Between ‘Pioneers’ of the Cardiovascular Revolution and Its ‘Late Followers’: Mortality Changes in the Czech Republic and Poland Since 1968

After several decades of stagnation, mortality in most Central European countries started to decrease after 1989. The Czech Republic and Poland were the first former Communist countries in this region to experience a rapid and sustained increase in life expectancy. This study focuses on the trends in cause-of-death mortality that have contributed to the recent progress in these two countries. The analysis is based on the cause-of-death time series (1968–2013) reconstructed in accordance with the 10th ICD revision, which makes the data fully comparable over the full period under study. Actual trends in cause-specific mortality are presented, and age, sex and causes of death components of life expectancy changes are disentangled. In both countries, the reduction in cardiovascular mortality at adult and old ages was crucial for the increase in life expectancy after 1991. Results are discussed in the context of institutional changes that occurred after the fall of Communism, such as the reorientation of health policies and the emergence of non-governmental organizations. Changes in health-related attitudes and behaviours as well as structural changes in societies, notably the rising share of persons with tertiary education, are also discussed.     

The 1991–2004 Evolution in Life Expectancy by Educational Level in Belgium Based on Linked Census and Population Register Data

The aim of this study is to determine trends in life expectancy by educational level in Belgium and to present elements of interpretation for the observed evolution. The analysis is based on census data providing information on educational level linked to register data on mortality for the periods 1991–1994 and 2001–2004. Using exhaustive individual linked data allows to avoid selection bias and numerator–denominator bias. The trends reveal a general increase in life expectancy together with a widening social gap. Summary indices of inequality based on life expectancies show, however, a more complex pattern and point to the importance to include the shifts in population composition by educational level in an overall assessment of the evolution of inequality by educational level.     

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.     

The Length of Working Life in Spain: Levels,Recent Trends,and the Impact of the Financial Crisis

While there has been considerable debate about extending the length of working life, relatively little is known about this issue. We use data from the Spanish Continuous Working Life Sample for 2004–2013 to calculate period working life tables, which in turn allows us to assess the impact of the financial crisis on working life expectancy in Spain. Before the recession hit, working life expectancy in Spain was around 38 years for males and 33 years for females. The recession had a tremendous impact on the Spanish labor market, but the effects differed considerably by gender and occupational category. Men working in skilled non-manual jobs were less affected, while men working in unskilled manual jobs lost close to 14 years of working life expectancy. Women were less affected than men. With working life expectancy decreasing, the average proportion of lifetime spent in unemployment and outside the labor market increased markedly, whereas the average number of years spent in retirement changed only a little. When we decompose losses in working life expectancy by age group, we find that economic fluctuations affect both older and younger workers. This result suggests that policies that focus on retirement ages only are incomplete. We also compare our findings to the results obtained by Sullivans method, which is based on prevalence rates rather than the incidence-based working life table approach. We find that the use of Sullivans approach does not accurately reflect the levels of and the trends in working life expectancy.     

A reconstruction of the population of North Italy from 1650 to 1881 using annual inverse projection with comparisons to England,France, and Sweden

North Italy annual population and vital rates are reconstructed from 1650 to 1881 using series of vital event indices from many rural parishes and cities. Inverse projection is applied to the reconstructed series of vital events and population to generate annual age distribution, gross reproduction rate, net reproduction rate, life expectancy at birth, and infant mortality rate. The results are compared with official sources and detailed demographic rates produced by annual inverse projection using data from England, France, and Sweden. Over the long term, North Italy is generally characterized by stagnant and relatively high mortality. Fertility and nuptiality are relatively high at the beginning and at the end of the period.     

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.     

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.     

Life expectancy at age 60 — Epidemiologic scenarios assuming delayed mortality for selected causes of death

The present analysis offers a projection of life expectancy at advanced ages in Austria for the year 2010. To estimate the gains in life expectancy the Simultaneous Multiple Cause-Delay (SIMCAD) method is used. This model takes into account the epidemiological concept of an additional delay in the onset of particular chronic-degenerative diseases. While the results of the SIMCAD method vary only slightly on the whole from the official projection of life expectancy at age 60, the similarity between the two projections decreases steadily with increasing age. The SIMCAD model predicts higher gains in life expectancy for the oldest age-groups of the population than do the official statistics.     

