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International Differences in Mortality at Older Ages: Dimensions and Sources
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 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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International Differences in Mortality at Older Ages: Dimensions and Sources
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 expectancy 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
1
The 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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International Differences in Mortality at Older Ages: Dimensions and Sources
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/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., Argentina, 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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International Differences in Mortality at Older Ages: Dimensions and Sources
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 mortality 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
2
During 1955-1980, women in the United Kingdom made the smallest gains in e50 (2.2 years) 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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International Differences in Mortality at Older Ages: Dimensions and Sources
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 2009]).
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International Differences in Mortality at Older Ages: Dimensions and Sources
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.
SOURCE: Data from Human Mortality Database (2009 [accessed November 2009]).
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International Differences in Mortality at Older Ages: Dimensions and Sources
TABLE 2-1 Life Expectancy at Age 50 (e50) and Gains in e50, Selected Countries, 1955-2006
1955
1980
2006
Gain in e50
e50
Rank
e50
Rank
e50
Rank
1955-1980
1980-2006
Total (1955-2006)
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, DNK, and NLD
27.0
30.6
35.2
3.6
4.6
8.2
Compositeb (all countries)
27.0
30.5
34.5
3.5
4.0
7.5
Excluding USA, DNK, and NLD
26.8
30.5
35.6
3.7
5.1
8.8
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, DNK, and NLD
23.2
25.3
30.5
2.0
5.2
7.2
Compositeb (all countries)
23.1
25.1
30.0
2.0
4.8
6.8
Excluding USA, DNK, and NLD
23.0
25.3
30.5
2.3
5.2
7.5
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: Dimensions and Sources
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 Database and the World Health Organization Mortality Database.
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International Differences in Mortality at Older Ages: Dimensions and Sources
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 contribution 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). Therefore, 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 isolated two groups of causes that are strongly associated with smoking: lung cancer and respiratory diseases.3 If the smoking hypothesis has merit, then
3
Previous research suggests that 75-90 percent of deaths from lung cancer and chronic pulmonary obstructive disease (COPD) are attributable to smoking (Royal College and Physicians 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: Dimensions and Sources
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 Database and the World Health Organization Mortality Database.
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International Differences in Mortality at Older Ages: Dimensions and Sources
FIGURE 2-6 Age-standardized mortality rates among women ages 50 and older by cause group, United States compared with Denmark, the Netherlands, Japan, and the 10-country average, 1980-2005.
SOURCE: Calculations by authors based on data from the World Health Organization Mortality Database.
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International Differences in Mortality at Older Ages: Dimensions and Sources
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, 270-299,640-689, 751-776
240-246, 251-289, 630-678, 740-779
240-246, 251-279.4, 279.8, 279.9, 280-289, 630-676, 740-779
E00-E07, E15-E88, D50-D89, O00-Q99
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 disorders). 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: Dimensions and Sources
FIGURE 2A-1 Proportion of deaths due to heart disease and ill-defined causes, Spain.
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 Organization 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 nervous system. A similar (albeit somewhat smaller) hump is apparent in other remaining causes (not shown). During the period 1984-1992, England and
FIGURE 2A-2 Proportion of deaths due to heart and other circulatory diseases, Japan.
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 Organization Mortality Database.
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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 redistributing ill-defined causes.
SOURCE: Calculations by authors based on data from the World Health Organization 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 Figures 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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International Differences in Mortality at Older Ages: Dimensions and Sources
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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GBR
ITA
JPN
NLD
USA
Meana
Compositeb
Excluding DNK, NLD, and USA
Meana
Compositeb
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
OCR for page 62
International Differences in Mortality at Older Ages: Dimensions and Sources
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.
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.
OCR for page 63
International Differences in Mortality at Older Ages: Dimensions and Sources
GBR
ITA
JPN
NLD
USA
Meana
Compositeb
Excluding DNK, NLD, and USA
Meana
Compositeb
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
OCR for page 64
International Differences in Mortality at Older Ages: Dimensions and Sources
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: .
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).
OCR for page 65
International Differences in Mortality at Older Ages: Dimensions and Sources
JPN
NLD
Meana
Compositeb
Excluding DNK and NLD
Meana
Compositeb
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
OCR for page 66
International Differences in Mortality at Older Ages: Dimensions and Sources
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.
OCR for page 67
International Differences in Mortality at Older Ages: Dimensions and Sources
GBR
ITA
JPN
NLD
Meana
Compositeb
Excluding DNK and NLD
Meana
Compositeb
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
