Mortality trends and causes of death: A comparison between Eastern and Western Europe, 1960s–1980s

Two distinctive mortality trends emerged in Europe between the mid-1960s and mid-1980s. Eastern European mortality rates remained constant for women over 40 and increased substantially for men over 35, while mortality in Western Europe decreased considerably above age 35 for women and men. I examine causes of deaths, using Pollard's method of decomposing changes in life expectancy into components specific to each age group and cause of death. Western European success in coping with circulatory system diseases at middle-to-old ages are by far the most important cause for the differing trends. Western Europe was also more successful in lowering mortality from malignant neoplasms and digestive and respiratory system diseases primarily at middle-to-old ages.     

What Impact Do Contextual Variables Have on the Changing Geography of Mortality in Italy?

Using data for 94 provinces, three periods (1971–1973, 1981–1983 and 1991–1993), and for men and women, we present an interesting picture of the geography of adult and elderly mortality by cause of death in Italy. This picture brings into focus the North/South gap that has yet again emerged, this time in gender differences in mortality. Particular attention is given to mortality from those causes that would appear to depend on the geographical context and that have a greater role to play in overall mortality differences. We then define which causes of death have changed the geographic pattern in the period considered. Lastly we study the relationship between mortality by cause and socio-economic, health care, environmental, cultural, and nutritional variables. This revised version was published online in July 2006 with corrections to the Cover Date.     

Causes of Fluctuating Mortality in Romania

During the post-communist transition, Romanians experienced some of the highest mortality rates in eastern Europe, some of the greatest fluctuations in life expectancy and some of the greatest delays in recovery. This study examines the shifts in cause-specific mortality underlying these fluctuations. Using demographic methods to understand the peaks and troughs in life expectancy during the past twenty years, we explore several explanations for these fluctuations: changes in exposure and behaviour associated with the social, economic and political changes; changes in health care affecting amenable causes of death and the progression of the epidemiologic transition. Throughout this period, there is a continuing shift from infectious towards chronic diseases mortality. Psycho-social stress during the period of transition affected survival, evidenced by increases in suicides and differences in mortality between men and women. Amenable causes of death took a greater toll on life expectancy, and increases in tuberculosis and congenital heart abnormality mortality provide evidence of a weakening of health services. However, decreases in vaccine-preventable mortality demonstrate that the health system did not fully fail. Policy changes also affected survival, including decreasing abortion-related mortality and, after initial increases in accidental mortality, new improvements, especially in traffic fatalities.     

La mortalité violente selon l'âge, le sexe et la cause: un essai de classification des pays industrialisés, 1985–1989

Violent death varies substantially according to age, reflecting the riskfactors which confront individuals at different stages in their lives.International comparison of the age-distribution of deaths by violence showsgreat variation from one region to another. Using cluster analysis, groupingsof countries can be made on the basis of the level of violent death, itsage-composition and its causes. It is possible to show that some countrieswith heavy and with light burdens of violent death have characteristicprofiles of mortality according to age and to cause of death. For example,surmortality in some Eastern (Hungary and Czechoslovakia) and in someNorthern and Western countries (Austria, Belgium, Denmark, Finland, France,Norway and Switzerland) produces a kind of horizontal corridor in Europe.Differences between countries in respect of mortality from motor vehicletraffic accidents, falls and suicide account to a considerable degree for thepatterns observed.     

Mortalité différentielle selon la cause de décès en Norvège, 1970–1985

Data from the three Norwegian censuses of 1960, 1970 and 1990 combined with information on migration status and survival between 1970 and 1985 have permitted the estimation, though logistic modelling, of the predictive abilities of different socio-economic indicators on the risk of death by cause. The risk has also been measured for each indicator separately, according to the path followed by the individual between 1960 and 1980. The study shows very strong disparities in risk both for men and for women, as well as a moderate reduction in differences in risk by age. The study also shows, among other things, the importance of taking account of socio-economic information covering as long a period as possible and to consider the cause of death in the study of differential mortality through a life-history approach.     

