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

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

The influence of cause-specific mortality conditions on the age pattern of mortality with special reference to Taiwan

Abstract This paper discusses the relationship between the level of mortality at ages one to four, on one hand, and five to 34 on the other. This relationship has been observed to vary considerably among mortality schedules at different levels of mortality and even among schedules at the same general level of mortality. This variation is shown among the modem life table systems of the Regional Model Life Tables and the United Nations Model Life Tables. Controlling for the leyel ofmortality from age five to age 34, the West Tables and the United Nations Tables embody approximately the same 'average' relationship between early childhood and adult mortality. Relatively to this average relationship, the South and East Tables consistently display higher childhood mortality rates for a given level of adult mortality. Indeed, the childhood rates of the South Table are twice those of the West Tables over a range of life expectancy at birth from 40 to 70 years. The relationship between childhood and adult mortality from 1957 to 1968, a period of rapid mortality decline, was investigated in Taiwan. In 1957, the Taiwanese data reflected the severe childhood mortality of the South Model Tables. However, by 1968, due to an especially large decline in childhood mortality, this relationship was more moderate and resembled the mortality pattern of the West or East Model Tables. An analysis of the decline in cause-specific mortality during the period revealed that a dramatic decline in childhood mortality from gastro-enteritis was primarily responsible for the shift in the relationship between childhood and adult mortality in Taiwan. It is asserted that, while any of several diseases which result in fatalities primarily among children of pre-school ages, could cause relatively severe childhood mortality, gastro-enteritis is likely to be a primary contributor to such an age pattern. This assertion is based on the fact that, especially in the developing areas of the world, malnutrition and gastro-enteritis are usually precipitating and complicating factors of other childhood diseases. A limited test of this hypothesis was provided by considering the causal components of childhood mortality rates in two populations known, for certain periods, to have exhibited relatively severe childhood mortality conditions; Spain and Portugal. For the years in which those populations were characterized by the South mortality pattern, gastro-enteritis was a principal cause of mortality in childhood. Moreover, with the decline in mortality from gastro-enteritis, the mortality pattern in Spain and Portugal no longer exhibited childhood mortality rates which were severe relative to those of adult life. The implications of these findings for the analysis of mortality conditions in many areas of the developing world, where the gastro-enteritis malnutrition syndrome annually claims a heavy toll of life in early childhood, are not clear. In those areas, the effect of this syndrome on the age pattern of mortality could be offset by special conditions inflating adult mortality rates. Nevertheless, in circumstances where there is evidence indicating substantial childhood mortality from this syndrome and no evidence indicating compensating severe adult mortality, there is reason to suspect that the existing mortality pattern reflects the relatively severe childhood mortality conditions of the South Model Tables. Additionally, where mortality from the gastro-enteritis malnutrition syndrome has been severe in past years, but has been reduced to low levels in recent years, it is probable that the relationship between childhood and adult mortality will shift in favour of the former - quite possibly, in the manner of Taiwan, from a South to an East or West age pattern.     

The calculation of mortality-rates in the construction of life tables. A mathematical statistical study

Official life tables are frequently calculated for a period of years, rather than for an individual year, and the question arises, how annual rates are to be combined, in order to give an indication of the average mortality of the period. The author examines this problem, and uses methods based on the binomial probability distribution to suggest a solution of the ‘weighting’ problem. Taking as his starting-point the work of the Dutch statistician Van Pesch, he modifies the latter's theory so as to make it applicable to the case, where mortality rates have a secular downward trend, and reaches the conclusion that the ‘most probable values for the mortality rates are not obtained by applying the weighted mean, but by the application of a weighted mean and a correction term. The inclusion of the correction term means that, practically speaking, the results do not differ from those obtained by the application of the unweighted mean. The unweighted mean, which has the advantage of requiring less computational work, may therefore be given preference over the theoretically more accurate method.’     

The Impact of Social and Economic Indicators on Maternal and Child Health

As early as 1985, Rosenfield and Maine began to look at what is called the maternal child field (MCH). More than two decades later, maternal and infant mortality is still among the worst performing health indicator in resource-poor countries and regions, and it has barely changed since 1990. Although three of the eight United Nations Millennium Development Goals aim at reducing child mortality, maternal mortality, and promoting gender equality, most literature in the field is either clinical or exclusively deals with women’s health problems. In this study, I proposed an empirical model that tests the impact of gender equality, women’s human rights, and maternity care on MCH with economic and political development as background factors. The proposed model was tested by using structural equation analysis. Data were obtained from 137 developing countries. The proposed model is partially supported by the data. Empirical findings demonstrate that gender equality has a pivotal role to play in the promotion of MCH. The relationship between MCH and maternity care is found to be strong and statistically significant. This finding may permit a probable verification given the current social conditions in some developing countries, particularly the neglect of many of women’s health needs and the assignment of their primary responsibilities in childrearing. The women’s human rights hypothesis is not supported by the data. It is perhaps that human rights instruments provide a legal discourse for political functions and social welfare issues, but that the legal approach alone does not necessarily provide a moral and social foundation to ensure the implementation of social welfare and human well-being, particularly maternal and child health in developing countries. The findings also indicate the importance of economic development in predicting maternity care. Finally, a positive and statistically significant relationship is found between economic development and gender equality. Implications and limitations of the study are discussed.     

