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2 Diverging Trends in Life Expectancy at Age 50: A Look at Causes of Death--Dana A. Glei, France Meslé, and Jacques Vallin
Pages 17-67

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From page 17...
... To begin to answer these questions, we explore which ages and which causes of death contributed to disparities across the 10 study countries. We mainly used the Human Mortality Database (HMD)
From page 18...
... Until the middle of the 20th century, life expectancy was still strongly dependent on the fight against infectious diseases (even above age 50) , which mainly relied on antibiotics and vaccines without much link to the GDP per capita, at least among rich countries.
From page 19...
... 0002x + 24 .156 AUS NOR R² = 0. 59 88 FR A CHE R ² = 0 .0481 NZL ITA CAN ESP SWE 32 NOR NLD ISR FIN GBR AUT 27 SGP IRL DEU SWE USA NLD BEL GRC PRT TAI DNK 30 DNK SVN CAN NZL GRC 26 ESP CHE ITA CZE AUS 28 POL USA GBR FR A HRV IRL PRT SVK 25 EST FRG BEL Life Expectancy at Age 50 AUT Life Expectancy at Age 50 26 LTU HUN LVA JPN 24 FIN 24 20 05 19 60 RUS 23 22 0 500 1,000 1,50 0 2,0 00 2,50 0 3,0 00 10,0 00 15,000 20,000 25,000 30,000 35,0 00 40,0 00 45,0 00 50,0 00 GDP per Capita (dollars)
From page 20...
... . Yet Danish women resumed progress after the mid-1990s, and in very recent years Dutch women also began making faster gains.
From page 21...
... SOURCE: Data from Human Mortality Database (2009 [accessed November Fig2-2.eps 2009]
From page 22...
... Fig2-3.eps SOURCE: Data from Human Mortality Database (2009 [accessed November 2009]
From page 23...
... NOTE: AUS = Australia, CAN = Canada, DNK = Denmark, ESP = Spain, FRA = France, GBR = United Kingdom, ITA = Italy, JPN = Japan, NLD = the Netherlands, USA = United States. SOURCE: Data from the Human Mortality Database, 2009 (accessed November 6, 2009)
From page 24...
... SOURCES: Calculations by authors based on data from the Human Mortality Database and the World Health Organization Mortality Database.
From page 25...
... Thus, we have isolated two groups of causes that are strongly associated with smoking: lung cancer and respiratory diseases.3 If the smoking hypothesis has merit, then 3Previous research suggests that 75-90 percent of deaths from lung cancer and chronic pulmonary obstructive disease (COPD) are attributable to smoking (Royal College and Physicians of London, 2000; U.S.
From page 26...
... SOURCES: Calculations by authors based on data from the Human Mortality Database and the World Health Organization Mortality Database.
From page 27...
...  landscape SOURCE: Calculations by authors based on data from the World Health Organization Mortality Database.
From page 28...
... SOURCE: Calculations by authors based on data from the World Health Organization Mortality Database. Fig2-7.eps landscape
From page 29...
... The story is different among men. Respiratory diseases and other cancers generally follow parallel trends across countries, while lung cancer rates appear to have converged somewhat.
From page 30...
... Although men made better progress than women against heart diseases, women did at least as well as men against other circulatory diseases and nonlung cancers. 4Two categories shown in Figures 2-6 and 2-7 -- infectious diseases and external causes -- have been combined with the residual category of all other causes.
From page 31...
... DNK = Denmark, NLD = the Netherlands, USA = United States. SOURCES: Calculations by authors based on data from the Human Mortality Database and the World Health Organization Mortality Database.
From page 32...
... DNK = Denmark, NLD = the Netherlands, USA = United States. SOURCES: Calculations by authors based on data from the Human Morality Database and the World Health Organization Mortality Database.
From page 33...
... In the 10-year period from 1995 to 2005, Danish women made greater gains than in the previous 15 years for heart diseases, other circulatory diseases, and other cancers and replaced losses with gains for other smoking-related cancers, breast cancer, respiratory diseases, and "all other causes" (see Figure 2-10)
From page 34...
