Contribution Of Specific Causes Research Articles

Sex differences in cause-specific mortality: regional trends in seven European countries, 1996-2019.

Male excess mortality is mostly related to non-biological factors, and is thus of high social- and health-policy concern. Previous research has mainly focused on national patterns, while subnational disparities have been less in the focus. This study takes a spatial perspective on subnational patterns, covering seven European countries at the crossroad between Eastern and Western Europe. We analyze a newly gathered spatially detailed data resource comprising 228 regions with well-established demographic methods to assess the contribution of specific causes of death to the evolution of sex mortality differentials (SMDs) since the mid-1990s. Our results show that declines in SMDs were mostly driven by a reduction of male excess mortality from cardiovascular diseases and neoplasms (about 50-60% and 20-30%, respectively). In Western Europe, trends in deaths from neoplasms contributed more to the reduction of SMDs, while among regions located in Eastern-Central Europe narrowing SMDs were mostly driven by changes in cardiovascular disease-related deaths. Moreover, men show up to three times higher mortality levels from external causes as compared to women in several analyzed regions. But in absolute terms, external deaths play only a minor role in explaining SMDs due to their small contribution to overall mortality. We conclude that examining the regional development of SMDs is useful for introducing targeted social and health policies in order to reduce and prevent mortality inequalities between women and men.

Significant impacts of the COVID-19 pandemic on race/ethnic differences in US mortality

The coronavirus 2019 (COVID-19) pandemic triggered global declines in life expectancy. The United States was hit particularly hard among high-income countries. Early data from the United States showed that these losses varied greatly by race/ethnicity in 2020, with Hispanic and Black Americans suffering much larger losses in life expectancy compared with White people. We add to this research by examining trends in lifespan inequality, average years of life lost, and the contribution of specific causes of death and ages to race/ethnic life-expectancy disparities in the United States from 2010 to 2020. We find that life expectancy in 2020 fell more for Hispanic and Black males (4.5 and 3.6 y, respectively) compared with White males (1.5 y). These drops nearly eliminated the previous life-expectancy advantage for the Hispanic compared with the White population, while dramatically increasing the already large gap in life expectancy between Black and White people. While the drops in life expectancy for the Hispanic population were largely attributable to official COVID-19 deaths, Black Americans saw increases in cardiovascular diseases and "deaths of despair" over this period. In 2020, lifespan inequality increased slightly for Hispanic and White populations but decreased for Black people, reflecting the younger age pattern of COVID-19 deaths for Hispanic people. Overall, the mortality burden of the COVID-19 pandemic hit race/ethnic minorities particularly hard in the United States, underscoring the importance of the social determinants of health during a public health crisis.

Alcohol-Attributable Deaths Help Drive Growing Socioeconomic Inequalities In US Life Expectancy, 2000-18.

Socioeconomic gaps in life expectancy have widened substantially in the United States since 2000. Yet the contribution of specific causes to these growing disparities remains unknown. We used death records from the National Vital Statistics System and population data from Current Population Surveys to quantify the contribution of alcohol-attributable causes of death to changes in US life expectancy between 2000 and 2018 by sex and socioeconomic status (as measured by educational attainment). During the study period, the gap in life expectancy between people with low (high school diploma or less) compared with high (college degree) levels of education increased by three years among men and five years among women. Between 2000 and 2010 declines in cardiovascular disease mortality among people with high education made major contributions to growing inequalities. In contrast, between 2010 and 2018 deaths from a cause with an alcohol-attributable fraction of 20percent or more were a dominant driver of socioeconomic divergence. Increased efforts to implement cost-effective alcohol control policies will be essential for reducing health disparities.

Contributors to reduced life expectancy among Native Americans in the Four Corners States

To assess trends in life expectancy and the contribution of specific causes of death to Native American-White longevity gaps in the Four Corners states, we used death records from the National Center for Health Statistics and population estimates from the U.S. Census Bureau from 1999–2017 to generate period life tables and decompose racial gaps in life expectancy. Native American-White life expectancy gaps narrowed between 2001 and 2012 but widened thereafter, reaching 4.92 years among males and 2.06 years among females in 2015. The life expectancy disadvantage among Native American males was primarily attributable to motor vehicle accidents (0.96 years), liver disease (1.22 years), and diabetes (0.78 years). These causes of deaths were also primary contributors to the gap among females, forming three successive waves of mortality that occurred in young adulthood, midlife, and late adulthood, respectively, among Native American males and females. Interventions to reduce motor vehicle accidents in early adulthood, alcohol-related mortality in midlife, and diabetes complications at older ages could reduce Native American-White longevity disparities in the Four Corners states.

