International Differences in Mortality at Older Ages Dimensions and Sources (2010) / Chapter Skim
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12 Geographic Differences in Life Expectancy at Age 50 in the United States Compared with Other High-Income Countries--John R. Wilmoth, Carl Boe, and Magali Barbieri
12 Geographic Differences in Life Expectancy at Age 50 in the United States Compared with Other High-Income Countries--John R. Wilmoth, Carl Boe, and Magali Barbieri
Pages 333-366
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From page 333... ...
. The broad pattern of geographic variation is similar across the four panels of Figure 12-1: relatively low values of e50 in the District of Columbia and across a large area of the Southeast, extending northward into Appalachia and to a lesser extent into parts of the Great Lakes region; and relatively high values of e50 across the far north central region of the country, extending into the mountain states as well.
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From page 334... ...
The selected set of countries includes all of the above except Chile, Israel, and Taiwan plus countries of Eastern Europe and the former Soviet Union (Belarus, Bulgaria, the Czech Repub lic, Estonia, Hungary, Latvia, Lithuania, Poland, Russia, Slovakia, Slovenia, and Ukraine)
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From page 335... ...
As a result of its relatively poor performance during these years, the position of the United States fell to 20th among the 34 comparison countries with data available in 2006. In fact, only Taiwan, Denmark, and the 12 countries of Eastern Europe and the former Soviet Union fared worse than the United States at that time.
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From page 336... ...
Male life expectancy at age e50 by State Fig12-1a.eps Fig12-1b.eps FIGURE 12-1 Geographic variation in life expectancy at age 50 in the contiguous bitmap -- outer ruled box marked for deletion United States, 2000.
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From page 337... ...
Census Bureau (from data files provided by Andrew Fenelon)
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From page 338... ...
Given the coincidence of timing (from the early 1980s until recently) and the shared characteristic of a greater impact on women, it is natural to inquire whether the increasing geographic disparity observed by Ezzati and colleagues is related in some causal fashion to the reduced pace of increase in values of life expectancy for the United States and thus to the country's loss of position in international rankings for this key indicator of population health.
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From page 339... ...
The selected set of countries includes all of the above except Chile, Israel, and Fig12-2b.eps Taiwan plus countries of Eastern Europe and the former Soviet Union (Belarus, Bulgaria, the Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Russia, Slovakia, Slovenia, and Ukraine)
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From page 340... ...
In this way we are able to obtain some key insights about the role of changing geographic disparities in e50 to trends in e50 itself for the United States and other high-income countries. Using this framework, convergence of subnational levels of e50 helps to accelerate the national trend, as the less 6It is well known that the direction of this causal relationship is more complex than depicted here (e.g., Smith, 1999)
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From page 341... ...
In this chapter, however, we focus on aggregate geographic differences as a means of gaining some preliminary insights into this matter. DATA Mortality indicators for selected years from 1950 to 2006 were collected for the United States, Canada, Japan, and 19 national or large subnational areas of Western Europe, namely Austria, Belgium, Denmark, England and Wales, Finland, France, West Germany, Iceland, Republic of Ireland, Northern Ireland, Italy, Luxembourg, the Netherlands, Norway, Portugal, Scotland, Spain, Sweden, and Switzerland.
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From page 342... ...
The underlying idea was that counties of the United States could be compared with relatively smaller administrative units in other countries, whereas states of the United States could be compared with larger administrative units within countries and with countries of Western Europe. At one level of aggregation, the United States is composed of 50 states plus the District of Columbia, with an average population (in 2000)
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From page 343... ...
. Western Europe is not a country but rather a statistical conglomeration that consists of the following countries and subnational areas: Austria, Belgium, Denmark, England and Wales, Finland, France, Iceland, Republic of Ireland, Northern Ireland, Italy, Luxembourg, the Netherlands, Norway, Portugal, Scotland, Spain, Sweden, Switzerland, and West Germany.
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From page 344... ...
. As a global measure of the geographic variability of life expectancy in a population, we computed the standard deviation across N population subunits, taking into account their relative sizes.
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From page 345... ...
So defined, the convergence effect represents the increased rate of change for the total population that is attributable to faster change in the lower half of the geographic distribution compared with the upper half. If change is faster in the upper half, the value is negative and thus represents a divergence effect.
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From page 346... ...
a difference in the trends of e50 for the upper 50 percent of the geographic distribution in the United States versus the upper 50 percent of the geographic distribution for the comparison population, (2) a divergence between the lower and the upper 50 percent of the geographic distribution for the United States,
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From page 347... ...
The first component can be interpreted as the portion of the differential increase that is attributable to factors affecting all states (or counties) of the United States in a similar fashion, whereas the second and third components measure the portions attributable to increasing geographic variability in the United States or declining variability in the comparison population.
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From page 348... ...
We then describe changes in regional dispari ties among the other high-income countries in the study before presenting the results of our analysis relating changes in regional variability within countries to changes in variability between countries. Geographic Disparities in the United States The geographic variability of mortality levels at older ages in the United States has been and continues to be quite large.
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From page 349... ...