... DNK = Denmark, USA = United States. SOURCE: Calculations by authors based on data from the Human Mortality Database and the World Health Organization Mortality Database.
From page 35...
... NLD = the Netherlands, USA = United States. SOURCES: Calculations by authors based on data from the Human Mortality Database and the World Health Organization Mortality Database.
From page 36...
... Fig2-12.eps SOURCES: Calculations by authors based on data from the Human Mortality Database and the World Health Organization Mortality Database. be distributed more evenly across all older ages.
From page 37...
... A SPECIAL FOCUS ON RECENT TRENDS IN U.S. FEMALE MORTALITY COMPARED WITH FRANCE, JAPAN, AND THE NETHERLANDS We further explore the age and cause-specific contributions to changes in life expectancy at old ages among women in four countries: two laggards, the Netherlands and the United States, and two leaders, France and Japan.
From page 38...
... ; Statistics Netherlands (1984; data provided by Fanny Janssen of the University of Groningen) ; and Meslé and Vallin (2006)
From page 39...
... SOURCES: Calculations by authors based on data from the Human Mortality Database; the World Health Organization Mortality Database; National Center for Health Statistics (1987, Table 8.5) ; Vallin and Meslé (1988, 1998)
From page 40...
... SOURCES: Calculations by authors based on data from the Human Mortality Database; the World Health Organization Mortality Database; National Center for Health Statistics (1987, Table 8.5) ; Vallin and Meslé (1988, 1998)
From page 41...
... Almost as important as respiratory diseases, lung cancer is the third source of losses in the United States and the Netherlands (–0.2 year in both 7As noted earlier, the exclusion of AD deaths in 1984 means that the losses attributed to mental disorders (including AD) are probably overstated.
From page 42...
... . The negative effects of respiratory diseases are more concentrated in the intermediate ages (70-84)
From page 43...
... This female disadvantage results from smaller gains at ages below 80 and less progress against lung cancer, respiratory diseases, heart diseases, and mental disorders, and diseases of the nervous system. Yet within these three countries, women fared as well or better than their male counterparts against other circulatory diseases and nonlung cancers, especially those less affected by smoking.
From page 44...
... While this analysis identifies cause-of-death categories that underlie the mortality trends, we can only speculate about the causal factors that explain these differences. Based on the evidence presented here, the most obvious explanation for the slowing of mortality decline among women in Denmark, the Netherlands, and the United States is smoking, which is strongly correlated with lung cancer and such respiratory diseases as chronic obstructive pulmonary disease.
From page 45...
... In fact, it did even better than the Netherlands in terms of lung cancer. The somewhat greater success of the Netherlands in terms of overall gains in female life expectancy at old ages mainly relies on two facts: (1)
From page 46...
... . Nonetheless, we observed notable gains from respiratory diseases among women in several other countries that contrast with the losses found among women in Denmark, the Netherlands, and the United States.
From page 47...
... Human Mortality Database.
From page 48...
... . Detailed Data Files of the WHO Mortality Database.
From page 49...
... In addition to the ill-defined codes included in the ICD chapter entitled "Symptoms, Signs, and Ill-defined Conditions," there are nonspecific codes included in other ICD chapters. Called "garbage codes," these include cardiovascular categories lacking diagnostic meaning (e.g., "cardiac arrest," "heart failure")
From page 50...
... bData for various countries are aggregated before calculating death rates; thus, the results represent a weighted mean. SOURCES: Calculations by authors based on data from the Human Mortality Database and the World Health Organization Mortality Database.
From page 51...
... . In contrast, if deaths due to heart disease were inappropriately coded to ill-defined causes, then our results would understate the true level of heart disease.
From page 52...
... bData for various countries are aggregated before calculating death rates; thus, the results represent a weighted mean. SOURCES: Calculations by authors based on data from the Human Mortality Database and the World Health Organization Mortality Database.
From page 53...
