Disease prevalence,disease incidence,and mortality in the United States and in England

We find that both disease incidence and disease prevalence are higher among Americans in age groups 55–64 and 70–80, indicating that Americans suffer from higher past cumulative disease risk and experience higher immediate risk of new disease onset compared with the English. In contrast, age-specific mortality rates are similar in the two countries, with an even higher risk among the English after age 65. We also examine reasons for the large financial gradients in mortality in the two countries. Among 55- to 64-year-olds, we estimate similar health gradients in income and wealth in both countries, but for 70- to 80-year-olds, we find no income gradient in the United Kingdom. Standard behavioral risk factor’s (work, marriage, obesity, exercise, and smoking) almost fully explain income gradients among those aged 55–64 in both countries and a significant part among Americans 70–80 years old. The most likely explanation of the absence of an English income gradient relates to the English income benefit system: below the median, retirement benefits are largely flat and independent of past income, and hence past health, during the working years. Finally, we report evidence using a long panel of American respondents that their subsequent mortality is not related to large changes in wealth experienced during the prior 10-year period.     

US mortality in an international context: age variations

Compared to other developed countries, the United States ranks poorly in terms of life expectancy at age 50. We seek to shed light on the US's low life expectancy ranking by comparing the age-specific death rates of 18 developed countries at older ages. A striking pattern emerges: between ages 40 and 75, US all-cause mortality rates are among the poorest in the set of comparison countries. The US position improves dramatically after age 75 for both males and females. We consider four possible explanations of the age patterns revealed by this analysis: (1) access to health insurance; (2) international differences in patterns of smoking; (3) age patterns of health care system performance; and (4) selection processes. We find that health insurance and smoking are not plausible sources of this age pattern. While we cannot rule out selection, we present suggestive evidence that an unusually vigorous deployment of life-saving technologies by the US health care system at very old ages is contributing to the age-pattern of US mortality rankings. Differences in obesity distributions are likely to be making a moderate contribution to the pattern but uncertainty about the risks associated with obesity prevents a precise assessment.     

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.     

The effects of demographic factors on age composition and the implications for per capita income

Multiple regression analysis techniques are used to measure the impact of variations in fertility and mortality rates on the population of labor-force age. The results of this analysis suggest that the impact of reductions in mortality on age composition are dependent on the level of mortality already attained, whereas reductions in fertility, as expected, increase the population in the nondependent age groups. The direct effect of vital rates on potential per capita income is assessed using the results of the regression equations, and such results suggest that variations in per capita income as large as 20 percent could be accounted for by variations in vital rates.     

Mortality of American Troops in the Iraq War

We estimate the death rate of United States troops deployed to Iraq from the beginning of the US invasion through 30 September 2006. Eighty percent of the deaths in Iraq were combat‐related. The death rate in Iraq is lower than that of the civilian population of the United States but substantially higher than that of young adults. It is much lower than the death rate of US troops in Vietnam, in part because a much smaller fraction die among those wounded in Iraq. We also estimate relative mortality levels for US troops according to numerous demographic variables through 30 November 2006. The risk of death in Iraq per deployment is shown to be highest for Marines; Naval and Air Force personnel in Iraq have lower death rates than the civilian population of comparable age. Other categories with above‐average mortality in Iraq are enlisted troops, males, younger persons, and Hispanics.     

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.     

Changing causes of death and the sex differential in the USA

This paper examines the sex differential in US life expectancy, the changes in this differential over the past 25 years and into the near future, and the apportionment of these differences among the leading causes of death. Movements in the sex differential over the years 1960–1985 were largely determined by changes in the accidents and violence and heart disease causes of death. The use of the life expectancy measure emphasizes the importance of those causes of death that impact most severely at younger ages. The historical analysis is extended through projections of life expectancies by sex. In the projections increased cancer mortality among males contributes to a widening differential, tempered by greater progress against heart disease for males.This is a revised version of a paper presented at the meetings of the Population Association of America, 30 April-2 June 1992, in Denver, Colorado.     

