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.     

Tobacco smoking and the sex mortality differential

This paper examines the effects of tobacco smoking on the sex mortality differential in the United States. It is found that all forms of smoking combined account for about 47 percent of the female-male difference in ₅₀ e ₃₇ (life expectancy between ages 37 and 87) in 1962,and about 75 percent of the increase in the female-male difference in ₅₀ e ₃₇over the period 1910–62. When these percentage effects of smoking are decomposed each into a sum of contributions by age and immediate medical cause of death, the degenerative diseases acting at the older ages are found to be of primary importance. The above results appear in large part to explain why the degenerative diseases also account for most of the 1910–65 increase in the female-male difference in life expectancy at birth. The analysis assumes that spurious effects due to the correlation of tobacco consumption with other mortality-related factors are small compared to the causal effects of tobacco consumption itself.     

On long-term mortality trends in the United States, 1850–1968

This study of United States life tables analyzes the process of mortality transition during 1850–1968. Special features of the study are (1) a phase-specific, rather than an age-specific, analysis of mortality and (2) use of measures based on person-years of life (nL _x ) in phase-intervals, rather than survival rates (nPx) or expectation of life at given ages (e _x ^o). The analysis suggests that the historical transition of mortality in the United States can be described as a three-stage process: an initial stage of slow improvement in life expectancy during 1850–1900, a second stage of rapid improvement during 1900–1950, and a third stage of slower improvement since 1950. Quantitative measures of rapidity of mortality decline in the several phases indicate that they are not identical for all phases and in all stages. The analysis also suggests that there have been rapid changes in the components of overall mortality differentials by sex and race in the United States. The paper draws attention to the need for studies of factors in variations of mortality at ages beyond 50 in the United States population subgroups.     

Obesity and excess mortality among the elderly in the United States and Mexico

Increasing levels of obesity could compromise future gains in life expectancy in low-and high-income countries. Although excess mortality associated with obesity and, more generally, higher levels of body mass index (BMI) have been investigated in the United States, there is little research about the impact of obesity on mortality in Latin American countries, where very the rapid rate of growth of prevalence of obesity and overweight occur jointly with poor socioeconomic conditions. The aim of this article is to assess the magnitude of excess mortality due to obesity and overweight in Mexico and the United States. For this purpose, we take advantage of two comparable data sets: the Health and Retirement Study 2000 and 2004 for the United States, and the Mexican Health and Aging Study 2001 and 2003 for Mexico. We find higher excess mortality risks among obese and overweight individuals aged 60 and older in Mexico than in the United States. Yet, when analyzing excess mortality among different socioeconomic strata, we observe greater gaps by education in the United States than in Mexico. We also find that although the probability of experiencing obesity-related chronic diseases among individuals with high BMI is larger for the U. S. elderly, the relative risk of dying conditional on experiencing these diseases is higher in Mexico.     

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.     

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.     

Estimating the Effect of Smoking on Slowdowns in Mortality Declines in Developed Countries

Declines in mortality rates for females at older ages in some developed countries, including the United States, have slowed in recent decades even as decreases have steadily continued in some other countries. This study presents a modified version of the indirect Peto-Lopez method, which uses lung cancer mortality rates as a proxy for smoking exposure, to analyze this trend. The modified method estimates smoking-attributable mortality for more-specific age groups than does the Peto-Lopez method. An adjustment factor is also introduced to account for low mortality in the indirect method’s study population. These modifications are shown to be useful specifically in the estimation of deaths attributable to smoking for females at older ages, and in the estimation of smoking-attributable mortality more generally. In a comparison made between the United States and France with the modified method, smoking is found to be responsible for approximately one-half the difference in life expectancy for females at age 65.     

Continued Reductions in Mortality at Advanced Ages

Mortality data for 30 mostly developed countries available in the Kannisto–Thatcher Database on Old‐Age Mortality (KTDB) are drawn on to assess the pace of decline in death rates at ages 80 years and above. As of 2004 this database recorded 37 million persons at these ages, including 130,000 centenarians (more than double the number in 1990). For men, the probability of surviving from age 80 to age 90 has risen from 12 percent in 1950 to 26 percent in 2002; for women, the increase has been from 16 percent to 38 percent. In the lowest‐mortality country, Japan, life expectancy at age 80 in 2006 is estimated to be 6.5 years for men and 11.3 years for women. For selected countries, average annual percent declines in age‐specific death rates over the preceding ten years are calculated for single‐year age groups 80 to 99 and the years 1970 to 2004. The results are presented in Lexis maps showing the patterns of change in old‐age mortality by cohort and period, and separately for men and women. The trends are not favorable in all countries: for example, old‐age mortality in the United States has stagnated since 1980. But countries with exceptionally low mortality, like Japan and France, do not show a deceleration in death rate declines. It is argued that life expectancy at advanced ages may continue to increase at the same pace as in the past.     