Cohort and life-course patterns in the relationship between education and health: A hierarchical approach

Recent medical sociological research has examined whether the relationship between education and health is dynamic across age, whereas recent demographic research has examined whether the relationship varies across cohorts. In this study, I examine how cohort structures the influence of education on life-course health trajectories. At the cohort level, changes in education and in the distribution of health and mortality make cohort differences in education's effect probable. At the life-course level, the effect of education may vary across age because the mediators of the education-health relationship may vary in their relevance to health across the life course. Using basic regression analyses and random-effects models of two national data sets, I find that the effect of education strengthens across age, that this pattern is becoming stronger across cohorts, and that these patterns are suppressed when either effect is ignored.     

Toward sociomedical health indicators

The various forms of mortality data and biomedical measures of morbidity have become inadequate measures of the level of health in economically developed countries. Measures of functional physical capacity have some advantages but do not reflect physical impairment. Current attempts to develop sociomedical health indicators include: measures of social disability; typologies of presenting symptoms, which have been used to estimate probable needs for care; measures which focus on behavioral expressions of sickness; research based on operational definitions of ‘positive mental health’, ‘happiness’ and perceived quality of life; assessments of met and unmet needs for health care, which are measures of social capacity to care for the sick. Sociomedical indicators reflect both objective conditions and social values. They are policy-oriented, serving as mobilizing agents for sociopolitical pressures concerned with raising the overall level of health of the population.     

Sex differences in the development of mild cognitive impairment and probable Alzheimer’s disease as predicted by hippocampal volume or white matter hyperintensities

This study examined biological sex differences in the development of mild cognitive impairment (MCI) and probable Alzheimer’s disease (AD) development as predicted by changes in the hippocampus or white matter hyperintensities. A secondary data analysis of the National Alzheimer’s Coordinating Center Uniform Data Set was conducted. We selected samples of participants with normal cognition at baseline who progressed to MCI (n = 483) and those who progressed to probable AD (n = 211) to determine if hippocampal volume or white matter hyperintensities (WMH) at baseline predicted progression to probable AD or MCI and whether the rate of progression differed between men and women. The survival analyses indicated that changes in hippocampal volumes affected the progression to probable AD (HR = 0.535, 95% CI [0.300–0.953]) only among women. White men had an increased rate of progression to AD (HR = 4.396, CI [1.012–19.08]; HR = 4.665, 95% CI [1.072–20.29]) compared to men in other race and ethnic groups. Among women, increases in hippocampal volume ratio led to decreased rates of progressing to MCI (HR = 0.386, 95% CI [0.166–0.901]). Increased WMH among men led to faster progression to MCI (HR = 1.048. 95% CI [1.011–1.086]). Women and men who were older at baseline were more likely to progress to MCI. In addition, results from longitudinal analyses showed that women with a higher CDR global score, older age at baseline, or more disinhibition symptoms experienced higher odds of MCI development. Changes in hippocampal volumes affect the progression to or odds of probable AD (and MCI) more so among women than men, while changes in WMH affected the progression to MCI only among men.     

Age,Period, Cohort and Early Mortality: An Analysis of Adult Mortality in Italy

Changes in adult mortality in Italy for cohorts born between 1882 and 1953 are analysed and interpreted by means of two different statistical models. The first, an Age–Period–Early Mortality (APEM) model, is employed to analyse the possible relationships between adverse conditions during the first 15 years of life and subsequent mortality. It is shown that higher mortality early in life is associated with higher mortality up to age 45 and lower mortality at latter ages. Finally, possible links between the observed decline in early mortality and the evolution of adult mortality are analysed and discussed.     