Mortality in the two Germanies in 1986 and trends 1976–1986

By using the new analysis programme LIFETIME the mortality data of the Federal Republic of Germany and the GDR are compared by age, sex and cause of death. The data submitted to the WHO were used for this purpose. Within the period from 1976 to 1986 life expectancy has risen in the Federal Republic of Germany, whereas in the GDR it increased to a minor extent only, so that the gap between the two parts of Germany has clearly enlarged. This enlarged gap in life expectancy largely depends on a higher mortality in the GDR due to diseases of the circular system and the respiratory organs, external influences and ‘other’ causes of death. The last-mentioned two groups also ‘contain’ the normally separatedly reported causes of death ‘cirrhosis of the liver’, ‘suicide’, ‘accidents’, and some diseases of the digestive system. These causes of death probably have gained a certain weight — like in other Eastern European countries — so that their evidence has been undesirable due to political reasons. In 1976 the GDR still reported these causes of death separately.     

世界各国预期寿命差异及影响因素定量分析

目前世界各国平均预期寿命的地区差异显著,不仅平均预期寿命高低悬殊,而且两性差正负不同,并呈"富国寿长、穷国命短"两极分布。通过因子分析发现,医疗文卫因素、政府投入因素和伤害归因因素是造成平均预期寿命地区差异显著的主要原因。通过聚类分析将世界各国分成了三大类地区,验证了上述因子对三类地区影响是显著的。最后指出,大力发展经济、加快城市化进程、改善医疗卫生条件、降低婴儿死亡率和传染性疾病死亡率是缩小世界各国平均预期寿命地区差异的有效路径。     

Recent Mortality Trend Reversal in Russia: Are Regions Following the Same Tempo?

After several decades of negative trends and short-term fluctuations, life expectancy has been increasing in Russia since 2004. Between 2003 and 2014, the length of life rose by 6.6 years among males and by 4.6 years among females. While positive trends in life expectancy are observed in all regions of Russia, these trends are unfolding differently in different regions. First, regions entered the phase of life expectancy growth at different points in time. Second, the age- and cause-specific components of the gains in life expectancy and the number of years added vary noticeably. In this paper, we apply decomposition techniques—specifically, the stepwise replacement algorithm—to examine the age- and cause-specific components of the changes in inter-regional disparities during the current period of health improvement. The absolute inter-regional disparities in length of life, measured by the population-weighted standard deviation, decreased slightly between 2003 and 2014, from 3.3 to 3.2 years for males, and from 2.0 to 1.8 years for females. The decomposition of these small changes by ages and causes of death shows that these shifts were the result of diverse effects of mortality convergence at young and middle ages, and of mortality divergence at older ages. With respect to causes of death, the convergence is mainly attributable to external causes, while the inter-regional divergence of trends is largely determined by cardiovascular diseases. The two major cities, Moscow and Saint Petersburg, are currently pioneering mortality improvements in Russia and are making the largest contributions to the inter-regional divergence.     

Targeting lifesaving: Demographic linkages between population structure and life expectancy

Life expectancy in a heterogeneous population can be increased by lowering mortality rates or by averting deaths at different ages, from different causes, or for different groups, as well as by changing the proportions of individuals in various risk groups, perhaps by altering the transition rates between groups. Understanding how such changes in population structure affect life expectancy is useful in evaluating alternative lifesaving policies.     

寿险公司投资养老地产风险评价指标体系的构建

寿险公司在试水养老地产的过程中面临诸多风险,不仅制约着养老地产行业投资者的积极性,也不利于解决中国老龄化背景下养老产业供给短缺的问题。因此,建立科学的风险指标体系对养老地产投资风险进行定量评价,既能让养老地产的投资者及时进行风险识别及风险管理,又能促进中国养老服务供给侧改革。从宏观和微观两个维度量化分析寿险公司投资养老地产的风险,选取5个一级指标和13个二级指标构建寿险公司投资养老地产的风险评价指标体系。采用层次分析法确定各个指标的权重,运用模糊综合评价法作为评判的标准,构建出寿险公司投资养老地产风险综合评价模型,并以HZ寿险公司为例进行实证研究。研究认为:寿险公司在投资养老地产过程中面临政策、市场、经济、筹划、运营5个方面的风险因素;HZ寿险公司的养老地产项目总体风险偏高,但总体风险偏向于一般风险水平,因此合适进行房地产项目的开发与投资;从单因素评价结果可以看出,“政策风险”“有效需求不足风险”“管理与服务风险”风险级别较高,是寿险公司在今后投资养老地产过程中重点关注的风险。     