Socioeconomic differentials in mortality in Finland and the United States: the role of education and income

We document social inequalities in cause-specific mortality at ages 35–64 in Finland and the United States, countries with different health systems, income distributions, and social welfare programs for the working-aged population. The education–mortality gradient was the most marked for Finnish men and for causes of death linked to risk-taking, health behaviors, and stress. The association between family income and mortality was curvilinear in both countries. The effects of education and income were strongly attenuated after controlling for each other, marital status, and labor force participation, with the greatest attenuation observed for income in Finland and education in the United States.Elo, I. T., Martikainen, P., et Smith, K. P. (2006). Mortalité sociale en Finlande et aux Etats-Unis: Róle du niveau d'instruction et du revenu. Revue Europeéenne de démographie, 22, 177–201     

Inequalities in Infant Survival: An Analysis of Czech Linked Records

This research analysed individual linked infantbirth and death records for the Czech Republicfor the years from 1986 to 1992. The studyfocused on differences in the risk of infantdeath in a former socialist country whereconditions were relatively egalitarian andhealth care was free. The key variablesanalysed included birthweight, gestational age,education level and age of mother, birth order,marital status and age of infant at the time ofdeath. Despite an expectation of low levels ofinequality in infant mortality, significantdifferences were found that were related to thelevel of mothers' education. In addition,infant mortality increased with birth order ofthe child in the postneonatal period and fornormal birthweight infants (even whencontrolling for other variables). Theseanomalies, we believe, have a significantsocio-economic root and not a biologicalrelationship. The inverted pattern in infantmortality for low birthweight babies foundamong Afro-American women in the U.S was alsofound for women with low levels of educationwithin the ethnically homogeneous Czechpopulation. Similar patterns were replicated atregional levels in the Czech Republic.Surprisingly, two very contrasting regions (interms of socio-economic development andfunctions) – Prague and Ceske Budejovice –were found to have the highest risk of infantdeath, characterized primarily by increasedrisk for infants in the ``normal' or usually lowrisk categories.     

The Effects of Education, Social Class and Income on Non-alcohol- and Alcohol-Associated Suicide Mortality: A Register-based Study of Finnish Men Aged 25–64

This study aimed to analyse the effects of different socioeconomic indicators on non-alcohol-associated and alcohol-associated suicide in Finland. The data used comprised the 1990 census records for men who were 25–64-years old linked to the death register for 1991–2001. Poisson regression was used to calculate the adjusted relative mortality rates. There were 6,452 suicides among the study population, and in 42% of them alcohol intoxication was a contributory cause. Education, occupation-based social class and household income were inversely and strongly related to suicide regardless of the link with alcohol. For non-alcohol-associated suicide, the effect of education was largely mediated by social class and income, the effect of social class was partly explained by education and partly mediated by income, and the effect of income was rather small after adjustment for the other two indicators. When alcohol was involved, social class mediated a large part of educational effect, but a strong association also remained. Respectively, education explained a large proportion of the social class differences. Income had a minor effect. Adjustment for employment status explained some of the income differences, but living arrangements had little effect. The findings imply that low social class is associated with increased suicide risk regardless of employment status, and that the roots of socioeconomic differences in alcohol-associated suicide lie in early adulthood when education and health behavioural patterns are set. This casts some doubt on claims that current material factors are the main drivers of socioeconomic differences in suicide.     

Male mortality from ischaemic heart disease in Finland: Relation to region of birth and region of residence

The purpose of the study is to shed light on the causes of the large difference in mortality from ischaemic heart disease (IHD) between East and West Finland. The study is based on the death certificate records on deaths from IHD in 1971–1975 among Finnish men aged 35–64. These records were linked with the records on persons in the 1970 census. Mortality from IHD is analyzed simultaneously by region of birth and region of residence, controlling for several socio-economic and demographic variables, by means of log-linear models. The analysis shows that being born in East Finland and living there both increase the risk of IHD, but that being born in East Finland is a more important risk factor than is living there.     