...  DIVERGING TRENDS IN LIFE EXPECTANCY AT AGE 0 Excluding DNK, NLD, and USA Meana Compositeb Meana Compositeb JPN NLD USA 0.8 0.3 0.6 0.8 0.8 0.9 0.9 0.2 0.0 0.2 0.2 0.2 0.2 0.2 0.2 0.1 0.2 0.3 0.3 0.3 0.3 0.4 0.2 0.2 0.3 0.4 0.4 0.4 2.6 0.9 0.8 1.6 1.7 1.9 2.2 0.6 0.2 0.3 0.4 0.4 0.5 0.6 0.9 0.3 0.3 0.6 0.6 0.7 0.7 1.1 0.4 0.3 0.7 0.7 0.9 0.9 2.7 0.5 0.6 1.2 1.3 1.4 1.7 1.2 0.3 0.3 0.6 0.6 0.8 0.8 0.9 0.2 0.2 0.4 0.4 0.6 0.6 0.7 0.0 0.1 0.2 0.2 0.3 0.3 6.1 1.6 2.1 3.7 3.7 4.3 4.8 0.9 1.4 1.5 1.6 1.5 1.7 1.6 0.3 0.3 0.4 0.4 0.4 0.4 0.4 0.3 0.4 0.5 0.5 0.5 0.6 0.5 0.4 0.6 0.6 0.7 0.6 0.7 0.6 2.1 1.8 1.8 2.1 2.2 2.3 2.3 0.6 0.7 0.7 0.7 0.8 0.8 0.8 0.7 0.6 0.7 0.7 0.8 0.8 0.8 0.8 0.5 0.5 0.6 0.6 0.7 0.7 1.1 0.2 0.6 0.7 0.8 0.8 0.9 0.6 0.2 0.4 0.4 0.4 0.5 0.5 0.4 0.0 0.2 0.2 0.2 0.3 0.3 0.2 0.0 0.1 0.1 0.1 0.1 0.1 4.1 3.3 3.9 4.4 4.4 4.7 4.8 Some countries have conducted comparability (i.e., "bridge-coding") studies to assess the impact of ICD revisions.
From page 54...
... SOURCE: Calculations by authors based on data from the World Health Organization Mortality Database. are available only for a select number of countries (e.g., Canada, England and Wales, France, Italy, Sweden, the United States)
From page 55...
... Thus, for Japan during the period 1980-2004, we may overestimate the contribution of heart disease to gains in e50 and understate the role of other circulatory diseases. For respiratory diseases, many countries exhibit an increase in mortality rates at the transition to ICD-8.
From page 56...
... Other circulatory diseases 330-334, 450-468 430-458 430-459 I60-I99, G45.8, G45.9 3) Lung cancer 162, 163 162 162 C33, C34 4)
From page 57...
... , 6.2 percent from lung disease due to external agents (J60-J70) , 1.8 percent from asthma, 0.8 percent from influenza, and 15.5 percent from other respiratory diseases.
From page 58...
... SOURCE: Calculations by authors based on data from the World Health Organiza tion Mortality Database. in mental disorders and diseases of the nervous system (Figure 2A-3)
From page 59...
... .25 .25 ICD-7 ICD -8 ICD-9 ICD -10 ICD-7 ICD -8 ICD-9 ICD -10 .2 .2 .15 .15 .1 .1 .05 .05 0 0 1960 1970 1980 1990 20 00 1960 1970 1980 1990 20 00 Year Year FIGURE 2A-3 Proportion of deaths due to respiratory diseases and mental/nervous system, United Kingdom. NOTES: Solid line = unadjusted proportion; dashed line = adjusted proportion after Fig2A-3.eps redistributing ill-defined causes.
From page 60...
... bData for various countries are aggregated before calculating death rates; thus, the results represent a weighted mean. SOURCES: Calculations by authors based on data from the Human Mortality Database and the World Health Organization Mortality Database.
From page 61...
