The measurement of historical trends in fetal mortality in England and Wales

This paper critically discusses recent attempts to estimate long-term trends in the stillbirth rate for England and Wales. It assesses the available historical evidence for the level of late-fetal mortality, drawing especially on examples from Norway, Sweden, and Denmark. A theoretical fetal-infant life table for a high-mortality population is also outlined as a means of analysing the relationship between segments of the conception-to-first-birthday mortality curve. Finally, new estimates of the stillbirth rate for England and Wales are proposed, based on variations in the early neonatal and maternal mortality rates during the 1930s. These estimates are substantially lower than the earlier estimates and are more in keeping with the available evidence from northern Europe. The implications of the revised estimates for interpretations of historical changes in mortality patterns are also considered.     

Mortality in New Zealand and England and Wales

This paper compares age-specific mortality rates in England and Wales with those of New Zealand. Differences in rates are greatest at the younger age groups, and are particularly high for infants under 1 year and children between 1 and 5 years. The age-specific mortality rates for females under 25 years and for males under 35 years are analysed by causes of death in order to discover where the main differences between the two countries occur, and for infant mortality in England and Wales a further analysis has been made by social class. The greatest room for improvement in England and Wales mortality rates, as compared with New Zealand rates, is at ages under 5 years, and in infant mortality in particular the greatest differences between England and Wales and New Zealand rates by causes of death are for those causes usually associated with environmental influences.     

The effect of long-term migration dynamics on population structure in England & Wales and Scotland

We investigated the effect of migration on population dynamics in England & Wales and Scotland from the mid-nineteenth century to the present by comparing actual population size and structure with estimates based on zero net migration from a range of starting dates. In this period, Scotland had the largest net outflow among countries in Europe for which detailed information is available, whereas overall net migration in England & Wales was close to zero. In the absence of migration, population would have been over twice as large in Scotland in 2013 as the actual value, but similar to its actual value in England & Wales. Levels and pace of population ageing have been broadly similar in both countries, so the major impact of differential migration has been on population size rather than structure. We discuss these findings in relation to the debate on migration policy between political parties supporting and opposing independence in the 2014 Scottish referendum.     

Fertility in England and Wales: a fifty-year perspective

This paper provides a detailed account of fertility levels and trends in England and Wales since 1938, with a briefer coverage of a much longer time-span. The paper is concerned both with the measurement of fertility and with understanding the observed fertility behaviour. We lament and correct the failure of demographers to apply measurement tools available since the 1950s to the analysis of fertility in England and Wales, with a particular emphasis on adjustment of period measures and period parity progression ratios and show how some of the grosser errors of analysis and interpretation might have been avoided by earlier use of these approaches. We also relate these estimates to more recent ones. Once a clearer account of trends has been established, the paper goes on to reinterpret and explain the baby boom and baby bust. The conclusion looks at future prospects for fertility.     

Fertility in England and Wales: A Fifty-Year Perspective

This paper provides a detailed account of fertility levels and trends in England and Wales since 1938, with a briefer coverage of a much longer time-span. The paper is concerned both with the measurement of fertility and with understanding the observed fertility behaviour. We lament and correct the failure of demographers to apply measurement tools available since the 1950s to the analysis of fertility in England and Wales, with a particular emphasis on adjustment of period measures and period parity progression ratios and show how some of the grosser errors of analysis and interpretation might have been avoided by earlier use of these approaches. We also relate these estimates to more recent ones. Once a clearer account of trends has been established, the paper goes on to reinterpret and explain the baby boom and baby bust. The conclusion looks at future prospects for fertility.     

Bridging the gap: Determining long-term changes in infant mortality in pre-registration England and Wales

Much effort has been expended in analysing a small sample of parish registers to produce national estimates of infant mortality for the period 1570–1840. However, in an age when inter-parish variations in infant mortality were considerable, national trends often obscured local and regional differences. By analysing data from the initial years of Civil Registration (1839–1846) together with infant mortality rates from a range of parishes, it is possible to assess the extent of variation and change in England and Wales during the period 1580–1840. The geographical variations in infant mortality and the age structure of infant deaths were sufficient to suggest that the most important influence on whether infants survived was disease environments.     

