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.     

Two Centuries of Mortality Change in Central Japan: The Evidence From a Temple Death Register

Temple registers in a remote area of central Japan are used to produce a portrait of mortality change over a period of nearly two centuries. This portrait is most remarkable in showing a near-stability in life expectancy at birth between 30 and 40 years until the middle of the twentieth century. This stability was to some extent a product of offsetting trends. Infant and child mortality declined sharply after 1885, coinciding with a major national effort to vaccinate against smallpox. At the same time, mortality was rising at ages 15–29 as industrialization brought increased exposure to tuberculosis. Both these trends are likely to have been shared throughout much of rural Japan.     

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.     

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.     

Famine Mortality in Nineteenth-Century Japan: The Evidence from a Temple Death Register

Economic and demographic historians who have studied Japan's early modern period argue that preventive checks to fertility were the primary cause of Japan's stationary population in the eighteenth and early nineteenth centuries, and that the role of ‘positive’ checks was negligible. This paper presents evidence and a claim that mortality crises – famines in particular – also played an important role in checking population growth during this period. It analyses data from the death register of Ogen-ji, a Buddhist temple in the Hida region of central Japan. These data provide a remarkably detailed picture of the short-term demographic consequences of Japan's last great famine, the Tenpō famine of the 1830s. ‘Normal’ mortality patterns, by age and sex, are compared with patterns of mortality during the famine. Mortality of males rose considerably more than that of females, with the greatest rise occurring among young boys aged 5–14 and adult men aged 30–59. A surprising finding was that mortality at ages 0–4 rose relatively little, in part a consequence of a marked fall in the number of births during the famine. The Tenpō subsistence crisis was not the sole cause of population stagnation in the Ogen-ji population, but it was a prominent feature of the ‘high mortality regime’ that this population experienced during the eighteenth and nineteenth centuries.     

The German East-West Mortality Difference: Two Crossovers Driven by Smoking

Before the fall of the Berlin Wall, mortality was considerably higher in the former East Germany than in West Germany. The gap narrowed rapidly after German reunification. The convergence was particularly strong for women, to the point that Eastern women aged 50–69 now have lower mortality despite lower incomes and worse overall living conditions. Prior research has shown that lower smoking rates among East German female cohorts born in the 1940s and 1950s were a major contributor to this crossover. However, after 1990, smoking behavior changed dramatically, with higher smoking intensity observed among women in the eastern part of Germany. We forecast the impact of this changing smoking behavior on East-West mortality differences and find that the higher smoking rates among younger East German cohorts will reverse their contemporary mortality advantage. Mortality forecasting methods that do not account for smoking would, perhaps misleadingly, forecast a growing mortality advantage for East German women. Experience from other countries shows that smoking can be effectively reduced by strict anti-smoking policies. Instead, East Germany is becoming an example warning of the consequences of weakening anti-smoking policies and changing behavioral norms.     

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.     

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.     

Mortality Increase in Late-Middle and Early-Old Age: Heterogeneity in Death Processes as a New Explanation

Deviations from the Gompertz law of exponential mortality increases in late-middle and early-old age are commonly neglected in overall mortality analyses. In this study, we examined mortality increase patterns between ages 40 and 85 in 16 low-mortality countries and demonstrated sex differences in these patterns, which also changed across period and cohort. These results suggest that the interaction between aging and death is more complicated than what is usually assumed from the Gompertz law and also challenge existing biodemographic hypotheses about the origin and mechanisms of sex differences in mortality. We propose a two-mortality model that explains these patterns as the change in the composition of intrinsic and extrinsic death rates with age. We show that the age pattern of overall mortality and the population heterogeneity therein are possibly generated by multiple dynamics specified by a two-mortality model instead of a uniform process throughout most 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。     

Educational Inequality in Adult Mortality: An Assessment with Death Certificate Data from Michigan

Education was added to the U.S. Standard Certificate of Death in 1989. The current study uses Michigan’s 1989–1991 death certificates, together with the 1990 Census, to evaluate the quality of data on education from death certificates and to examine educational differences in mortality rates. With log-rates modeling, we systematically analyze the variability in educational differences in mortality by race and sex across the adult life cycle. The relative differences in mortality rates between educational levels decline with age at the same pace for all sex and race categories. Women gain a slightly greater reduction in mortality than men by reaching the secondary-education level, but a modestly smaller reduction by advancing beyond it. Blacks show a reduction in predicted mortality rates comparable to whites’ by moving from the secondary to the postsecondary level of education but experience less reduction than whites by moving from the primary to the secondary level. Thus, the secular decline in mortality rates that generally accompanies historical improvements in education might actually be associated with an increase in the relative differences between blacks’ and whites’ mortality. We discuss limitations of the data and directions for future research.     

