Mortality Flashcards
What is the crude death rate?
Crude death rate: # of death (in 1 year) / people in population (mid year) x 1000
–> Crude rates are influenced by the underlying age distribution of the state’s population. Even if two states have the same age-adjusted rates, the state with the relatively older population generally will have higher crude rates because incidence or death rates for most cancers increase with increasing age.
Most important factor that influences death?
Age
How do mortality rates differ across individual’s life course?
- relatively high in infancy and early childhood (but so low that cannot be reduced further)
- drops to its lowest level at age 9
- sharp increase in the late teens and early 20s, an age period particularly prone to accidental death and
- slow but steadily increases each year from the mid-20s to the older ages. Compared to 10-year olds, those aged 80 are over 400 times as likely to die
How did the mortality rate change from 1900-now?
- In 1900, 20% of population died between birth and age 10; today less than 1% (probably due to decrease in infectious diseases, since infants and children are the most vulnerable, their mortality was most affected by that)
- Between 1920-1960, survival improved substantially for middle-aged individuals.
- Between 1960 and 2000, mortality improvements were significant at the older ages. In fact, individuals aged 85 and older in the U.S. have experienced remarkable declines in mortality over the last several decades.
-> Drastistic compression of mortality: while 1900 50% reached age 60, nowadays 50% reach 85
Measuring/Comparing death by age/gender
Compared to males, females in the U.S. experience fewer deaths at middle age, and relatively more deaths at the oldest ages
Measuring death by cause?
Infectious disease declined greatly in the first half of the century, while cardiovascular disease mortality reductions were particularly important after 1960
Life expectancy - broken limits?
Relatively new perspective, historically long time no improvement but now it seems to increase further and further –> Although somewhat controversial, there is an emerging consensus among demographers that there is little reason to expect a generalized slowdown in the near future
How did historic mortality decline occur?
3 phase
For most of human history, life was: “nasty, brutish, and short.” (Hobbes),
Life expectancy at birth for our hunter–gatherer ancestors (10000 years ago) was perhaps 25 years & rose only to 37 years in 1700 in England (2nd richest country!)
BUT THEN:
First phase (mid-18th to mid-19th century, first ca. 1750 in England)
- Improved nutrition (better fed people are more resistent) & economic growth
(but: English aristocrats had no life expectancy advantage over the rest of the population)
Second phase (late-19th to early-20th century)
- first negative effects due to Urbanization: unsanitary conditions + easier spread of disease
- then positive effect from Urbanization (especially in combo with era of “big public health”): delivery of clean water, removal of waste, etc
Third phase (from 1930s)
- From 30s on has been the era of “big medicine”, starting with vaccination and antibiotics, and moving on to the expensive and intensive personal interventions that characterize the medical system today
Historic cross-country differences in mortality decline
Common global trends, but tremendous & continuous differences in
- levels of life expectancy
50-70 years in Sub-Saharan Africa
80+ in Westeurope, Australia
- timing of mortality transition!
Europa & Americas around 1870s
Asia around 1920s
Africa around 1930s
Difference in life expectancy:
Rich-country vs poor-country
Life-expectancy is profoundly lower for countries with lower levels of per capita income
BUT Preston estimates that only about 15 % of the increase in life expectancy between the 1930s and 1960s is a result of increases in income alone (Preston, 1975)
Mortality in post-communist countries: Dissolution of USSR
Life expectancy in central Europe + former USSR declined substantially in transformation period
Why?
Rate of violent deaths was very high –>
heavy influenced by policies: anit-alcohol campaign had a positive effect in LD, loosing it = negative effect
Then: Acceleration of decrease in LE during transition to market economy (1992-94) and subsequent recovery
Mortality in post-communist countries: East-Germany after Re-unification
(1) Sustained reduction in mortality that started before reunification, indicating onset of ‘CVD revolution’ and shifts in individual behavior
(2) Temporary increase in mortality in 1990–1991, related to the abrupt social transition, as reflected by socially sensitive causes of death such as accidents or alcohol related diseases
(3) Reunification-driven process of convergence, mostly caused by the accelerated decline in mortality from CVD due to progress in health care.
-> enormous stress after unification, then better western medicine to eastern
How is US life expectancy different from other high-income countries?
US did not further increase after 2010 – and even decreased after 2014!
Why?
- Obesity, Homicide rate, Opioid crisis, CVD mortality stagnation
- Failure to prevent poor health despite medical expenditures being very high - spending most of the money to cure disease not prevent
- Not everybody has health insurance
Result:
- Americans at lower incomes die at a younger age than poor people in other rich countries
- > reflects widening socio-economic gradient in US mortality during the first two decades of the 21st century
What are the main factors driving social inequalities in mortality?
1) Demographic factors
Sex:
Biological sex or social determinants?
Study of nuns and monks reveals: biology only accounts for max. 2 years in difference of LE, bulk of difference is due to – behavioral & environmental factors which are socially shaped
Decline in difference due to emancipation and adaption to men’s unhealthy lifestyle (i.e. smoking)
Race:
always difference due to race but pandemics even enhance it
–> Good example: Covid hit USA particularly hard, especially Black/Hispanic Americans
What are the main factors driving social inequalities in mortality?
2) Distel cause
Socioeconomic status:
- Health and longevity are intimately related to position in the social hierarchy. The lower the status, the higher risk of illness and death, and consequently the shorter the life expectancy –> Michael Marmot calls this social gradient in health the “Status Syndrome”.
- So what exactly is the cause of this gradient?
Whitehall study points to a central role of relative deprivation. As health follows a gradient: the higher the social position, the better the health. Absolute poverty only won’t do as an explanation –> the lower the class, the higher the stress, the less healthy the person
(+ Social cohesion seems also –> Rich should contribute to elevate general average, so they are not so worried about s.o. stealing their money)
- Along similar lines: Adverse effects of income inequality (Gini) on individuals’ morbidity and mortality (Wilkinson & Pickett 2006)
- Recent evidence from Sweden indicates that a clear social class gradient in mortality did not (!) emerge before the 1950s (first for women and younger adults, then for men and older adults).
-> suggests that psychosocial and life style factors (i.e. reg physical activity, healthy weight & diet, medical prescriptions , etc.) – rather than social transfers and health care provision – matter (Bengtsson et al. 2021)!
Consequences of increased life expectancy?
1) Concept of age has become more complicated because life expectancy has increased and people at each age have had progressively more remaining years of life. As people modified their behavior to reflect these changes, 40-yearolds began to act more like 30-year-olds had acted in the past. The key to understanding how 40 could be the new 30 lies in the history of life expectancy change (see Figure 1, page 4) age in two dimensions?
2) High old age dependency rate and its implications (i.e. higher tax rates as government spending will go up due to pension share, health care, etc; lower pension funds; higher retirement age; reduced international competitiveness, bigger political voice of old people?, etc.)
