The German East-West Mortality Difference: Two Crossovers Driven by Smoking

Before the fall of the Berlin Wall, mortality was considerably higher in the former East Germany than in West Germany. The gap narrowed rapidly after German reunification. The convergence was particularly strong for women, to the point that Eastern women aged 50–69 now have lower mortality despite lower incomes and worse overall living conditions. Prior research has shown that lower smoking rates among East German female cohorts born in the 1940s and 1950s were a major contributor to this crossover. However, after 1990, smoking behavior changed dramatically, with higher smoking intensity observed among women in the eastern part of Germany. We forecast the impact of this changing smoking behavior on East-West mortality differences and find that the higher smoking rates among younger East German cohorts will reverse their contemporary mortality advantage. Mortality forecasting methods that do not account for smoking would, perhaps misleadingly, forecast a growing mortality advantage for East German women. Experience from other countries shows that smoking can be effectively reduced by strict anti-smoking policies. Instead, East Germany is becoming an example warning of the consequences of weakening anti-smoking policies and changing behavioral norms.     

Lifespan Dispersion in Times of Life Expectancy Fluctuation: The Case of Central and Eastern Europe

Central and Eastern Europe (CEE) have experienced considerable instability in mortality since the 1960s. Long periods of stagnating life expectancy were followed by rapid increases in life expectancy and, in some cases, even more rapid declines, before more recent periods of improvement. These trends have been well documented, but to date, no study has comprehensively explored trends in lifespan variation. We improved such analyses by incorporating life disparity as a health indicator alongside life expectancy, examining trends since the 1960s for 12 countries from the region. Generally, life disparity was high and fluctuated strongly over the period. For nearly 30 of these years, life expectancy and life disparity varied independently of each other, largely because mortality trends ran in opposite directions over different ages. Furthermore, we quantified the impact of large classes of diseases on life disparity trends since 1994 using a newly harmonized cause-of-death time series for eight countries in the region. Mortality patterns in CEE countries were heterogeneous and ran counter to the common patterns observed in most developed countries. They contribute to the discussion about life expectancy disparity by showing that expansion/compression levels do not necessarily mean lower/higher life expectancy or mortality deterioration/improvements.     

SHORT REVIEWS

Books reviewed in this article: Gay Becker, The Elusive Embryo: How Women and Men Approach New Reproductive Technologies Theodore Caplow, Louis Hicks, and Ben J. Wattenberg, The First Measured Century: An Illustrated Guide to Trends in America, 1900–2000 Stephen Moore and Julian L. Simon, It's Getting Better All the Time: 100 Greatest Trends of the Last 100 Years Elisabeth Croll, Endangered Daughters: Discrimination and Development in Asia Barbara Entwisle and Gail E. Henderson (Eds.), Re‐Drawing Boundaries: Work, Households, and Gender in China David T. Graham and Nana K. Poku (Eds.), Migration, Globalisation and Human Security Paul Harrison and Fred Pearce, AAAS Atlas of Population and Environment Russell King, Paolo De Mas, and Jan Mansvelt Beck (Eds.), Geography, Environment and Development in the Mediterranean Michael T. Klare, Resource Wars: The New Landscape of Global Conflict Korea Institute for Health and Social Affairs and United Nations Population Fund, Low Fertility and Policy Responses to Issues of Ageing and Welfare National Assessment Synthesis Team, Climate Change Impacts on the United States: The Potential Consequences of Climate Variability and Change. Report for the US Global Change Research Program Jacques Vaixin and Thérèse Locoh (Eds.), Population et développement en Tunisie: La métamorphose     

The duration of unemployment in Russia

This paper uses longitudinal survey data to assess factors affecting the duration of unemployment in Russia. We examine four types of marginalised labour force participants, according to ILO guidelines and survey responses, and we estimate duration models for each type. It turns out that the sets of characteristics with the strongest effects on the duration are remarkably similar across the different unemployment definitions and model specifications. Therefore, despite the formidable practical measurement problems, problematic groups of individuals can actually be identified. Received: 27 January 1999/Accepted: 27 January 2000     

Perturbation Analysis of Indices of Lifespan Variability

A number of indices exist to calculate lifespan variation, each with different underlying properties. Here, we present new formulae for the response of seven of these indices to changes in the underlying mortality schedule (life disparity, Gini coefficient, standard deviation, variance, Theil’s index, mean logarithmic deviation, and interquartile range). We derive each of these indices from an absorbing Markov chain formulation of the life table, and use matrix calculus to obtain the sensitivity and the elasticity (i.e., the proportional sensitivity) to changes in age-specific mortality. Using empirical French and Russian male data, we compare the underlying sensitivities to mortality change under different mortality regimes to determine the conditions under which the indices might differ in their conclusions about the magnitude of lifespan variation. Finally, we demonstrate how the sensitivities can be used to decompose temporal changes in the indices into contributions of age-specific mortality changes. The result is an easily computable method for calculating the properties of this important class of longevity indices.     

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.     

Bayesian blinded sample size re-estimation

Information before unblinding regarding the success of confirmatory clinical trials is highly uncertain. Current techniques using point estimates of auxiliary parameters for estimating expected blinded sample size: (i) fail to describe the range of likely sample sizes obtained after the anticipated data are observed, and (ii) fail to adjust to the changing patient population. Sequential MCMC-based algorithms are implemented for purposes of sample size adjustments. The uncertainty arising from clinical trials is characterized by filtering later auxiliary parameters through their earlier counterparts and employing posterior distributions to estimate sample size and power. The use of approximate expected power estimates to determine the required additional sample size are closely related to techniques employing Simple Adjustments or the EM algorithm. By contrast with these, our proposed methodology provides intervals for the expected sample size using the posterior distribution of auxiliary parameters. Future decisions about additional subjects are better informed due to our ability to account for subject response heterogeneity over time. We apply the proposed methodologies to a depression trial. Our proposed blinded procedures should be considered for most studies due to ease of implementation.     

Inference in Targeted Group‐Sequential Covariate‐Adjusted Randomized Clinical Trials

This article is devoted to the construction and asymptotic study of adaptive, group‐sequential, covariate‐adjusted randomized clinical trials analysed through the prism of the semiparametric methodology of targeted maximum likelihood estimation. We show how to build, as the data accrue group‐sequentially, a sampling design that targets a user‐supplied optimal covariate‐adjusted design. We also show how to carry out sound statistical inference based on such an adaptive sampling scheme (therefore extending some results known in the independent and identically distributed setting only so far), and how group‐sequential testing applies on top of it. The procedure is robust (i.e. consistent even if the working model is mis‐specified). A simulation study confirms the theoretical results and validates the conjecture that the procedure may also be efficient.