Changing mortality and morbidity rates and the health status and life expectancy of the older population

This paper demonstrates the consequences of changes in mortality and health transition rates for changes in both health status life expectancy and the prevalence of health problems in the older population. A five-state multistate life table for the mid-1980s provides the baseline for estimating the effect of differing mortality and morbidity schedules. Results show that improving mortality alone implies increases in both the years and the proportion of dependent life; improving morbidity alone reduces both the years and the proportion of dependent life. Improving mortality alone leads to a higher prevalence of dependent individuals in the life table population; improving morbidity alone leads to a lower percentage of individuals with problems in functioning.     

Diet,mortality and life expectancy A cross national analysis

There are numerous reasons why mortality and life expectancy vary between countries. Epidemiological studies seem to indicate that dictary variations may be among them. A sample of 51 countries studied with data from the International Comparisons Project and other sources, shows that after controlling for nutrient intake, consumption of medical goods and services, income distribution, weather, and literacy, countries with more meat and poultry in their diet have lower life expectancies after age five. The results for infant mortality and child death between one and five indicate that a more animal-intensive diet may be actually be beneficial, especially if fish consumption is increased and meat and poultry consumption reduced.I thank Jere Behrman, David Crawford, Anil Deolalikar, the Managing Editor, two anonymous referees, and especially Samuel Preston for valuable comments, and Alan Heston and Robert Summers for being generous with their time and their data. Financial support was provided by a Compton Foundation Fellowship. All errors remain my responsibility.     

Changes in mortality and life expectancy: Some methodological issues

Measuring and explaining the effects of mortality changes on life expectancy has been discussed for the past three decades. Different approaches have been proposed using discrete or continuous methods. Two basic ideas underlie these approaches. The first compares two different mortality schedules and quantifies the contribution of each age group to the increase in life expectancy. The second analyzes how the progress in the mortality schedule translates into progress in life expectancy. This paper discusses and compares the approaches proposed by the United Nations (1982), Arriaga (1984), Pollard (1982, 1988), and Vaupel (1986), identifying their problems, advantages, and the types of situations where each one can best be applied.     

[A biological analysis of sex differences in mortality and in life expectancy].]

Biological determinants of differential mortality by sex are examined. The author suggests that a difference in male sex chromosomes is the main reason for the higher mortality rate and lower life expectancy observed in males and for their susceptibility to some genetic diseases. The production of more male fertilized ova is considered as a natural control to balance the sex ratio.     

The narrowing sex differential in life expectancy in high-income populations: effects of differences in the age pattern of mortality

Using data from the Human Mortality Database for 29 high-income national populations (1751-2004), we review trends in the sex differential in e(0). The widening of this gap during most of the 1900s was due largely to a slower mortality decline for males than females, which previous studies attributed to behavioural factors (e.g., smoking). More recently, the gap began to narrow in most countries, and researchers tried to explain this reversal with the same factors. However, our decomposition analysis reveals that, for the majority of countries, the recent narrowing is due primarily to sex differences in the age pattern of mortality rather than declining sex ratios in mortality: the same rate of mortality decline produces smaller gains in e(0) for women than for men because women's deaths are less dispersed across age (i.e., survivorship is more rectangular).     

The narrowing sex differential in life expectancy in high-income populations: Effects of differences in the age pattern of mortality

Using data from the Human Mortality Database for 29 high-income national populations (1751–2004), we review trends in the sex differential in e(0). The widening of this gap during most of the 1900s was due largely to a slower mortality decline for males than females, which previous studies attributed to behavioural factors (e.g., smoking). More recently, the gap began to narrow in most countries, and researchers tried to explain this reversal with the same factors. However, our decomposition analysis reveals that, for the majority of countries, the recent narrowing is due primarily to sex differences in the age pattern of mortality rather than declining sex ratios in mortality: the same rate of mortality decline produces smaller gains in e(0) for women than for men because women's deaths are less dispersed across age (i.e., survivorship is more rectangular).     

