Underlying and multiple causes of death related to smoking

Although smoking has been linked to various causes of death, there is no systematic account of the underlying and multiple cause-of-death distributions associated with various smoking statuses. We analyze such patterns by age and gender for the USA in 1986. Our study is based on a one-percent random sample of decedents 25 and over in the USA for whom survey data from informants were linked to death certificate data. Smoking is related to several underlying causes of death, the most common being circulatory diseases. Lung cancer is less prevalent than circulatory diseases or other cancers among ever smokers. Multiple medical conditions are common for both smokers and nonsmokers, but particular combinations vary among persons with different smoking statuses. Former smokers who quit soon before death and were under frequent medical care are most likely to have had lung cancer. Amount of smoking is tied to variations in cause-of-death patterns. Differences by age and gender are not substantial, although other cancers appear frequently for both smokers and non-smokers among women. The distribution of medical causes of death for ever smokers is not radically different from that of never smokers. However, differences in cause patterns are seen when smoking statuses are detailed by amount of smoking and timing of quitting. These similarities and differences in cause patterns must be related to the fundamental fact that the average smoker will die earlier than the average nonsmoker. Such findings should especially influence programs for diseases whose links to smoking have been underestimated.     

The future of sex mortality differentials in industrialized countries: A structural hypothesis

This paper advances the hypothesis that the future of sex mortality differentials in industrialized countries may depend on the future mortality rates of blue collar men. Data are presented to support the argument that mortality rates from ischemic heart disease for this population subgroup play a significant role in current differentials and, furthermore, that sexsocial class-mortality differentials correspond to social structural differences in protection against and/or exposure to health risks. Research and policy implications of this argument are addressed briefly.The views expressed in this paper are those of the authors and do not necessarily reflect the policy or views of the World Health Organization.     

Estimates of coverage of the population by sex,race, and age in the 1970 census

Several estimates of total net underenumeration and of net census errors by sex, race (white, Negro-and-other-races, Negro), and age (five-year groups) in the 1960 and 1970 Censuses, for the total population of the United States, derived by the methods of demographic analysis, are presented. The different data, procedures, and assumptions employed in developing the various estimates are described briefly, and the findings are then discussed in terms of a”preferred” set of estimates. The preferred set of estimates of corrected population for 1970 combines estimates for persons under age 35 based directly on birth, death, and migration statistics, estimates for females aged 35 to 64 based on the Coale-Zelnik estimates (white) for 1950 or the Coale-Rives estimates (Negro) for 1960, estimates for males aged 35 to 64 based on the use of expected sex ratios, and estimates for the population 65 and over based on”Medicare” enrollments and expected sex ratios. These estimates indicate an overall net underenumeration of 5.3 million persons or 2.5 percent in 1970, as compared with 5.1 million or 2.7 percent in 1960, and a net underenumeration of 1.9 percent for whites and of 7.7 percent for Negroes in 1970, as compared with 2.0 percent and 8.0 percent, respectively, in 1960. As in 1960, undercoverage in 1970 was greatest for Negro males (9.9 percent); net error rates exceeded 12 percent in each age group 20 to 49 and reached 17 to 19 percent at ages 25 to 44. All sex-race groups showed marked increases between 1960 and 1970 for children under ten and marked declines at ages ten to 24. Equally reliable estimates of population coverage cannot be prepared for states and smaller geographic units or for the population of Spanish ancestry.     

Federal job training programs and employment outcomes: Effects by sex and race of participants

This article examines the extent to which the program activity assignments of participants in federal job training programs affect their future employment prospects. We analyze the effects of three types of programs—classroom training, on-the-job training, and work experience—on the post-program employment outcomes of black and white women and men. The data are from the Continuous Longitudinal Manpower Survey of fiscal 1976 participants in the Comprehensive Employment and Training Act (CETA). Logistic regression and event history analysis are used to assess the likelihood of immediate employment upon leaving CETA and the rates at which participants enter and leave their first post-program spells of employment and nonemployment.     