Early-life mortality clustering in families: A literature review

Research on early-life mortality in contemporary and historical populations has shown that infant and child mortality tend to cluster in a limited number of high-mortality families, a phenomenon known as ‘mortality clustering’. This paper is the first to review the literature on the role of the family in early-life mortality. Contemporary results, methodological and theoretical shortfalls, recent developments, and opportunities for future research are all discussed in this review. Four methodological approaches are distinguished: those based on sibling deaths, mother heterogeneity, thresholds, and excess deaths in populations. It has become clear from research to date that the death of an older child harms the survival chances of younger children in that family, and that fertility behaviour, earlier stillbirths, remarriages, and socio-economic status all explain mortality clustering to some extent.     

Urban‐Rural Mortality Differentials: An Unresolved Debate

Historians and demographers have long debated the existence, causes, and consequences of historical differences between urban and rural mortality levels. In Europe it has been usual to observe excess mortality in cities compared to the countryside, but in East Asia, by contrast, it has been found that urban areas had relatively favorable mortality environments. The debate continues because a number of pertinent questions remain to be resolved. For example, the way in which mortality is measured may influence the apparent extent of the differential, as may the way in which“urban” and“rural” are defined. Cultural factors need to be taken into account, including the practices of childrearing and the conventions surrounding baptism. Examples drawn from Japan, China, England, and France illustrate the issues involved in comparative analysis, while the urban‐rural mortality continuum is examined for nineteenth‐century England and Wales using log‐normal distributions.     

Infant Mortality and Socioeconomic Status: New Bottle,Same Old Wine

This paper presents the results of an ecological analysis of the relationship between infant mortality and economic status in metropolitan Ohio for the period 1960–2000. The data examined are centered on the five censuses undertaken during this 40-year period. The basic unit of analysis is the census tract of mother’s usual residence, with economic status being determined by the percentage of low income families living in each tract. For each of the five periods covered, census tracts were aggregated into broad income areas and three-year average infant mortality rates were computed for each area, by age, sex, race and exogenous-endogenous causes of death. The most important conclusion to be drawn from the data is that in spite of some very remarkable declines in infant mortality at all class levels since 1960, there continues to be a very clear and pronounced inverse association between income status and infant mortality. Indeed, the evidence indicates that the relationship has become stronger over the years. These observations are applicable for both sexes, for whites and nonwhites, for neonatal and postneonatal deaths, and for both major cause of death groups. It is concluded that while public health programs are important, any progress in narrowing this long-standing differential is unlikely unless ways can be found to enhance the economic well-being of the lower socioeconomic groups.     

Beyond infant mortality: gender and stillbirth in reproductive mortality before the twentieth century

Though it has been the largest component of reproductive mortality since its statutory registration in 1928, stillbirth has received little attention from historical demographers, who have relied on the more orthodox indicator of early human survival changes - "infant mortality". The exclusion of stillbirth hampers demographic analysis, underestimates progress in newborn vitality, and over-privileges post-natal causes in theoretical explanation. A case is made for estimating stillbirth before 1928 as a ratio of early neonatal death, and for employing perinatal mortality as an historical indicator of female health status. The long-run trend of reproductive mortality (encompassing mature foetal and live born infant death during the first eleven months) reveals a substantial decline in perinatal causes in the first industrial century (1750-1850), implying a major concurrent improvement in the nutritional status of child bearers. Reproductive mortality is a more complete indicator of death in infancy. It offers demographers a means of fracturing the fertility versus mortality dualism and a potential purchase on gender as a demographic variable, while re-opening the case on mortality in the demographic dynamic of the world we have lost.     

Infant mortality by Father’s occupation from the 1911 Census of England and Wales

Infant mortality in England and Wales only began its secular decline at the beginning of this century, although mortality among those aged 1-4 began to decline earlier. The 1911 Census of Fertility provides the basis for estimates of infant mortality among occupational groups. A diagrammatic model of decline is elaborated, using fertility decline, social class, income, and urban/rural distribution as explanatory variables. Results of the analysis suggest that infant mortality decline, whose average value was 35 percent from a peak of 132 per 1,000, was increased by improvements in the urban environment and advanced by high or regular income, whereas fertility decline had only a small effect.     

Mortality in England and Wales from 1848 to 1947

This is a survey of the changing causes of death in England and Wales during the past 100 years. Based on the published mortality statistics of the General Register Office the framework of the survey is a series of specially prepared tables of death rates by sex, age and cause of death for the periods 1848–72, 1901–10, 1921, 1931, 1939 and 1947. Adjustments were made wherever necessary to compensate for changes in medical nomenclature and in the statistical classification of disease.

After allowance has been made for the changing age structure of the population, the male death rate at all ages in 1947 was 42% of the rate in 1846–50, and the female rate 35 %. Maximum improvement was among girls aged 5–9 years, whose death rate in 1947 was 9% of the rate 100 years before.

