The influence of cause-specific mortality conditions on the age pattern of mortality with special reference to Taiwan

Abstract This paper discusses the relationship between the level of mortality at ages one to four, on one hand, and five to 34 on the other. This relationship has been observed to vary considerably among mortality schedules at different levels of mortality and even among schedules at the same general level of mortality. This variation is shown among the modem life table systems of the Regional Model Life Tables and the United Nations Model Life Tables. Controlling for the leyel ofmortality from age five to age 34, the West Tables and the United Nations Tables embody approximately the same 'average' relationship between early childhood and adult mortality. Relatively to this average relationship, the South and East Tables consistently display higher childhood mortality rates for a given level of adult mortality. Indeed, the childhood rates of the South Table are twice those of the West Tables over a range of life expectancy at birth from 40 to 70 years. The relationship between childhood and adult mortality from 1957 to 1968, a period of rapid mortality decline, was investigated in Taiwan. In 1957, the Taiwanese data reflected the severe childhood mortality of the South Model Tables. However, by 1968, due to an especially large decline in childhood mortality, this relationship was more moderate and resembled the mortality pattern of the West or East Model Tables. An analysis of the decline in cause-specific mortality during the period revealed that a dramatic decline in childhood mortality from gastro-enteritis was primarily responsible for the shift in the relationship between childhood and adult mortality in Taiwan. It is asserted that, while any of several diseases which result in fatalities primarily among children of pre-school ages, could cause relatively severe childhood mortality, gastro-enteritis is likely to be a primary contributor to such an age pattern. This assertion is based on the fact that, especially in the developing areas of the world, malnutrition and gastro-enteritis are usually precipitating and complicating factors of other childhood diseases. A limited test of this hypothesis was provided by considering the causal components of childhood mortality rates in two populations known, for certain periods, to have exhibited relatively severe childhood mortality conditions; Spain and Portugal. For the years in which those populations were characterized by the South mortality pattern, gastro-enteritis was a principal cause of mortality in childhood. Moreover, with the decline in mortality from gastro-enteritis, the mortality pattern in Spain and Portugal no longer exhibited childhood mortality rates which were severe relative to those of adult life. The implications of these findings for the analysis of mortality conditions in many areas of the developing world, where the gastro-enteritis malnutrition syndrome annually claims a heavy toll of life in early childhood, are not clear. In those areas, the effect of this syndrome on the age pattern of mortality could be offset by special conditions inflating adult mortality rates. Nevertheless, in circumstances where there is evidence indicating substantial childhood mortality from this syndrome and no evidence indicating compensating severe adult mortality, there is reason to suspect that the existing mortality pattern reflects the relatively severe childhood mortality conditions of the South Model Tables. Additionally, where mortality from the gastro-enteritis malnutrition syndrome has been severe in past years, but has been reduced to low levels in recent years, it is probable that the relationship between childhood and adult mortality will shift in favour of the former - quite possibly, in the manner of Taiwan, from a South to an East or West age pattern.     

Adult height and childhood disease

Taller populations are typically richer populations, and taller individuals live longer and earn more. In consequence, adult height has recently become a focus in understanding the relationship between health and wealth. We investigate the childhood determinants of population adult height, focusing on the respective roles of income and of disease. Across a range of European countries and the United States, we find a strong inverse relationship between postneonatal (ages 1 month to 1 year) mortality, interpreted as a measure of the disease and nutritional burden in childhood, and the mean height of those children as adults. Consistent with these findings, we develop a model of selection and stunting in which the early-life burden of undernutrition and disease not only is responsible for mortality in childhood but also leaves a residue of long-term health risks for survivors, risks that express themselves in adult height and in late-life disease. The model predicts that at sufficiently high mortality levels, selection can dominate scarring, leaving a taller population of survivors. We find evidence of this effect in the poorest and highest-mortality countries of the world, supplementing recent findings on the effects of the Great Chinese Famine.     