A probabilistic interpretation of the United Nations’ 1995–2005 population projections

I develop probabilistic interpretations for the United Nations’ 10-year population forecasts by comparing 1995 projections for 212 countries to the population sizes reported for 2005. Errors in the estimation of the intrinsic rate of increase, presumably caused by erroneous assumptions about birth, death and/or immigration rates, appear to be more consequential than errors based on inaccurate estimation of the starting, or ‘jump-off’, population size. For only about 20% of the countries did the ‘actual’ 2005 population size fall between the United Nations’ low- and high-variant projections. I propose prediction intervals for country-specific population sizes 10 years in the future of the form [ N_i^￠ (t+10) / k ,  k ·N_i^￠ (t+10) ],[ N_i^{\prime} (t+10) / k , \, k \cdot N_i^{\prime} (t+10) ], where N _i ′(t + 10) is the medium-variant prediction for year t + 10 made in year t, and k is a number that varies with starting population size. Based on the 1995–2005 United Nations’ data, values of k giving 95% coverage range from 1.11 for countries with a population on the order of 10⁹, to 1.45 for countries with a population of 10⁵.     

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.     

Changes in the age dependence of mortality and disability: Cohort and other determinants

Though the general trend in the United States has been toward increasing life expectancy both at birth and at age 65, the temporal rate of change in life expectancy since 1900 has been variable and often restricted to specific population groups. There have been periods during which the age- and gender-specific risks of particular causes of death have either increased or decreased. These periods partly reflect the persistent effects of population health factors on specific birth cohorts. It is important to understand the ebbs and flows of cause-specific mortality rates because general life expectancy trends are the product of interactions of multiple dynamic period and cohort factors. Consequently, we first review factors potentially affecting cohort health back to 1880 and explore how that history might affect the current and future cohort mortality risks of major chronic diseases. We then examine how those factors affect the age-specific linkage of disability and mortality in three sets of birth cohorts assessed using the 1982, 1984, and 1989 National Long Term Care Surveys and Medicare mortality data collected from 1982 to 1991. We find large changes in both mortality and disability in those cohorts. providing insights into what changes might have occurred and into what future changes might be expected.     

A short note on the taeuber paradox

When the force of mortality is reduced by a constant fraction 0 at every age, the relative increase in life expectancy e(0) can be measured by δH, where H is determined by the l(a) values of the life table. Although H is not easily reducible in terms of the well-known life table parameters, it has been shown that it can be approximately estimated by 2 – e(0)/à in which d is the average age of the stationary population. It has been found that, for a given value of 0, the relative gain in life expectancy is less appreciable in countries with larger values of e(0).     

US mortality in an international context: age variations

Compared to other developed countries, the United States ranks poorly in terms of life expectancy at age 50. We seek to shed light on the US's low life expectancy ranking by comparing the age-specific death rates of 18 developed countries at older ages. A striking pattern emerges: between ages 40 and 75, US all-cause mortality rates are among the poorest in the set of comparison countries. The US position improves dramatically after age 75 for both males and females. We consider four possible explanations of the age patterns revealed by this analysis: (1) access to health insurance; (2) international differences in patterns of smoking; (3) age patterns of health care system performance; and (4) selection processes. We find that health insurance and smoking are not plausible sources of this age pattern. While we cannot rule out selection, we present suggestive evidence that an unusually vigorous deployment of life-saving technologies by the US health care system at very old ages is contributing to the age-pattern of US mortality rankings. Differences in obesity distributions are likely to be making a moderate contribution to the pattern but uncertainty about the risks associated with obesity prevents a precise assessment.     