2000年以来台湾地区人口死亡率水平及其特点

利用台湾地区2000年以来相关的人口资料,对台湾地区人口死亡率的变化特征进行分析,认为近十几年来,台湾地区除95岁以上年龄组外,其他年龄组死亡率持续下降;婴儿死亡率较低;人口平均预期寿命提高;且具有城乡死亡率及不同性别死亡率差异显著等特点。认为经济、文化教育、医疗水平的提高是人口死亡率降低的主要原因。     

Cause-of-Death Contributions to Educational Inequalities in Mortality in Austria between 1981/1982 and 1991/1992

This article uses census records and deaths records to analyze trends in educational inequalities in mortality for Austrian women and men aged 35–64 years between 1981/1982 and 1991/1992. We find an increasing gradient in mortality by education for circulatory diseases and especially ischaemic heart disease. Respiratory diseases and, in addition for women, cancers showed the opposite trend. Using decomposition analysis, we give evidence that in many cases changes in the age-structure within the 10-year interval had a bigger effect than direct improvements in mortality on the analyzed subpopulations.     

The Effects of Area and Individual Social Characteristics on Suicide Risk: A Multilevel Study of Relative Contribution and Effect Modification

The aim of this study is to analyse how area characteristics affect suicide mortality and to assess whether the effects of individual socio-economic characteristics vary in socio-economically different areas. Data come from the 1990 census records of 15–99-year-old Finns linked to death records in 1991–2001 including 13,589 suicides. Area characteristics were obtained for 85 functional regions. We show that hypotheses of interaction between individual and area socio-economic status for suicide mortality are not supported. However, area socio-economic characteristics, family cohesion and voting turnout are consistently related to suicide. The effects of median income and income inequality are less consistent. Adjusting for individual level variables partly attenuate these associations. The results indicate that improving the areas people live in may prevent suicide.     

试论汉代平民妇女在婚姻生活中的地位

两汉时期的社会文明,承先秦之余绪,开魏晋之大端。因此,两汉平民妇女在婚姻生活中的地位也带有鲜明的时代特色:一方面男尊女卑的倾向十分明显,构成主流,另一方面汉代的平民妇女在婚姻生活中又有一定的自主地位,主要表现在结婚择夫、离婚改嫁、夫死再嫁上。导致这种现象的原因有:其一,随着中央集权的加强和完善,正统封建伦理观念的日渐盛行,女性地位呈现出递降的趋势;其二,两汉时期,儒家思想束缚尚浅,统治者具有开阔的胸襟和气度,更重要的是汉代妇女广泛参加社会生产,成为汉代社会生产的主要创造者。     

Determinants of the health and survival of the elderly: Suggestions from two different experiences — Italy and Israel

This study compares the health status and survival of the elderly in two countries, Italy and Israel. While both are developed Mediterranean countries, their degree of ageing, characteristic features of the elderly, health status and survival are different. The data are from two sample surveys and, for Israel, from a record linkage between survey and mortality data at five years remove. A preliminary analysis, using a multiple correspondence factorial analysis, highlighted a gradual change in living arrangements and socio-economic features as the population ages, which was only slightly associated with health conditions. In Israel, moreover, the Arab minority differs according to social conditions, living arrangements and health status. The determinants of health status and survival of the elderly in both countries were studied using as dependent variables; 1) self-perceived health status, 2) the frequency of medical examinations; 3) medical tests, for both countries and 4) (for Israel) deaths. Linear logistic models were constructed using, as explanatory variables, sex, age and living arrangements, a variable indicative of community level socio-economic and cultural conditions, two indicators describing individual socio-economic conditions and smoking habits. Thus it is possible to assess the impact of explanatory variables by comparing both subjective conditions and behaviour factors regarding medical care, with the unequivocal confirmation provided by death.     

