1991–2005, mortality from ill-defined conditions in Russia increased in all age groups. The pace of increase was particularly high at working ages and the mean expected age at death from ill-defined conditions has shifted to younger ages, particularly for men. The analysis of individual medical death certificates issued in Kirov and Smolensk regions of Russia demonstrate that 89–100% of working-age deaths from ill-defined conditions correspond to human bodies found in a state of decomposition. Data from Smolensk region shows that over 60% of these decedents were unemployed. Temporal trends of mortality from ill-defined conditions and injuries of undetermined intent in Moscow city suggest that deaths from the latter cause were probably misclassified as ill-defined conditions. This practice can lead to underestimation of mortality from external causes. Growing number of socially isolated marginalized people in Russia and insufficient investigation of the circumstances of their death contribute to the observed trends in mortality from ill-defined conditions.     

Late Marriage and Less Marriage in Japan

Between 1975 and 1995, the singulate mean age at marriage in Japan increased from 24.5 to 27.7 years for women and from 27.6 to 30.7 years for men, making Japan one of the latest‐marrying populations in the world. Over the same period, the proportion of women who will never marry, calculated from age‐specific first‐marriage probabilities pertaining to a particular calendar year, increased from 5 to 15 percent for women and from 6 to 22 percent for men—behaviors sharply different from those characterizing the universal‐marriage society of earlier years. This article investigates how and why these changes have come about. The reasons are bound up with rapid educational gains by women, massive increases in the proportion of women who work for pay outside the home, major changes in the structure and functioning of the marriage market, extraordinary increases in the prevalence of premarital sex, and far‐reaching changes in values relating to marriage and family life.     

Changing mortality patterns that led life expectancy in Japan to surpass Sweden’s: 1972–1982

Between 1972 and 1982, Japan caught up to and then surpassed Sweden as the country with the longest life expectancy. The contributions of different causes of death and age groups to life expectancy changes in males during this time period are examined in detail for these two countries. Even though cerebrovascular disease mortality rates remained lower in Sweden over the entire interval, the rapid gain made by Japan relative to Sweden for this cause of death was a prime factor in Japan's ending the period with a higher life expectancy. Important contributions to life expectancy improvement in Japan came from declining mortality rates in those aged 55 and older.     

Inequality in Life Spans and a New Perspective on Mortality Convergence Across Industrialized Countries

The second half of the twentieth century witnessed substantial convergence in life expectancy around the world. We examine differences in the age pattern of mortality in industrialized countries over time to show that inequality in adult life spans, which we measure with the standard deviation of life table ages at death above age 10 years, S₁₀, is increasingly responsible for the remaining divergence in mortality. We report striking differences in level and trend of S₁₀ across industrialized countries since 1960, which cannot be explained by aggregate socioeconomic inequality or differential external‐cause mortality. Rather, S₁₀ reflects both within‐ and between‐group inequalities in life spans and conveys new information about their combined magnitudes and trends. These findings suggest that the challenge for health policies in this century is to reduce inequality, not just lengthen life.     

Falling Short of Highest Life Expectancy: How Many Americans Might Have Been Alive in the Twentieth Century?

Life expectancy at birth in the United States during the twentieth century was lower than in many other highly developed countries. We investigate how this mortality disadvantage in the last 100 years translates into the number of hypothetical lives lost and their sex and age structure. We estimate the hypothetical US population if it had experienced in each decade since 1900 the mortality level of the country with the then highest life expectancy and compare the results to the actual figures in 2000. By 2000, the number of additional people who could have been alive had the mortality levels in the United States been as low as those in countries with the highest life expectancy was 66 million. This number is distributed equally between males and females. Suboptimal mortality at reproductive ages is crucial for the cumulative effect of potential lives lost, resulting from premature deaths of women who could still become first‐time mothers or bear additional children. Out of the 66 million additional persons who could have been alive in 2000, 45 million are attributable to those indirect deaths. Although the differences in the composition of the population by sex and age under the two mortality regimes are minor, the majority of people who might have been alive—54 million—were of working age or younger.