The Changing Shape of Soviet Mortality, 1958–1985: An Evaluation of Old and New Evidence

Changes in mortality in the Soviet Union have attracted the attention of both scholars and the popular media. After a hiatus of more than ten years, the government of the Soviet Union has released data on mortality for the 1980s, which allow assessment of recent changes. The new life table for 1984–85 shows that mortality of Soviet females has improved at ages below 45 and deteriorated above that age since the last age-specific mortality data were published in the early 1970s, while mortality of males has improved at ages below 25 and deteriorated above that age. At the same time, the official mortality rates for persons aged 60 and over in 1958–59, 1968–71, and 1984–85 are implausibly low. Poor-quality data at the older ages, particularly in rural areas and the less developed regions of the country, contributed to these low mortality rates of the old. As data quality has improved with time, the reported mortality rates at old ages have increased. Adjustment of the official data for error, especially above age 60, shows that whereas the reported value of e₀ for males fell by 1.5 years between 1958–59 and 1984–85, the actual value probably fell by no more than 0.5 years; the corresponding figures for females were a reported rise of one year, and an actual rise of at least two years. Examination of these Soviet data illustrates how important consideration of error in mortality statistics of the old can be in understanding mortality trends.     

The Courbage-Fargues method of indirect measurement of mortality: adequacy and inadequacy of the case of Togo in 1971

This study tests the validity of an indirect method of estimating mortality from inaccurate data from demographic investigations conducted in Togo in 1971. The method yields good results for Togo where life expectancy at birth is estimated at 40.51 years for males and 43.12 years for females. The article responds to the request of participants of the Colloquim of Abidjan and then corrects the mortality level of Togo in 1971 derived from the biased demographic investigation in Togo in 1971. OCDE tables were used to support estimates of mortality. A hypothesis of the method was that the deaths of the last 12 months are underreported in a constant proportion. A 2nd hypothesis was that the mortality of the country is related to a mortality pattern according to age. This method of Courbage-Fargues has produced satisfactory results. Certain demographers believe that the undercount rates are probably differentials according to age, particularly among those who die in the 1st few years of life. Others believe that knowledge of deaths that occur in the later years lacks certainty. Mortality data in Africa are not adequate enough to utilize as bases for estimates. For Togo, in particular, the application of other indirect measures of mortality is hoped for to allow comparisons.     

The Level and Age Pattern of Mortality in Bandafassi (Eastern Senegal): Results From a Small-Scale and Intensive Multi-Round Survey

The data collected in the Bandafassi demographic study in Eastern Senegal, a small-scale intensive and experimental follow-up survey of a population of about 7,000 in 1983, were analysed to derive an estimated life table. The use of multi-round surveys, combined with anthropological methods to estimate ages and collect genealogies, has resulted in unusually reliable data. Taking into account the uncertainty of the estimates due to the small size of the population, mortality was high, with life-expectancy at birth close to 31 years; a pattern of infant and child mortality close to that observed in other rural areas of Senegal, with a very high level or mortality between ages six months and three years; a seasonal pattern in child mortality with two high-risk periods, the rainy season and the end of the dry season; an adult mortality pattern similar to that described in model life tables for developed countries; no significant difference by sex or ethnic group. The Bandafassi population study and a few similar studies suggest that one possible way to improve demographic estimates in countries where vital registration systems are defective would be to set up a sample of population laboratories where intensive methods of data collection would continue for extended periods.     

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 choice among past trends as a basis for the prediction of future trends in old-age mortality

We explored the extent to which projections of future old-age mortality trends differ when different projection bases are used. For seven European countries, four alternative sets of annual rates of mortality change were estimated with age-period log-linear regression models, and subsequently applied to age-specific all-cause mortality rates (80+) in 1999 to predict mortality levels up to 2050. On average, up to 2050, e80 is predicted to increase further by 2.33 years among men and 4.03 years among women. Choosing a historical period of 25 instead of 50 years results in higher predicted gains in e80 for men but lower gains for women. Choosing non-smoking-related mortality instead of all-cause mortality leads to higher gains for women and mixed results for men. In all alternatives there is a strong divergence of predicted mortality levels between the countries. Future projections should be preceded by a thorough study of past trends and their determinants.     

