The impact of early-life economic conditionson cause-specific mortality during adulthood

The aim of this study is to assess the effects of economic conditions in early life on cause-specific mortality during adulthood. The analyses are performed on a unique historical sample of 14,520 Dutch individuals born in 1880–1918, who are followed throughout life. The economic conditions in early life are characterized using cyclical variations in annual real per capital gross domestic product during pregnancy and the first year of life. Exposure to recessions in early life appears to significantly increase cancer mortality risks of older males and females. It also significantly increases other mortality risks especially for older females. The residual life expectancies are up to about 8 and 6 % lower for male and female cancer mortality, respectively, and up to about 5 % lower for female cardiovascular mortality. Our analyses show that cardiovascular and cancer mortality risks are related and that not taking this association into account leads to biased inference.     

Changing mortality patterns that led life expectancy in Japan to surpass Sweden’s: 1972–1982

Between 1972 and 1982, Japan caught up to and then surpassed Sweden as the country with the longest life expectancy. The contributions of different causes of death and age groups to life expectancy changes in males during this time period are examined in detail for these two countries. Even though cerebrovascular disease mortality rates remained lower in Sweden over the entire interval, the rapid gain made by Japan relative to Sweden for this cause of death was a prime factor in Japan's ending the period with a higher life expectancy. Important contributions to life expectancy improvement in Japan came from declining mortality rates in those aged 55 and older.     

The Contribution of Smoking to Black-White Differences in U.S. Mortality

Smoking has significantly impacted American mortality and remains a major cause of morbidity and mortality. No previous study has systematically examined the contribution of smoking-attributable deaths to mortality trends among blacks or to black-white mortality differences at older ages over time in the United States. In this article, we employ multiple methods and data sources to provide a comprehensive assessment of this contribution. We find that smoking has contributed to the black-white gap in life expectancy at age 50 for males, accounting for 20 % to 48 % of the gap between 1980 and 2005, but not for females. The fraction of deaths attributable to smoking at ages above 50 is greater for black males than for white males; and among men, current smoking status explains about 20 % of the black excess relative risk in all-cause mortality at ages above 50 without adjustment for socioeconomic characteristics. These findings advance our understanding of the contribution of smoking to contemporary mortality trends and differences and reinforce the need for interventions that better address the needs of all groups.     

Some aspects of socio-economic determinants of mortality in tropical Africa

Measurements of mortality levels and trends continue to be inadequate in Africa, largely because of the lack of reliable and adequate information on deaths. A series of estimates depicting mortality levels and trends has been prepared by demographers, different kinds of data and employing different estimation procedures, but knowledge of the "true" structure of mortality in tropical Africa is virtually nonexistent. Because of these problems only a "bird's eye view" of the prevailing situation in tropical Africa is presented. The discussion -- directed to mortality by sex and age, by residence, and by cause -- is based on secondary and fragmentary data. Socioeconomic and cultural determinants of mortality are also examined. Available information on male and female mortality indicates that the death rates for males are higher than they are for females. Early childhood mortality (1-4 years) in tropical Africa is relatively high compared with the other age groups, including infants. Mortality differentials have been noted among geographical and administrative units and subdivisions of populations within the various countries of tropical Africa. Also, urban dwellers enjoy a higher expectation of life at birth than do rural dwellers. Communicable diseases are the main killers in tropical Africa. Persistent poverty and malnutrition, poor housing, unhealthy conditions in the growing cities, nonexistence of health facilities in the rural areas, rapid population expansion, and low levels of education are among the factors impeding progress in reducing mortality in tropical Africa. The need exists to express development goals in terms of the progressive reduction and eventual elimination of malnutrition, disease, illiteracy, squalor, and inequalities. Future trends in mortality in tropical Africa may depend more than they have in the recent past on economic and social development.     

The Dynamics of Welfare Opinions in Changing Economic, Institutional and Political Contexts: An Empirical Analysis of Dutch Deservingness Opinions, 1975–2006

Long-term trends in deservingness opinions and how these fluctuate in relation to changes in the economic, institutional and political contexts have not often been examined. In this paper, we address these trend questions by analyzing 22 waves of the repeated cross-sectional Cultural Change in The Netherlands (CCN, 1975–2006) survey. Our analyses show fairly stable public deservingness opinions regarding five different needy groups over the long term. Over the short term, opinions fluctuate more. Explanatory analyses show that economic and political factors, but not institutional factors, are especially influential over fluctuations in opinions. When real GDP grows, the Dutch public is more likely to consider the disabled, the elderly and social assistance beneficiaries deserving of more welfare support. In addition, when unemployment rises, the unemployed and social assistance beneficiaries are more likely to be seen as deserving of more support. Finally, when the national political climate is more leftist, most needy groups are considered to be deserving of more welfare support.     

Persistence,Mean-Reversion and Non-linearities in Infant Mortality Rates

This study examines the time series behavior of infant mortality rates within a long memory approach with non-linear trends using data for 37 countries. The main results show significant differences both in the degree of integration and non-linearities among the analyzed series. Furthermore, non-linearities in the time trends are found in most of the cases, in contrast with the main assumption of linearity used in the literature. Finally, the results on the integration order of the series have important policy implications in many areas, such as on international convergence in mortality rates, on the income and infant mortality relationship, and, on whether health policy interventions will have transitory or permanent effects on infant mortality rates.     