, 2000. SOURCES: Authors' analysis of data from various sources: for states from 1940 to 1990, National Center for Health Statistics and predecessors, state life table publica tions; for states in 2000, authors' calculations based on data for 1999, 2000, and 2001, from the National Center for Health Statistics and the U.S.
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From page 350... ...
1.5 1.0 0.5 Male 0 1920 1940 1960 1980 2000 Year Fig12-5b.eps FIGURE 12-5 Trends in the standard deviation of e50 across geographic subunits, five countries plus Western Europe, 1921-2007.
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From page 351... ...
The convergence effect represents the increased rate of change for the total population that is attributable to a more rapid increase in the lower 50 percent of the geographic distribution compared with the upper 50 percent. If the pace of change is faster in the upper 50 percent, the value is negative and thus represents a divergence effect.
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From page 352... ...
Women Canada 0.052 66.7 15.2 18.1 France 0.113 90.7 7.1 2.3 Germany 0.160 72.4 5.0 22.6 Japan 0.192 94.2 4.2 1.6 Western Europe 0.104 101.6 7.7 –9.3 Men Canada 0.029 47.8 37.7 14.5 France 0.039 60.6 27.6 11.8 Germany 0.094 58.7 11.5 29.8 Japan 0.009 –62.0 114.4 47.5 Western Europe 0.033 55.0 33.0 12.1 NOTES: Using the column notation of Table 12-2, the partitioning of differential rates of change shown here can be expressed as follows: Comparison(a)
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From page 353... ...
standard deviation of e50 across geographic subunits in five countries, as well as among the countries of Western Europe, from 1921 to 2007. For the countries with available data, it appears that the level of regional variability in e50 fell somewhat dur
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From page 354... ...
, as did Germany beginning about 10 years after reunification. Western Europe as a whole shows a continuous and steep increase in regional variability attributable to the differential pace of growth in female life expectancy among the various countries.
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From page 355... ...
30 Female 25 Male 20 1940 1950 1960 1970 1980 1990 2000 Year 1990, National Center for Health Statistics and predecessors, state life table publications; for states in 2000, authors' calculations based on data for 1999, 2000, and Fig12-6b.eps 2001, from the National Center for Health Statistics and the U.S. Census Bureau (from data files provided by Andrew Fenelon)
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From page 356... ...
United States and Western Europe SOURCES: Authors' analysis of data from various sources: for Canada, Canadian Human Mortality Database (see http://www.bdlc.umontreal.ca/CHMD [accessed March 2009]
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From page 357... ...
Although the intercountry gap was relatively small for men, it was quite sizeable for women, with average annual gains of less than 3 additional weeks of life in the United States compared with more than 1 month in Canada, nearly 2 months in Western Europe as a whole, 3 in Germany, and 4 in Japan. Male e50 increased by somewhat less than 2 months per calendar year in the United States, which is not far from the gains achieved in the other areas (with the exception of Germany, following reunification, which gained nearly 3 months per year on average during the 1990s)
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From page 358... ...
Over 30 percent of the difference in the average annual change of e50 between the United States and Western Europe on one hand, Canada on the other, is attributable to increasing regional variability in the former and only 12 and 14 percent, respectively, to declining regional variability in the latter. For women, the portion of differential increase due to trends in geographic variability is around 30 percent when comparing the United States with Canada or Germany but less than 10 percent when comparing the United States with France, Japan, or Western Europe as a whole.
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From page 359... ...
Indeed, whereas internal disparities in the United States, whether measured at the state or at the county level, tended to decline up to the early 1980s, they have increased since then, in contrast to most other populations in the study (with the notable exception of women in Western Europe taken as a whole) , which have experienced stability or an ongoing decline of geographic variability.
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From page 360... ...
, 2037-2045. Canadian Human Mortality Database.
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From page 361... ...
Hyattsville, MD: National Center for Health Statistics. Human Mortality Database.
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From page 362... ...
United States States For 1940-1990, mortality statistics for the individual states of the United States and the District of Columbia come from the decennial life tables that are published each decade by the National Center for Health Statistics (NCHS 1966, 1975, 1986, 1998) and its predecessor, the National Office of Vital Statistics (NOVS 1948, 1956)
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From page 363... ...
for 19902007 for the German States come from the Federal Statistical Office of Germany. Eva Kibele, of the Max Planck Institute for Demographic Research in Rostock, Germany, computed annual life tables for federal states using these underlying vital statistics and provided all life-table and population data for Germany used in this analysis.
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From page 364... ...
For 1995, we used the adjusted life tables that remove the effect of earthquake mortality in Hanshin/Kobe prefecture. The underlying source for the life tables is Ministry of Health, Labour and Welfare (various years)
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From page 365... ...
, x2 – m2) be an n by 2 matrix whose columns contain the recentered values of male and female life expectancy.
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From page 366... ...
INTERNATIONAL DIFFERENCES IN MORTALITY AT OLDER AGES 1T Z Z = I Note them so that the variation along each axis is now unity: n that the matrix, Z, like X and Y previously, contains two column vectors, z1 = (z11,z21, .
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