International Differences in Mortality at Older Ages Dimensions and Sources (2010) / Chapter Skim
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14 The Divergent Life-Expectancy Trends in Denmark and Sweden - and Some Potential Explanations--Kaare Christensen, Michael Davidsen, Knud Juel, Laust Mortensen, Roland Rau, and James W. Vaupel
14 The Divergent Life-Expectancy Trends in Denmark and Sweden - and Some Potential Explanations--Kaare Christensen, Michael Davidsen, Knud Juel, Laust Mortensen, Roland Rau, and James W. Vaupel
Pages 385-408
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From page 385... ...
Sweden maintained its position among the world leaders in life expectancy throughout the 20th century and made significant gains in comparison to Denmark. The life-expectancy difference between Sweden and Denmark grew from marginal in the 1950s to 3 years in the early 1990s (Juel, 2008)
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From page 386... ...
Life disparity can be measured as the average remaining life
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From page 387... ...
Countries with long life expectancy tend to have low life disparity because these countries have been successful in reducing premature deaths -- doing so increases life expectancy and reduces life disparity. That is, efforts to avert deaths that occur at ages well below the life expectancy of a population appear to be especially effective in increasing life expectancy -- and, simultaneously, reducing life disparity.
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From page 388... ...
INTERNATIONAL DIFFERENCES IN MORTALITY AT OLDER AGES a Women Men 85 85 80 80 75 75 e0 e0 70 70 65 65 60 60 1950 1960 1970 1980 1990 2000 2010 1950 1960 1970 1980 1990 2000 2010 Year Year b Fig14-1a.eps Women Men 25.0 25.0 22.5 22.5 22.0 22.0 17.5 17.5 e85 e85 15.0 15.0 12.5 12.5 10.0 10.0 1950 1960 1970 1980 1990 2000 2010 1950 1960 1970 1980 1990 2000 2010 Year Year Fig14-1b.eps
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From page 389... ...
DIVERGENT LIFE EXPECTANCY TRENDS IN DENMARK AND SWEDEN Women Men c 11 11 10 10 9 9 8 8 e80 e80 7 7 6 6 5 5 4 4 1950 1960 1970 1980 1990 2000 2010 1950 1960 1970 1980 1990 2000 2010 Year Year FIGURE 14-1 Life expectancy in Denmark and other high-income countries.
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From page 390... ...
0 0 Highest 1 2 3 4 5 6 7 8 9 10 11 12 13 Relative Placement 14 15 16 17 18 19 Lowest 20 1950 -1959 1960-1969 1970 -1979 1980-1989 1990 -1999 2000-2004 Swedish men Swedish women Danish men Danish women FIGURE 14-2 Denmark's and Sweden's rank in life expectancy at birth among 20 OECD countries. Fig14-2.eps landscape patterned fills
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From page 391... ...
Distribution of Lifestyle Risk Factors National comparable survey data are available for the period when Denmark went from stagnating to increasing in life expectancy. Four nationally representative health interview surveys among adult Danes were
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From page 392... ...
–0.1 0 0.1 0.2 0.3 0.4 0.5 –0.1 0 0.1 0.2 0.3 0.4 0.5 1960 1960 1970 1970 1980 1980 Year Year Women Women 1990 1990 2000 2000 2010 2010 Annual Increase in e65 in Years Annual Increase in e0 in Years (in successive 10-year periods) (in successive 10-year periods)
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From page 393... ...
Annual Increase in e80 in Years Annual Increase in e80 in Years 0.4 0.4 0.3 0.3 0.2 0.2 0.1 0.1 0 0 1960 1970 1980 1990 2000 2010 1960 1970 1980 1990 2000 2010 –0.1 –0.1 Year Year Fig14-3c.eps FIGURE 14-3 Annual increase in life expectancy.
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From page 394... ...
Men (b) Women NOTE: Life disparity is a measure of discrepancies in life spans; it is calculated as the average remaining life expectancy at the ages of death (Zhang and Vaupel, 2009)
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From page 395... ...
a (a) Tobacco-related mortality Lowest 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Highest 20 1950 -1959 1960-1969 1970 -1979 1980-1989 1990 -1999 2000 -2007 Swedish men Swedish women Danish men Danish women FIGURE 14-5 Denmark's rank among the 20 OECD countries for (a)
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From page 396... ...
b (b) Liver cirrhosis Lowest 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Highest 19 20 1950 -1959 1960-1969 1970 -1979 1980-1989 1990 -1999 2000 -2007 Swedish men Swedish women Danish men Danish women FIGURE 14-5 Continiued.
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From page 397... ...
. The CRS, which has existed in Denmark for more than 40 years, is a nationwide civil register whose purposes are to administrate the unique personal identification number system, to administer general personal data reported from national registration offices to the CRS, and to forward personal data in a technically/economically suitable manner in accordance with the Register's Act and other legislation governing civil registration.
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From page 398... ...
High alcohol consumption is defined as drinking above moderate drinking limits (21 units of alcohol for men and 14 for women per week)
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From page 399... ...
The figures show that the improvement in Danish life expectancy that occurred in the mid-1990s co-occurs with a decrease in three mortality risk factors: smoking, alcohol consumption, and sedentary lifestyle, while one risk factor, the obesity rate, goes up, albeit to a low level compared with, for example, the United States (see Chapter 6, in this volume)
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From page 400... ...
The Health Care System There has been a long-standing debate concerning the extent to which the level of investment in the Danish health care system could account for part of the difference in life expectancy in Denmark and Sweden. Both countries base their health care policy on the Scandinavian universal welfare state model, with free and equal access to health care.
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From page 401... ...
is part of the official health care budget and thus raises health care expenditures by its inclusion (Søgaard, 2008)
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From page 402... ...
Neonatal survival chances are highly dependent on specialized medical care, which is typically administered by neonatal intensive care units, in which technologies, such as continuous positive airway pressure and surfactant therapy, have pushed the limit of viability downward (Goldenberg and Rouse, 1998)
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From page 403... ...
Fig14-14c.eps (b) Moderately preterm (33-36 weeks)
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From page 404... ...
. DISCUSSION Smoking -- The Major Explanation The data presented above on cause-of-death trajectories, the disease incidence pattern, and the fractions of death estimated to be attributable to smoking using fundamentally different methods all suggest that smoking is the major explanation for the divergent Danish life expectancy trend compared with Sweden.
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From page 405... ...
in Denmark suggest a slowing of progress in reducing life disparity occurring at roughly the same time as the slowing of progress in increasing life expectancy. That is, Danish life expectancy may have stagnated, at least in part, because the Danes did not continue to reduce inequalities in the length of life in the 1970s and 1980s.
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From page 406... ...
. Increased mortality among Danish women: Population based register study.
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From page 407... ...
. Forecasting United States mortality using cohort smoking histories.
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