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Diverging Trends in Life Expectancy at Age 50: A Look at Causes of Death

Dana A. Glei, France Meslé, and Jacques Vallin


This study focuses on three main questions: (1) Why did mortality decline slow among women (but not men) after 1980 in the United States? (2) Can slowing in Danish and Dutch trends be explained by similar sources? (3) Why did Denmark and more recently the Netherlands resume progress but the United States has not? To begin to answer these questions, we explore which ages and which causes of death contributed to disparities across the 10 study countries. We mainly used the Human Mortality Database (HMD) (2009) for age-specific mortality data and the World Health Organization (WHO) database (World Health Organization, 2009) for causes of death; additional data were obtained from national sources to complete or update these two international databases. Throughout our analyses, we focus particular attention on several outliers: countries in which levels of life expectancy at age 50 (e50) in 2006 among women are lowest (Denmark, the Netherlands, and the United States) and highest (France and Japan).

The chapter is organized in several sections. First, we investigate age group contributions to gains in e50 during the periods 1955-1980 and 1980-2004. Second, we explore trends in mortality rates by cause of death. Third, we determine the contribution of cause groups to the gains in e50. Fourth, we examine the age and cause-specific components of recent progress in Denmark and the Netherlands compared with the United States. Fifth, we present more in-depth analyses comparing several of the outliers (i.e., France, Japan, the Netherlands, and United States). The paper concludes with a review of the main findings with respect to our research questions and a discussion of the implications.



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2 Diverging Trends in Life Expectancy at Age 50: A Look at Causes of Death Dana A. Glei, France Meslé, and Jacques Vallin This study focuses on three main questions: (1) Why did mortality de- cline slow among women (but not men) after 1980 in the United States? (2) Can slowing in Danish and Dutch trends be explained by similar sources? (3) Why did Denmark and more recently the Netherlands resume progress but the United States has not? To begin to answer these questions, we ex- plore which ages and which causes of death contributed to disparities across the 10 study countries. We mainly used the Human Mortality Database (HMD) (2009) for age-specific mortality data and the World Health Orga- nization (WHO) database (World Health Organization, 2009) for causes of death; additional data were obtained from national sources to complete or update these two international databases. Throughout our analyses, we focus particular attention on several outliers: countries in which levels of life expectancy at age 50 (e50) in 2006 among women are lowest (Denmark, the Netherlands, and the United States) and highest (France and Japan). The chapter is organized in several sections. First, we investigate age group contributions to gains in e50 during the periods 1955-1980 and 1980- 2004. Second, we explore trends in mortality rates by cause of death. Third, we determine the contribution of cause groups to the gains in e50. Fourth, we examine the age and cause-specific components of recent progress in Denmark and the Netherlands compared with the United States. Fifth, we present more in-depth analyses comparing several of the outliers (i.e., France, Japan, the Netherlands, and United States). The paper concludes with a review of the main findings with respect to our research questions and a discussion of the implications. 

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 INTERNATIONAL DIFFERENCES IN MORTALITY AT OLDER AGES INTRODUCTION Before focusing in-depth analysis on a small number of high-income countries, we begin by showing the 35 richest countries in terms of life ex- pectancy at age 50 relative to gross domestic product (GDP) per capita. We then proceed to the main analysis, which is based on 10 countries selected by the committee as the most relevant for understanding the position of the United States. In 2005, among the richest countries, we see a clear relation between e50 (both sexes) and the GDP per capita (Figure 2-1, right graph) (R² = 0.60), which contrasts with the situation observed in 1960 (Figure 2-1, left graph) (R² = 0.05). In between, major changes occurred in the field of public health. Until the middle of the 20th century, life expectancy was still strongly dependent on the fight against infectious diseases (even above age 50), which mainly relied on antibiotics and vaccines without much link to the GDP per capita, at least among rich countries. On the contrary, by 2005, e50 depends mostly on the success of the fight against degenerative diseases, including circulatory diseases. Figure 2-1 shows some geographic clustering: among these countries at the top of the world income distribution, the group of countries in the lower left corner (lowest e50 and lowest GDP per capita) includes Russia and most of the countries in Central and Eastern Europe, and the countries in the rest of the world are clustered in the top half of the graph (with higher e50 and generally higher GDP per capita). However, the general correlation between GDP per capita and e50 appears to be rather strong.1 Yet under the diagonal on Figure 2-1, there are a few outliers: e50 in Denmark (DNK), Ireland (IRL), Russia (RUS), Singapore (SGP), and even more so Norway (NOR) and the United States (USA), are lower than one might expect given their income level. Specific explanations could certainly be given for each of these exceptions, but it seems that at least three of them were enriched rather suddenly in recent years, perhaps without sufficient time to realize the health benefits (Ireland, Norway, and Singapore). Denmark is well known for having encountered difficulties controlling some human-made diseases like tobacco-related conditions, and Russia is not a surprise at all but typical of the excess adult mortality in Eastern Europe. Above all, the United States is the most striking because e50 lags many other countries despite much higher levels of income, without any clear explanation. Indeed, when excluding the six exceptional cases, the correlation is even stronger (R² = 0.75). When looking at the trends in e50 over the period since 1955 among the 10 study countries, the strikingly unfavorable position of the United States 1The difficulty of ensuring good and comparable income measurement is well known. This first graph is a rough indication that a few countries, including the United States, appear to be unusual.

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Fig2-1.eps 34 28 JPN HKG y = 0. 0003x + 25 .24 y = 0 . 0002x + 24 .156 AUS NOR R² = 0. 59 88 FR A CHE R ² = 0 .0481 NZL ITA CAN ESP SWE 32 NOR NLD ISR FIN GBR AUT 27 SGP IRL DEU SWE USA NLD BEL GRC PRT TAI DNK 30 DNK SVN CAN NZL GRC 26 ESP CHE ITA CZE AUS 28 POL USA GBR FR A HRV IRL PRT SVK 25 EST FRG BEL Life Expectancy at Age 50 AUT Life Expectancy at Age 50 26 LTU HUN LVA JPN 24 FIN 24 20 05 19 60 RUS 23 22 0 500 1,000 1,50 0 2,0 00 2,50 0 3,0 00 10,0 00 15,000 20,000 25,000 30,000 35,0 00 40,0 00 45,0 00 50,0 00 GDP per Capita (dollars) GDP per Capita (dollars) FIGURE 2-1 GDP per capita and life expectancy at age 50 in the richest countries in 1960 and 2005, both sexes. NOTES: Countries are designated by the standard United Nations country codes (see http://unstats.un.org/unsd/methods/m49/ Fig2-1.eps m49alpha.htm); see the complete list below. We define the richest countries to be those in which GDP per capita was more than 10,000 purchasing power parity dollars in 2005, excluding those in which population size is less than 1 million (i.e., Bahrain, Botswana, Brunei, Cyprus, Equatorial Guinea, Gabon, Iceland, Kuwait, Luxembourg, Macao, Malta, Oman, Qatar) or in which mortality data quality is questionable (i.e., Argen- tina, Chile, Malaysia, Mexico, Saudi Arabia, South Korea). In total, 35 countries are considered for the year 2005: Australia (AUS), Austria (AUT), Belgium (BEL), Canada (CAN), Croatia (HRV), Czech Republic (CZE), Denmark (DNK), Estonia (EST), Finland (FIN), France (FRA), Germany (DEU), Greece (GRC), Hong Kong (HKG), Hungary (HUN), Ireland (IRL), Israel (ISR), Italy (ITA), Japan (JPN), Latvia (LVA), Lithuania (LTU), the Netherlands (NLD), New Zealand (NZL), Norway (NOR), Poland (POL), Portugal (PRT), Russia (RUS), Singapore (SGP), Slovak Republic (SVK), Slovenia (SVN), Spain (ESP), Sweden (SWE), Switzerland (CHE), Taiwan (TAI), United Kingdom (GBR), United States (USA). For 1960, we include the same countries subject to data availability (except Germany, which is replaced by West Germany, FRG). SOURCE: Drawn from data on Gross Domestic Product per capita from the World Bank (1976, 2008); estimates of life expectancy  at age 50 from Human Mortality Database (2009 [accessed January 2009]).

