Abstract
BackgroundReducing lifespan inequality is increasingly recognized as a health policy objective. Whereas lifespan inequality declined with rising longevity in most developed countries, Danish life expectancy stagnated between 1975 and 1995 for females and progressed slowly for males. It is unknown how Danish lifespan inequality changed, which causes of death drove these developments, and where the opportunities for further improvements lie now.MethodsWe present an analytical strategy based on cause-by-age decompositions to simultaneously analyze changes in Danish life expectancy and lifespan inequality from 1960 to 2014, as well as current Swedish-Danish differences.ResultsStagnation in Danish life expectancy coincided with a shorter period of stagnation in lifespan inequality (1975–1990). The stagnation in life expectancy was mainly driven by increases in cancer and non-infectious respiratory mortality at higher ages (−.63 years) offsetting a reduction in cardiovascular and infant mortality (+ 1.52 years). Lifespan inequality stagnated because most causes of death did not show compression over the time period. Both these observations were consistent with higher smoking-related mortality in Danes born in 1919–1939. After 1995, life expectancy and lifespan equality increased in lockstep, but still lag behind Sweden, mainly due to infant mortality and cancer.ConclusionsSince 1960, Danish improvements in life expectancy and lifespan equality were halted by smoking-related mortality in those born 1919–1939, while also reductions in old-age cardiovascular mortality held back lifespan equality. The comparison with Sweden suggests that Denmark can reduce inequality in lifespans and increase life expectancy through a consistent policy target: reducing cancer and infant mortality.
Highlights
Reducing lifespan inequality is increasingly recognized as a health policy objective
Trends in lifespan inequality and life expectancy 1960–2014 The 1975–1995 stagnation in life expectancy for Danish females was accompanied by a shorter period of stagnation in lifespan inequality (Fig. 1a)
In this study, we found that the same causes and age groups that held back Danish life expectancy in 1975– 1995, especially for females, held back lifespan equality in the same period
Summary
Reducing lifespan inequality is increasingly recognized as a health policy objective. Whereas lifespan inequality declined with rising longevity in most developed countries, Danish life expectancy stagnated between 1975 and 1995 for females and progressed slowly for males. Life expectancy at birth is one of the most commonly used measures of the health status of a population and the performance of the healthcare system [1] It represents the average age at death if everyone experienced the prevailing death rates throughout their lifetime. Smoking-related mortality was considerably higher in Danish compared to Swedish males because of the widespread use of snus instead of cigarettes in Sweden [15] While these factors are known contributors to life expectancy differences, [16] their effects on lifespan inequality differences are unknown. Previous evidence has shown mixed results for the effects of smoking on lifespan inequality: little to no effect on the Finnish population, [17] while it increased lifespan inequality in some European countries [18]
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