Adult mortality differentials associated with cigarette smoking in the USA

Although cigarette smoking has been extensively researched, surprising little knowledge has been produced by demographers using demographic perspectives and techniques. Thus, this paper contributes to the literature by extending a demographic framework to an important behavior for mortality research: cigarette smoking. In earlier works, the authors used nationally-representative data to show that cause of death patterns varied by smoking status and that multiple causes of death characterized smokers moreso than non-smokers. The present work extends previous analysis by estimating smoking status mortality differentials by underlying and multiple causes of death and by age and sex. Data from the 1986 National Mortality Followback Survey are related to data from the 1985 and 1987 National Health Interview Survey supplements to assess the smoking-related mortality differentials. We find that cigarette smoking is associated with higher mortality for all population categories studied, that the smoking mortality differentials vary across the different smoking status categories and by demographic group, and that the mortality differentials vary according to whether underlying cause or multiple cause patterns of death are examined. Moreover, the multiple cause analysis highlights otherwise obscured smoking-mortality relations and points to the importance of respiratory diseases and cancers other than lung cancer for cigarette smoking research.     

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.     

Effect of aggregation on the estimation of trend in mortality

There are three approaches to analyzing and forecasting age‐specific mortality: (1) analyze age‐specific data directly, (2) analyze each cause‐specific mortality series separately and add the results, (3) analyze cause‐specific mortality series jointly and add the results. We show that if linear models are used for cause‐specific mortality, then the three approaches often give close results even when cause‐specific series are correlated. This result holds for cross‐correlations arising from random misclassification of deaths by cause, and also for certain patterns of systematic misclassification. It need not hold, if one or more causes serve as “leading indicators”; for the remaining causes, or if outside information is incorporated into forecasting either through expert judgment or formal statistical modeling. Under highly nonlinear models or in the presence of modeling error the result may also fail. The results are illustrated with U.S. age‐specific mortality data from 1968–1985. In some cases the aggregate forecasts appear to be the more credible ones.     

Structure and change in causes of death: An international summary

Abstract Model patterns of the cause structure of mortality at different levels were established for males and females, based on data for 165 national populations. These patterns suggest that the cause of death most responsible for mortality variation is influenza/bronchitis, followed by 'other infectious and parasitic diseases', respiratory tuberculosis, and diarrhoeal disease. Together, these causes typically account for about 60 per cent of the change in level of mortality from all causes combined. Their respective contributions have not depended in an important way on the initial level of mortality. These results - especially tbe importance of the respiratory and diarrhoeal diseases - imply that past accounts may have over-emphasized the role in mortality decline of specific and well-defined infectious diseases and their corresponding methods of control. There is strong statistical support for the suggestion that most of the remainder of mortality variation should be ascribed to changes in cardio-vascular diseases, but that methods of cause-of-death assignment in high-mortality populations have often obscured the importance of these diseases. When death rates from 'other and unknown' causes are held constant, changes in cardio-vascular disease account for about one-quarter of the decline in mortality from 'all causes'.Although the causal factors are poorly established, corroborative results have been demonstrated cross-sectionally in the United States. The composition of the group of populations most deviant from the structural norms is apparently dominated by differentials in the mode of assigning deaths to cardio-vascular disease. However, when broad groups of regions or periods are distinguished, more subtle differences emerge. Controlling mortality level for all causes combined, diarrhoeal diseases are significantly higher in non-Western populations and southern/eastern Europe than in overseas Europe or northern/western Europe. These differences are probably related to standards of nutrition and personal hygiene, but may also reflect climatic factors. Much higher cardio-vascular mortality in overseas European populations than in non-Western populations at similar overall levels probably reflects variation in habits of life. Regional differences in death rates from violence, maternal mortality, respiratory tuberculosis and influenza/pneumonia/bronchitis are briefly noted and commented upon. Cause-of-death structures at a particular level of mortality display some important changes over time. Respiratory tuberculosis and 'other infectious and parasitic diseases' have tended to contribute less and less to a certain level of mortality. They have in part been 'replaced' by diarrhoeal disease, specifically in non-Western populations. These developments reflect an accelerating rate of medical and public health progress against the specific infectious diseases, and a disappointing rate of progress against diarrhoeal disease. Western and non-western populations have shared to approximately the same extent in the accelerating progress against infectious diseases, and developments during the post-war period are more appropriately viewed as an extension of prior trends rather than as radical departures therefrom. For males, cardio-vascular disease and cancer have significantly increased their contribution to a particular level of mortality, while no such tendency is apparent for females. These developments may be related to changes in personal behaviour and in environmental influences whose differential impact on the sexes has been demonstrated in epidemiological studies. Although we have avoided an explicit treatment of age by having recourse at the outset to standardization, certain of the results are apparently reflected in studies of age patterns of mortality. The joint occurrence in non-Western populations and Southern/Eastern populations of exceptionally high death rates from diarrhoeal disease may explain why the 'South' age-pattern, with it high death rates between ages one and five, is often the most accurate referent for use in Latin America and Asia. The fact that the list of populations with the least deviation cause structure is almost exclusively confined to members of the 'West' group of Coale and Demeny may account for the lack of persistent deviation in this group's age patterns. Finally, tbe increasing importance of cardio-vascular disease and neoplasms in cause-of-death structures for males but not females is probably associated with the changing age patterns of male mortality noted by Coale and Demeny.     