A norm-referenced population health status index based on life expectancy and disability

This paper describes a population health status index for health services research and planning purposes. The H-index uses data on average life expectancy at birth and percent of the population free from disability, however defined. It is useful in comparing the health status of health services areas relative to that of the more healthy areas selected to serve as the norm. The statistical procedure used in deriving the H-index is centour analysis, by means of which the Euclidian distances of the service areas in the study sample in two-dimensional space to the centroid of the normative areas are reflected in the H values computed. The farther away from the centroid, the less resemblance the service area has to the norm and the lower its health status. A computational example with seven normative states and 10 states in the study sample is given.     

Statistically tested comparisons of the accuracy of forecasting methods for age-specific and sex-specific mortality and life expectancy

Although there are continuing developments in the methods for forecasting mortality, there are few comparisons of the accuracy of the forecasts. The subject of the statistical validity of these comparisons, which is essential to demographic forecasting, has all but been ignored. We introduce Friedman's test statistics to examine whether the differences in point and interval forecast accuracies are statistically significant between methods. We introduce the Nemenyi test statistic to identify which methods give results that are statistically significantly different from others. Using sex-specific and age-specific data from 20 countries, we apply these two test statistics to examine the forecast accuracy obtained from several principal component methods, which can be categorized into coherent and non-coherent forecasting methods.     

Time series analysis and stochastic forecasting: An econometric study of mortality and life expectancy

Methods for time series modeling of mortality and stochastic forecasting of life expectancies are explored, using Canadian data. Consideration is given first to alternative indexes of aggregate mortality. Age-sex group system models are then estimated. Issues in the forecasting of life expectancies are discussed and their quantitative implications investigated. Experimental stochastic forecasts are presented and discussed, based on nonparametric, partially parametric, and fully parametric methods, representing alternatives to the well known Lee-Carter method. Some thoughts are offered on the interpretation of historical data in generating future probability distributions, and on the treatment of demographic uncertainty in long-run policy planning. All correspondence to Frank T. Denton. This paper is a revised version of one presented at the Annual Congress of the European Society for Population Economics, Athens, Greece, June 2001. The underlying work was carried out as part of the SEDAP (Social and Economic Dimensions of an Aging Population) Research Program supported by the Social Sciences and Humanities Research Council of Canada, Statistics Canada and the Canadian Institute for Health Information. Ronald Lee provided comments that were very helpful in revising an earlier version of the paper. We thank him and participants at the ESPE session at which that version was presented. We thank also the Journal's anonymous referees. Responsible editor: Junsen Zhang.     

On the decomposition of life expectancy and limits to life

Life expectancy is a measure of how long people are expected to live and is widely used as a measure of human development. Variations in the measure reflect not only the process of ageing but also the impacts of such events as epidemics, wars, and economic recessions. Since 1950, the influence of these events in the most developed countries has waned and life expectancy continues to lengthen unabated. As a result, it has become more difficult to forecast long-run trends accurately, or identify possible upper limits. We present new methods for comparing past improvements in life expectancy and also future prospects, using data from five developed, low-mortality countries. We consider life expectancy in 10-year age intervals rather than over the remaining lifetime, and show how natural limits to life expectancy can be used to extrapolate trends. We discuss the implications and compare our approach with other commonly used methods.

Supplementary material for this article is available at: http://dx.doi.org/10.1080/00324728.2014.972433     

Summary indices of the age distribution of a population

In this paper a method for characterizing the age distribution of a population by means of an ‘index word’ is outlined. It is shown that the method can be applied to yield approximations to population forecasts.     

On the relationship between household composition and population age distribution

Summary Composition of households by age of head and by age of other household members has recently been presented in a convenient algebraic expression, the household composition matrix. It has been shown that this matrix operates as a linear transformation from the vector of household distribution by age of head to the vector of population age distribution. A further analysis will show that the first row of the matrix may be interpreted as representing a vector of average household fertility rates. If the linear relationship between household and population distributions is fully implemented, then a relationship between household fertility and the size of the youngest age group can be derived. If w is the population age distribution and w (1) is the number of persons in the youngest age group, then: where α is the first row of the household composition matrix with its first element eliminated, C is the household composition matrix with its first row and first column eliminated, and Ψ is the vector w with its first element, w (1) eliminated. Extension of this result will enable simultaneous projection of population and households, suitable for computer application to conventional five-year age groups.     