Mortality and Socio-economic Status in Two Eighteenth-century Dutch Villages

This study is an analysis of mortality levels and their patterns of change among different socio-economic groups in two eighteenth-century Dutch villages. In these two villages – Gilze and Rijen – there were substantial mortality differentials between farmers and agricultural labourers. Mortality differentials of this magnitude have not been found in other European villages, although they are not unheard of in cities. The differentials are probably unrelated to malnutrition, or a polluted water supply among the lower class. Relative overcrowding and poor hygiene are more probable causes. During the second half of the eighteenth century mortality levels were lower, especially among the lower class. These changes, however, did not result from a higher standard of living. They were probably related to a diminution in the amount of military activity on land in Europe after the War of the Austrian Succession.     

居住安排变化对老年人死亡风险的影响

本文利用2002~2008年中国老龄健康长寿影响因素跟踪调查(CLHLS)数据,在倾向值加权的基础上,采用含有frailty因子的Cox回归分析法,考察居住安排变化对老年人死亡风险的影响。研究结果表明,居住安排变化对老年人死亡风险存在影响,其中与子女同住变为不同住老人的死亡风险最高。研究结果还表明,考虑了脆弱性因子的回归系数绝对值大于没有考虑脆弱性因子的回归系数绝对值。在本研究中,没有考虑脆弱性因子的同住变为不同住低估了其对死亡风险的作用,而不同住变为同住以及一直同住则高估了其对死亡风险的作用。     

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。     

Migration and Pacific Mortality: Estimating Migration Effects on Pacific Mortality Rates Using Bayesian Models

Pacific people living in New Zealand have higher mortality rates than New Zealand residents of European/Other ethnicity. The aim of this paper is to see whether Pacific mortality rates vary by natality and duration of residence. We used linked census-mortality information for 25- to 74-year-olds in the 2001 census followed for up to three years. Hierarchical Bayesian modeling provided a means of handling sparse data. Posterior mortality rates were directly age-standardized. We found little evidence of mortality differences between the overseas-born and the New Zealand–born for all-cause, cancer, and cardiovascular disease (CVD) mortality. However, we found evidence for lower all-cause (and possibly cancer and CVD) mortality rates for Pacific migrants resident in New Zealand for less than 25 years relative to those resident for more than 25 years. This result may arise from a combination of processes operating over time, including health selection effects from variations in New Zealand’s immigration policy, the location of Pacific migrants within the social, political, and cultural environment of the host community, and health impacts of the host culture. We could not determine the relative importance of these processes, but identifying the (modifiable) drivers of the inferred long-term decline in health of the overseas-born Pacific population relative to more-recent Pacific migrants is important to Pacific communities and from a national health and policy perspective.     

Beyond Self‐Reports: Changes in Biomarkers as Predictors of Mortality

The proliferation of biosocial surveys has increased the importance of weighing the costs and benefits of adding biomarker collection to population‐based surveys. A crucial question is whether biomarkers offer incremental value beyond self‐reported measures, which are easier to collect and impose less respondent burden. We use longitudinal data from a nationally representative sample of older Taiwanese (aged 54+ in 2000, examined in 2000 and 2006 with mortality follow‐up through 2011) to address that question with respect to predicting all‐cause mortality. A summary measure of biomarkers improves mortality prediction (as measured by the area under the receiver operating characteristic curve) compared with self‐reports alone, but individual biomarkers perform better than the summary score. We find that incorporating change in biomarkers over a six‐year period yields a small improvement in mortality prediction compared with one‐time measurement. But, is the incremental value worth the costs?     

Death Clustering,Mothers' Education and the Determinants of Child Mortality in Rural Punjab,India

In this paper the behavioural factors which make for continuing high levels of child mortality in rural Punjab, despite favourable conditions in terms of nutrition, income, women's literacy and health care facilities are examined. A major factor is that inadequate attention has been paid to improved health care practices within the home. Women's autonomy, social class, and mothers' education significantly influence child survival. One of the pathways by which mothers' education affects child survival is through improved child care. In this society, a woman's autonomy is lowest during that part of her life-cycle which also contains her peak childbearing years: this perverse overlap raises child mortality. The risk of dying is distributed very unevenly amongst children, as the majority of child deaths are clustered amongst a small proportion of the families. The death-clustering variable remained significant even after several possible biological and socio-economic reasons for clustering had been controlled. It is argued that this clustering of deaths is partly due to the poor basic abilities of some mothers and other carers.     

生育与死亡转变对人口老龄化和老年抚养的影响

上海、北京和天津市在20世纪都经历了生育率急剧下降和预期寿命大幅度上升。生育率和死亡率的这些变化形成并将继续形成大量的老年人口。文章分析了这三大城市及中国的老年人口状况和未来的增长趋势,并就中国及这三个城市的人口趋势对老年抚养的影响进行讨论。     

About the Effect of Changes in Age-specific Mortality on Life Expectancy

About the Effect of Changes in Age-Specific Mortality on Life Expectancy