The Effects of Childhood,Adult, and Community Socioeconomic Conditions on Health and Mortality among Older Adults in China

Using a large, nationally representative longitudinal sample of Chinese aged 65 and older, this study examines the effects of childhood, adult, and community socioeconomic conditions on mortality and several major health outcomes. The role of social mobility is also tested. We find that childhood socioeconomic conditions exert long-term effects on functional limitations, cognitive impairment, self-rated health, and mortality independent of adult and community socioeconomic conditions. Achieved conditions matter for most outcomes as well, considering that adult and community socioeconomic conditions have additional impacts on health among Chinese elders. The majority of the effects of childhood conditions are not mediated by adult and community conditions. The results also show that social mobility and health in later life are linked in complex ways and that psychosocial factors have marginal explanatory power for the effects of socioeconomic conditions. Overall, this study provides new longitudinal evidence from China to support the notion that health and mortality at older ages are influenced by long-term and dynamic processes structured by the social stratification system. We discuss our findings in the context of the life course and ecological perspective, emphasizing that human development is influenced by a nexus of social experiences that impact individuals throughout life.     

The long arm of childhood: The influence of early-life social conditions on men’s mortality

Increasingly, social scientists are turning to childhood to gain a better understanding of the fundamental social causes of adult mortality. However, evidence of the link between childhood and the mortality of adults is fragmentary, and the intervening mechanisms remain unclear. Drawing on the National Longitudinal Survey of Older Men, our analysis shows that men's mortality is associated with an array of childhood conditions, including socioeconomic status, family living arrangements, mother's work status, rural residence, and parents' nativity. With the exception of parental nativity, socioeconomic-achievement processes in adulthood and lifestyle factors mediated these associations. Education, family income, household wealth, and occupation mediated the influence of socioeconomic status in childhood. Adult lifestyle factors, particularly body mass, mediated the effects of family living arrangements in childhood, mother's work status, and rural residence. Our findings bring into sharp focus the idea that economic and educational policies that are targeted at children's well-being are implicitly health policies with effects that reach far into the adult life course.     

Gender differences in the link between childhood socioeconomic conditions and heart attack risk in adulthood

A growing body of evidence shows that childhood socioeconomic status (SES) is predictive of disease risk in later life, with those from the most disadvantaged backgrounds more likely to experience poor adult-health outcomes. Most of these studies, however are based on middle-aged male populations and pay insufficient attention to the pathways between childhood risks and specific adult disorders. This article examines gender differences in the link between childhood SES and heart attack risk trajectories and the mechanisms by which early environments affect future disease risk. By using methods that model both latent and path-specific influences, we identify heterogeneity in early life conditions and human, social, and health capital in adulthood that contribute to diverse heart attack risk trajectories between and among men and women as they age into their 60s and 70s. We find that key risk factors for heart attack operate differently for men and women. For men, childhood SES does not differentiate those at low, increasing, and high risk for heart attack. In contrast, women who grew up without a father and/or under adverse economic conditions are the most likely to experience elevated risk for heart attack, even after we adjust for the unequal distribution of working and living conditions, social relationships, access to health care, and adult lifestyle behaviors that influence health outcomes.     

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.     

Reproducing inequalities: Luck, wallets, and the enduring effects of childhood health

In this article, I argue that research on social stratification, on intergenerational transmission of inequalities, and on the theory of factor payments and wage determination will be strengthened by studying the role played by early childhood health. I show that the inclusion of such a factor requires researchers to integrate theories in each of these fields with new theories linking early childhood health conditions and events that occur at later stages in the life course of individuals, particularly physical and mental health as well as disability and mortality. The empirical evidence I gather shows that early childhood health matters for the achievement of or social accession to, adult social class positions. Even if the magnitude of associations is not overwhelming, it is not weaker than that found between adult social accession and other, more conventional and better-studied individual characteristics, such as educational attainment. It is very likely that the evidence presented in this article grossly underplays the importance of early childhood health for adult socioeconomic achievement.     