Racial differences in infant mortality by cause of death: The impact of birth weight and maternal age

This research examines racial disparities in infant mortality, overall and separately according to cause of death. Using linked birth and death records for the 1975 cohort of live births in Florida, racial differences are initially described and then explained statistically as a product of the distribution of births by birth weight and maternal age. The impact of birth weight is more pronounced than is the effect of maternal age. The analysis suggests the potential utility of examining infant mortality separately by cause of death. Based on the findings, we argue for systematic research focused on factors affecting birth weight.     

Ethnic dimensions of gender differentials in mortality in Malaysia

Higher mortality rates among males are a common occurrence across different cultures and countries. The causes of this higher mortality can be biological as well as behavioural in nature. The biological evidence applies across all nations and communities, but the behavioural causes, arising from the decision processes and communication strategies of individuals, will necessarily have cultural and environmental dimensions that change with time. This study examines gender disparities in mortality across ethnicity and time in Malaysia. The study shows that there is a consistent gender differential across time but it has widened for the Malays and the Indians and narrowed for the Chinese. Most importantly, it has widened considerably for young adults. Analysis of the leading causes of death show that young adult males are more likely to engage in risk-taking behaviour, and that the related causes and the extent of such causes vary across the ethnic groups.     

Estimates Of U.S. Multiple Cause Life Tables

Cause elimination life tables estimated from multiple cause of death data for four race/sex groups are presented for the U.S. population in 1969. These “multiple cause” life tables are then compared to cause elimination life tables where the mortality risk eliminated is that of the cause of death only in its occurrence as the underlying cause of death. An evaluation is made of the possible effects of the multiple cause data on our perception of the relative importance of the major causes of death. The reconceptualization of mortality risks made possible by the multiple cause of death data is also assessed in terms of its providing further insight into the “Taeuber paradox.”     