人口老龄化、老年贫困与养老保障--基于德国的数据与经验

人口老龄化及老年女性比重较高增加了老年贫困的概率。对此,德国主要采取两项对策避免老年贫困：养老保障是第一道防线,里斯特／吕鲁普养老金、最低养老金等都是重要的政策选项;社会救助提供了最后一道有效安全网。借鉴德国经验,中国应通过完善多支柱模式并逐步扩大第二支柱比重、养老保险参量改革、建立老年低收入群体收入保护机制、建立健全老年社会救助制度等措施来有效解决人口老龄化过程中老年人特别是老年低收入群体的养老保障问题,有效规避老年贫困风险。     

Child marriage in India]

Child marriages have been practiced in India for thousands of years. Even though its popularity has now decreased due to changes in law and society, it is still a major problem, causing a great deal of hardship. Even though laws prohibited child marriage as early as 1860, statistics show that, on the average, Indians marry very young (1972: females at age 17; males at age 22 years of age; 34 females and 13 males under age 15). The following are incentives to marry young and have large families: 1) religion teaches that only those with descendants go to heaven; 2) unmarried women are traditionally scorned; and 3) most importantly, economic reasons encourage people to have large families as soon as possible, e.g., male children are encouraged to marry to obtain the dowry as soon as possible and children are considered a source of income in India. Child marriage in India causes the following problems: 1) a high infant mortality rate, as much as 75% in rural areas; 2) an imbalance in the male to female ratio (1901: 970 females/1000 males; 1971: 930 females/1000 males) because women who marry young tend to lose their health earlier; 3) a population explosion: in 1971, the Indian population was found to be increasing at the rate of 225/1000.     

Recent health trends in the Native American population

This paper reviews the changes in the health status of Native Americans since the mid-1950s, how the disease pattern differs from non-Natives, and regional differences within the Native American population. Despite some limitations, data from the Indian Health Service indicate that substantial decline in the infant mortality rate and mortality from such infectious diseases as tuberculosis and gastroenteritis has occurred. With the exception of cardiovascular diseases and cancer, the risk of death from most causes are higher among Native Americans than the total US population. Geographic variation in disease rates can be demonstrated, most notable in diabetes. The unique pattern of diseases among Native Americans reflect the interaction of environmental and genetic factors. Genetic susceptibility plays a significant role in some diseases, such as diabetes, while for others, the generally lower socioeconomic status, higher prevalence of certain health risk behaviors and lower utilization of preventive services in the Native American population are important determinants.     

A Comparison of US and Canadian Mortality in 1998

On average, Americans die earlier than Canadians. An estimate based on comparing the number of actual US deaths with the number that would have obtained had Canadian age‐ and sex‐specific death rates applied to the US population shows an excess number of US deaths in 1998 amounting approximately to 253,000. Excess US deaths were especially numerous among older women, middle‐aged men, and nonwhites. Circulatory diseases were the major cause of excess deaths. Prevalences of two of the major risk factors for circulatory deaths—smoking and hypertension—were higher in Canada than in the US. But obesity was higher in the US, suggesting a likely important role that obesity plays in higher mortality in the US relative to Canada. Comparisons of the level, age pattern, and causes of US and Canadian mortality, however, raise more questions than currently available data can answer.     

The Association Between Individual Income and Remaining Life Expectancy at the Age of 65 in the Netherlands

This article quantifies the association between individual income and remaining life expectancy at the statutory retirement age (65) in the Netherlands. For this purpose, we estimate a mortality risk model using a large administrative data set that covers the 1996–2007 period. Besides age and marital status, the model includes as covariates individual and spouse’s income as well as a random individual specific effect. It thus allows for dynamic selection based on both observed and unobserved characteristics. We find that conditional on marital status, individual income is about equally strong and negatively associated with mortality risk for men and women and that spouse’s income is only weakly associated with mortality risk for women. For both men and women, we quantify remaining life expectancy at age 65 for low-income individuals as approximately 2.5 years less than that for high-income individuals.     

The increase in marital status differences in mortality up to the oldest age in seven European countries, 1990-99

We investigate mortality differentials by marital status among older age groups using a database of mortality rates by marital status at ages 40 and over for seven European countries with 1 billion person-years of exposure. The mortality advantage of married people, both men and women, continues to increase up to at least the age group 85-89, the oldest group we are able to consider. We find the largest absolute differences in mortality levels between marital status groups are at high ages, and that absolute differentials are: (i) greater for men than for women; (ii) similar in magnitude across countries; (iii) increase steadily with age; and (iv) are greatest at older age. We also find that the advantage enjoyed by married people increased over the 1990s in almost all cases. We note that results for groups such as older divorced women need to be interpreted with caution.     

The increase in marital status differences in mortality up to the oldest age in seven European countries, 1990–99

We investigate mortality differentials by marital status among older age groups using a database of mortality rates by marital status at ages 40 and over for seven European countries with 1 billion person-years of exposure. The mortality advantage of married people, both men and women, continues to increase up to at least the age group 85–89, the oldest group we are able to consider. We find the largest absolute differences in mortality levels between marital status groups are at high ages, and that absolute differentials are: (i) greater for men than for women; (ii) similar in magnitude across countries; (iii) increase steadily with age; and (iv) are greatest at older age. We also find that the advantage enjoyed by married people increased over the 1990s in almost all cases. We note that results for groups such as older divorced women need to be interpreted with caution.     