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0 INTERNATIONAL DIFFERENCES IN MORTALITY AT OLDER AGES appears to result from different patterns by sex (see Figures 2-2 and 2-3). Trends for U.S. men are quite similar to those of most other countries (with the exception of Denmark). It is true that U.S. men have consistently ranked among the three or four lowest positions in terms of e50, but their position does not appear to have deteriorated over the past five decades. In contrast, trends for women have strongly diverged since 1980. Until around that year, e50 among U.S. women stayed solidly in the middle of the group following a trend similar to the others with the exception of Japan, which started out way behind but made faster gains than the other countries throughout the period. Around 1980, the pace of gains in e50 slowed among women in the United States, along with Denmark and the Netherlands, while continuing at a faster pace among other countries.2 Between 1980 and 2006, women in these three countries gained only 2.0-2.4 years in e50, whereas women in most of the other countries gained 4 or more years (see Table 2-1). Yet Danish women resumed progress after the mid-1990s, and in very recent years Dutch women also began making faster gains. During the past 26 years, gains in e50 among U.S. women (2.4 years) were about half of those in Australia, France, and Italy (4.5-5.2 years) and less than 40 percent that of Japan (6.3 years). Not only is U.S. longevity (among both sexes combined) shorter than expected given its GDP per capita (Figure 2-1), but women appear to have fallen further behind over the last quarter of a century. AGE GROUP CONTRIBUTIONS TO GAINS IN E50 Figure 2-4 shows the contributions by age group to female gains in e50 during the periods 1955-1980 and 1980-2004 for Denmark, the Nether- lands, and the United States compared with the 10-country mean. Detailed results for all countries are provided in Annex Tables 2A-1 and 2A-2. Among women in the United States as well as the Netherlands and Denmark, the pace of mortality decline at ages 65-79 slowed considerably in recent years: that is, they made smaller gains in 1980-2004 compared with 1955-1980. Such a slowdown is not evident among the other countries (except Canada). In the same way, at the oldest ages (80+), the pace of mor- tality decline decreased somewhat in Denmark, the Netherlands, and the United States while it increased dramatically in most other countries (again, with the exception of Canada). For example, among women in France and Japan, ages 80 and older contributed 0.6-0.8 years to gains in e50 during the period 1955-1980 (Table 2A-1), whereas the contribution grew to 1.7-2.7 2During 1955-1980, women in the United Kingdom made the smallest gains in e (2.2 years) 50 among these 10 countries. Yet they achieved much faster gains since 1980 (4.0 years)—far above those of the United States, Denmark, and the Netherlands. Thus, British women appear to have followed a different pattern and have not diverged in recent years.

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 DIVERGING TRENDS IN LIFE EXPECTANCY AT AGE 0 32 30 28 USA e 50 (in year s) AUS JPN 26 CAN ITA ESP 24 22 20 1950 1960 1970 1980 1990 2000 2010 Year 32 30 28 USA e 50 (in year s) FRA 26 GBR NLD DNK 24 22 20 1950 1960 1970 1980 1990 2000 2010 Year FIGURE 2-2 Annual trends in e50 by sex among 10 selected countries, men, 1955- 2007. NOTES: The United States is shown relative to the other countries (listed in rank order by level of e50 in 2006). AUS = Australia, CAN = Canada, DNK = Denmark, ESP = Spain, FRA = France, GBR = United Kingdom, ITA = Italy, JPN = Japan, NLD = the Netherlands, USA = United States. SOURCE: Data from Human Mortality Database (2009 [accessed November Fig2-2.eps 2009]).

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 INTERNATIONAL DIFFERENCES IN MORTALITY AT OLDER AGES 37 35 USA 33 e 50 (in year s) JPN FRA ESP 31 AUS ITA 29 27 25 1950 1960 1970 1980 1990 2000 2010 Year 37 35 33 USA e 50 (in year s) CAN NLD 31 GBR DNK 29 27 25 1950 1960 1970 1980 1990 2000 2010 Year FIGURE 2-3 Annual trends in e50 by sex among 10 selected countries, women, 1955-2007. NOTES: The United States is shown relative to the other countries (listed in rank order by level of e50 in 2006). AUS = Australia, CAN = Canada, DNK = Denmark, ESP = Spain, FRA = France, GBR = United Kingdom, ITA = Italy, JPN = Japan, NLD = the Netherlands, USA = United States. Fig2-3.eps SOURCE: Data from Human Mortality Database (2009 [accessed November 2009]).

