Trends in Causes of Death in Low‐Mortality Countries: Implications for Mortality Projections

This study examines the potential role that information about trends in causes of death could have in improving projections of mortality in low‐mortality countries. The article first summarizes overall trends in mortality by cause since the middle of the twentieth century. Special attention is given to the crucial impact of the smoking epidemic on mortality and on cause‐of‐death patterns. The article then discusses the implications for projections and reaches two conclusions. First, mortality projections can be improved by taking into account the distorting effects of smoking. Mortality attributable to smoking has risen in the past but has now leveled off or declined, thus boosting improvements in life expectancy. Second, making cause‐specific projections is not likely to be helpful. Trends in specific medical causes of death have exhibited discontinuities in the past, and future trends are therefore difficult to predict.     

Clustering EU Countries by Causes of Death

Population Research and Policy Review - Countries with different mortality patterns face different health and demographic challenges. Knowing a country’s position relative to other countries...     

Relative Trends In Mortality From Related Respiratory and Airborne Infectious Diseases

Poor living conditions and inadequate diet were undoubtedly major contributors to high infectious disease death rates in Britain during the nineteenth century, but improvements were not necessarily the precondition for mortality decline. Evidence of consistent improvements is far from conclusive, while different trends for different diseases have to be explained. Scarlet fever and whooping cough death rates did not decline until the last few decades of a century in which measles mortality was continuing high Respiratory and gastro-intestinal complications are frequently involved in conditions of overcrowding and poverty. Death rates for recorded respiratory diseases themselves reveal a downturn at the end of the century, but respiratory tuberculosis mortality declined throughout and smallpox was virtually eliminated through vaccination measures. The interrelated nature and aetiology of these diseases has implications for changes in mortality, while population variables and other transmission factors including social behaviour patterns are probably crucial for an understanding of historical and contemporary trends.     

Cardiovascular and Tuberculosis Mortality: The Contrasting Effects of Changes in Two Causes of Death

Tuberculosis was the largest source of deaths among younger adults, and cardiovascular disease among older adults, in the America of 1900. Decreases in deaths from tuberculosis since 1900 and cardiovascular disease since 1940 explain most of the mortality drops in those age groups over the century. This article, building on previous work by White and Preston, shows the results of increased survival from these two causes on the US population structure. Standard demographic cause-specific mortality calculations are used to generate life tables without deaths from cardiovascular disease or tuberculosis. Then fixed rates for these diseases from early in the century are assumed while all other causes of death are allowed to change as they did historically. Improvements in cardiovascular mortality and tuberculosis produce some seemingly illogical contrasts. More people are alive today because of the decrease in tuberculosis. Yet more deaths from cardiovascular disease have been prevented, and cardiovascular improvements have raised life expectancy more. Lower tuberculosis mortality had virtually no effect on the average age of the population. Lower cardiovascular mortality alone has raised that average more than all twentieth-century causes of improved mortality combined.     

Measuring The Effects Of Race Differentials In Mortality Upon Surviving Family Members

A model is developed to use marital history data from the U.S. Current Population Survey and mortality statistics from the federal registration system to estimate color differences in (a) the risk of widowhood among women in the working ages and (b) the cumulative duration of widowhood. Color differentials in mortality among married males are thereby translated into person-years of dependent survivorship among women, in anticipation of our later estimating average and cumulative lifetime income losses for the survivors. Initial results of this model, dealing with the demographic aspects of survivorship, are presented.     

Survivorship Of Sons Under Conditions Of Improving Mortality

The strong desire of fathers to be assured that at least one son will outlive them, coupled with the traditional belief in a high probability of sons predeceasing their father, is often a deterrent to restriction of family size. A calculation of the probabilities of survivorship of sons on the basis of the United Nations Model Life Tables, however, shows that the probabilities of a father being outlived by even one son are remarkably high, particularly after that son has survived the first two years of life. When cohort tables are used, reflecting expected mortality improvements, the probabilities are even higher. In general, it is found that the probability that a two-year-old son will outlive his father is 80% or better, subject to the current mortality level and the age of the father.Finally, this paper examines (1) probabilities of a father being outlived by at least one of two or three sons, (2) probabilities of a mother or of both parents being outlived by a son, and (3) the probability that at least one of two sons will outlive a father when allowance is made for the fact that mortality probabilities of the sons are not independent of one another.     

Child Mortality and Environment in Developing Countries

This paper studies child mortality and fertility in 61 developing countries including the Central Asian Republics (CARs). To control for simultaneity, an estimated value of fertility was used in the mortality equation and a final specification included only exogenous socio-economic, health and environmental variables. We confirm the importance of female literacy in explaining both fertility and mortality, and also find a measure of consumption for the poorest share of the population to be significant, while controlling for nutrition, health expenditure, and income distribution. Incidence of tuberculosis and female agricultural population proxy for environmental impacts, but in spite of these controls, approximately 41% additional mortality was estimated due to living in the CARs. The results fill gaps in the literature: we use a wider range of socio-economic and environmental health variables than previously in an encompassing analysis of mortality and fertility, and find evidence of excessive mortality in the CARs most likely linked to environmental degradation in the region.