CDC on Vaccines and Children's Health: United States 1900–98

During the twentieth century, the health and life expectancy of persons residing in the United States—as in most other countries of the globe—have improved greatly. (For a discussion of some aspects of that improvement, see the article in this issue by Kevin White assessing the effects of changes in cardiovascular and tuberculosis mortality in the United States since 1900.) A considerable share of this change is attributable to advances in public health. To highlight these advances the Morbidity and Mortality Weekly Report (MMWR) of the Centers for Disease Control and Prevention (an agency of the US Department of Health and Human Services) is issuing a series of reports profiling ten great public health achievements in the United States during the present century. The first of these reports discusses vaccination: “Impact of vaccines universally recommended for children—United States, 1900–1998,” MMWR 48 (12), 2 April 1999. It is reproduced below in full. The improvements chronicled in the report are especially great with respect to morbidity. In many developing countries mortality resulting from vaccine-preventable causes is, however, still very high. Recent international initiatives, involving UN agencies, bilateral aid agencies, foundations, and the vaccine industry, aim at accelerating the outreach of immunization in developing countries. A meeting discussing an expanded program of vaccination (Bellagio, March 1999) estimated that global immunization, at a cost of approximately $3 billion per year, could save some 40 million lives over the next ten years.     

Measuring longevity achievements under welfare interdependencies: a case for joint life expectancy indicators

Whereas period life expectancy constitutes an intuitive indicator of the survival conditions prevailing at a particular period, this paper argues that, given the existence of welfare interdependencies, that widespread indicator is nonetheless an incomplete measure of the longevity achievements relevant for human well-being. The central importance of coexistence for human-beings implies that usual life expectancy measures should be complemented by joint life expectancy indicators, which measure the average coexistence time under particular survival conditions. After a study of the theoretical foundations of ‘single’ and ‘joint’ life expectancy indicators, it is shown that joint life expectancy measures tend to enrich significantly the comparison of longevity achievements across countries and periods. Moreover, the introduction of joint life expectancy indicators—as a complement to conventional life expectancy measures—into multi-variable indexes such as the United Nations’ HDI is also shown to affect international rankings of standards of living to a non negligible extent.

Reduced Variation in Death Rates after Introduction of Antimicrobial Agents

There was a sharp, persistent drop in annual variation in life expectancy at birth in the United States between 1940 and 1950. To evaluate the possible relationship of this drop to the introduction of antimicrobial agents, we examined standardized death rates (SDR) and life expectancy (LE) in the United States and in England and Wales, both of which participated in the discovery and development of antimicrobials, especially penicillin, during this period. Annual variation in life expectancy and directly standardized death rates are measured as residuals from moving means. There were sharp drops in residual variation for males and females starting as early as 1944 in the United States and 1951 in England and Wales that persist to the present. The standard deviations of residuals dropped by 59–81% from before 1940 to after 1950 depending on sex, country, and SDR or LE. The timing and persistence of reduced annual variation indicates that antimicrobials contributed substantially to the change.     

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.     

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.     

Future life expectancy in Australia,Europe, Japan and North America

Human life expectancy has risen in most developed countries over the last century, causing the observed demographic shifts. Babel, Bomsdorf and Schmidt (forthcoming) introduce a stochastic mortality model using panel data procedures which distinguishes between a common time effect and a common age effect of mortality evolvement. Using this mortality model, the present paper provides forecasts of future life expectancy for 17 countries divided into 12 regions: Australia, Alps, Bene, Canada, England and Wales, France, Germany, Italy, Japan, Spain, Scandinavia and the United States of America. We consider (traditional) period life expectancies as well as cohort life expectancies, the latter being a more realistic approach but less common. It turns out that a continuing increase of life expectancy is expected in all considered countries. Further, we show that the probabilistic uncertainty of forecast life expectancies is different if either period life expectancies or cohort life expectancies are considered and, moreover, the uncertainty increases substantially if the error of parameter estimation is included.     

Projecting the Effect of Changes in Smoking and Obesity on Future Life Expectancy in the United States

We estimate the effects of declining smoking and increasing obesity on mortality in the United States over the period 2010–2040. Data on cohort behavioral histories are integrated into these estimates. Future distributions of body mass indices are projected using transition matrices applied to the initial distribution in 2010. In addition to projections of current obesity, we project distributions of obesity when cohorts are age 25. To these distributions, we apply death rates by current and age-25 obesity status observed in the National Health and Nutrition Examination Survey, 1988–2006. Estimates of the effects of smoking changes are based on observed relations between cohort smoking patterns and cohort death rates from lung cancer. We find that changes in both smoking and obesity are expected to have large effects on U.S. mortality. For males, the reductions in smoking have larger effects than the rise in obesity throughout the projection period. By 2040, male life expectancy at age 40 is expected to have gained 0.83 years from the combined effects. Among women, however, the two sets of effects largely offset one another throughout the projection period, with a small gain of 0.09 years expected by 2040.