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 DIVERGING TRENDS IN LIFE EXPECTANCY AT AGE 0 TABLE 2-1 Life Expectancy at Age 50 (e50) and Gains in e50, Selected Countries, 1955-2006 1955 1980 2006 Gain in e50 Total 1955- 1980- (1955- e50 Rank e50 Rank e50 Rank 1980 2006 2006) Women AUS 27.4 5 30.7 6 35.3 4 3.3 4.6 7.9 CAN 27.9 1 31.3 1 34.5 6 3.5 3.2 6.7 DNK 27.4 4 29.8 9 31.9 10 2.4 2.1 4.5 FRA 27.1 6 31.1 3 35.7 2 4.0 4.5 8.6 ITA 27.1 7 30.0 8 35.2 5 2.9 5.2 8.1 JPN 25.7 10 30.8 5 37.1 1 5.1 6.3 11.4 NLD 27.7 2 31.3 2 33.3 7 3.6 2.0 5.6 ESP 27.0 8 31.0 4 35.4 3 4.0 4.4 8.4 GBR 26.9 9 29.1 10 33.1 8 2.2 4.0 6.2 USA 27.5 3 30.6 7 33.0 9 3.0 2.4 5.4 Meana (all countries) 27.2 30.6 34.5 3.4 3.9 7.3 Excluding USA, 27.0 30.6 35.2 3.6 4.6 8.2 DNK, and NLD Compositeb (all 27.0 30.5 34.5 3.5 4.0 7.5 countries) Excluding USA, 26.8 30.5 35.6 3.7 5.1 8.8 DNK, and NLD Men AUS 23.0 7 25.0 5 31.5 1 1.9 6.6 8.5 CAN 24.2 4 25.7 3 30.7 3 1.5 5.0 6.5 DNK 25.4 2 24.8 8 28.2 10 –0.7 3.5 2.8 FRA 22.6 8 24.8 7 29.9 6 2.2 5.1 7.3 ITA 24.3 3 24.7 9 30.6 4 0.3 5.9 6.2 JPN 22.4 10 26.6 1 31.0 2 4.2 4.4 8.6 NLD 25.7 1 25.5 4 29.4 8 –0.2 4.0 3.8 ESP 23.7 5 26.2 2 29.9 5 2.5 3.7 6.2 GBR 22.5 9 23.9 10 29.7 7 1.5 5.7 7.2 USA 23.1 6 24.9 6 29.2 9 1.8 4.3 6.1 Meana (all countries) 23.7 25.2 30.0 1.5 4.8 6.3 Excluding USA, 23.2 25.3 30.5 2.0 5.2 7.2 DNK, and NLD Compositeb (all 23.1 25.1 30.0 2.0 4.8 6.8 countries) Excluding USA, 23.0 25.3 30.5 2.3 5.2 7.5 DNK, and NLD aBased on the simple mean across countries. bData for various countries are aggregated before calculating death rates; thus, the results represent a weighted mean. NOTE: AUS = Australia, CAN = Canada, DNK = Denmark, ESP = Spain, FRA = France, GBR = United Kingdom, ITA = Italy, JPN = Japan, NLD = the Netherlands, USA = United States. SOURCE: Data from the Human Mortality Database, 2009 (accessed November 6, 2009).

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 INTERNATIONAL DIFFERENCES IN MORTALITY AT OLDER AGES 1955 -1980 3 Contribution to Gain in e 50 (in year s) 2 1 0 Ages 50 -64 Ages 65 -79 Ages 80 + DNK NLD USA 10- countr y mean 1980 -2004 3 Contribution to Gain in e 50 (in year s) 2 1 0 Ages 50 -64 Ages 65 -79 Ages 80 + DNK NLD USA 10- countr y mean FIGURE 2-4 Age group contributions to gains in e50, 1955-1980 and 1980-2004, women. NOTE: DNK = Denmark, NLD = the Netherlands, USA = United States. SOURCES: Calculations by authors based on data from the Human Mortality Da- tabase and the World Health Organization Mortality Database. Fig2-4.eps

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 DIVERGING TRENDS IN LIFE EXPECTANCY AT AGE 0 years during the period 1980-2004 (Table 2A-2). Thus, ages 65 and older account for the vast majority of the difference between the three laggards (Denmark, the Netherlands, United States) and the other countries: ages 65-79 because progress slowed in the former, but not the latter, and ages 80+ because the pace of mortality decline increased among the latter but not the former. Figure 2-5 presents the corresponding results for men, who generally made faster gains in recent years across the age range in all countries. For Denmark, the Netherlands, and the United States during the period 1980- 2004, the biggest sex difference occurs below age 80. For example, among these three countries, ages 50-79 contributed 2.6-3.3 years to gains in e50 for males during the period 1980-2004, whereas the corresponding contri- bution for women was only 1.1-1.4 years (Table 2A-3). CAUSE-OF-DEATH DATA Comparative analysis of cause-of-death trends is complicated by issues of variation in coding practice. There are two main problems: (1) accuracy of diagnosing cause of death and (2) changes in the classification system. Both can create artificial variation in cause-of-death statistics across time and place. (See the Annex for a more detailed discussion of these potential problems.) The intercountry disparities in ill-defined coding shown in Table 2A-3 could explain some of the disparities in other causes. Similarly, a shift in coding over time from ill-defined to other causes could create an artificial increase in the latter (or at least attenuate the true level of decline). There- fore, to improve comparability of the results across time and place, we have redistributed ill-defined deaths proportionately to all other cause groups. We made no other adjustments to the WHO cause-of-death data. Trends in Mortality Rates by Cause of Death Figures 2-6 and 2-7 show trends since 1980 in the age-standardized mortality rate (among women and men above age 50) for nine main groups of causes. One factor that might explain the slowed progress among women in the laggard countries is increased levels of smoking. Thus, we have iso- lated two groups of causes that are strongly associated with smoking: lung cancer and respiratory diseases.3 If the smoking hypothesis has merit, then 3Previous research suggests that 75-90 percent of deaths from lung cancer and chronic pulmonary obstructive disease (COPD) are attributable to smoking (Royal College and Physi- cians of London, 2000; U.S. Department of Health and Human Services, 1989). The WHO data are not sufficiently detailed to identify COPD death for the entire period of this study. Nonetheless, among deaths at ages 50+ in 2003 in the 10-study countries, COPD comprised 38 percent of all deaths due to respiratory diseases.

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 INTERNATIONAL DIFFERENCES IN MORTALITY AT OLDER AGES 1955 -1980 3 Contribution to Gain in e 50 (in year s) 2 1 0 Ages 50 -64 Ages 65 -79 Ages 80 + DNK NLD USA 10- countr y mean 1980 -2004 3 Contribution to Gain in e 50 (in year s) 2 1 0 Ages 50 -64 Ages 65 -79 Ages 80 + DNK NLD USA 10- countr y mean FIGURE 2-5 Age group contributions to gains in e50, 1955-1980 and 1980-2004, men. NOTE: DNK = Denmark, NLD = the Netherlands, USA = United States. SOURCES: Calculations by authors based on data from the Human Mortality Data- base and the World Health Organization Mortality Database. Fig2-5.eps