In 1848–72 the group to which were allocated the largest proportion of the deaths at all ages were the infectious diseases with one-third of the total; and these were followed by the respiratory, nervous and digestive diseases. In 1947, on the other hand, diseases of the circulatory system came first with rather more than one-third of the total at all ages, and these were followed by cancer.

Changes in proportionate mortality rates from various causes have been examined at successive ages from infancy to old age. There was a decline in proportionate mortality from the infectious diseases other than tuberculosis, but increased mortality from tuberculosis in the younger age groups and from violence, circulatory diseases and cancer.

The trends of absolute mortality from the various causes were also studied. The reduction in total mortality was such that whereas there were half a million deaths of civilians registered in England and Wales in 1947, the total would have been over a million had the death rates of 1848–72 still prevailed.

The article concludes with a brief review of the factors responsible for the changes that have taken place.     

Comparing two survey methods for estimating maternal and perinatal mortality in rural Cambodia

PURPOSE: We need solid estimates of maternal mortality rates (MMR) to monitor the impact of maternal care programs. Cambodian health authorities and WHO report the MMR in Cambodia at 450 per 100,000 live births. The figure is drawn from surveys where information is obtained by interviewing respondents about the survival of all their adult sisters (sisterhood method). The estimate is statistically imprecise, 95% confidence intervals ranging from 260 to 620/100,000. The MMR estimate is also uncertain due to under-reporting; where 80-90% of women deliver at home maternal fatalities may go undetected especially where mortality is highest, in remote rural areas. The aim of this study was to attain more reliable MMR estimates by using survey methods other than the sisterhood method prior to an intervention targeting obstetric rural emergencies. PROCEDURES: The study was carried out in rural Northwestern Cambodia where access to health services is poor and poverty, endemic diseases, and land mines are endemic. Two survey methods were applied in two separate sectors: a community-based survey gathering data from public sources and a household survey gathering data direct from primary sources. FINDINGS: There was no statistically significant difference between the two survey results for maternal deaths, both types of survey reported mortality rates around the public figure. The household survey reported a significantly higher perinatal mortality rate as compared to the community-based survey, 8.6% versus 5.0%. Also the household survey gave qualitative data important for a better understanding of the many problems faced by mothers giving birth in the remote villages. There are detection failures in both surveys; the failure rate may be as high as 30-40%. PRINCIPLE CONCLUSION: Both survey methods are inaccurate, therefore inappropriate for evaluation of short-term changes of mortality rates. Surveys based on primary informants yield qualitative information about mothers' hardships important for the design of future maternal care interventions.     

Trends in Numbers and Mortality at High Ages in England and Wales

In the paper new estimates of the numbers of deaths and death rates at ages 80 and over in England and Wales are derived for the period 1911–90. These estimates were made by applying the methods of extinct generations and reverse survival to data on deaths in 1911–90, and pensioners in 1990. Estimates are given for individual years of age. It is found that death rates at these high ages have been falling, slowly, for the last 50 years. The paper also gives information on the highest ages at death which have been recorded and verified.     

Early-life conditions and adult mortality decline in Dutch cohorts born 1812–1921

Mounting evidence suggests that early-life conditions have an enduring effect on an individual’s mortality risks as an adult. The contribution of improvements in early-life conditions to the overall decline in adult mortality, however, remains a debated issue. We provide an estimate of the contribution of improvements in early-life conditions to mortality decline after age 30 in Dutch cohorts born between 1812 and 1921. We used two proxies for early-life conditions: median height and early-childhood mortality. We estimate that improvements in early-life conditions contributed more than five years or about a third to the rise in women’s life expectancy at age 30. Improvements in early-life conditions contributed almost three years or more than a quarter to the rise in men’s life expectancy at age 30. Height appears to be the more important of the two proxies for early-life conditions.     

Precision in population estimates

Summary

Given the Registrar General's estimate of the home population of a local government administrative area in England and Wales, is it possible to construct a 95 per cent. confidence interval for the true value? The author has attempted to provide an approximate answer to this question by considering estimates made before and after the 1951 census, together with such data as are available to improve the comparability of the estimates. The analysis suggests that urban and rural areas must be separately considered, and that the margin of error is of the order of five per cent, for the former and eight per cent. for the latter.     