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.     

Comparison of information on death certificates and matching 1960 census records: age,marital status,race, nativity and country of origin

A sample of death certificates matched with 1960 Census records permitted comparison of response data for items asked on both records. Estimates of bias in death rates which are based on information from the two records are derived from the comparison data. Most of the comparisons yielded small discrepancies of inconsequential effect on the mortality rates. Some large inconsistencies, however, of potentially serious impact on the death rates were observed. The comparisons are examined and the implications of the results for the relevant mortality rates are discussed. In addition, age-specific death rates "corrected" for the disparities found in the age information on the two records are presented.     

The effects of race,ethnicity, and age on obesity

About 30% of Americans are obese, which is roughly a 100% increase from 25 years ago. This study examines the effects of changes in the racial/ethnic composition and age distribution on the prevalence of obesity, identifies the portion of the increase in obesity caused by these changes, and projects the effects of future racial/ethnic and age changes on obesity using National Health and Nutrition Examination Survey data. Results indicate that racial/ethnic composition changes and age distribution changes have accounted for about 10% of the increase in obesity over the last 25 years. However, future racial/ethnic and age changes are not projected to increase obesity substantially.      

Plague mortality rates by age and sex in the parish of St. Botolph's without Bishopsgate,London, 1603

The Bills of Mortality for London were instituted at least as early as 1528 but only a few figures survive before the extant annual series that begins in 1603. Ages at death, even in broad groups of ages, are not generally available until 1728, which is more than 50 years too late to give us any inkling of the ages, if any, at which people were specially susceptible to plague. There are reports, it is true, that suggest that children suffered from plague more severely than adults, at least on certain occasions (as in 1361 or 1418 for example), but nothing more precise. The legend of the Pied Piper of Hamelin may be a folk-memory of a plague (possibly in 1284) that killed mainly the children of the town, for the connection between infestation of rats and the loss of children suggests some kind of plague outbreak. Pollitzer concludes that no particular age group is specially liable to plague, and attributes all differences observed to different risks of exposure. The determinants of the severity of an outbreak would therefore be the environmental details and social customs.     

Plague mortality rates by age and sex in the parish of St. Botolph's without Bishopsgate, London, 1603

Abstract The Bills of Mortality for London were instituted at least as early as 1528 but only a few figures survive before the extant annual series that begins in 1603. Ages at death, even in broad groups of ages, are not generally available until 1728, which is more than 50 years too late to give us any inkling of the ages, if any, at which people were specially susceptible to plague. There are reports, it is true, that suggest that children suffered from plague more severely than adults, at least on certain occasions (as in 1361 or 1418 for example), but nothing more precise. The legend of the Pied Piper of Hamelin may be a folk-memory of a plague (possibly in 1284) that killed mainly the children of the town, for the connection between infestation of rats and the loss of children suggests some kind of plague outbreak. Pollitzer concludes that no particular age group is specially liable to plague, and attributes all differences observed to different risks of exposure. The determinants of the severity of an outbreak would therefore be the environmental details and social customs.     

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.     

The narrowing sex differential in life expectancy in high-income populations: Effects of differences in the age pattern of mortality

Using data from the Human Mortality Database for 29 high-income national populations (1751–2004), we review trends in the sex differential in e(0). The widening of this gap during most of the 1900s was due largely to a slower mortality decline for males than females, which previous studies attributed to behavioural factors (e.g., smoking). More recently, the gap began to narrow in most countries, and researchers tried to explain this reversal with the same factors. However, our decomposition analysis reveals that, for the majority of countries, the recent narrowing is due primarily to sex differences in the age pattern of mortality rather than declining sex ratios in mortality: the same rate of mortality decline produces smaller gains in e(0) for women than for men because women's deaths are less dispersed across age (i.e., survivorship is more rectangular).     