Mobile Internet Use and Multidimensional Poverty: Evidence from A Household Survey in Rural China

The impact of specific living conditions on the population of geographically and socially segregated Roma settlements in Eastern Slovakia is considerable. They are characterized by high unemployment, lower education, poor housing and sanitary conditions, a poor quality of life, which all affects significantly their higher mortality rates and worse health status. In this paper we try to approach the problem of adverse mortality conditions and health with a deeper demographic insight. The fundamental goal of the paper is to analyse mortality in the population from Roma settlements over the past two decades using complex demographic methods such as life tables, direct standardization with the objective of eliminating differences in the age structure, single and multi-dimensional decomposition of age, sex and causes of death. We also analyse mortality using the concept of avoidable mortality. The results obtained from Roma settlements confirmed significantly worse mortality rates for both sexes. In addition, it appears that the disparities between them and the majority population are growing over time. The primary reason is the higher mortality of the youngest children and persons at post-reproductive age. Basically, all main chapters of the causes of death shorten the life expectancy of persons from Roma settlements, but cardiovascular diseases have the greatest negative impact. Conclusions obtained from the avoidable mortality analysis point to problems related to the accessibility and quality of health care, as well as the lack of interest of population from Roma settlements in their own health, along with the need for more targeted prevention and screening campaigns in this environment. Although the answers of respondents from Roma settlements to their own health confirm the deteriorating quality of health, increasing morbidity and the degree of restriction of normal daily activities with increasing age, they also point to some problems associated with the use of this approach.

     

Trends in the relationship between socioeconomic status and infant mortality in metropolitan Ohio, 1960–1990

This paper presents the results of an ecological analysis of the relationship between infant mortality and economic status in metropolitan Ohio at four points in time centering on the censuses of 1960, 1970, 1980 and 1990. The basic unit of analysis is the census tract of mother's usual residence, with economic status being determined by the percentage of low income families living in each tract. For each period, the census tracts were aggregated into broad income groups and three-year average infant mortality rates were computed for each area, by age, sex, race and exogenous-endogenous causes of death. The most important conclusion to be drawn from the data is that in spite of some very remarkable declines in infant mortality for all socioeconomic groups since 1960, there continues to be a very clear and pronounced inverse association between income status and infant mortality. Indeed, there is some evidence to suggest that it is stronger in 1990 than it was three decades earlier. The general inverse association is observed for both sexes, for whites and nonwhites, and for all major causes of death. At the same time, the data reveal notable variations in the pattern of the relationship over time, as well as several differences between whites and nonwhites in the nature and magnitude of the relationship. Some macro-economic hypotheses are offered to explain these temporal and racial differences in the pattern of the relationship between economic status and infant mortality.This article is an expanded version of a paper presented at the annual meetings of the Southern Demographic Association in New Orleans, 21–23 October 1993.     

Absolute Change in Cause-Specific Infant Mortality for Blacks and Whites in the US: 1983–2002

This paper examines absolute change in infant mortality from 5 leading causes of death for whites and blacks over a 20 year period. Change in infant mortality varies by cause, race, and birth weight. Absolute decline in mortality from respiratory distress syndrome (RDS) and sudden infant death syndrome (SIDS) in the overall study population has been more rapid for black infants during the period after specific technological innovations were approved and behavioral practices were recommended for these conditions. For low birth weight infants, blacks experienced greater decline in mortality from SIDS and whites experienced greater decline in RDS mortality. Despite remarkable declines in mortality from these causes, relative racial disparities have increased over this time period. For the overall study population, blacks and whites experienced similar rates of mortality decline from congenital anomalies. Mortality decline from this cause among low birth weight infants occurred at a faster pace for whites. Mortality from causes for which no specific innovations were developed increased for blacks but remained relatively constant for whites. An analysis of absolute change complements the relative disparities approach by revealing the dynamics of change, thus providing a more complete understanding of changing racial disparities in infant mortality.     

Spanish Surname and Anglo Infant Mortality: Differentials Over a Half-Century

Using a half-century of death records from San Antonio/Bexar County, Texas, we examine the timing and cause structure of Spanish surname and Anglo infant mortality. Our findings show that despite the substantial disparities between ethnic-specific infant mortality rates in the early years of the study, there have been consistent declines in overall, neonatal, and postneonatal mortality for both groups, as well as a major convergence of mortality rates between Spanish surname and Anglo infants. Further, we demonstrate that the convergence is of relatively recent origin and is due primarily to shifts in postneonatal mortality. Finally, we examine the transition reflected in the cause structure of ethnic-specific infant mortality and show that the convergence was largely the result of reductions in deaths from exogenous causes. Implications for research into the "epidemiologic paradox" are discussed.     