No change in life expectancy: the devil is in the detail

Abstract Background The rate of improvement in life expectancy in high income countries has slowed down over the past few years, and instances where life expectancy is lower than a year before are increasingly common. This paper aims to analyse changes in life expectancy over the last decade to better understand what causes and age groups contribute to the slowdown. Methods We use WHO mortality data by age and cause to construct life tables, and we use Arriaga decomposition method to analyse the contribution of specific causes and age groups to changes in life expectancy in Australia, Canada, France, Germany, Netherlands, United Kingdom and the United States of America. We look at the change between 2007-2012 and 2012-2017 (or latest available). Results All countries experienced a slowdown in life expectancy in the past 5 years (2012-2017), in comparison to the preceding period. Slowdown in under 65s was particularly pronounced, with younger age groups only contributing minimally (between 0.4 years for males in Germany and -0.4 years for males in the United States) to changes in life expectancy. Among people aged 65 and over, gains ranged between 0.05 years for females in France and 0.6 years for males in the Netherlands. Certain causes of death contributed negatively to change in life expectancy between 2012 and 2017, with notable increases in deaths from accidental poisonings in males (up to -0.09 year in the UK and Canada, and -0.34 in the US) and suicides (up to -0.08 year in Australia and -0.07 in the US). Conclusions While recent slowdown in life expectancy gains in high income countries is often attributed to lack of improvement in people of older ages, we show that, beyond this, there are increases in mortality in younger age groups from external causes, that contribute negatively to change in life expectancy in some countries. This pattern is of a particular concern, as deterioration in preventable mortality points to broader worsening of socio-economic climate. Key messages Improvements in life expectancy in high income countries slowed down markedly over the past few years, but contributing mortality patterns differ for age groups and causes of death across countries. Persistent increases in preventable mortality from certain external causes in younger age groups in Australia, Canada, US and UK point to broader deterioration of socio-economic climate.

Why did life expectancy decline in the United States in 2015? A gender-specific analysis

In 2015, age-adjusted mortality rates increased for 8 of the 10 leading causes of death in the United States. As a result, life expectancy declined by 0.17 years for both women and men. The decline could be just an anomaly, or it could represent the start of a new trend of stagnation or decline in life expectancy, as some scholars have warned. The first step is to determine the sources of the decline. In this study we analyze the contribution of specific causes of death to the decline in men's versus women's life expectancy, as well as the mechanisms that generated the decline. With regard to mechanisms, we examine whether the decline in life expectancy resulted from reductions in the average age at death for most causes of death, or from a greater risk of dying of causes that disproportionately affect the young and middle-aged. Using CDC mortality data, we construct life tables for men and women separately, based on 20 different underlying causes of death. We find that men's reduction in life expectancy was attributable primarily to changes in midlife mortality, with a greater risk of dying of causes such as accidental poisoning or homicide. The reduction in women's life expectancy, on the other hand, was attributable primarily to changes in old-age mortality, where the mean age at death for most causes (such as heart disease and mental illnesses) was lower in 2015 than it was in 2014. These gender-specific mechanisms that contributed to the decline in life expectancy are common to the major racial/ethnic groups, but the magnitude of the decline differs greatly across racial/ethnic groups. Future research can use the tools provided here to investigate in more detail how the gender-specific mechanisms of the 2015 decline differ by race.

Trends in educational inequalities in premature mortality in Belgium between the 1990s and the 2000s: the contribution of specific causes of deaths

BackgroundReducing socioeconomic inequalities in mortality, a key public health objective may be supported by a careful monitoring and assessment of the contributions of specific causes of death to the global...

Socioeconomic inequalities in premature mortality in Colombia, 1998–2007: The double burden of non-communicable diseases and injuries

ObjectivesNon-communicable diseases have become the leading cause of death in middle-income countries, but mortality from injuries and infections remains high. We examined the contribution of specific causes to disparities in adult premature mortality (ages 25–64) by educational level from 1998 to 2007 in Colombia. MethodsData from mortality registries were linked to population censuses to obtain mortality rates by educational attainment. We used Poisson regression to model trends in mortality by educational attainment and estimated the contribution of specific causes to the Slope Index of Inequality. ResultsMen and women with only primary education had higher premature mortality than men and women with post-secondary education (RRmen=2.60, 95% confidence interval [CI]: 2.56, 2.64; RRwomen=2.36, CI: 2.31, 2.42). Mortality declined in all educational groups, but declines were significantly larger for higher-educated men and women. Homicide explained 55.1% of male inequalities while non-communicable diseases explained 62.5% of female inequalities and 27.1% of male inequalities. Infections explained a small proportion of inequalities in mortality. ConclusionInjuries and non-communicable diseases contribute considerably to disparities in premature mortality in Colombia. Multi-sector policies to reduce both interpersonal violence and non-communicable disease risk factors are required to curb mortality disparities.