The variance of population characteristics in stable populations, with applications to the distribution of income

Summary Stable population theory has recently been used to analyse the effects of changes in fertility and mortality on economic variables such as income per head. In this paper more general results are derived to describe the effects of changing vital rates on the variance and higher moments of the distribution of some age-dependent variable. Simple analytical expressions are derived which decompose the effects of changes in age structure into the effects on inter-cohort and intra-cohort variance. The results are easily applied to standard measures of the distribution of income. By combining the analytical results with actual age profiles of income and income variance from the United States and Brazil it is observed that both the magnitude and direction of the effects of population growth on measured inequality are sensitive to the specific age profiles used. The most surprising result is that the Brazilian age profiles suggest that higher growth rates may actually reduce measured inequality, although the effect is relatively small.     

Losses of Expected Lifetime in the United States and Other Developed Countries: Methods and Empirical Analyses

Patterns of diversity in age at death are examined using e ^†, a dispersion measure that equals the average expected lifetime lost at death. We apply two methods for decomposing differences in e ^†. The first method estimates the contributions of average levels of mortality and mortality age structures. The second (and newly developed) method returns components produced by differences between age- and cause-specific mortality rates. The United States is close to England and Wales in mean life expectancy but has higher life expectancy losses and lacks mortality compression. The difference is determined by mortality age structures, whereas the role of mortality levels is minor. This is related to excess mortality at ages under 65 from various causes in the United States. Regression on 17 country-series suggests that e ^† correlates with income inequality across countries but not across time. This result can be attributed to dissimilarity between the age- and cause-of-death structures of temporal mortality reduction and intercountry mortality variation. It also suggests that factors affecting overall mortality decrease differ from those responsible for excess lifetime losses in the United States compared with other countries. The latter can be related to weaknesses of health system and other factors resulting in premature death from heart diseases, amenable causes, accidents and violence.     

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.     

Urban Form,Heart Disease,and Geography: A Case Study in Composite Index Formation and Bayesian Spatial Modeling

Recent studies indicate a relationship between measures of urban form as applied to urban and suburban areas, and obesity, a risk factor for heart disease. Measures of urban form for exurban and rural areas are considerably scarce; such measures could prove useful in measuring relationships between urban form and both mortality and morbidity in such areas. In modeling area-level mortality, geographic relationships between counties warrant consideration because geographically adjacent areas tend to have more in common than areas farther from each other. We modify county-level indices of urban form found in the literature so that they can be applied to exurban and rural counties. We then use these indices in a Bayesian spatial model that accounts for spatial autocorrelation to determine if there is a relationship between such measures and cardiovascular disease mortality for white males age 35 and older for the time period 1999–2001. Issues related to the formation and usefulness of the indices, and issues related to the spatial model, are discussed. Maps of observed and expected relative risk of mortality are presented. Jimmie Givens retired from his service.     

The spread of HIV into the general population of the USA: A simulation

The spread of HIV from injection drug users and male homosexuals into the general US population is simulated, using survey data on sexual behavior. We estimate that approximately 150,000 persons are currently infected with HIV through heterosexual transmission, the majority of whom are female partners of drug-using or bisexual men. The estimated number of AIDS cases generated by the model is close to the CDC statistics for males, but much higher for females. We conclude that prevention efforts should be targeted towards these high risk groups rather than the general population.Abbreviations IDU injection drug users - NORC National Opinion Research Center; Chicago - STD sexually-transmitted disease     

Falling Short of Highest Life Expectancy: How Many Americans Might Have Been Alive in the Twentieth Century?

Life expectancy at birth in the United States during the twentieth century was lower than in many other highly developed countries. We investigate how this mortality disadvantage in the last 100 years translates into the number of hypothetical lives lost and their sex and age structure. We estimate the hypothetical US population if it had experienced in each decade since 1900 the mortality level of the country with the then highest life expectancy and compare the results to the actual figures in 2000. By 2000, the number of additional people who could have been alive had the mortality levels in the United States been as low as those in countries with the highest life expectancy was 66 million. This number is distributed equally between males and females. Suboptimal mortality at reproductive ages is crucial for the cumulative effect of potential lives lost, resulting from premature deaths of women who could still become first‐time mothers or bear additional children. Out of the 66 million additional persons who could have been alive in 2000, 45 million are attributable to those indirect deaths. Although the differences in the composition of the population by sex and age under the two mortality regimes are minor, the majority of people who might have been alive—54 million—were of working age or younger.