Underlying and Multiple Case Mortality Advanced Ages: United States 1980-1998

Abstract

This paper evaluates changes in cause-specific mortality for the general noninsured U.S. elderly population aged 65 years and older by sex and five-year age groups over the calendar years 1980, 1990, and 1998 for 14 leading causes of death coded according to the International Classification of Diseases (9th revision). The goals of the paper are substantive and methodological. Substantively, the goal is to assess the different contributions to the mortality decline made by diseases as underlying causes versus associated or contributing causes—as recorded in the multiple cause condition field of the death certificate. Methodologically, the goal is to introduce these data into actuarial practice and provide an initial set of tabulation methods that facilitate their use. The patterns of change over age and time of the 14 leading causes exhibited distinct characteristics in one or more of the tables presented, demonstrating unequivocally that the diseases are neither homogeneous nor independent. This suggests that standard models such as the multiple decrement life table model that assume independent competing risks may be invalid. However, the specification of realistic and accurate alternative models will be a major challenge because of the complexity of the morbid processes involved and the requirements for data linkages that are only beginning to be developed.