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Rate ( per 10 0,000) Rate ( per 10 0,000 ) Rate ( per 10 0,000 ) 70 0 50 0 50 Other diseases of 450 Infectious diseases 45 Hear t diseases 60 0 circulator y system 40 0 40 USA Japan 50 0 Denmark 350 35 USA 30 0 Mean 30 40 0 250 Denmark 25 Netherlands Japan 30 0 20 0 20 Netherlands 150 15 20 0 Mean Japan Mean USA 10 0 10 10 0 50 5 Denmark Netherlands 0 0 0 19 80 19 85 19 90 19 95 2000 20 05 19 80 1985 19 90 19 95 20 00 20 05 19 80 19 85 19 90 19 95 20 00 20 05 Rate ( per 10 0,000 ) Rate ( per 10 0,000 ) Rate ( per 10 0,000) 18 0 16 0 50 0 Denmark Denmark 16 0 Denmark 140 450 USA 140 120 Netherlands USA 120 40 0 10 0 Mean 10 0 Netherlands Mean 80 350 Mean 80 USA 60 Japan 60 30 0 Japan 40 Netherlands 40 250 Japan Respirator y diseases 20 20 Other cancers Lung cancer 0 0 20 0 19 80 19 85 19 90 19 95 2000 20 05 19 80 19 85 19 90 19 95 20 00 20 05 19 80 19 85 19 90 19 95 20 00 20 05 Rate ( per 10 0,000 ) Rate ( per 10 0,000 ) Rate ( per 10 0,000) 90 90 19 0 Mental disorder s and Other diseases 80 80 diseases of nervous Denmark 170 USA 70 70 system Netherlands USA 60 150 60 Netherlands Japan 50 50 13 0 Mean 40 Mean 40 Denmark Denmark 110 Mean USA 30 30 90 Netherlands 20 Japan 20 70 10 10 Japan Ex ternal c auses 0 50 0 19 80 19 85 19 90 19 95 2000 20 05 19 80 19 85 19 90 19 95 20 00 20 05 19 80 19 85 19 90 19 95 20 00 20 05 FIGURE 2-6 Age-standardized mortality rates among women ages 50 and older by cause group, United States compared with Fig2-6.eps Denmark, the Netherlands, Japan, and the 10-country average, 1980-2005.  landscape SOURCE: Calculations by authors based on data from the World Health Organization Mortality Database.

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c) Diabetes mellitus 260 250 250 E10-E14 d) Skin and musculoskeletal diseases 700-749 690-738 690-739 L10-M99 e) Digestive diseases 530-587 520-577 520-579 K00-K92 f) Genitourinary diseases 590-594 580-584 580-589, 591-629 N00-N07, N13.0-N13.5, N13.7-N14, N17-N98 g) All else 240-254, 270-299, 240-246, 251-289, 240-246, 251-279.4, E00-E07, E15-E88, 640-689, 751-776 630-678, 740-779 279.8, 279.9, D50-D89, O00-Q99 280-289, 630-676, 740-779 aIncludes cancers for which at least 25 percent of deaths (among men or women) are attributable to smoking according to the CPS-II study (U.S. Department of Health and Human Services, 1989, Table 2-11). Although we refer to this grouping as “other smoking-related cancers,” we recognize that it is an oversimplification: smoking is likely to account for a substantial fraction of these deaths, but this category includes many deaths that are not due to smoking, while excluding deaths from other causes that are due to smoking. bFor ICD-7, this category excludes hay fever (240), asthma (241), and pneumonia of newborns (763) because the WHO data are not sufficiently detailed to identify these particular causes. In 2003, among all deaths at ages 50+ in this category for the 10 study countries, 38.1 percent resulted from COPD (ICD-10: J40-J44, J47), 37.6 percent from pneumonia (J12-J18), 6.2 percent from lung disease due to external agents (J60-J70), 1.8 percent from asthma, 0.8 percent from influenza, and 15.5 percent from other respiratory diseases. cAlzheimer’s disease was not coded separately under ICD-7 or ICD-8 (it was probably coded as senile or presenile dementia under mental disor- ders). In ICD-9, a code for Alzheimer’s (331.0) was included with diseases of the nervous system, but we do not have data at the 4-digit level required to identify these deaths. In 2003, among all deaths at ages 50+ in this category for the 10 study countries, 65.4 percent resulted from dementia and Alzheimer’s (ICD-10: F01, F03, G30), 11.9 percent from Parkinson’s (G20), 0.3 percent from Huntington’s (G10), and 22.4 percent from other mental disorders and diseases of the nervous system. dIn order to be comparable with ICD-10 coding of HIV/AIDS (B20-B24), we have included ICD-9 codes 279.5 (human immunodeficiency virus disease) and 279.6 (AIDS-related complex) with other infectious diseases. 

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 INTERNATIONAL DIFFERENCES IN MORTALITY AT OLDER AGES Propor tion of Deaths at Ages 50 + Propor tion of Deaths at Ages 50 + Hear t Diseases, Spain Ill-Defined Causes, Spain .4 .4 ICD-7 ICD -8 ICD-9 ICD -10 ICD-7 ICD -8 ICD-9 ICD -10 .3 .3 .2 .2 .1 .1 0 0 1960 1970 1980 1990 20 00 1960 1970 1980 1990 2000 Year Year FIGURE 2A-1 Proportion of deaths due to heart disease and ill-defined causes, Spain. Fig2A-1.eps NOTES: Solid line = unadjusted proportion; dashed line = adjusted proportion after redistributing ill-defined causes. SOURCE: Calculations by authors based on data from the World Health Organiza- tion Mortality Database. in mental disorders and diseases of the nervous system (Figure 2A-3). We see a similar pattern for Canada and France (not shown). Thus, for the period 1980-2004, we may overestimate the decline in respiratory diseases among these three countries. Within ICD-9, the United Kingdom also exhibits a curious drop in respiratory diseases in 1984 and a later increase in 1993, which is mirrored by a “hump” in mental disorders and diseases of the ner- vous system. A similar (albeit somewhat smaller) hump is apparent in other remaining causes (not shown). During the period 1984-1992, England and Propor tion of Deaths at Ages 50 + Propor tion of Deaths at Ages 50 + Hear t Diseases, Japan Other Circulator y Diseases, Japan .4 .4 ICD-7 ICD -8 ICD-9 ICD -10 ICD-7 ICD -8 ICD-9 ICD -10 .3 .3 .2 .2 .1 .1 0 0 1960 1970 1980 1990 2000 1960 1970 1980 1990 20 00 Year Year FIGURE 2A-2 Proportion of deaths due to heart and other circulatory diseases, Japan. NOTES: Solid line = unadjusted proportion; dashed line = adjusted proportion after Fig2A-2.eps redistributing ill-defined causes. SOURCE: Calculations by authors based on data from the World Health Organiza- tion Mortality Database.