Mortality by sex,age, and cause of death,in European and highly developed extra-European countries in the years 1960-1984

"A comparative analysis of mortality, in which standardized death rates...were used, was conducted for 24 European and 5...[other] developed countries. The analysis shows that in spite of medical progress in fighting high mortality stemming from primary sources (diseases of [the] circulatory system and malignant neoplasms), its very high level is still registered in many Middle and Eastern European countries (especially in Hungary, in former Czechoslovakia and Poland). A high increase of premature mortality of men aged 45-64 is also observed."     

Heterogeneity,dependence among causes of death and Gompertz

Heterogeneity in a population with respect to mortality, or variation in “frailty”; among members of that population, which has been discussed extensively in the literature over the last decade and a half is essential to any realistic model of dependence among causes of death. The main problem then is the development of a mortality model incorporating heterogeneity and cause of death which is both realistic and of manageable proportions.

In a recent paper (J. H. Pollard, 1991), it has been shown that many life table results are remarkably insensitive to the strict shape of the mortality curve, at least for more developed populations, and that accurate approximations can in many cases be obtained knowing only the mortality rates at two representative ages (e.g. 50 and 70). These results and the Gompertz “law”; of mortality can be used to develop manageable approximate formulae for the expectation of life under heterogeneity and correlation among the causes of death. The formulae are confirmed by simulation.

Numerical results indicate, somewhat surprisingly, that the effects of correlation among causes of death, even at quite high levels, on expectation of life and changes on expectation of life when particular causes of death are reduced or eliminated are relatively minor.     

One-year rates of public shelter utilization by race/ethnicity,age, sex and poverty status for New York City (1990 and 1995) and Philadelphia (1995)

This study calculates public homeless shelter utilization rates by sex, race/ethnicity and age status for New York City (1990 and 1995) and Philadelphia (fiscal year 1995) to determine the relative risk for shelter use among different demographic groups in these cities. The resulting shelter utilization rates reveal large disparities among age groups and across racial/ethnic groups, as well as showing different trends in shelter utilization among the two cities. Among the results reported, the rate of shelter utilization declined by 11% in New York City over this period, while the overall utilization rate in Philadelphia has increased to where it is 40% higher than that of New York City. Children under age 5, at a rate of 0.0248, have the highest shelter utilization rate among the age groups studied and the overall rate for blacks is 2.3 times that of the overall population. And while shelter utilization rates among single men have decreased by 30% in New York City, a similar decrease has not occurred among women of early childbearing ages or among young children. Finally, policy implications related to these findings are discussed.     

Demographic scenarios by age,sex and education corresponding to the SSP narratives

In this paper, we translate the five narratives as defined by the Shared Socioeconomic Pathways (SSPs) research community into five alternative demographic scenarios using projections by age, sex and level of education for 171 countries up to 2100. The scenarios represent a significant step beyond past population scenarios used in the Intergovernmental Panel for Climate Change context, which considered only population size. The definitions of the medium assumptions about future fertility, mortality, migration and education trends are taken from a major new projections effort by the Wittgenstein Centre for Demography and Global Human Capital, while the assumptions for all the other scenarios were defined in interactions with other groups in the SSP community. Since a full data base with all country-specific results is available online, this paper can only highlight selected results.     

Temporal trends in U. S. multiple cause of death mortality data: 1968 to 1977

An analysis is made of the mortality trends over the period 1968 to 1977 indicated by two types of cause-specific mortality data. The first type of data is “underlying cause” of death data—the data heretofore used in national vital statistics reports on cause-specific mortality. The second type of data is “multiple cause” data which contain a listing of all medical conditions recorded on the death certificate. A comparison of trends in the two types of data yields useful insights on mortality declines over the study period for two reasons. First, these declines were largely due to a reduction in the mortality rates of circulatory diseases. Second, the multiple cause data contain considerably more information than the underlying cause data on the role of circulatory diseases, and many other chronic diseases, in causing death. This additional information is especially useful in examining mortality patterns among the elderly, where the prevalence at death of chronic degenerative diseases is high.