Discrete Barker Frailty and Warped Mortality Dynamics at Older Ages

We develop a discrete variant of a general model for adult mortality influenced by the delayed impact of early conditions on adult health and mortality. The discrete variant of the model builds on an intuitively appealing interpretation of conditions that induce delayed effects and is an extension of the discrete form of the standard frailty model with distinct implications. We show that introducing delayed effects is equivalent to perturbing adult mortality patterns with a particular class of time-/age-varying frailty. We emphasize two main results. First, populations with delayed effects could experience unchanging or increasing adult mortality even when background mortality has been declining for long periods of time. Although this phenomenon also occurs in a regime with standard frailty, the distortions can be more severe under a regime with Barker frailty. As a consequence, conventional interpretations of the observed rates of adult mortality decline in societies that experience Barker frailty may be inappropriate. Second, the observed rate of senescence (slope of adult mortality rates) in populations with delayed effects could increase, decrease, or remain steady over time and across adult ages even though the rate of senescence of the background age pattern of mortality is time- and age-invariant. This second result implies that standard interpretations of empirical estimates of the slope of adult mortality rates in populations with delayed effects may be misleading because they can reflect mechanisms other than those inducing senescence as conventionally understood in the literature.     

On the Survival of Centenarians and the Span of Life

It has been argued in the literature that the observed mortality crossover among older black Americans relative to the white population is a result of ‘differential early mortality which selects the least robust persons from the disadvantaged population at relatively earlier ages so that, at advanced ages, the disadvantaged population has proportionately more robust persons’ (Kenneth G. Manton). The authors examine the plausibility of the observed black mortality crossover and the heterogeneity argument supporting its existence. In addition to citing evidence from the literature, they use life tables from various countries known to have good mortality data to explore the relation between mortality in childhood and at younger adult ages and mortality in old age for cohorts and periods. Analysis suggests that the association between childhood and old-age mortality for cohorts is positive, implying that observed mortality crossovers are produced by deficient data rather than population heterogeneity.     

Males’ Later-Life Mortality Consequences of Coresidence With Paternal Grandparents: Evidence From Northeast China, 1789–1909

In this study, we investigate the effect of early-life coresidence with paternal grandparents on male mortality risks in adulthood and older age in northeast China from 1789 to 1909. Despite growing interest in the influence of grandparents on child outcomes, few studies have examined the effect of coresidence with grandparents in early life on mortality in later life. We find that coresidence with paternal grandmothers in childhood is associated with higher mortality risks for males in adulthood. This may reflect the long-term effects of conflicts between mothers and their mothers-in-law. These results suggest that in extended families, patterns of coresidence in childhood may have long-term consequences for mortality, above and beyond the effects of common environmental and genetic factors, even when effects on childhood mortality are not readily apparent.     

The health of the clergy: A review of demographic literature

A combination of special studies and official statistics permits an evaluation of the health of the clergy over the past century. The mortality experience of clergymen has been consistently more favorable than that of the general male population. It also has been favorable in comparison with the experience of men in the legal and medical professions although this differential has been diminishing. The initially favorable position of the clergy relative to teachers has been reversed. There is some evidence of mortality differentials within the clerical profession by major faith, denomination, or ministerial specialty. Clergymen have a relatively high mortality rate from cardiovascularrenal diseases and malignancies, but a very low rate for non-degenerative diseases and suicide. Morbidity statistics for the clergy are fragmentary. They may be over-represented among persons hospitalized for conditions that are emotional in origin. The clergy has some special advantages for studies of health, primarily that both membership in the study population and mortality can be determined with comparative ease. Several areas of future research are suggested.     

The effects of breastfeeding and pace of childbearing on mortality at early ages

The effects of the pace of childbearing and breastfeeding practices on infant mortality have rarely been considered together. In this paper, we design and use a set of methodological tools to test a variety of hypotheses postulating the effects of breastfeeding and pace of childbearing on mortality in infancy and early childhood, the mechanisms through which those effects operate, and the contingencies that strengthen or weaken them. The strong effects of both length of breastfeeding and the pace of childbearing on the risks of child death suggest that neither of them exerts an impact on mortality totally mediated by the other. Social and demographic factors (such as age of child, education of mother, and region of residence) also condition the impact of breastfeeding and pace of childbearing on mortality.     