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 DIVERGING TRENDS IN LIFE EXPECTANCY AT AGE 0 Propor tion of Deaths at Ages 50 + Propor tion of Deaths at Ages 50 + Respirator y Diseases, U.K. Mental /Ner vous System, U.K. .25 .25 ICD-7 ICD -8 ICD-9 ICD -10 ICD-7 ICD -8 ICD-9 ICD -10 .2 .2 .15 .15 .1 .1 .05 .05 0 0 1960 1970 1980 1990 20 00 1960 1970 1980 1990 20 00 Year Year FIGURE 2A-3 Proportion of deaths due to respiratory diseases and mental/nervous system, United Kingdom. NOTES: Solid line = unadjusted proportion; dashed line = adjusted proportion after Fig2A-3.eps redistributing ill-defined causes. SOURCE: Calculations by authors based on data from the World Health Organiza- tion Mortality Database. Wales broadened coding rule 3, and as a result contributing causes of death were more frequently coded as the underlying cause of death (Janssen and Kunst, 2004; Office of Population Censuses and Surveys, 1995). Detailed Cause of Death Contributions to Gains in e50 For the decomposition by cause of death, we extracted death counts by sex, age group, and cause of death from the WHO Mortality Database (World Health Organization, 2009). Data were available through 2003 for Italy and through 2004 for all other countries. In most cases, the WHO data are given by the following age groups: 0, 1-4, 5-9, . . . 80-84, 85+. For the most recent year, more detailed data at the oldest ages (85-89, 90-94, 95+) are available for all countries except Canada. All-cause death rates and exposure estimates come from the HMD (2009). To obtain cause-specific death rates, we apply the distribution of death counts by cause based on the WHO data to the all-cause death rates from the HMD. In cases in which the WHO data are available only to ages 85+, we apply the distribution by cause for deaths at age 85+ to the all-cause death rates at ages 85-89, 90- 94, and 95+. We use the Pollard (1988) method to decompose the gains in e50 into the contributions by cause of death. The contribution of ill-defined causes is shown separately here (see Tables 2A-5 and 2A-6), but for Fig- ures 2-6 to 2-11 (in the main text) we have redistributed ill-defined deaths proportionately to all other cause groups before decomposing the gains in e50 by cause group.

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0 INTERNATIONAL DIFFERENCES IN MORTALITY AT OLDER AGES TABLE 2A-5 Cause-of-Death Contributions to Gains in e50, 1955-1980 AUS CAN DNK ESP FRA Females Cardiovascular diseases 2.4 2.8 2.0 1.0 1.5 Heart diseases 1.4 1.7 0.9 0.5 0.7 Cerebrovascular & other circulatory diseases 1.1 1.1 1.1 0.5 0.8 Cancers 0.0 0.1 0.1 0.0 0.3 Lung cancer –0.1 –0.2 –0.2 0.0 0.0 Other smoking-related cancers –0.1 0.0 –0.1 0.0 –0.1 Breast cancer 0.0 –0.1 0.0 –0.1 –0.1 All other cancers 0.2 0.3 0.4 0.2 0.4 Respiratory diseases 0.1 0.0 –0.2 0.5 0.4 Mental disorders/nervous system/sense organs 0.0 0.0 0.0 0.1 0.2 Ill-defined causes 0.2 0.1 –0.2 1.8 1.6 Other remaining causes 0.6 0.5 0.6 0.6 0.1 External causes 0.1 0.1 0.1 0.0 –0.1 Infectious diseases 0.1 0.1 0.2 0.2 0.1 Diabetes mellitus 0.1 0.1 0.0 –0.1 0.0 Digestive diseases 0.1 0.0 0.3 0.2 0.1 Genitourinary diseases 0.1 0.2 0.1 0.2 0.0 All else 0.1 0.1 0.0 0.1 –0.1 Total gain in e50 3.3 3.5 2.4 4.0 4.0 Males Cardiovascular diseases 1.5 1.7 0.0 0.3 0.9 Heart diseases 1.1 1.2 –0.4 –0.1 0.4 Cerebrovascular and other circulatory diseases 0.5 0.5 0.4 0.5 0.6 Cancers –0.5 –0.5 –0.4 –0.5 –0.7 Lung cancer –0.4 –0.5 –0.5 –0.3 –0.4 Other smoking-related cancers –0.1 0.0 –0.2 –0.2 –0.3 Prostate cancer 0.0 0.0 –0.1 –0.1 0.0 Other cancers 0.0 0.1 0.3 0.0 0.0 Respiratory diseases 0.0 –0.2 –0.4 0.3 0.2 Mental disorders/nervous system/sense organs 0.0 0.0 0.0 0.1 0.2 Ill-defined causes 0.1 0.0 –0.3 1.5 1.1 Other remaining causes 0.8 0.5 0.5 0.8 0.5 External causes 0.2 0.1 0.1 0.0 0.1 Infectious diseases 0.2 0.1 0.1 0.4 0.4 Diabetes mellitus 0.0 0.0 0.0 –0.1 0.0 Digestive diseases 0.1 0.0 0.1 0.1 0.0 Genitourinary diseases 0.2 0.2 0.3 0.2 0.1 All else 0.1 0.1 0.0 0.2 0.0 Total gain in e50 1.9 1.5 –0.7 2.5 2.2 NOTE: AUS = Australia, CAN = Canada, DNK = Denmark, ESP = Spain, FRA = France, GBR = United Kingdom, ITA = Italy, JPN = Japan, NLD = the Netherlands, USA = United States. aBased on the simple mean across countries. bData for various countries are aggregated before calculating death rates; thus, the results represent a weighted mean. SOURCES: Calculations by authors based on data from the Human Mortality Database and the World Health Organization Mortality Database.

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 DIVERGING TRENDS IN LIFE EXPECTANCY AT AGE 0 Excluding DNK, NLD, and USA Meana Compositeb Meana Compositeb GBR ITA JPN NLD USA 1.9 1.7 1.4 2.2 2.7 2.0 2.1 1.8 1.7 1.1 1.0 0.0 0.9 1.6 1.0 1.1 0.9 0.8 0.8 0.7 1.4 1.2 1.1 1.0 1.0 0.9 0.9 –0.2 0.0 0.1 0.3 0.0 0.1 0.1 0.0 0.1 –0.2 –0.1 –0.1 –0.1 –0.3 –0.1 –0.2 –0.1 –0.1 0.0 –0.1 –0.1 –0.1 0.0 0.0 0.0 0.0 0.0 –0.1 –0.1 0.0 –0.1 0.0 –0.1 0.0 –0.1 –0.1 0.2 0.2 0.3 0.5 0.3 0.3 0.3 0.3 0.3 –0.1 0.3 0.1 0.3 –0.1 0.1 0.1 0.2 0.2 0.0 0.1 0.1 0.1 –0.1 0.1 0.0 0.1 0.1 0.2 0.6 1.7 0.2 0.0 0.6 0.7 0.9 1.0 0.3 0.2 1.7 0.5 0.4 0.6 0.5 0.6 0.6 0.1 –0.1 0.0 0.0 0.2 0.0 0.1 0.0 0.0 0.1 0.1 0.4 0.1 0.1 0.1 0.1 0.2 0.2 0.0 –0.1 –0.1 0.2 0.1 0.0 0.0 0.0 0.0 0.0 0.1 0.8 0.1 0.1 0.2 0.2 0.2 0.2 0.0 0.1 0.3 0.1 0.1 0.1 0.1 0.1 0.1 0.1 0.1 0.2 0.1 0.0 0.1 0.1 0.1 0.1 2.2 2.9 5.1 3.6 3.0 3.4 3.5 3.6 3.7 0.6 0.3 1.3 0.0 1.9 0.9 1.3 0.9 0.9 0.2 –0.1 0.0 –0.5 1.3 0.3 0.7 0.4 0.3 0.4 0.4 1.3 0.5 0.7 0.6 0.6 0.6 0.6 –0.1 –0.9 –0.3 –0.8 –0.4 –0.5 –0.4 –0.5 –0.4 –0.2 –0.6 –0.3 –0.7 –0.5 –0.4 –0.4 –0.4 –0.3 0.0 –0.2 –0.1 –0.2 0.0 –0.1 –0.1 –0.1 –0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.0 0.1 0.1 0.1 0.1 0.1 0.0 0.1 0.3 0.0 0.0 0.0 –0.3 0.0 0.0 0.1 0.1 0.0 0.1 0.1 0.1 –0.1 0.0 0.0 0.1 0.1 0.1 0.4 1.2 0.1 0.0 0.4 0.4 0.6 0.7 0.6 0.4 1.9 0.5 0.5 0.7 0.7 0.8 0.8 0.1 0.0 0.1 0.1 0.2 0.1 0.1 0.1 0.1 0.2 0.3 0.6 0.1 0.2 0.3 0.3 0.3 0.4 0.0 –0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.1 –0.1 0.7 0.1 0.1 0.1 0.1 0.1 0.2 0.2 0.1 0.2 0.2 0.1 0.2 0.2 0.2 0.2 0.1 0.1 0.3 0.1 0.0 0.1 0.1 0.1 0.1 1.5 0.3 4.2 –0.2 1.8 1.5 2.0 2.0 2.2