Sex Ratio at Birth and Infant Mortality Rate in China: An Empirical Study

In this article, we used the data from the last three population censuses of China in 1982, 1990 and 2000, to study the dynamics of the sex ratio at birth and the infant mortality rate in China. In the late 1970s, China started its economic reform and implemented many family planning programs. Since then there has been great economic development and a dramatic decrease in fertility in most of its provinces. Along with these achievements, the sex ratio at birth of the Chinese population has increased to significantly more males to females, and in some provinces of China reached unprecedented levels. The ratio of infant mortality of the males to females for manyprovinces in China become extremely unbalanced with a much higher female infant mortality rate. In our study, we investigated the statistical relationship between the sex ratio at birth and the ratio of the infant mortality of males to female. Social and economic reasons for these unnatural trends are also discussed.     

Mortality attributable to obesity among middle-aged adults in the united states

Obesity is considered a major cause of premature mortality and a potential threat to the longstanding secular decline in mortality in the United States. We measure relative and attributable risks associated with obesity among middle-aged adults using data from the Health and Retirement Study (1992–2004). Although class II/III obesity (BMI _ 35.0 kg/m2) increases mortality by 40% in females and 62% in males compared with normal BMI (BMI = 18.5-24.9), class I obesity (BMI = 30.0-34.9) and being overweight (BMI = 25.0-29.9) are not associated with excess mortality. With respect to attributable mortality, class II/III obesity (BMI _ 35.0) is responsible for approximately 4% of deaths among females and 3% of deaths among males. Obesity is often compared with cigarette smoking as a major source of avoidable mortality. Smoking-attributable mortality is much larger in this cohort: about 36% in females and 50% in males. Results are robust to confounding by preexisting diseases, multiple dimensions of socioeconomic status (SES), smoking, and other correlates. These findings challenge the viewpoint that obesity will stem the long-term secular decline in U.S. mortality.     

Injury and violence: a public health perspective

This report examined injury and violence from a public health perspective. The discussion focuses on the magnitude of the problem, age and regional patterns, war mortality, motor vehicle accidents, natural disasters, US injury and violence mortality and morbidity trends by age, the history of injury, the relationship between energy and injury, similarities between disease and injuries, injury and violence prevention, risk factors, and medical care. The US has two Centers for Disease Control surveillance systems for monitoring behavior that increases the risk of injury or disease. A youth surveillance system surveys high school students about high risk behavior, such as use of weapons and nonuse of seat belts. The surveillance system misses the homeless and people without telephones and undersamples minorities, low income people, and males. Youth surveillance misses groups with high dropout rates, such as Blacks and Hispanics. Lower income people have higher disease and injury rates. US Black males are particularly vulnerable. Health professionals that aim to reduce injury risks must address underlying conditions that perpetuate poverty, such as residential segregation, racial discrimination, unemployment, and inferior educational opportunities. Survival of the injured is dependent on the speed with which Emergency Medical Teams can treat the injury. Treatment within the first hour is a critical determining factor. Specialized trauma centers and emerging technologies, such as geographic information systems, improve survival. The global diffusion of beliefs, values, and practices can promote or inhibit injury and violence.     

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.     

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.     

For richer, if not for poorer? Marriage and divorce over the business cycle

Despite anecdotal evidence that recessions affect marriage and divorce rates, researchers do not agree about the direction and magnitude of the relationship. This paper reexamines the effect of business cycles on flows into and out of marriage, finding that increased unemployment rates are associated with reductions in both outcomes. The results are robust to the use of alternative measures of economic conditions, hold for both blacks and whites, and are concentrated among working-age individuals. Lag specifications and impulse response functions suggest that the effect of an unemployment shock on marriage is permanent, while the effect on divorce is temporary.     

Aging population scenarios: an Australian experience

During the past decade, there has been wide public discussion about the effects of population and immigration policies. There is some consensus that an older population imposes economic costs but uncontrolled population growth imposes congestion and environmental burdens. While many realize that policies which restrict population tend to exacerbate aging, the inevitable trade-off is not widely acknowledged. Fewer still appreciate that there is a sustainable age distribution that is largely imposed on us by nature that cannot be defeated in the long term. In this paper, we look at the ‘aging issue’ for Australia by looking at the total population and age distribution as a joint outcome. For ease of interpretation, the age distribution is converted into a required retirement age (RRA) to maintain dependency ratios at 2010 levels. We examine the effects of alternative policy scenarios on total population and RRAs, benchmarked against a hypothetical population in zero population growth equilibrium. We account for differing demographic groups of immigrants and emigrants as well as trends in mortality. Policy scenarios can be well summarized by plotting the trajectory of the two outcomes, total population and RRA, with the equilibrium values as axes.     

