Mortality in Catalonia in the context of the third, fourth and future phases of the epidemiological transition theory

Abstract

Abstract In the period 1960-2000, male and female life expectancy in Spain's Autonomous Region of Catalonia increased by 8.2 and 10.5 years, respectively, thus raising it to among one of the highest in the world. Initially, most gains were due to lower infant mortality, but as cardiovascular diseases declined, this later shifted to advanced ages. Between the mid-1980s and early 1990s life expectancy improvements stagnated as the mortality risk from traffic accidents and HIV/AIDS in young adults increased. Both the age-delay in old age mortality and the simultaneous influence of behavior and lifestyle reflect distinct aspects of the fourth stage of the epidemiological transition. This analysis quantifies the age and cause-of-death contributions to changes and sex-differences in life expectancy in Catalonia. We then compare the most recent life table for women with the Duchene-Wunsch limited life table to estimate the potential gain in life expectancy if all deaths were aging-related and in which ages these improvements would fall. 1. Introduction The decline of mortality constitutes one of the basic, perhaps most fundamental, aspects of demographic change in the 20th century. Its history shows a large heterogeneity between countries, with a variety of traditional models that have been defined in function of its timing, intensity, extent, and underlying causes. Catalonia is one of Spain's Autonomous Regions, but with a larger population than for example Denmark, and is an example of the accelerated transition within the western model, as changes were similar but occurred over a shorter period of time (and later). During the last century, male and female life expectancy increased by 40 and 45 years, respectively, during which time Catalonia consistently enjoyed a higher life expectancy than Spain as a whole. While their current levels are among the highest in the world, the impact of HIV/AIDS and an increased number of motor vehicle accidents caused male life expectancy to actually drop in Catalonia during the second half of the 1980s. This did not occur in Spain as a whole, hence the accelerated mortality transition and the influence of behavior and lifestyle on the mortality trends of young adults merit studying Catalonia on its own. The objective of this article is to describe and analyze mortality trends in Catalonia during the last four decades, starting with the beginning of the 1960s. At that time life expectancy at birth was still slightly lower than the average for the 15 Western European countries of the European Union (former EU15): 68.0 vs. 68.3 years for men and 72.8 vs. 73.8 years for women. Analysis is set within the conceptual framework of the epidemiological transition, whereby the evolution of Catalonian survival and mortality patterns is analyzed based on the features that define the last phases of the transition. Our study therefore links up well with similar studies on the evolution of Canadian mortality during the latter half of the 20th century (e.g. Bah and Rajulton 1991; Lussier et al. 2008). In order to attain our objective, life tables have been reconstructed, making it possible to analyze mortality by age and sex. First, the effects of changes in the age- and sex-specific mortality risk on the change in life expectancy over time are quantified. Subsequently, from 1980, causes of death are introduced. This permits a more detailed study of the characteristics of the current pattern of mortality in Catalonia, and can therefore be seen as an extension of recent research by Gomez- Redondo and Boe (2005) on the contributions of age and sex to changes in life expectancy at birth in Spain. The theory of the epidemiological transition, formulated by Omran (1971, 1983), establishes a general framework to describe and interpret the changes in mortality and health patterns during the broad decline of mortality, as well as its determinants and consequences. Until the second half of the 19th century, mortality was still partly subjected to plagues and famines (first phase). …