当前养老保险制度给付水平的几个问题研究

社会统筹和个人账户相结合的部分基金积累制是我国社会养老制度改革的基本模式。在市场经济的条件下,随着利率、工资、物价水平、失业率以及人口寿命的变化,个人账户养老金的实际给付水平和方式也是随之变化的,客观上要求在它们之间建立一套正常的调整机制。因此,对退休人员实际待遇水平和相关因素的关系进行研究是非常有必要的。本文结合2003年中国统计年鉴有关数据,论证了当前养老制度中目标替代率的合理性;指出实现目标替代率的关键之一是工资增长率应和个人账户记账利率相等;同时指出当前制度中目标替代率下限过低,造成制度内的部分职工进入贫困救济范围;并采用精算模型中给付精算现值和缴费精算现值必须相等的原理,结合1990年全国从业人口生命表对个人账户的发放系数以及延长退休年龄对给付水平的影响进行了讨论。     

集体化时期农村地区人口身体素质分析(1956—1983)

我国集体化时期,农民的生活水平并不高,农村的劳动生产率没有本质提高,因而被称为"没有发展的增长"的时期。不过,这一时期,在均平化集体经济和救助型集体保障的推动下,农民的生存条件得到改善,农村人口身体素质得到很大的提升,婴儿死亡率、青少年发育状况、各种疾病的患病率和病死率、人口平均预期寿命等指标都得到优化。     

休闲活动、健康自评对老年人主观幸福感的影响研究

随着我国人口老龄化程度加深和老年人预期寿命的延长, 其生活质量和幸福感水平的提高离不开积极的社会参与。休闲活动作为社会参与的重要内容, 对提高老年人的生活质量和幸福感具有重要作用。文章根据中国老年人健康长寿影响因素跟踪调查数据并基于多元回归模型, 考察了不同年龄段老年人休闲活动参与、健康自评对其主观幸福感的影响差异并检验了健康自评的中介效应。结果显示:休闲活动参与度和健康自评对老年人主观幸福感影响显著, 均与老年人的积极情绪显著正相关, 与其消极情绪负相关; 参加休闲活动对其积极情绪的促进作用大于对其消极情绪的缓解效应; 休闲活动在不同年龄段老年人身上产生的影响存在差异; 老年人健康自评在休闲活动参与和主观幸福感之间发挥了部分中介效应。     

Pension design and gender: Analyses of developed and developing countries

In this article the authors examine different ways of organizing and financing pension systems in China, France, Ghana, Jordan, Mexico, Poland, and Sweden. They explore the advantages and disadvantages of the combinations of different features with special reference to gender differences. Men and women have different patterns of work history, with women usually having a lower participation rate in the formal labor market, including interrupted career in response to child rearing, as well as lower wages in general. Women have a longer life expectancy than men and are more likely to become widows than men are to become widowers. These differences influence the financial resources available to women in old age, depending on how a pension system is designed.     

Assumptions for long-term stochastic population forecasts in 18 European countries

The aim of the ‘Uncertain Population of Europe’(UPE) project was to compute long-term stochastic (probabilistic) population forecasts for 18 European countries. We developed a general methodology for constructing predictive distributions for fertility, mortality and migration. The assumptions underlying stochastic population forecasts can be assessed by analysing errors in past forecasts or model-based estimates of forecast errors, or by expert judgement. All three approaches have been used in the project. This article summarizes and discusses the results of the three approaches. It demonstrates how the—sometimes conflicting—results can be synthesized into a consistent set of assumptions about the expected levels and the uncertainty of total fertility rate, life expectancy at birth of men and women, and net migration for 18 European countries.     

小品模糊语言构建的不自足语境

为取得幽默效果,小品台词往往表现出对现实语言的夸张与变异,进而形成难以准确定位的模糊语言。模糊语言导致演员接受语境不自足的幽默比较常见。这种现象的泛滥又使小品创作与演绎缺乏生活内涵。