Socio-economic Differentials in Infant and Child Mortality during Mortality Decline: England and Wales, 1890–1911

In this paper data from the 1911 Census of the Fertility of Marriage of England and Wales are used to study patterns of mortality decline by socio-economic characteristics, principally the occupation of husband. That census reported data on number of wives, children ever born, and children dead by marriage-duration cohorts for 190 non-overlapping occupations of husband. These results, along with those on number of rooms in the dwelling of the family are used to make indirect estimates of childhood mortality using the techniques described in United Nations, Manual X. These procedures produce values of q(a), the probability of dying before reaching some exact age ‘a’. Estimates for q(2), q(3), q(5), q(10), q(15), and q(20) are derived from data on women married 0–4, 5–9, 10–14, 15–19, 20–24, and 25–29 years, respectively. These estimates can also be dated to a point in the past. These values can also be converted to a corresponding level of a Model West life table, which describes the ‘average’ mortality regime which the children of those women experienced. This furnishes a basis to look at mortality decline for various social classes and occupational groups. Ordinary least squares regressions of the levels of Model West life tables implied by the 1(a) values on time give one measure of mortality decline. Another is the absolute amount of the increase in the level of the Model West life tables from marriage-duration cohort 20–24 years to 0–4 years. The aggregate results indicate that social class in England and Wales during the 1890s and 1900s tended to be related to the speed of mortality decline: childhood mortality declined more rapidly in the higher and more privileged social class groups. But the results were neither nearly as strong nor as regular as those which predicted the level of mortality within any marriage-duration cohort. These outcomes are not particularly sensitive to the three different social-class stratification schemes used: the 1911 English Registrar General's classification; the 1951 English Registrar General's classification; and the 1950 U.S. Census classification. There was also a fairly regular and predictable gradient for the number of rooms in the home: child mortality was higher in families who lived in larger dwellings. Analysis of 190 detailed male occupational groups revealed that considerably more of the variation in mortality levels than of trends could be explained by social-class categories. Between 20 and 40 per cent of variation in mortality trend could be accounted for by social class alone, as opposed to 50 to 80 per cent of mortality levels for different marriage-duration cohorts. Results for a more restricted sample of 116 occupations for which income estimates could be made revealed a similar pattern. In addition, income was virtually unrelated to the pattern of mortality decline, and improvement was more rapid in groups who were more urban. This reflects the role of rapidly improving urban sanitation in the late nineteenth and early twentieth centuries in England. In contrast, income was significantly related to childhood morality levels for various marriage-duration cohorts (with higher income associated with lower mortality), while urbanization was inversely correlated with mortality levels (more urban groups experienced higher mortality). Overall, social class (or occupation group), income, and urbanization were more successful in explaining mortality levels than time trends across occupations, although social class and the extent of urbanization did reasonably well in accounting for trends. Over a longer period, the transition in child mortality was under way by the 1890s, but its pace and timing varied in different occupations and social class groupings. Although absolute differences in infant mortality were reduced after about 1911, relative inequality persisted even as infant and child survival improved for all groups.     

A note on the under-registration of births in Britain in the nineteenth century

In this note an attempt has been made to estimate the incompleteness of birth registration in Great Britain in the first decades of civil registration. For Scotland, registration appears to have been reasonably complete after 1861. For England and Wales, however, there seems to have been a considerable initial deficiency, with a consistent improvement over time and no sudden change following the 1874 amending Act. The estimates given in this note suggest that, to allow for under-registration in England and Wales, registered births should be multiplied by a factor of about 1.094 for the period 1841-5, the factor falling steadily to 1.o by 1880. It should be emphasized that the methods of estimation used in this note are indirect and the results very approximate. In the view of the writer, the estimates tend in general to be somewhat too low, especially for the earlier part of the period covered.     

Future life expectancy in Australia,Europe, Japan and North America

Human life expectancy has risen in most developed countries over the last century, causing the observed demographic shifts. Babel, Bomsdorf and Schmidt (forthcoming) introduce a stochastic mortality model using panel data procedures which distinguishes between a common time effect and a common age effect of mortality evolvement. Using this mortality model, the present paper provides forecasts of future life expectancy for 17 countries divided into 12 regions: Australia, Alps, Bene, Canada, England and Wales, France, Germany, Italy, Japan, Spain, Scandinavia and the United States of America. We consider (traditional) period life expectancies as well as cohort life expectancies, the latter being a more realistic approach but less common. It turns out that a continuing increase of life expectancy is expected in all considered countries. Further, we show that the probabilistic uncertainty of forecast life expectancies is different if either period life expectancies or cohort life expectancies are considered and, moreover, the uncertainty increases substantially if the error of parameter estimation is included.