Adult Mortality Five Years after a Natural Disaster

Exposure to extreme events has been hypothesized to affect subsequent mortality because of mortality selection and scarring effects of the event itself. We examine survival at and in the five years after the 2004 Indian Ocean earthquake and tsunami for a population‐representative sample of residents of Aceh, Indonesia who were differentially exposed to the disaster. For this population, the dynamics of selection and scarring are a complex function of the degree of tsunami impact in the community, the nature of individual exposures, age at exposure, and gender. Among individuals from tsunami‐affected communities we find evidence for positive mortality selection among older individuals, with stronger effects for males than for females, and that this selection dominates any scarring impact of stressful exposures that elevate mortality. Among individuals from other communities, where mortality selection does not play a role, there is evidence of scarring with property loss associated with elevated mortality risks in the five years after the disaster among adults age 50 or older at the time of the disaster.     

Mortality,past and future

The study of mortality in previous centuries and of the trends in recent decades helps to elucidate some present-day medical problems and to contribute to their solution. The author considers, from a historical and socio-economic point of view, the factors which, during the last 200 years, have influenced the trends of mortality. This analysis indicates the lines along which present research, aimed at reducing mortality and extending expectation of life, should be directed.

Infancy (0–1 year): In backward countries, the whole of infancy is a period of high mortality. In progressive countries, on the other hand, the main reproductive wastage is in the ‘perinatal’ period, that is to say, covering stillbirths and deaths during the first week of life. For example, even in New Zealand, the death risk per day is more than eighty times as high during the first week of life than in the following 358 days.

Historical studies and social class comparisons suggest that further reduction of perinatal mortality is likely to depend on socio-economic, housing and cultural factors rather than on improvements in obstetric skill. Evidence cited by the author indicates that a crucial factor may be to provide expectant mothers with adequate rest during the weeks immediately prior to delivery. In general, research into mortality in infancy is too much bounded by a purely medical point of view whereas a socio-medical approach is needed.

Childhood (1–14 years): There has been an immense reduction in childhood mortality during the last 200 years. Less than 200 years ago the mortality among children aged 1–4 and 5–9 years was thirty-three times, and among those aged 10–14 years twelve times, that of the present day. Future reduction of mortality among children will be primarily a function of social factors and trends.

Adolescence and maturity (15–49 years): One of the outstanding trends of the last 200 years has been a relative increase in tuberculosis mortality among those aged 15–49 years, whereas among children tuberculosis has become relatively less important

as a cause of death. Recently, however, there has been a decline in the relative importance of tuberculosis as a cause of death among the adolescent and mature and, among New York males, it now takes second place to the cardiovascular

diseases. The total mortality of people in this age group has fallen, since the sixteenth century, by 77% for men and 81% for women. No spectacular discoveries are needed to reduce the mortality of this group by a further third; in doing this, control of environment will be the important factor.

Later maturity and old age (50 years and over): In the four centuries since the Renaissance the mortality of people over 50 years of age has been reduced by half. Among the factors contributing to this reduction is a fall in mortality due to tuberculosis. But even cancer, which is popularly supposed to have increased, used to be more common in the eighteenth century than it is now and to appear at an earlier. age. Moreover, there has been a change in the organs most commonly affected. The distribution of the greater proportion of cancer in a given population is a function of living conditions in the broadest sense of the term. Studies of groups exposed to carcinorelevant factors suggest that a high incidence of cancer in one organ is associated with a low incidence in other organs. But on many other causes of death at the older ages far more research is required, especially on the cardio-vascular-renal complex, and on the degenerative joint and bone diseases.     