Diverging Trends in Female Old‐Age Mortality: The United States and the Netherlands versus France and Japan

In the most advanced countries, child mortality and adult mortality under age 65 years have fallen so low that further improvement in life expectancy relies almost completely on the decline of mortality at older ages. This phenomenon is particularly pronounced among women, who are far ahead of men in survival rates. Thus, to project the future of life expectancy, this study focuses on trends in female life expectancy at ages 65 and older. Four countries are selected for this analysis: the United States, Netherlands, France, and Japan. It is particularly interesting to understand why American and Dutch trends in female old‐age mortality have been diverging from those in France and Japan for two decades. It is shown here that most of the divergence derives from the fact that decline in cardiovascular mortality is more and more offset by increases in other causes of death in the United States and the Netherlands, while the other two countries are more successful in reducing mortality from all causes at increasingly older ages. This latter phenomenon could represent a new stage of the health transition.     

Demographic transition and economic growth: Empirical evidence from Greece

Over the past decades, due to a combination of declining fertility rates and rising life expectancies, most industrialized countries have experienced aging populations and low numbers of young populations that may pose economic problems in the future. This paper investigates the relationship first between fertility rate and infant mortality rate and second among demographic changes, real wages and real output in Greece over the period 1960–96. When we control for fluctuations in overall economic activity and the labor market on the bivariate relationship between fertility and mortality rates, the evidence suggests that Granger-causation must exist in at least one direction. The results show that in the long run a decrease in infant mortality rates, taking into consideration economic performance and the labor market, causes a reduction in fertility rates. Also, employing the vector error-correction models, the variance decomposition analysis and the impulse response functions, the empirical results support the endogeneity of fertility choice to infant mortality, the labor market and the growth process. Received: 16 May 1999/Accepted: 18 September 2000     

Changing vital rates and age distributions

Abstract In a time of rapid change in birth and death rates demographers need to know the consequences of such changes for age distribution. Does the fall in death rates tend to make the age distribution older? It certainly enables individuals to grow older, but for population aggregates the effect depends on the ages at which mortality improves. Coale, Stolnitz, Schwarz, Lorimer, the United Nations and other writers have investigated trends in age-specific birth and death rates. In particular they have demonstrated that the falling mortality which is now nearly universal does not generally make the population older and sometimes makes it younger. The present article contributes a technique for further examination of this phenomenon.     

Business Cycles,Medicaid Generosity,and Birth Outcomes

Birth outcomes influence many aspects of later life health and wellbeing, making healthcare access during pregnancy a policy priority. Low-income mothers often depend on Medicaid, for which eligibility is determined by their income relative to state eligibility thresholds. The prevalence of adverse birth outcomes is known to exhibit cyclical variation, due in part to changes in the composition of women giving birth in response to changing economic conditions. However, cyclical variation in adverse birth outcomes also varies with respect to Medicaid eligibility thresholds. Our analysis uses birth-records data for 2000 through 2013, aggregated into 173,936 county-by-quarter observations and linked to county-level unemployment rates and state-level parental Medicaid thresholds. Using fixed-effects negative binomial models, we examine the role of Medicaid generosity in influencing birth outcomes across business cycles. We test for interactions between Medicaid and unemployment, hypothesizing that the negative effects of recessions are worse where Medicaid thresholds are more restrictive. We find that higher Medicaid generosity dampens the negative effects of recessions on birth outcomes. The extent to which Medicaid interacts with unemployment also varies according to the age and race composition of mothers; in particular, Black mothers are both most affected by unemployment and most responsive to Medicaid generosity. Given current concerns about racial gaps in both infant and maternal mortality, our findings suggest that Medicaid may be an important feature of a strategy to close gaps in the prevalence of adverse birth outcomes across racial groups, especially during bust years.     

Changing sex differences in life expectancy in Australia between 1970 and 1990

Between 1970 and 1990, Australia experienced a narrowing of its sex difference in life expectancy by just over one year, which is a substantial amount when compared to the experience of other industrialized nations. Most of this reduction materialized in the decade between 1980 and 1990. In this study we decompose the gender based survival difference in 1970, 1980 and 1990 into components that can be attributed to different causes of death. Our analysis indicates that a significant component of the constriction in the differential was due to males having made larger gains than females over time with respect to heart disease, accidents and violence excluding suicide, and lung cancer. A large part of the narrowing in female-male difference in life expectancy can be attributed to narrowing sex differences in mortality in the older ages. We discuss these findings in the context of emerging epidemiological trends in the industrialized world, and the implications these have for the future of the sex differential in survival.     

The choice among past trends as a basis for the prediction of future trends in old-age mortality

We explored the extent to which projections of future old-age mortality trends differ when different projection bases are used. For seven European countries, four alternative sets of annual rates of mortality change were estimated with age-period log-linear regression models, and subsequently applied to age-specific all-cause mortality rates (80+) in 1999 to predict mortality levels up to 2050. On average, up to 2050, e80 is predicted to increase further by 2.33 years among men and 4.03 years among women. Choosing a historical period of 25 instead of 50 years results in higher predicted gains in e80 for men but lower gains for women. Choosing non-smoking-related mortality instead of all-cause mortality leads to higher gains for women and mixed results for men. In all alternatives there is a strong divergence of predicted mortality levels between the countries. Future projections should be preceded by a thorough study of past trends and their determinants.