The effect of number of siblings on adult mortality: Evidence from Swedish registers for cohorts born between 1938 and 1972

Demographic research has paid much attention to the impact of childhood conditions on adult mortality. We focus on one of the key aspects of early life conditions, sibling group size, and examine the causal effect of growing up in a large family on mortality. While previous studies have focused on low- or middle-income countries, we examine whether growing up in a large family is a disadvantage in Sweden, a context where most parents have adequate resources, which are complemented by a generous welfare state. We used Swedish register data and frailty models, examining all-cause and cause-specific mortality between the ages of 40 and 74 for the 1938–72 cohorts, and also a quasi-experimental approach that exploited multiple births as a source of exogenous variation in the number of siblings. Overall our results do not indicate that growing up in a large family has a detrimental effect on longevity in Sweden.     

Assessing the Potential Impact of the HIV-1 Epidemic on Orphanhood and the Demographic Structure of Populations in sub-Saharan Africa

Much of the debate on the demographic consequences of the HIV epidemic in sub-Saharan Africa has so far centred around the plausibility of population declines in areas where unprecendently high rates of population growth have recently been in evidence. In this article, the authors use a mathematical model, which combines epidemiological and demographic processes, to illustrate how, under a broad range of impacts on population growth, major changes in demographic features, such as the extent of orphanhood within populations, are likely to occur. At the same time, HIV epidemics are liable to cause significant shifts in the age and sex composition of affected populations, which may have important implications for the ways in which they are best able to cope with the increases in orphanhood, as well as those in infant, early childhood and adult mortality.     

Marriage behavior response to prime-age adult mortality: evidence from malawi

This article examines the effect of AIDS-related mortality of the prime-age adult population on marriage behavior among women in Malawi. A rise in prime-age adult mortality increases risks associated with the search for a marriage partner in the marriage market. A possible behavioral change in the marriage market in response to an increase in prime-age adult mortality is to marry earlier to avoid exposure to HIV/AIDS risks. We test this hypothesis by using micro data from Malawi, where prime-age adult mortality has drastically increased. In the analysis, we estimate the probability of prime-age adult mortality that sample women have observed during their adolescent period by utilizing retrospective information on deaths of their siblings. Empirical analysis shows that excess prime-age adult mortality in the local marriage market lowers the marriage age for females and shortens the interval between the first sex and first marriage.     

Health Interventions and Health Equity: The Example of Measles Vaccination in Bangladesh

Although the existence of socioeconomic differentials in infant and childhood mortality in developing countries is well established. little consensus exists as to the most effective approaches to reducing such differentials. This article utilizes longitudinal data from the Matlab study area in rural Bangladesh to investigate the impact of an efficacious child survival intervention—measles vaccination—on reductions in gender and socioeconomic differentials in childhood mortality. The article analyzes data from 16,270 vaccinated children and randomly matched controls, and evaluates their subsequent mortality risks. Proportional hazards analysis demonstrates that unvaccinated children from very poor families face more than a threefold higher risk of subsequent early child mortality, compared to vaccinated children from families of high economic status. While measles vaccination has little impact on mortality risks among children of higher economic status, the improvement in survival among children from poorer households is pronounced. The provision of measles vaccination markedly reduces mortality risks for poorer children—from over three times higher to just over 1.5 times higher relative to vaccinated children from wealthier families. The findings of this study are evaluated in terms of the potential of child survival interventions such as measles vaccination to promote greater health equity.     

Cigarette Smoking and All-Cause and Cause-Specific Adult Mortality in the United States

This study illuminates the association between cigarette smoking and adult mortality in the contemporary United States. Recent studies have estimated smoking-attributable mortality using indirect approaches or with sample data that are not nationally representative and that lack key confounders. We use the 1990–2011 National Health Interview Survey Linked Mortality Files to estimate relative risks of all-cause and cause-specific mortality for current and former smokers compared with never smokers. We examine causes of death established as attributable to smoking as well as additional causes that appear to be linked to smoking but have not yet been declared by the U.S. Surgeon General to be caused by smoking. Mortality risk is substantially elevated among smokers for established causes and moderately elevated for additional causes. We also decompose the mortality disadvantage among smokers by cause of death and estimate the number of smoking-attributable deaths for the U.S. adult population ages 35+, net of sociodemographic and behavioral confounders. The elevated risks translate to 481,887 excess deaths per year among current and former smokers compared with never smokers, 14 % to 15 % of which are due to the additional causes. The additional causes of death contribute to the health burden of smoking and should be considered in future studies of smoking-attributable mortality. This study demonstrates that smoking-attributable mortality must remain a top population health priority in the United States and makes several contributions to further underscore the human costs of this tragedy that has ravaged American society for more than a century.     