Indonesia’s social capacity for population health: the educational gap in active life expectancy

In this paper, we lay the initial groundwork for anticipating Indonesia’s future burden of disease by developing a demographic model of population health. We develop this model within the analytic framework of a Markov-based multistate life table model to calculate an important indicator of the burden of disease, the expected years of active life of elderly Indonesians. The magnitude of the gap points to the potential consequences of improvements in the nation’s educational level for the future burden of disease. The results show that having some education increases life expectancy but it also expands the expected years with a major functional problem. Overall educational attainment levels, however, are very low, indicating that Indonesia’s elderly are at the leading edge of improvements in the nation’s social capacity for health. The life tables suggest that at the early stages of development, longer life is accompanied by an expansion of morbidity.     

On the decomposition of changes in expectation of life and differentials in life expectancy

The projection of mortality rates requires inter alia close examination of the mortality experience of a population over a long period of time and will usually also involve the analysis of mortality trends by cause of death. In two of the more important recent contributions, techniques were devised for explaining change in life expectancy in terms of mortality changes in particular age groups and by different causes of death. The approaches adopted by the authors differ, and the purpose of this article is to reconcile the two and tie the results in with those obtained by earlier writers. A new method for explaining the change in a life expectancy differential in terms of the observed changes in the mortality differentials and the observed change in overall mortality level is also described.     

Inequality in life expectancy, functional status, and active life expectancy across selected black and white populations in the United States

We calculated population-level estimates of mortality, functional health, and active life expectancy for black and white adults living in a diverse set of 23 local areas in 1990, and nationwide. At age 16, life expectancy and active life expectancy vary across the local populations by as much as 28 and 25 years respectively. The relationship between population infirmity and longevity also varies. Rural residents outlive urban residents, but their additional years are primarily inactive. Among urban residents, those in more affluent areas outlive those in high-poverty areas. For both whites and blacks, these gains represent increases in active years. For whites alone they also reflect reductions in years spent in poor health.     

On age distribution of population,government expenditure and fiscal federalism

In this paper I build a simple model to analyze the consequences that population growth imposes on the relative needs of expenditure of governments in a fiscal federalism setup. I assume, first, that some government expenditure items can be classified according to the age of their recipient individuals and, second, that different levels of government are usually assigned different expenditure programs. The implication is that, for an initially given level of effective public good provision, changes in the size of population as well as in its age structure will influence the composition of public expenditure for different layers of administration in a different manner.I would like to thank Jordi Caballé, Ángel de la Fuente, Javier Gardeazabal, Federico Grafe, Juan Urrutia and Jesús Vázquez for their valuable comments and suggestions. Two anonymous referees helped improve the initial version. Remaining errors and shortcomings are my own responsibility. Financial support from UPV 035.321-HA090/92 and UPV 035.321-HA130/93 is gratefully acknowledged.     

On the derivation of a full life table from mortality data recorded in five-year age groups

Mortality data are often gathered using 5-year age groups rather than individual years of life. Furthermore, it is common practice to use a large open-ended interval (such as 85 and over) for mortality data at the older ages. These limitations of the data pose problems for the actuary or demographer who wishes to compile a full and accurate life table using individual years of life. The author devises formulae which handle these problems. He also devises methods for handling mortality during the 1st year of life and for dealing with other technical problems which arise in the compilation of the full life table from grouped data.     

上海市人口老龄化反其对社会保障的影响

本文首先分析了上海市人口发展趋势,并对上海市人口老龄化趋势进行预测,在此基础上,详细论述了人口老龄化将对上海市社会保障所产生的影响,同时,对于上海市未来合理的社会保障支出水平进行了测度。     

Mortality and life expectancy in Poland 10 years before the end of the century

"In the article we discuss the mortality rates in Poland by [voivodship] at the end of the 80's. In the comparative analysis, we employed general standardized rates of deaths for men and women, and coefficients presenting the levels of mortality resulting from...circulatory system diseases and malignant neoplasms.... In the second part of the paper, we examine the differences in...life expectancy by sex and administrative provinces."