Socio-economic determinants of mortality in Latin America

The characteristics and sources of socioeconomic differentials of mortality in Latin America, in so far as they are currently known, are examined in an attempt to clarify the present situation and its perspectives. Mortality in a population is a function of the frequency of illness (incidence) and the probability of dying of the sick individual (lethality). Information on the socioeconomic differentials of mortality in Latin America is systematically reviewed with attention directed to the following: differentials among Latin American countries, regional differences within countries, urban-rural contrasts in mortality, mortality and income level and level of education, and mortality and ethnic groups. Latin America shows considerable heterogeneity with respect to the risk of dying, which varies from 202/1000 births in Bolivia to 38/1000 in Uruguay. It is estimated that more than 1/2 of the children born in Latin America are exposed to a mortality rate of over 120/1000. A study of the urban and rural populations of 12 Latin American countries revealed that the risk for rural populations exceeds that for urban populations by 30-60%. There is extensive evidence showing that mortality is higher in the working class and is associated with lower levels of education and income. Mortality was also higher in certain indigenous groups. Socioeconomic differentials of mortality are more marked in Latin America than in the developed nations. The mother's level of educational attainment is the variable most significantly associated with infant and child mortality. The prospect of reducing the current mortality levels is dependent primarily upon the implementation of policies aimed at a more egalitarian distribution of the benefits of socioeconomic development among the population.     

The Differential Mortality of Undesired Infants in Sub-Saharan Africa

With high rates of infant mortality in sub-Saharan Africa, investments in infant health are subject to tough prioritizations within the household, in which maternal preferences may play a part. How these preferences will affect infant mortality as African women have ever-lower fertility is still uncertain, as increased female empowerment and increased difficulty in achieving a desired gender composition within a smaller family pull in potentially different directions. I study how being born at a parity or of a gender undesired by the mother relates to infant mortality in sub-Saharan Africa and how such differential mortality varies between women at different stages of the demographic transition. Using data from 79 Demographic and Health Surveys, I find that a child being undesired according to the mother is associated with a differential mortality that is not due to constant maternal factors, family composition, or factors that are correlated with maternal preferences and vary continuously across siblings. As a share of overall infant mortality, the excess mortality of undesired children amounts to 3.3 % of male and 4 % of female infant mortality. Undesiredness can explain a larger share of infant mortality among mothers with lower fertility desires and a larger share of female than male infant mortality for children of women who desire 1–3 children. Undesired gender composition is more important for infant mortality than undesired childbearing and may also lead couples to increase family size beyond the maternal desire, in which case infants of the surplus gender are particularly vulnerable.     

Income and inequality as determinants of mortality: An international cross-section analysis

This paper analyses the effects of income and income distribution on mortality. The likely relation between income and mortality for individuals is discussed, and implications for the determinants of mortality at the community level inferred. Measures of income inequality are likely to be related to mortality on aggregate data because of the non-linearity of income effects. An international cross-section analysis is then undertaken in which different measures of income and income distribution are investigated as determinants of mortality, with life expectancy at birth and age five, and infant mortality taken as measures of the dependent variable. It is found that income distribution is consistently and strongly related to mortality; in a relatively inegalitarian country life expectancy may be between five and ten years lower than in a more egalitarian country.     

Socioeconomic Inequalities in Infant Mortality in Egypt: Analyzing Trends Between 1995 and 2014

This paper analyses the trend of the socioeconomic inequalities in infant mortality rates in Egypt over the period 1995–2014, using repeated cross-sectional data from the National Demographic and Health Survey. A multivariate logistic regression and concentration indices are used to examine the demographic and socioeconomic correlates of infant mortality, and how the degree of socioeconomic disparities in child mortality rates has evolved over time. We find a significant drop in infant mortality rates from 63 deaths per 1000 live births in 1995 to 22 deaths per 1000 live births in 2014. However, analyzing trends over the study period reveals no corresponding progress in narrowing the socioeconomic disparities in childhood mortality. Infant mortality rates remain higher in rural areas and among low-income families than the national average. Results show an inverse association between infant mortality rates and living standard measures, with the poor bearing the largest burden of early child mortality. Though the estimated concentration indices show a decline in the degree of socioeconomic inequality in child mortality rates over time, infant mortality rate among the poor remains twice the rate of the richest wealth quintile. Nonetheless, this decline in the degree of socioeconomic inequality in child mortality is not supported by the results of the multivariate logistic regression model. Results of the logistic model show higher odds of infant mortality among rural households, children who are twins, households with risky birth intervals. We find no statistically significant association between infant mortality and child’s sex, access to safe water, mothers’ work, and mothers’ nutritional status. Infant mortality is negatively associated with household wealth and regular health care during pregnancy. Concerted effort and targeting intervention measures are still needed to reduce the degree of socioeconomic and regional inequalities in child health, including infant mortality, in Egypt.     

老龄多人口死亡率联合建模与一致性预测

退休年龄以上的老年人群死亡率预测是养老金精算和长寿风险度量的基础。针对我国大陆地区退休年龄以上人群死亡率数据量较小且波动较大的问题,借助多人口联合建模思想,基于单人口CBD模型,提出了一个适用于老龄死亡率建模的Logistic多人口模型。通过加入更多相关人口数据信息来预测我国老年人口死亡率,选取我国台湾地区分性别死亡率相关数据,与我国大陆地区分性别死亡率数据进行联合建模。研究发现,Logistic多人口死亡率模型比单人口CBD模型表现出更好的拟合效果和长期预测一致性效果。     

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.     