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 INTERNATIONAL DIFFERENCES IN MORTALITY AT OLDER AGES TABLE 2A-6 Cause of Death Contributions to Gains in e50, 1980-2004* AUS CAN DNK ESP FRA Females Cardiovascular diseases 3.9 3.1 2.1 3.2 2.6 Heart diseases 2.5 2.2 1.7 1.2 1.3 Cerebrovascular & other circulatory diseases 1.5 0.9 0.5 2.0 1.3 Cancers 0.2 0.0 0.0 0.2 0.4 Lung cancer –0.1 –0.4 –0.4 0.0 –0.1 Other smoking-related cancers 0.0 0.0 0.0 0.0 0.0 Breast cancer 0.1 0.1 0.0 0.0 0.0 Other cancers 0.2 0.2 0.4 0.3 0.5 Respiratory diseases 0.0 –0.1 –0.2 0.3 0.2 Mental disorders/nervous system/sense organs –0.2 –0.4 –0.4 –0.4 –0.1 Ill-defined causes 0.0 0.0 0.0 0.3 0.3 Other remaining causes 0.2 0.1 –0.1 0.4 1.0 External causes 0.1 0.1 0.2 0.1 0.3 Infectious diseases 0.0 –0.1 0.0 0.0 0.0 Diabetes mellitus 0.0 0.0 –0.1 0.2 0.0 Digestive diseases 0.1 0.1 –0.1 0.2 0.4 Genitourinary diseases 0.0 0.0 0.0 0.0 0.1 All else 0.0 0.0 –0.1 –0.1 0.1 Total gain in e50 4.1 2.7 1.6 4.0 4.3 Males Cardiovascular diseases 4.5 3.6 2.8 2.6 2.3 Heart diseases 3.4 2.9 2.5 1.3 1.3 Cerebrovascular & other circulatory diseases 1.1 0.8 0.3 1.4 1.1 Cancers 0.6 0.5 0.3 –0.3 0.7 Lung cancer 0.4 0.3 0.2 –0.2 0.0 Other smoking-related cancers 0.1 0.1 0.0 –0.1 0.4 Prostate cancer 0.0 0.0 0.0 0.0 0.1 Other cancers 0.1 0.1 0.1 0.0 0.2 Respiratory diseases 0.5 0.3 0.2 0.3 0.4 Mental disorders/nervous system/sense organs –0.1 –0.2 –0.3 –0.2 0.0 Ill-defined causes 0.0 0.0 0.1 0.2 0.2 Other remaining causes 0.4 0.2 –0.1 0.6 1.1 External causes 0.2 0.2 0.2 0.1 0.4 Infectious diseases 0.0 –0.1 0.0 0.0 0.0 Diabetes mellitus 0.0 –0.1 –0.1 0.0 0.0 Digestive diseases 0.2 0.2 –0.1 0.4 0.6 Genitourinary diseases 0.1 0.0 0.0 0.1 0.1 All else 0.0 0.0 –0.1 0.0 0.1 Total gain in e50 5.9 4.4 2.9 3.2 4.7 NOTE: AUS = Australia, CAN = Canada, DNK = Denmark, ESP = Spain, FRA = France, GBR = United Kingdom, ITA = Italy, JPN = Japan, NLD = the Netherlands, USA = United States. *Based on data from 2003 for Italy. aBased on the simple mean across countries. bData for various countries are aggregated before calculating death rates; thus, the results represent a weighted mean. SOURCES: Calculations by authors based on data from the Human Mortality Database and the World Health Organization Mortality Database.