基于家庭社会经济地位的儿童生存水平研究

儿童的生存、保护和发展是当今国际社会优先考虑的问题之一,提高儿童健康水平,关键在于改善儿童健康的公平性。基于浙江省30个监测县（市、区）2012—2014年5岁以下死亡儿童家长或监护人的回顾性问卷调查,研究结果显示,家庭社会经济地位分层越高,儿童死亡地点为医院的概率越高,上层家庭为下层家庭的2.193倍;儿童死亡前接受住院治疗的比例也越高,上层家庭为下层家庭的2.904倍;儿童死因诊断级别也越高,上层家庭儿童死因诊断级别为省市级医院的比例是下层家庭的3.233倍。儿童生存水平与家庭社会经济地位密切相关,社会经济地位越高,其儿童的卫生医疗服务利用率就越高。     

245例老年住院患者死因分析

目的了解干部病房老年住院患者的死因现状。方法对2006年至2008年三年间在我院干部病房住院期间245例老年死亡患者的临床资料进行统计分析。结果三年间干部病房老年住院患者的前三位死因依次为：恶性肿瘤、循环系统疾病、呼吸系统疾病。结论恶性肿瘤、心脑血管疾病、呼吸系统疾病是危害老年人生命的头三位严重疾患。     

Life table analysis for areas using vital register data

This study considers the utility of parameterised life tables derived by survival analysis for comparing mortality between areas, using death registration records and accompanying information on the social characteristics for each individual deceased. Such methods enable a comparison of summary measures of mortality experience such as life expectancy and median age at death before and after adjustment for socio-economic variables. In the absence of comparable information on the survivor population an approximate life table method is investigated as a means of comparing mortality profiles and the effects of social factors. Such factors may pertain both to the individuals (e.g. their birthplace) or to their small area of residence (e.g. measures of area deprivation). These methods also permit a comparison of the impact of socio-economic factors on different causes of death. The application is to mortality in London over the period 1990–92 and to its constituent boroughs and electoral wards.     

Factors Associated with Return Migration of First-Generation Immigrants in Belgium (2001–2011)

Belgium is a country with a long and diverse history of migration. Given the diverse context of immigration to Belgium, reasons for return migration will most likely vary as well. With this study, we want to quantify the return migration of Belgium’s immigrants and assess whether socio-economic, sociodemographic and health factors are related to return migration. Individually linked census and register data comprising the total Belgian first-generation immigrant population aged 25+ were used. Age-standardized emigration rates (ASER) by migrant origin and gender were calculated for the period 2001–2011. Additionally, relative return migration differences were calculated by country of origin and gender, adjusted for age group, length of stay, household composition, socio-economic indicators (education, home ownership and employment status) and self-rated health in 2001. Return migration was most common among immigrants from Spanish descent and from the neighbouring countries and higher among men than among women. Return migration was highly selective in terms of older age, lower length of stay in Belgium, not living with a partner or children, being high-educated, unemployed and in good health. Key issues for future research include examining the reasons for return migration, identifying the country of destination and accounting for household characteristics.     

Monitoring Suicide Mortality: A Bayesian Approach

A significant fall in suicide mortality relative to England and Wales levels has occurred in London though with wide variation between its 33 constituent boroughs in the extent of mortality reduction. A Bayesian random effects approach is used is to model differential changes in suicide by borough and time over a 16 year period, 1979–94. Of particular concern in such modelling are persistent differences between boroughs in suicide risk (temporal correlation) and spatial clustering in relative risk. It is also important to represent the changing impact on suicide of socio-economic factors such as social deprivation. The data used are defined by deaths through de-jure suicide (ICD9 categories E950-E959) and those through undetermined injury, whether accidental or purposely inflicted (ICD E980-E989).     

山东省城镇劳动者经济地位的获得路径与社会性别分析

社会性别视角下的经济地位研究关注社会资源占有和收益的性别差异,注重分析不同劳动力市场所依赖的不同资源。按照是否拥有高等教育文凭的标准将劳动力市场划分为高教育劳动群体和低教育劳动群体,由分析两类群体人员经济地位获得的不同路径——对高教育群体经济地位提升起关键性作用的是“人力资本”,对低教育群体经济地位提升起关键性作用的是其在单位中所处的“结构”,进而进一步探究不同劳动力市场所需资源的性别差异更有意义。研究发现,低教育群体显著的性别差异来自于女性群体受到更多的结构性限制——管理职务对女性的排斥以及劳动力市场对大龄女性的歧视;高教育群体趋向于性别平等,原因在于影响该群体经济地位获得的因素——教育、年资和培训经历趋向于收益率的性别平等化。