International Differences in Mortality at Older Ages Dimensions and Sources (2010) / Chapter Skim
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1 Introduction and Overview--Eileen M. Crimmins, Samuel H. Preston, and Barney Cohen
1 Introduction and Overview--Eileen M. Crimmins, Samuel H. Preston, and Barney Cohen
Pages 1-14
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. The decline in the relative position of the United States cannot be easily explained by higher rates of infant mortality in the United States than in other developed countries or by higher rates of violent deaths among young adults in the United States.
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However, the empirical basis for certain conclusions is significantly stronger in some cases than in others. For example, a lot is known about international differences in smoking patterns and levels of obesity, but far less about international differences in stress, physical exercise, and social networks.
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NATURE OF THE DIFFERENCES To better understand some of the main features of the diverging trends in life expectancy across countries, the paper by Glei, Meslé, and Vallin (Chapter 2) examines mortality changes and differences in 10 countries where high-quality mortality and cause of death data are available.
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Cancer registries show that the reported incidence of prostate cancer, breast cancer, and lung cancer is also highest in the United States. Colorectal cancer is the only disease for which the United States does not rank first in reported morbidity among the countries in the analysis.
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In addition, it has been linked to a host of other respiratory diseases (asthma, bronchitis, emphysema, influenza, pneumonia, pulmonary fibrosis, and pulmonary tuberculosis) , cardiovascular diseases (aortic aneurysms, cerebral vascular disease, coronary heart disease, and hypertension)
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; in contrast, Pampel explores the hypothesis that international differences in smoking can best be understood from the vantage point of an epidemic that spreads from a relatively small part of a population to other parts, and then recedes, like other epidemics. Pampel emphasizes the importance of diffusion theory to explain observed patterns of cigarette consumption by socioeconomic group.
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Among other obstacles are a paucity of internationally comparable time-series data, a lack of common metrics, and questions about the relative quality of personal recall data versus data derived by objective measurement. In addition, there is no definitive theoretical framework to guide how to assess the effects of physical activity on life expectancy: this lack of a framework results in a lack of clarity about the most important variables and when and how to measure them.
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The authors recognize that this comparison is not ideal because the two countries share relatively similar mortality profiles. Their analysis of the relationship between measures of social integration and health in the two countries suggests a relatively weak role for social integration in explaining national differences.
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The authors consider in greater depth mortality from prostate cancer and breast cancer, diseases for which effective methods of identification and treatment have been developed and for which behavioral factors do not play a dominant role. They show that mortality reductions from prostate cancer and breast cancer have been significantly more rapid in the United States than in other high-income countries.
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The authors conclude that a modest part of the difference between U.S. and European mortality rates for women is attributable to larger excess mortality at lower educational levels.
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. But when mortality decline continued, it became increasingly unlikely that milder temperatures could be the sole driving force.
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There are also some indications that lower budgets for Denmark's free national health care system, in comparison with other Nordic countries, may play a role in Denmark's adverse position. THE WAY AHEAD Clearly, there is a need to continue to conduct research to better understand the factors underlying international differences in life expectancy at older ages.
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. Mortality attributable to cigarette smoking in the United States.
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