...  DIVERGING TRENDS IN LIFE EXPECTANCY AT AGE 0 Excluding DNK, NLD, and USA Meana Compositeb Meana Compositeb GBR ITA JPN NLD USA 1.9 1.7 1.4 2.2 2.7 2.0 2.1 1.8 1.7 1.1 1.0 0.0 0.9 1.6 1.0 1.1 0.9 0.8 0.8 0.7 1.4 1.2 1.1 1.0 1.0 0.9 0.9 –0.2 0.0 0.1 0.3 0.0 0.1 0.1 0.0 0.1 –0.2 –0.1 –0.1 –0.1 –0.3 –0.1 –0.2 –0.1 –0.1 0.0 –0.1 –0.1 –0.1 0.0 0.0 0.0 0.0 0.0 –0.1 –0.1 0.0 –0.1 0.0 –0.1 0.0 –0.1 –0.1 0.2 0.2 0.3 0.5 0.3 0.3 0.3 0.3 0.3 –0.1 0.3 0.1 0.3 –0.1 0.1 0.1 0.2 0.2 0.0 0.1 0.1 0.1 –0.1 0.1 0.0 0.1 0.1 0.2 0.6 1.7 0.2 0.0 0.6 0.7 0.9 1.0 0.3 0.2 1.7 0.5 0.4 0.6 0.5 0.6 0.6 0.1 –0.1 0.0 0.0 0.2 0.0 0.1 0.0 0.0 0.1 0.1 0.4 0.1 0.1 0.1 0.1 0.2 0.2 0.0 –0.1 –0.1 0.2 0.1 0.0 0.0 0.0 0.0 0.0 0.1 0.8 0.1 0.1 0.2 0.2 0.2 0.2 0.0 0.1 0.3 0.1 0.1 0.1 0.1 0.1 0.1 0.1 0.1 0.2 0.1 0.0 0.1 0.1 0.1 0.1 2.2 2.9 5.1 3.6 3.0 3.4 3.5 3.6 3.7 0.6 0.3 1.3 0.0 1.9 0.9 1.3 0.9 0.9 0.2 –0.1 0.0 –0.5 1.3 0.3 0.7 0.4 0.3 0.4 0.4 1.3 0.5 0.7 0.6 0.6 0.6 0.6 –0.1 –0.9 –0.3 –0.8 –0.4 –0.5 –0.4 –0.5 –0.4 –0.2 –0.6 –0.3 –0.7 –0.5 –0.4 –0.4 –0.4 –0.3 0.0 –0.2 –0.1 –0.2 0.0 –0.1 –0.1 –0.1 –0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.0 0.1 0.1 0.1 0.1 0.1 0.0 0.1 0.3 0.0 0.0 0.0 –0.3 0.0 0.0 0.1 0.1 0.0 0.1 0.1 0.1 –0.1 0.0 0.0 0.1 0.1 0.1 0.4 1.2 0.1 0.0 0.4 0.4 0.6 0.7 0.6 0.4 1.9 0.5 0.5 0.7 0.7 0.8 0.8 0.1 0.0 0.1 0.1 0.2 0.1 0.1 0.1 0.1 0.2 0.3 0.6 0.1 0.2 0.3 0.3 0.3 0.4 0.0 –0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.1 –0.1 0.7 0.1 0.1 0.1 0.1 0.1 0.2 0.2 0.1 0.2 0.2 0.1 0.2 0.2 0.2 0.2 0.1 0.1 0.3 0.1 0.0 0.1 0.1 0.1 0.1 1.5 0.3 4.2 –0.2 1.8 1.5 2.0 2.0 2.2
From page 62...
... SOURCES: Calculations by authors based on data from the Human Mortality Database and the World Health Organization Mortality Database.
From page 63...