Using survey data to assess neonatal tetanus mortality levels and trends in developing countries

Demographic and health surveys are a useful source of information on the levels and trends of neonatal mortality in developing countries. Such surveys provide data on mortality occurring at 4–14 days of life, which is a sensitive indicator of neonatal tetanus mortality. We analyze birth history data from 37 national surveys in developing countries to assess the quality of neonatal mortality data and to estimate levels and trends in mortality occurring at 4–14 days. It is shown that mortality at 4-14 days has declined considerably during the last decade in most developing countries, concomitant with development and expansion of programs to reduce neonatal tetanus. These declines show that reductions in neonatal tetanus mortality probably have been an important contributor to the decline of neonatal and infant mortality during the 1980s.     

香港人口死亡率演变及其未来发展

与其它发展地区类似 ,二战以后香港人口死亡率已经经历了显著的下降 ,达到了一个非常低的水平。在这种极低水平的现状下 ,香港人口死亡率进一步下降的空间还有多大呢 ?本文基于香港人口死亡率历史数据 ,探讨了其演变趋势 ,同时利用Lee -Carter模型对香港未来 5 0年分性别的人口死亡率进行了预测。如果我们将预测结果与最近的官方预测数据进行比较 ,可以发现 ,本文Lee -Carter模型预测的未来香港人口死亡率下降趋势比官方预测结果要乐观     

Mortality in Quebec during the nineteenth century: from the state to the cities

The aim of this paper is to explore mortality in Quebec during the nineteenth century from a demographic perspective. During the nineteenth century, there was excess urban mortality in various countries; in order to identify such mortality differentials, we compared mortality indicators for the province of Quebec and then for the urban areas of Montreal and Quebec City. Using data from various studies, we produced life tables and compared life expectancies. We show that at different times during the nineteenth century, spatial variations in mortality levels across the province of Quebec and its urban areas were significant. According to the data we analyzed, mortality is undoubtedly higher in urban areas even though a convergence in trends took place towards the end of the century, resulting in an overall reduction in mortality. Also, exploring life expectancies within a cohort approach at times of fast-changing mortality patterns has proved to be instructive. Life expectancy estimates based on a cross-sectional approach were systematically lower than those resulting from a cohort-specific one. Trends diverged to a greater extent beginning with the 1870 cohort, reflecting the improvements made from that point on to World War II. Since current mortality levels are substantially determined by the cumulative effects of past behaviour specific to each generation, it is quite obvious that mortality analysis will reveal its true meaning only with the help of cohort life tables.     

Population Variation in Cause of Death: Level,Gender, and Period Effects

The trends in 13 cause of death categories are examined with respect to expectation of life, sex differences, and period effects while misclassification of cause of death is controlled. The results suggest that as mortality declines, 1) the increasingly U-shaped age pattern of mortality is a period effect associated with the infectious diseases, 2) the risks of both overall infectious and degenerative causes of death decline, and 3) infectious disease mortality declines more in males, while degenerative disease mortality declines more in females. Finally, the model shows that some contemporary populations are approaching the .limits of reduction in mortality during infancy, childhood, and young adulthood. Past declines in the degenerative diseases, however, suggest that mortality may continue to decline.     

The First Fifty Years – A Tribute to E. Grebenik

India is a country with a pervasive preference for sons and one of the highest levels of excess child mortality for girls in the world (child mortality for girls exceeds child mortality for boys by 43 per cent). In this article, data from the National Family Health Survey are used to examine the effect of son preference on parity progression and ultimately on child mortality. The demographic effects of family composition are estimated with hazard models. The analysis indicates that son preference fundamentally affects demographic behaviour in India. Family composition affects fertility behaviour in every state examined and son preference is the predominant influence in all but one of these states. The effects of family composition on excess child mortality for girls are more complex, but girls with older sisters are often subject to the highest risk of mortality.     

The relative effects of shocks in early- and later-life conditions on mortality

The relative importance of cohorts' early-life conditions, compared to later period conditions, on adult and old-age mortality is not known. This article studies how cohort-level mortality depends on shocks in cohorts' early- and later-life (period) conditions. I use cohorts' own mortality as a proxy for the early-life conditions, and define shocks as deviations from trend. Using historical data for five European Countries i find that shocks in early-life conditions are only weakly associated with cohorts' later mortality. This may be because individual-level health is robust to early-life conditions, or because at the cohort level scarring, selection, and immunity cancel each other. Shocks in period conditions, measured as deviations from trend in period child mortality, are strongly and positively correlated with mortality at all older ages. The results suggest that at the cohort level changing period conditions drive mortality variation and change.