Infant Mortality and Socioeconomic Status: New Bottle,Same Old Wine

This paper presents the results of an ecological analysis of the relationship between infant mortality and economic status in metropolitan Ohio for the period 1960–2000. The data examined are centered on the five censuses undertaken during this 40-year period. The basic unit of analysis is the census tract of mother’s usual residence, with economic status being determined by the percentage of low income families living in each tract. For each of the five periods covered, census tracts were aggregated into broad income areas and three-year average infant mortality rates were computed for each area, by age, sex, race and exogenous-endogenous causes of death. The most important conclusion to be drawn from the data is that in spite of some very remarkable declines in infant mortality at all class levels since 1960, there continues to be a very clear and pronounced inverse association between income status and infant mortality. Indeed, the evidence indicates that the relationship has become stronger over the years. These observations are applicable for both sexes, for whites and nonwhites, for neonatal and postneonatal deaths, and for both major cause of death groups. It is concluded that while public health programs are important, any progress in narrowing this long-standing differential is unlikely unless ways can be found to enhance the economic well-being of the lower socioeconomic groups.     

The Epidemiologic Transition Revisited: Compositional Models for Causes of Death by Age and Sex

For decades, researchers have noted systematic shifts in cause‐of‐death patterns as mortality levels change. The notion of the “epidemiologic transition” has influenced thinking about the evolution of health in different societies and the response of the health system to these changes. This article re‐examines the epidemiologic transition in terms of empirical regularities in the cause composition of mortality by age and sex since 1950, and considers whether the theory of epidemiologic transition presents a durable framework for understanding more recent patterns. Age‐sex‐specific mortality rates from three broad cause groups are analyzed: Group 1 (communicable diseases, maternal and perinatal causes, and nutritional deficiencies); Group 2 (noncommunicable diseases); and Group 3 (injuries), using the most extensive international database on mortality by cause, including 1,576 country‐years of observation, and new statistical models for compositional data. The analyses relate changes in cause‐of‐death patterns to changing levels of all‐cause mortality and income per capita. The results confirm that declines in overall mortality are accompanied by systematic changes in the composition of causes in many age groups. These changes are most pronounced among children, for whom Group 1 causes decline as overall mortality falls, and in younger adults, where strikingly different patterns are found for men (shift from Group 3 to Group 2) compared to women (shift toward Group 2 then Group 3). The underlying patterns that emerge from this analysis offer insights into the epidemiologic transition from high‐mortality to low‐mortality settings.     

Geographic Ancestry and Cause-specific Mortality in a National Population

There are marked differentials in mortality risks across regions in Finland. No exhaustive explanation to this variation has been provided, however. The aim of this paper is to analyse how geographic ancestry, as proxied by persons’ birth region and population group, interrelates with cause-specific mortality risks. Focusing on people aged between their mid-thirties and late-forties, we use longitudinal population register data that offer opportunities to account for variables that represent both persons’ social background and their own social status at young adult age. Results of Cox proportional hazard models say that these variables have substantial effects on mortality of different causes, but only a marginal impact on the variation in death rates by birth region and population group. The geographic mortality pattern is found to be specifically prominent for causes of death that are fairly unrelated to persons’ lifestyles. Our findings suggest that genetic predisposal as expressed in terms of geographic ancestry might play a relevant role in understanding mortality variation within the population of Finland.     