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 DIVERGING TRENDS IN LIFE EXPECTANCY AT AGE 0 Excluding DNK, NLD, and USA Meana Compositeb Meana Compositeb GBR ITA JPN NLD USA 3.0 3.1 4.1 2.0 2.8 3.0 3.1 3.3 3.4 2.0 1.8 1.7 1.5 2.0 1.8 1.9 1.8 1.8 1.0 1.3 2.4 0.6 0.7 1.2 1.2 1.5 1.6 0.3 0.2 0.4 0.0 0.1 0.2 0.3 0.2 0.4 –0.1 –0.1 0.0 –0.3 –0.3 –0.2 –0.1 –0.1 –0.1 0.0 0.0 0.0 –0.1 0.0 0.0 0.0 0.0 0.0 0.2 0.0 –0.1 0.1 0.1 0.1 0.1 0.0 0.1 0.2 0.3 0.5 0.3 0.3 0.3 0.3 0.3 0.4 0.5 0.3 0.2 –0.2 –0.3 0.1 0.1 0.2 0.3 –0.2 –0.2 0.0 –0.4 –0.4 –0.3 –0.3 –0.2 –0.1 –0.1 0.2 0.8 0.1 0.0 0.2 0.1 0.2 0.2 0.1 0.5 0.7 0.1 –0.1 0.3 0.3 0.4 0.5 0.1 0.2 0.1 0.2 0.0 0.1 0.1 0.2 0.2 0.0 0.0 0.0 0.0 –0.1 0.0 –0.1 0.0 0.0 0.0 0.2 0.1 –0.1 –0.1 0.0 0.0 0.1 0.1 –0.1 0.3 0.3 0.0 0.1 0.1 0.2 0.2 0.2 0.0 0.0 0.1 0.0 –0.1 0.0 0.0 0.0 0.0 0.0 –0.1 0.1 0.0 0.0 0.0 0.0 0.0 3.6 4.1 6.1 1.6 2.1 3.4 3.6 4.1 4.7 3.7 2.9 3.0 2.5 3.4 3.1 3.2 3.2 3.1 2.9 1.8 1.2 2.1 2.8 2.2 2.3 2.1 1.9 0.8 1.1 1.8 0.4 0.6 0.9 1.0 1.1 1.2 0.7 0.5 0.2 0.7 0.5 0.4 0.5 0.4 0.4 0.6 0.2 –0.1 0.6 0.3 0.2 0.2 0.2 0.2 0.0 0.2 –0.1 0.0 0.1 0.1 0.1 0.1 0.1 0.0 0.0 –0.1 0.0 0.1 0.0 0.0 0.0 0.0 0.1 0.1 0.4 0.2 0.2 0.1 0.2 0.1 0.2 0.9 0.5 0.1 0.0 0.2 0.3 0.3 0.4 0.4 –0.1 –0.1 0.0 –0.2 –0.2 –0.1 –0.1 –0.1 –0.1 0.0 0.1 0.3 0.2 0.1 0.1 0.1 0.1 0.1 0.1 0.9 0.5 0.1 0.0 0.4 0.4 0.5 0.6 0.1 0.2 0.0 0.1 0.1 0.2 0.1 0.2 0.1 0.0 0.0 0.1 0.0 –0.1 0.0 0.0 0.0 0.0 0.0 0.1 0.0 –0.1 –0.1 0.0 0.0 0.0 0.0 –0.1 0.6 0.4 0.0 0.2 0.2 0.3 0.3 0.4 0.1 0.1 0.1 0.1 0.0 0.0 0.0 0.1 0.1 0.0 –0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 5.2 4.8 4.1 3.3 4.0 4.3 4.4 4.6 4.7

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 INTERNATIONAL DIFFERENCES IN MORTALITY AT OLDER AGES TABLE 2A-7 Age Group Contributions to Gap in e50 in 2004 AUS CAN DNK ESP FRA GBR ITA Females Ages 50-64 0.9 0.6 0.0 1.1 0.8 0.4 1.0 50-54 0.3 0.2 0.0 0.3 0.1 0.1 0.2 55-59 0.3 0.2 0.0 0.4 0.3 0.1 0.3 60-64 0.4 0.2 0.0 0.5 0.4 0.2 0.4 Ages 65-79 1.1 0.7 –0.6 1.4 1.6 0.1 1.3 65-69 0.4 0.3 –0.1 0.5 0.5 0.1 0.5 70-74 0.4 0.3 –0.3 0.5 0.6 0.1 0.5 75-79 0.3 0.2 –0.2 0.4 0.5 –0.1 0.4 Ages 80+ 0.1 0.1 –0.7 –0.2 0.4 –0.5 0.1 80-84 0.2 0.2 –0.2 0.1 0.3 –0.1 0.2 85-89 0.0 0.0 –0.2 –0.1 0.1 –0.2 0.0 90+ –0.1 –0.1 –0.2 –0.2 0.0 –0.2 –0.1 Total gap in e50 2.2 1.4 –1.2 2.3 2.8 0.1 2.4 Males Ages 50-64 1.3 0.8 0.1 0.5 0.2 0.6 1.0 50-54 0.4 0.3 0.1 0.2 0.0 0.2 0.4 55-59 0.4 0.3 0.0 0.1 0.0 0.2 0.3 60-64 0.4 0.3 0.0 0.2 0.2 0.2 0.3 Ages 65-79 0.9 0.5 –0.7 0.3 0.5 0.0 0.5 65-69 0.4 0.2 –0.1 0.2 0.2 0.1 0.3 70-74 0.3 0.2 –0.3 0.1 0.2 0.0 0.2 75-79 0.2 0.1 –0.3 0.0 0.1 –0.1 0.1 Ages 80+ –0.1 –0.1 –0.6 –0.2 –0.1 –0.4 –0.2 80-84 0.1 0.0 –0.3 –0.1 0.1 –0.2 0.0 85-89 –0.1 –0.1 –0.2 –0.1 –0.1 –0.1 –0.1 90+ –0.1 –0.1 –0.1 –0.1 –0.1 –0.1 –0.1 Total gap in e50 2.0 1.3 –1.2 0.6 0.7 0.3 1.3 NOTE: AUS = Australia, CAN = Canada, DNK = Denmark, ESP = Spain, FRA = France, GBR = United Kingdom, ITA = Italy, JPN = Japan, NLD = the Netherlands. aBased on the simple mean across countries. bData for various countries are aggregated before calculating death rates; thus, the results represent a weighted mean. SOURCES: Calculations by authors based on data from the Human Mortality Database and the World Health Organization Mortality Database. Current Gap in e50: The United States Versus Other High-Income Countries For the tables in this Annex, the gap in e50 is defined as: eCountryX − eUSA . 50 50 For example, among women, the gap of 4.3 for Japan indicates that, on average, women in Japan can expect to live 4.3 years longer after age 50 than their U.S. counterparts (see Table 2A-7).

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 DIVERGING TRENDS IN LIFE EXPECTANCY AT AGE 0 Excluding DNK and NLD Meana Compositeb Meana Compositeb JPN NLD 1.1 0.4 0.7 0.9 0.8 0.9 0.3 0.1 0.2 0.2 0.2 0.2 0.4 0.1 0.2 0.3 0.3 0.3 0.5 0.2 0.3 0.4 0.4 0.4 2.0 0.5 0.9 0.9 1.2 1.4 0.6 0.2 0.3 0.3 0.5 0.5 0.7 0.2 0.3 0.3 0.5 0.5 0.7 0.1 0.2 0.3 0.4 0.4 1.1 –0.6 0.0 0.2 0.2 0.3 0.6 –0.1 0.1 0.2 0.2 0.3 0.3 –0.2 0.0 0.0 0.1 0.1 0.3 –0.2 –0.1 0.0 0.0 0.0 4.3 0.3 1.6 1.9 2.2 2.6 0.9 0.7 0.7 0.7 0.8 0.8 0.3 0.3 0.2 0.3 0.3 0.3 0.3 0.2 0.2 0.2 0.2 0.2 0.3 0.2 0.2 0.3 0.3 0.3 0.9 –0.2 0.3 0.5 0.5 0.6 0.4 0.1 0.2 0.3 0.3 0.3 0.3 –0.1 0.1 0.2 0.2 0.2 0.2 –0.2 0.0 0.1 0.1 0.1 0.1 –0.6 –0.2 –0.1 –0.1 –0.1 0.1 –0.3 –0.1 0.0 0.0 0.0 0.0 –0.2 –0.1 –0.1 –0.1 –0.1 0.0 –0.1 –0.1 –0.1 –0.1 –0.1 1.9 –0.1 0.8 1.1 1.2 1.2