The choice among past trends as a basis for the prediction of future trends in old-age mortality

We explored the extent to which projections of future old-age mortality trends differ when different projection bases are used. For seven European countries, four alternative sets of annual rates of mortality change were estimated with age–period log-linear regression models, and subsequently applied to age-specific all-cause mortality rates (80+) in 1999 to predict mortality levels up to 2050. On average, up to 2050, e80 is predicted to increase further by 2.33 years among men and 4.03 years among women. Choosing a historical period of 25 instead of 50 years results in higher predicted gains in e80 for men but lower gains for women. Choosing non-smoking-related mortality instead of all-cause mortality leads to higher gains for women and mixed results for men. In all alternatives there is a strong divergence of predicted mortality levels between the countries. Future projections should be preceded by a thorough study of past trends and their determinants.     

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.     

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.     

Infant mortality trends in rural East Pakistan

Infant mortality trends in a rural area of East Pakistan are analyzed utilizing the Bogue pregnancy history technique. The findings indicate that infant mortality has declined slightly over 20 percent between 1958 and 1967. The existence of development programs in women’s education and family planning since 1961 are proposed as possible reasons for this finding. A convergence in infant mortality rates to mothers in the age range 15–39 years was found in the final year under analysis, while the standard U shaped pattern of infant mortality with age structure was exhibited in the previous years. One possible explanation for the convergence is that the development programs are reaching women within this age range more equally than in the past. An alternative explanation relating to the problems of recall of mortality events was discussed.     

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.     

Structural and Cognitive Aspects of Social Capital and All-Cause Mortality: A Meta-Analysis of Cohort Studies

Social capital covers different characteristics such as social networks, social participation, social support and trust. The aim of this study was to explore which aspects of social capital were predictive of mortality. Criteria for inclusion in the meta-analysis were: population based observational cohort studies (follow-up ≥5 years); study sample included the adult population; parts of social capital as the primary exposure variable of interest; reported a mortality outcome; and sample size >1,000 individuals. Twenty studies provided eligible data for the meta-analyses. A random effect model was used to estimate the combined overall hazard rate ratio effects of structural social capital such as social participation and social networks, and cognitive social capital including social support and trust in relation to mortality. The results showed that social participation and social networks were negatively associated with mortality. The impact of social networks attenuated somewhat when controlling for gender and age. While trust also appeared to be negatively associated with mortality, we remain cautious with this conclusion, since only two studies provided eligible data. Perceived social support failed to show a significant impact upon mortality. The findings suggest that people who engage socially and report frequent contacts with friends and family live longer.     

Period‐Based Mortality Change: Turning Points in Trends since 1950

We investigate a major turning point in mortality trends at adult ages that occurred for many low‐mortality countries in the late 1960s or early 1970s. We analyze patterns of total and cause‐specific mortality over the past 60 years using data from the Human Mortality Database and the World Health Organization. We focus on four broad categories of causes of death: heart diseases, cerebrovascular diseases, smoking‐related cancers, and all other cancers. We use a two‐slope regression model to assess the timing and magnitude of turning points in mortality trends over this era, making separate analyses by sex, age, and cause of death. The age pattern of temporal changes is given particular attention. Our results demonstrate convincingly that period‐based factors were very significant in the onset of the “cardiovascular revolution” in the years around 1970. In general, although cohort processes cannot be ruled out as a driver of mortality change in recent decades (especially for mortality due to smoking‐related cancers), the evidence reviewed here suggests that period factors have been the dominant force behind the mortality trends of high‐income countries during this era.     

Mortality in Ghana: Evidence from the cape coast project data

Abstract This paper deals with the estimation of mortality for a rural community of about 20,000 persons in the rain-forest area of south-west Ghana. Specifically, infant, child and adult mortality estimates have been obtained by the application of a wide range of direct and indirect methods of measuring mortality from the different statistics collected by a longitudinal mortality and fertility project conducted during 1974-7. It was noted that infant and childhood mortality rates obtained from death registrations were consistent with those rates yielded by pregnancy histories and child survival statistics. However, the adult mortality estimates derived from orphanhood statistics tended to be lower than those suggested by death registrations. The analysis revealed an infant mortality rate of 100 for boys and 84 for girls, equal childhood mortality rates for boys and girls (85-6), a lower expectation of life at birth for men (45.8 years) than for women (52.8), and a much more severe incidence of mortality among men aged over 40 than for women at the corresponding ages.     