Population Variation in Cause of Death: Level,Gender, and Period Effects

The trends in 13 cause of death categories are examined with respect to expectation of life, sex differences, and period effects while misclassification of cause of death is controlled. The results suggest that as mortality declines, 1) the increasingly U-shaped age pattern of mortality is a period effect associated with the infectious diseases, 2) the risks of both overall infectious and degenerative causes of death decline, and 3) infectious disease mortality declines more in males, while degenerative disease mortality declines more in females. Finally, the model shows that some contemporary populations are approaching the .limits of reduction in mortality during infancy, childhood, and young adulthood. Past declines in the degenerative diseases, however, suggest that mortality may continue to decline.     

Education,cognitive ability,and cause-specific mortality: A structural approach

Education is negatively associated with most major causes of death. Prior work ignores the premise that cause-specific hazards are interdependent and that both education and mortality depend on cognitive ability. We analyse Swedish men aged 18–63, focusing on months lost due to specific causes—which solves the interdependence problem—and use a structural model that accounts for confounding due to cognitive ability. In a standard Cox model controlling for Intelligence Quotient, improving education is associated with large decreases in mortality for major causes of death. In the structural model, improving education is associated with a small decrease in months lost for most causes and education levels. Among the least educated, however, improving education strongly reduces the months lost, mainly those lost from external causes, such as accidents and suicide. Results suggest that conventional analysis of education and mortality may be biased, even if accounting for observed cognition.     

Underlying versus multiple causes of death: Effects on interpreting cancer mortality differentials by age,sex, and race

The conventional approach to measuring the medical cause of death in mortality analysis bases death on a single, underlying cause. An alternative approach, which makes use of all of the medical conditions cited by a physician on the death certificate and treats them in a multiplecause framework, is compared with the conventional approach in studying differential mortality among those 45 years of age and older in Florida. The two approaches are seen to provide different patterns of information that have analytical as well as policy ramifications.     

Effects of targets and aggregation on the propagation of error in mortality forecasts

Official forecasts of mortality depend on assumptions about target values for the future rates of decline in mortality rates. Smooth functions connect the jump‐off (base‐year) mortality to the level implied by the targets. Three alternative sets of targets are assumed, leading to high, middle, and low forecasts. We show that this process can be closely modeled using simple linear statistical models. These explicit models allow us to analyze the error structure of the forecasts. We show that the current assumption of perfect correlation between errors in different ages, at different forecast years, and for different causes of death, is erroneous. An alternative correlation structure is suggested, and we show how its parameters can be estimated from the past data.

The effect of the level of aggregation on the accuracy of mortality forecasts is considered. It is not clear whether or not age‐ and cause‐specific analyses have been more accurate in the past than analyses based on age‐specific mortality alone would have been. The major contribution of forecasting mortality by cause appears to have been in allowing for easier incorporation of expert opinion rather than in making the. data analysis more accurate or the statistical models less biased.     

The Contribution of Health Care and Other Interventions to Black–White Disparities in Life Expectancy, 1980–2007

Black–white mortality disparities remain sizable in the United States. In this study, we use the concept of avoidable/amenable mortality to estimate cause-of-death contributions to the difference in life expectancy between whites and blacks by gender in the United States in 1980, 1993, and 2007. We begin with a review of the concept of “avoidable mortality” and results of prior studies using this cause-of-death classification. We then present the results of our empirical analyses. We classified causes of death as amenable to medical care, sensitive to public health policies and health behaviors, ischemic heart disease, suicide, HIV/AIDS, and all other causes combined. We used vital statistics data on deaths and Census Bureau population estimates and standard demographic decomposition techniques. In 2007, causes of death amenable to medical care continued to account for close to 2 years of the racial difference in life expectancy among men (2.08) and women (1.85). Causes amenable to public health interventions made a larger contribution to the racial difference in life expectancy among men (1.17 years) than women (0.08 years). The contribution of HIV/AIDS substantially widened the racial difference among both men (1.08 years) and women (0.42 years) in 1993, but its contribution declined over time. Despite progress observed over the time period studied, a substantial portion of black–white disparities in mortality could be reduced given more equitable access to medical care and health interventions.     

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.