...  DIVERGING TRENDS IN LIFE EXPECTANCY AT AGE 0 Excluding DNK, NLD, and USA Meana Compositeb Meana Compositeb GBR ITA JPN NLD USA 3.0 3.1 4.1 2.0 2.8 3.0 3.1 3.3 3.4 2.0 1.8 1.7 1.5 2.0 1.8 1.9 1.8 1.8 1.0 1.3 2.4 0.6 0.7 1.2 1.2 1.5 1.6 0.3 0.2 0.4 0.0 0.1 0.2 0.3 0.2 0.4 –0.1 –0.1 0.0 –0.3 –0.3 –0.2 –0.1 –0.1 –0.1 0.0 0.0 0.0 –0.1 0.0 0.0 0.0 0.0 0.0 0.2 0.0 –0.1 0.1 0.1 0.1 0.1 0.0 0.1 0.2 0.3 0.5 0.3 0.3 0.3 0.3 0.3 0.4 0.5 0.3 0.2 –0.2 –0.3 0.1 0.1 0.2 0.3 –0.2 –0.2 0.0 –0.4 –0.4 –0.3 –0.3 –0.2 –0.1 –0.1 0.2 0.8 0.1 0.0 0.2 0.1 0.2 0.2 0.1 0.5 0.7 0.1 –0.1 0.3 0.3 0.4 0.5 0.1 0.2 0.1 0.2 0.0 0.1 0.1 0.2 0.2 0.0 0.0 0.0 0.0 –0.1 0.0 –0.1 0.0 0.0 0.0 0.2 0.1 –0.1 –0.1 0.0 0.0 0.1 0.1 –0.1 0.3 0.3 0.0 0.1 0.1 0.2 0.2 0.2 0.0 0.0 0.1 0.0 –0.1 0.0 0.0 0.0 0.0 0.0 –0.1 0.1 0.0 0.0 0.0 0.0 0.0 3.6 4.1 6.1 1.6 2.1 3.4 3.6 4.1 4.7 3.7 2.9 3.0 2.5 3.4 3.1 3.2 3.2 3.1 2.9 1.8 1.2 2.1 2.8 2.2 2.3 2.1 1.9 0.8 1.1 1.8 0.4 0.6 0.9 1.0 1.1 1.2 0.7 0.5 0.2 0.7 0.5 0.4 0.5 0.4 0.4 0.6 0.2 –0.1 0.6 0.3 0.2 0.2 0.2 0.2 0.0 0.2 –0.1 0.0 0.1 0.1 0.1 0.1 0.1 0.0 0.0 –0.1 0.0 0.1 0.0 0.0 0.0 0.0 0.1 0.1 0.4 0.2 0.2 0.1 0.2 0.1 0.2 0.9 0.5 0.1 0.0 0.2 0.3 0.3 0.4 0.4 –0.1 –0.1 0.0 –0.2 –0.2 –0.1 –0.1 –0.1 –0.1 0.0 0.1 0.3 0.2 0.1 0.1 0.1 0.1 0.1 0.1 0.9 0.5 0.1 0.0 0.4 0.4 0.5 0.6 0.1 0.2 0.0 0.1 0.1 0.2 0.1 0.2 0.1 0.0 0.0 0.1 0.0 –0.1 0.0 0.0 0.0 0.0 0.0 0.1 0.0 –0.1 –0.1 0.0 0.0 0.0 0.0 –0.1 0.6 0.4 0.0 0.2 0.2 0.3 0.3 0.4 0.1 0.1 0.1 0.1 0.0 0.0 0.0 0.1 0.1 0.0 –0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 5.2 4.8 4.1 3.3 4.0 4.3 4.4 4.6 4.7
From page 64...
... bData for various countries are aggregated before calculating death rates; thus, the results represent a weighted mean. SOURCES: Calculations by authors based on data from the Human Mortality Database and the World Health Organization Mortality Database.
From page 65...
...  DIVERGING TRENDS IN LIFE EXPECTANCY AT AGE 0 Excluding DNK and NLD Meana Compositeb Meana Compositeb JPN NLD 1.1 0.4 0.7 0.9 0.8 0.9 0.3 0.1 0.2 0.2 0.2 0.2 0.4 0.1 0.2 0.3 0.3 0.3 0.5 0.2 0.3 0.4 0.4 0.4 2.0 0.5 0.9 0.9 1.2 1.4 0.6 0.2 0.3 0.3 0.5 0.5 0.7 0.2 0.3 0.3 0.5 0.5 0.7 0.1 0.2 0.3 0.4 0.4 1.1 –0.6 0.0 0.2 0.2 0.3 0.6 –0.1 0.1 0.2 0.2 0.3 0.3 –0.2 0.0 0.0 0.1 0.1 0.3 –0.2 –0.1 0.0 0.0 0.0 4.3 0.3 1.6 1.9 2.2 2.6 0.9 0.7 0.7 0.7 0.8 0.8 0.3 0.3 0.2 0.3 0.3 0.3 0.3 0.2 0.2 0.2 0.2 0.2 0.3 0.2 0.2 0.3 0.3 0.3 0.9 –0.2 0.3 0.5 0.5 0.6 0.4 0.1 0.2 0.3 0.3 0.3 0.3 –0.1 0.1 0.2 0.2 0.2 0.2 –0.2 0.0 0.1 0.1 0.1 0.1 –0.6 –0.2 –0.1 –0.1 –0.1 0.1 –0.3 –0.1 0.0 0.0 0.0 0.0 –0.2 –0.1 –0.1 –0.1 –0.1 0.0 –0.1 –0.1 –0.1 –0.1 –0.1 1.9 –0.1 0.8 1.1 1.2 1.2
From page 66...