Trends in Mortality Decrease and Economic Growth

The vast literature on extrapolative stochastic mortality models focuses mainly on the extrapolation of past mortality trends and summarizes the trends by one or more latent factors. However, the interpretation of these trends is typically not very clear. On the other hand, explanation methods are trying to link mortality dynamics with observable factors. This serves as an intermediate step between the two methods. We perform a comprehensive analysis on the relationship between the latent trend in mortality dynamics and the trend in economic growth represented by gross domestic product (GDP). Subsequently, the Lee-Carter framework is extended through the introduction of GDP as an additional factor next to the latent factor, which provides a better fit and better interpretable forecasts.     

Age-Specific Variation in Adult Mortality Rates in Developed Countries

This paper investigates historical changes in both single-year-of-age adult mortality rates and variation of the single-year mortality rates around expected values within age intervals over the past two centuries in 15 developed countries. We apply an integrated hierarchical age-period-cohort—variance function regression model to data from the human mortality database. We find increasing variation of the single-year rates within broader age intervals over the life course for all countries, but the increasing variation slows down at age 90 and then increases again after age 100 for some countries; the variation significantly declined across cohorts born after the early 20th century; and the variation continuously declined over much of the last two centuries but has substantially increased since 1980. Our further analysis finds the recent increases in mortality variation are not due to increasing proportions of older adults in the population, trends in mortality rates, or disproportionate delays in deaths from degenerative and man-made diseases, but rather due to increasing variations in young and middle-age adults.     

Methods For Comparing The Mortality Experience of Heterogeneous Populations

Methods are presented which produce Maximum Likelihood Estimates (MLE) of the degree of heterogeneity in individual mortality risks under a variety of assumptions about the age trajectory of those mortality risks. With these estimates of the degree of population heterogeneity it is possible to adjust comparisons of mortality risks across populations for the effects of population heterogeneity, differential mortality selection, and different age trajectories of the force of mortality. These methods are demonstrated by applying a variety of standard assumptions about the age trajectory of the force of mortality to the analysis of a broad range of cohort mortality data for the U.S. and Swedish populations. The estimates of the degree of heterogeneity, produced under all of the selected force of mortality models, consistently indicated a considerable degree of heterogeneity in mortality risks.     

The Distribution of Infectious Diseases and Extrinsic Mortality Across Countries

Analysis of the spatial distribution and geographical determinants of human infectious agents across countries suggests that the total number of multi-host vector-transmitted diseases provides a useful measure of the mortality environment. Pathogens of this type are difficult to eradicate because they multiply in both humans and non-human hosts and are bound to specific climatological conditions. The count index of multi-host vector-transmitted diseases that are endemic in a country is a good proxy of life expectancy and of the likelihood of epidemics. This count is useful for cross-country empirical comparisons because it is not driven by demographic and economic conditions.     

Twinning Rates in Developed Countries: Trends and Explanations

The twinning rate has increased dramatically over the last four decades in developed countries. Two main factors account for this increase: delayed childbearing, as older women tend to have twins more frequently than younger ones, and the expansion of medically assisted reproduction (MAR), which carries an increased probability of multiple births. Using civil registration data, we estimate the share of the increase in twinning rates attributable to the rise in the age at childbearing and to MAR. The effect of MAR is estimated to be about three times as important as the effect of delayed childbearing. Negative health outcomes associated with multiple births and the cost of MAR have raised concerns. We find that in one‐quarter of developed countries with the relevant data, the twinning rate reached a plateau around the early 2000s and decreased thereafter. We examine the reasons for this reversal, in particular changes in MAR policies and practices.     

中国高龄老人健康状况和死亡率变动趋势

文章对“中国老年健康影响因素跟踪调查”近两万名80～105岁高龄老人的数据分析发现,社会经济发展使得2008年高龄老人存活概率和自评日常生活自理能力比1998年有显著改善.医疗条件进步使健康较差高龄老人被“救”存活率提高,使2008年高龄老人客观量测的躯体功能和认知功能比10年前显著下降;这给社会和亿万家庭带来严峻挑战.研究表明,经济社会发展和人类寿命提高带来效益的同时,也会产生一定成本;但它不是以往不少国际文献解释这一现象时所称的“胜利的失败”,所以没有必要为此恐慌,而需要全社会积极应对,努力实现人口健康老龄化.     

The Cause-Deleted Index: Estimating Cause of Death Contributions to Mortality

Causes underlying mortality disparities are often determined by causal decomposition. This method is based on the decomposition of differences in mortality or life expectancy into parameters representing the contribution of underlying causes. It quantifies disparities as differences in mortality rates and does not account for the fact that many underprivileged groups are more likely to die from nearly all causes. Results are driven by the frequency of cause of death. Alternatively, the cause deleted index quantifies the role of underlying causes in mortality disparities as the change in the relative risk of dying that is related to deleting a specific cause. The consistency between the methods in estimating cause of death contributions is analyzed using 2000 U.S. mortality data and simulated mortality profiles. The two methods often produce divergent results because causal decomposition relies on the prevalence of causes of death.     