Methods for combining ancillary data in stochastic compartment models of cancer mortality: Generalization of heterogeneity models∗

In analyzing mortality data there may be available information from survey and other sources that describe the marginal distribution of risk factors. We present a mortality model where nationally representative survey data on risk factor distributions are combined with data on cohort mortality rates to increase information, i.e., a fixed marginal risk factor distribution is combined with a cohort model representing unobserved individual risk heterogeneity. The model is applied to lung cancer mortality in nine U.S. white male cohorts aged 30 to 70 in 1950 and followed 38 years. Estimates of the cohort specific proportions of smokers were made from the National Health Interview Survey. Comparisons are made for models with different patterns of changes with age of individual heterogeneity.     

A population survey of the Yi nationality in Meigu County, Sichuan Province]

In 1980, 95.35% of the 129,819 inhabitants of Meigu County in Faxin District of the Jinshan Yi autonomous district, Sichuan Province, were of Yi nationality. Agriculture is the primary mode of production and animal husbandry is an important secondary industry. Prior to Liberation, slavery was an integral part of Yi society. The standard of living was low, mortality high, and population growth slow. After Liberation from 1956-1980, the population grew 47.1%, 90% of which was a natural increase. The primary reason for the growth was a post-1960s annual average birth rate of 46/1000 and a mortality rate that fell from 35/1000 before Liberation to 13.3/1000 in 1976. The age structure also became younger. The average age in 1964 was 24 years, with a median age of 21.8 years, as compared to a 1980 average age of 23.8 years and a median age of 17 years. 47.2% of the population were aged from birth to 14 years; 2.9% were over 65 years. At the same time, 28% of the female population were of childbearing age. By 2000 Meigu County's population will reach 259,000. Although the primary reasons for the relatively rapid population increase are due to the destruction of the slave system and a higher standard of living, factors peculiar to Yi society are also significant: 1) the destruction of the slave system permitted the population to grow without the restraints of strict codes of class stratification; 2) the high value placed on having many offsprings, and of favoring male children still prevails; 3) the attitude of early marriage and the custom of widows marrying a relative of her deceased husband still prevail; 4) and infant mortality and the mortality rate of fertile women have declined. Elements which influence the population development of Meigu County include economic factors such as the need to support the old and the young, or the inability to produce enough food to keep up with the needs of an expanding population.     

The Effects of Allostatic Load on Racial/Ethnic Mortality Differences in the United States

This study expands on previous findings of racial/ethnic and allostatic load (AL) associations with mortality by addressing whether differential AL levels by race/ethnicity may explain all-cause mortality differences. This study used data from the third National Health and Nutrition Survey public-use file, gathered between 1988 and 1994, with up to 18 years of mortality follow-up (n = 11,733). AL scores were calculated using a 10-biomarker algorithm based on clinically determined thresholds. Results of discrete-time hazard models suggest that AL is associated with increased mortality risks, independent of other factors, including race/ethnicity and SES. The results also suggest that the AL–mortality association is stronger for non-Hispanic blacks than for non-Hispanic whites, and that at low levels of AL observed mortality differences between non-Hispanic blacks and non-Hispanic whites are non-significant. These findings suggest that mortality differences between non-Hispanic blacks and non-Hispanic whites may be the result of how early life exposure causes premature aging and increased mortality risks. More attention to resource allocation and local environments is needed to understand why non-Hispanic blacks experience premature aging that leads to differential mortality risks compared to non-Hispanic whites.     

Maternal Reading Skills and Child Mortality in Nigeria: A Reassessment of Why Education Matters

Mother’s formal schooling—even at the primary level—is associated with lower risk of child mortality, although the reasons why remain unclear. This study examines whether mother’s reading skills help to explain the association in Nigeria. Using data from the Demographic and Health Survey, the analysis demonstrates that women’s reading skills increase linearly with years of primary school; however, many women with several years of formal school are unable to read at all. The results further show that mother’s reading skills help to explain the relationship between mother’s formal schooling and child mortality, and that mother’s reading skills are highly associated with child mortality. The study highlights the need for more data on literacy and for more research on whether and how mother’s reading skills lower child mortality in other contexts.