Explaining Divergent Levels of Longevity in High-Income Countries (2011) / Chapter Skim
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2 Causes of Death, Health Indicators, and Divergence in Life Expectancy
2 Causes of Death, Health Indicators, and Divergence in Life Expectancy
Pages 26-42
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From page 26... ...
To see whether differences in life expectancy are mirrored in other dimensions of health, it is also useful to examine such factors as disease prevalence; degree of functional disability; and prevalence of risk factors, including high blood pressure, cholesterol, and weight. THE ROLE OF VARIOUS CAUSES OF DEATH IN DIVERGING LIFE EXPECTANCY TRENDS Perhaps the most direct approach to understanding diverging trends in life expectancy is to look for differences in trends in the causes of death for 26
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From page 27... ...
They found that most of the divergence derived from the fact that the declines in mortality due to heart disease and cerebrovascular disease in the United States and the Netherlands were partially offset by increases in several other causes of death in those countries, while Japan and France managed to achieve lower mortality from a variety of causes at increasingly older ages (Meslé and Vallin, 2006)
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From page 28... ...
Rate (per 100,000) 90 90 Mental disorders and 190 Other diseases 80 80 diseases of nervous Denmark USA 170 70 70 system Netherlands USA 60 150 60 Netherlands Japan 50 50 130 Mean Mean Denmark 40 40 Denmark 110 Mean USA 30 30 90 Netherlands Japan 20 20 70 Japan 10 10 External causes 0 50 0 1980 1985 1990 1995 2000 2005 1980 1985 1990 1995 2000 2005 1980 1985 1990 1995 2000 2005 Fig2-1.eps FIGURE 2-1 Age-standardized mortality rates among women aged 50 and older by landscape cause group, United States compared with the Netherlands, Denmark, Japan, and the 10-country average, 1980-2005.
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From page 29... ...
100,000) 140 180 300 Mental disorders and External causes Other diseases Denmark 160 diseases of nervous 120 Denmark Japan Denmark 250 140 system USA 100 USA 120 200 80 Mean USA 100 60 80 Netherlands 150 Mean Mean 60 40 Netherlands Japan 40 Netherlands 100 20 Japan 20 0 0 50 1980 1985 1990 1995 2000 2005 1980 1985 1990 1995 2000 2005 1980 1985 1990 1995 2000 2005 FIGURE 2-2 Age-standardized mortality rates among men aged 50 and older by cause group, United States compared with the Netherlands, Denmark, Japan, and the 10-country average, 1980-2005.
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From page 30... ...
Age-standardized mortality rates for lung cancer for women over age 50 have risen in the past 25 years in the United States, the Netherlands, and Denmark but have remained flat in Japan. Similarly, women in the United States, Denmark, and to a lesser extent the Netherlands have higher rates of respiratory disease than women in Japan, and these rates have diverged significantly since 1980.
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From page 31... ...
Denmark Netherlands USA 10-country mean FIGURE 2-3 Contributions of causes of death to gains in life expectancy at age 50, Fig2-3.eps 1955-1980. NOTE: Deaths from ill-defined causes have been redistributed proportionately to all other categories.
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From page 32... ...
Denmark Netherlands USA 10-country mean Fig2-4.eps FIGURE 2-4 Contributions of causes of death to gains in life expectancy at age 50, 1980-2004. NOTE: Deaths from ill-defined causes have been redistributed proportionately to all other categories.
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From page 33... ...
Cause-of-death data point to the particular areas in which progress has slowed for women. The most notable gender differences in the United States, Denmark, and the Netherlands are in the contributions to changes in life expectancy at age 50 made by lung cancer and respiratory diseases.
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From page 34... ...
Although this analysis does not identify the factors underlying the differences in the cause-of-death trends, it does point clearly in a particular direction: "Based on the evidence presented here, the most obvious explanation for the slowing of mortality decline among women in the United States, Denmark, and the Netherlands is smoking, which is strongly correlated with lung cancer and respiratory diseases such as chronic obstructive pulmonary disease" (Glei et al., 2010, p.
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From page 35... ...
A country, such as the United States, with aggressive screening will appear to have both greater incidence and greater prevalence of health problems than a country with poorer screening, all other things being equal. So the existence of national differences in health problems -- incidence or prevalence -- is not free of some difficulty in interpretation.
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From page 36... ...
Differences in Disease Prevalence Heart Disease, Stroke, and Diabetes Cardiovascular disease accounts for about half of the female gap in life expectancy at age 50 between the United States and the nine other countries studied here and for most of the male gap. Self-reports of having been diagnosed with heart disease among those aged 65 and over are more numerous in the United States than in the other countries: only England has a rate close to that of the United States, while people in Japan and Denmark report heart disease at a rate less than half that in the United States (see Table 2-1)
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From page 37... ...
The fact that several cancer incidence rates are so high in the United States while cancer mortality rates -- except for lung cancer among women -- are not particularly high is likely to stem 3Because prevalence rates are based on self-reports, another possible explanation for higher rates of heart disease and diabetes is that older Americans have more screening for these diseases (as discussed later in the report)
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From page 38... ...
The panel considered whether differences in these risk factors might play a role in the diverging trends in life expectancy between the United States and other high-income countries. Recent research indicates that certain biological risk factors, such as high levels of glycated hemoglobin, cholesterol, C-reactive protein, systolic blood pressure, or fibrinogen, are more common among Americans than among the English and Japanese (Banks et al., 2006; Crimmins et al., 2008)
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From page 39... ...
. Yet men in the United States generally have relatively low measured blood pressure levels compared with men in other countries; this is less true for women (see Table 2-4)
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From page 40... ...
to have more measured high blood pressure than the United States. The fact that Americans have the highest use of antihypertensive medications (see Table 2-5)
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From page 41... ...
Death rates from two leading causes of death -- heart disease and diabetes -- are both relatively high in the United States. The fact that heart disease accounts for most of the differences in life expectancy between the United States and the other countries must be related to higher levels of heart disease per se in the United States, although TABLE 2-6 Percentage of Population Self-Reporting Functioning Problems: Ages 50+ Country Men Women United States 61.5 74.0 Denmark 34.2 50.3 France 38.3 59.0 Italy 43.8 60.2 Netherlands 31.7 51.5 Spain 43.1 64.9 England 49.2 64.0 SOURCE: Adapted from Crimmins et al.
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From page 42... ...
In particular, while they share poor life expectancy trends with the United States, the Netherlands and Denmark differ from the United States in a number of aspects of health. They report relatively low levels of heart disease and diabetes and have relatively little disability.
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