The completeness of enumeration in the 1973 census of the population of Colombia

The effort is made to determine the true size and distribution by age and sex of the population of the Republic of Colombia in October 1973. After initially arriving at estimates of the levels of fertility and mortality during the intercensal period and then correcting the 1964 census population for age misreporting and selective undernumeration of males, a hypothetical populaiton corresponding to October 1973 is constructed. Comparing the constructed population with the population observed in the census yelds an estimate of completeness of enumeration in 1973 that is relative to the enumeration of females in 1964. This estimate is obtained under the assumption that net international migration during the period was of negligible importance. As there is reason to believe that this is not a valid assumption and upon examining the limited amount of evidence available, speculaitons are made concerning the amount of net out-migration to have occurred during the 1964-1973 period and the size of the coresponding modificaiton in the estimate of completeness of enumeration. After adjusting for underenumeration of males in 1964 and neglecting the impact of international migration, a theoretical 1973 census population of 23,201,000 was estimated. Apart from the total number of people enumerated, the information that was analyzed from the advance sample appears to be of good quality, at least in relation to prior censuses. The estimates of fertility and mortality reveal an important decline in Colombian fertility. By coming up with separate estimates of infant and childhood and adult mortality, it has been possible to shed new light on the shape and the level of mortality in Colombia. The new Brass method for estimating adult mortality provides reliable results even when mortality has been declining, and there are recognizable distortions in the distribution of the population by age.     

The Effects of Childhood SNAP Use and Neighborhood Conditions on Adult Body Mass Index

The disproportionate number of individuals who are obese or overweight in the low-income U.S. population has raised interest in the influence of neighborhood conditions and public assistance programs on weight and health. Generally, neighborhood effects and program participation effects have been explored in separate studies. We unite these two areas of inquiry, using the 1968-2005 Panel Study of Income Dynamics (PSID) to examine the long-term effects of childhood Supplemental Nutrition Assistance Program (SNAP) participation, neighborhood conditions, and the interaction of these two, on adult body mass index (BMI). Using sibling fixed-effects models to account for selection bias, we find that relative to children in other low-income families, children in SNAP-recipient households have higher average adult BMI values. However, the effects of childhood SNAP usage are sensitive to both residential neighborhood and age at receipt. For those growing up in advantaged neighborhoods, projected adult BMI is higher for children in SNAP-recipient households than for children in low-income, nonrecipient households. In contrast, for those growing up in less-advantaged areas, adult BMI differences between children in SNAP-recipient and those in low-income, nonrecipient households are small. SNAP usage during preschool years (0 to 4) has no impact on adult BMI scores. However, at later childhood ages, the time elapsed receiving SNAP income increases adult BMI values relative to a condition of low-income nonreceipt.     

Mortality in Ghana: Evidence from the cape coast project data

Abstract This paper deals with the estimation of mortality for a rural community of about 20,000 persons in the rain-forest area of south-west Ghana. Specifically, infant, child and adult mortality estimates have been obtained by the application of a wide range of direct and indirect methods of measuring mortality from the different statistics collected by a longitudinal mortality and fertility project conducted during 1974-7. It was noted that infant and childhood mortality rates obtained from death registrations were consistent with those rates yielded by pregnancy histories and child survival statistics. However, the adult mortality estimates derived from orphanhood statistics tended to be lower than those suggested by death registrations. The analysis revealed an infant mortality rate of 100 for boys and 84 for girls, equal childhood mortality rates for boys and girls (85-6), a lower expectation of life at birth for men (45.8 years) than for women (52.8), and a much more severe incidence of mortality among men aged over 40 than for women at the corresponding ages.