Infant Mortality by Cause of Death: Main and Interaction Effects

We examine infant mortality among the 1980-1982 live birth cohorts in the state of Florida, specific to five categories of underlying cause of death: infections, perinatal conditions, delivery complications, congenital malformations, and sudden infant death syndrome. The gross and net effects of eight categorical and continuous independent variables, along with 11 first-order interactions, are examined with microlevel data through the use of multinomial logit regression. Findings suggest the complexity of variable effects by cause of death and indicate the simultaneous importance of biological and social factors. It is important that the pattern of interactions suggests an overall dependence of infant life chances on social circumstances. It also suggests that these effects are attenuated for some variables and causes of death at lower birth weights, probably due to advances in health care organization, access, and technology.     

Causes of Male Excess Mortality: Insights from Cloistered Populations

The degree to which biological factors contribute to the existence and the widening of mortality differences by sex remains unclear. To address this question, a mortality analysis for the years 1890 to 1995 was performed comparing mortality data on more than 11,000 Catholic nuns and monks in Bavarian communities living in very nearly identical behavioral and environmental conditions with life table data for the general German population. While the mortality differences between women and men in the general German population increased considerably after World War II, they remained almost constant among the members of Bavarian religious orders during the entire observation period, with slight advantages for nuns. Thus, the higher differences observable in the general population cannot be attributed to biological factors. The different trends in sex‐specific mortality between the general and the cloistered populations are caused exclusively by men in the general population who were unable to follow the trend in mortality reduction of women, nuns, and especially monks. Under the special environmental conditions of nuns and monks, biological factors appear to confer a maximum survival advantage for women of no more than one year in remaining life expectancy at young adult ages.     

宁夏人口死亡率成因分析

宁夏人口死亡率自2000年以来连续7年低于5‰,为全国最低水平。本文从建国以来宁夏人口死亡率的变化特征、从经济社会发展水平、人们的生活方式、人口的年龄构成等方面对宁夏人口死亡率偏低原因进行深入的分析,为各级领导决策提供科学的政策理论依据。     

山东省百年人口老龄化趋势前瞻

山东省是我国的人口大省,也是人口老龄化速度较快的省份。本文利用人口发展数学模型,得出五种预测方案,然后再根据山东省的实际形势确定了备选方案,分析了山东省百年人口老龄化总趋势,以及2005-2020年山东省人口老龄化发展特征,最后提出了相应的对策和建议。     

Future Trends In World Population Growth

Because world population growth is marked by differing trends in the more developed and developing regions, the successful solution of future social and demographic problems will depend, in all likelihood, on whether population growth is considered in isolation or as a problem which is inextricably interwoven with other leading features of social and economic development.Both total population growth and changing age structure produce new economic and social problems, and within both the more developed and the developing regions, there are sub-areas in various stages of development. First, together with the total estimated increase in working-age population, there will be substantial differences in age structure. Although the proportion of world population of dependent age is expected to go down, up to 1980its level will be higher than in 1960, owingto an upward tendency in developing regions, where the "heavy youth dependency" is so extraordinarily high that even in 1980 there will be about ten children to every old person, and at the end of the century, more than seven. It is estimated that in the more developed regions there will be twenty-five to every one-hundred old persons in 1980, and twenty-two in the year 2000. This shows that heavy old-age dependency will have arisen in these regions. Second, the dependency ratio will probably grow, moreover, as a consequence of the degree of economic activity and variation. Although there will bea decrease in the proportion of dependent children, these will still constitute over one-half of the dependents in all areas. These forecasts seem to indicate that the changing structure of dependency and the increase in its total volume may be expected to create problems, particularly in the developing regions. Third, working life tends to become longer as a result of declining mortality, and this, combined with rising labor-force replacement levels, will result in an increased total labor supply.While such an expansion of world population obviously emphasizes the quantitative aspect of population problems, structural and qualitative aspects seem to be of equal importance. But these aspects are largely overshadowed by the growth problem, for growing numbers of people have more and more needs: the inflow of people into schools, into the labor market, and into towns and cities will be apparently unprecedented.In recent years circumstances have not favored the development of conditions needed for rapid change in reproductive behavior in the developing regions. The mobilization of resources and the adaption of different types of society in view of the future growth of total population-with emphasis on the less-developed regions-will be one of the most important challenges to mankind's ability to meet its own needs.The main value of the calculations of various characteristics of future population growth discussed in this paper is to show "in the light of contemporary information" future trends and some relationships of world population of world population growth to economic and social development.     

中国育龄期女性死因分析

育龄期女性的健康风险远远不只是与生殖和生育相关的风险。将人口统计数据和卫生统计数据相结合分析,发现1990-2000年间,育龄期女性人口死亡概率下降了1/4,主要死因为损伤和中毒、肿瘤、循环系统疾病。但这三种主要死因下降程度慢于其他死因的下降,反映了社会、文化、习俗等因素的改善滞后于经济发展和物质生活条件改善对育龄期女性健康的影响。同时,城乡育龄期女性人口存在不同的死因模式。