... SOURCES: Calculations by authors based on data from the Human Mortality Database and the World Health Organization Mortality Database.
From page 67...
...  DIVERGING TRENDS IN LIFE EXPECTANCY AT AGE 0 Excluding DNK and NLD Meana Compositeb Meana Compositeb GBR ITA JPN NLD 0.1 0.1 1.8 0.4 0.7 1.0 0.9 1.0 0.6 0.4 1.9 0.6 0.9 1.1 1.0 1.1 –0.5 –0.3 –0.1 –0.2 –0.2 –0.1 –0.1 –0.1 –0.2 0.3 0.8 –0.3 0.1 0.4 0.3 0.4 0.2 0.5 0.6 0.2 0.3 0.4 0.4 0.5 –0.1 0.0 0.1 –0.1 0.0 0.0 0.0 0.0 –0.1 0.0 0.3 –0.1 0.0 0.1 0.0 0.1 –0.2 –0.3 –0.1 –0.3 –0.2 –0.1 –0.1 –0.1 –0.2 0.6 0.3 0.2 0.3 0.3 0.3 0.3 0.1 0.3 0.8 –0.1 0.2 0.3 0.2 0.3 –0.1 0.0 –0.2 –0.3 –0.2 –0.1 –0.1 –0.1 0.4 0.4 0.8 0.3 0.4 0.5 0.5 0.5 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.2 0.1 0.1 0.1 0.1 0.1 0.1 0.2 0.0 0.3 0.1 0.1 0.2 0.1 0.2 –0.2 0.0 0.1 –0.1 0.0 0.0 0.0 0.0 0.1 0.1 0.1 0.1 0.1 0.1 0.1 0.1 0.1 0.1 0.2 0.1 0.0 0.1 0.1 0.1 0.1 1.6 4.3 0.3 1.5 2.4 2.1 2.5 –0.1 0.3 1.5 0.3 0.7 0.9 0.8 0.9 0.4 0.6 1.9 0.6 0.9 1.1 1.0 1.2 –0.4 –0.4 –0.4 –0.3 –0.2 –0.3 –0.2 –0.3 –0.2 –0.6 –0.3 –0.6 –0.4 –0.4 –0.3 –0.4 0.2 0.0 0.3 –0.1 0.1 0.1 0.1 0.1 –0.1 –0.1 0.0 –0.1 –0.1 –0.1 –0.1 –0.1 –0.1 0.0 0.1 –0.1 0.0 0.0 0.0 0.0 –0.2 –0.5 –0.6 –0.2 –0.3 –0.4 –0.4 –0.4 –0.2 0.3 –0.2 0.0 0.1 0.0 0.1 0.0 0.1 0.2 0.4 0.0 0.1 0.2 0.1 0.2 0.0 0.0 –0.1 –0.3 –0.1 –0.1 –0.1 –0.1 0.7 0.5 0.4 0.5 0.4 0.4 0.4 0.4 0.2 0.1 –0.1 0.2 0.1 0.0 0.1 0.0 0.2 0.2 0.1 0.1 0.1 0.1 0.1 0.1 0.2 0.1 0.2 0.1 0.1 0.2 0.1 0.2 –0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.1 0.1 0.1 0.1 0.1 0.1 0.1 0.1 0.1 0.1 0.1 0.0 0.1 0.0 0.1 0.3 0.6 1.9 –0.1 0.7 1.0 1.1 1.1


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