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 INTERNATIONAL DIFFERENCES IN MORTALITY AT OLDER AGES TABLE 2A-8 Cause-of-Death Contributions to Gap in e50 in 2004* AUS CAN DNK ESP FRA Females Cardiovascular diseases 0.7 0.9 0.1 0.8 1.6 Heart diseases 0.9 0.8 0.5 0.9 1.4 Cerebrovascular & other circulatory diseases –0.1 0.1 –0.4 –0.1 0.2 Cancers 0.3 –0.2 –0.9 0.8 0.5 Lung cancer 0.4 0.0 –0.1 0.6 0.6 Other smoking-related cancers 0.0 0.0 –0.2 0.1 0.0 Breast cancer 0.0 0.0 –0.2 0.1 –0.1 Other cancers –0.1 –0.1 –0.4 0.0 –0.1 Respiratory diseases 0.3 0.3 –0.2 0.4 0.7 Mental disorders/nervous system/sense organs 0.2 0.0 0.0 0.1 0.1 Ill-defined causes 0.1 0.0 –0.4 –0.1 –0.4 Other remaining causes 0.6 0.3 0.0 0.4 0.4 External causes 0.1 0.0 0.0 0.1 –0.1 Infectious diseases 0.1 0.1 0.1 0.1 0.1 Diabetes mellitus 0.1 0.1 0.1 0.1 0.2 Digestive diseases 0.1 0.0 –0.2 0.0 0.0 Genitourinary diseases 0.1 0.1 0.1 0.1 0.2 All else 0.0 0.0 0.0 0.1 0.0 Total gap in e50 2.2 1.4 –1.3 2.3 2.8 Males Cardiovascular diseases 0.9 0.8 0.0 0.9 1.2 Heart diseases 1.0 0.8 0.5 1.1 1.3 Cerebrovascular & other circulatory diseases –0.1 0.0 –0.5 –0.2 0.0 Cancers 0.0 –0.1 –0.7 –0.5 –0.7 Lung cancer 0.3 0.1 0.0 0.0 0.0 Other smoking-related cancers 0.0 0.0 –0.2 –0.2 –0.2 Prostate cancer –0.1 0.0 –0.2 0.0 –0.1 Other cancers –0.2 –0.2 –0.3 –0.3 –0.5 Respiratory diseases 0.3 0.2 0.0 –0.1 0.4 Mental disorders/nervous system/sense organs 0.2 0.0 –0.2 0.1 0.0 Ill-defined causes 0.0 0.0 –0.4 –0.1 –0.4 Other remaining causes 0.6 0.4 0.1 0.3 0.2 External causes 0.2 0.1 0.1 0.1 –0.1 Infectious diseases 0.2 0.1 0.1 0.1 0.1 Diabetes mellitus 0.1 0.0 0.0 0.2 0.2 Digestive diseases 0.1 0.0 –0.2 –0.2 –0.1 Genitourinary diseases 0.1 0.1 0.0 0.1 0.1 All else 0.0 0.0 0.0 0.1 0.0 Total gap in e50 2.1 1.3 –1.2 0.6 0.7 NOTE: AUS = Australia, CAN = Canada, DNK = Denmark, ESP = Spain, FRA = France, GBR = United Kingdom, ITA = Italy, JPN = Japan, NLD = the Netherlands. *Based on data from 2003 for Italy. aBased on the simple mean across countries. bData for various countries are aggregated before calculating death rates; thus, the results represent a weighted mean. SOURCES: Calculations by authors based on data from the Human Mortality Database and the World Health Organization Mortality Database.

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 DIVERGING TRENDS IN LIFE EXPECTANCY AT AGE 0 Excluding DNK and NLD Meana Compositeb Meana Compositeb GBR ITA JPN NLD 0.1 0.1 1.8 0.4 0.7 1.0 0.9 1.0 0.6 0.4 1.9 0.6 0.9 1.1 1.0 1.1 –0.5 –0.3 –0.1 –0.2 –0.2 –0.1 –0.1 –0.1 –0.2 0.3 0.8 –0.3 0.1 0.4 0.3 0.4 0.2 0.5 0.6 0.2 0.3 0.4 0.4 0.5 –0.1 0.0 0.1 –0.1 0.0 0.0 0.0 0.0 –0.1 0.0 0.3 –0.1 0.0 0.1 0.0 0.1 –0.2 –0.3 –0.1 –0.3 –0.2 –0.1 –0.1 –0.1 –0.2 0.6 0.3 0.2 0.3 0.3 0.3 0.3 0.1 0.3 0.8 –0.1 0.2 0.3 0.2 0.3 –0.1 0.0 –0.2 –0.3 –0.2 –0.1 –0.1 –0.1 0.4 0.4 0.8 0.3 0.4 0.5 0.5 0.5 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.2 0.1 0.1 0.1 0.1 0.1 0.1 0.2 0.0 0.3 0.1 0.1 0.2 0.1 0.2 –0.2 0.0 0.1 –0.1 0.0 0.0 0.0 0.0 0.1 0.1 0.1 0.1 0.1 0.1 0.1 0.1 0.1 0.1 0.2 0.1 0.0 0.1 0.1 0.1 0.1 1.6 4.3 0.3 1.5 2.4 2.1 2.5 –0.1 0.3 1.5 0.3 0.7 0.9 0.8 0.9 0.4 0.6 1.9 0.6 0.9 1.1 1.0 1.2 –0.4 –0.4 –0.4 –0.3 –0.2 –0.3 –0.2 –0.3 –0.2 –0.6 –0.3 –0.6 –0.4 –0.4 –0.3 –0.4 0.2 0.0 0.3 –0.1 0.1 0.1 0.1 0.1 –0.1 –0.1 0.0 –0.1 –0.1 –0.1 –0.1 –0.1 –0.1 0.0 0.1 –0.1 0.0 0.0 0.0 0.0 –0.2 –0.5 –0.6 –0.2 –0.3 –0.4 –0.4 –0.4 –0.2 0.3 –0.2 0.0 0.1 0.0 0.1 0.0 0.1 0.2 0.4 0.0 0.1 0.2 0.1 0.2 0.0 0.0 –0.1 –0.3 –0.1 –0.1 –0.1 –0.1 0.7 0.5 0.4 0.5 0.4 0.4 0.4 0.4 0.2 0.1 –0.1 0.2 0.1 0.0 0.1 0.0 0.2 0.2 0.1 0.1 0.1 0.1 0.1 0.1 0.2 0.1 0.2 0.1 0.1 0.2 0.1 0.2 –0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.1 0.1 0.1 0.1 0.1 0.1 0.1 0.1 0.1 0.1 0.1 0.0 0.1 0.0 0.1 0.3 0.6 1.9 –0.1 0.7 1.0 1.1 1.1