Most Important Outcomes Research Papers on Cardiac Arrest and Cardiopulmonary Resuscitation

Cardiac arrest is a common and treatable cause of death and disability. Each year ≈424 000 people experience emergency medical services (EMS)-assessed out-of-hospital cardiac arrest (OHCA) in the United States.1 The actual burden of OHCA is likely significantly higher because a substantial number go unassessed. In a prospective analysis of deaths in a US county, 5.6% of annual mortality was attributable to cardiac arrest.2 Many patients who suffer OHCA do not receive prompt cardiopulmonary resuscitation (CPR). Among those who receive CPR, a large number do not survive because of an inability to restore spontaneous circulation, or anoxic cerebral injury even after restoration of circulation. Nevertheless, when timely interventions are provided, a small proportion of patients (10.4% of all EMS-treated OHCA) recover to resume normal lives. The key therapeutic interventions that make the difference between life and death, metaphorically characterized as the 5 links in a chain of survival by the American Heart Association, include: (1) immediate recognition of cardiac arrest and activation of the EMS, (2) early CPR with emphasis on chest compression, (3) rapid defibrillation, (4) effective advanced life support, and (5) integrated postcardiac arrest care.3 Resuscitation science has undergone major advances since the origins of modern CPR >50 years ago.4 The field continues to be dynamic with emergence of new therapies such as therapeutic hypothermia5 and improvements in systems of care. However, many questions remain on issues such as optimum compression rate, efficacy of chest compression only CPR (CCCPR), dispatcher-assisted CPR, and benefits of postresuscitation measures such as hypothermia. A critical challenge also lies in the translation of resuscitation science into practice. To improve outcomes, each of the links in the chain of survival needs to be executed promptly and effectively. There remain several lacunae, which need to be overcome to develop an …

The Contribution of Specific Causes of Death to Sex Differences in Mortality

Men have higher mortality rates than women for most causes of death. This study was conducted to determine the contribution of specific causes of death to the sex difference in years of potential life lost (YPLL). The authors examined data from the National Health Interview Survey with linked mortality data through 1997. Using survival analysis estimates, a stochastic simulation model to simulate death events for cohorts of white, African American, and Latino adults was created. YPLL from all causes were greater among men than women. Homicide, motor vehicle accidents, and suicide accounted for 33% of YPLL sex difference among whites, 36% among African Americans, and 52% among Latinos. For all three racial/ethnic groups, cardiovascular disease (principally ischemic heart disease) was the second largest contributor to the sex difference in YPLL (29% among whites, 23% among African Americans, and 25% among Latinos). Lung cancer was also important among whites and African Americans, accounting for 15% and 17% of the sex difference in YPLL from all causes, respectively. Ischemic heart disease, lung cancer, and traumatic deaths account for as much as three-quarters of the excess YPLL among men, suggesting that a few modifiable behaviors such as the use of tobacco, alcohol.

Differences in Cause-Specific Mortality Between Latino and White Adults

Understanding differences in cause-specific mortality between Latinos and whites is important for targeting future public health interventions and research aimed at eliminating health disparities. We sought to determine the contribution of specific causes of death to Latino-white differences in mortality. Using nationally representative data, we estimated cause-specific mortality risks, which were then used in a simulation model to estimate mortality events for a cohort of persons starting at age 25 and followed until death or age 75. Subjects were 507,820 Latino and white adults, age 25 or older, who participated in the 1986-1994 National Health Interview Surveys. Outcomes were years of potential life lost before age 75 from specific causes of death and age-specific mortality rate ratios for Latinos compared with whites. Latinos had higher mortality rates than whites before age 45 and similar mortality rates at older ages. Latino women lost 315 (95% confidence interval [CI], 229-2423) more years of potential life (per 1000 persons before the age of 75) than white women and Latino men lost 595 (95% CI, 513-1675) more years than white men. For both men and women, whites lost substantially more years of potential life than Latinos from lung cancer. Homicide, diabetes, HIV, and liver disease contributed most to the excess years of potential life lost among Latino men, and diabetes and HIV contributed most to the excess years of potential life lost among Latino women. To eliminate health disparities between Latinos and whites, future health policy and public health efforts should target diabetes, homicide, HIV, and liver disease among Latinos and lung cancer among whites.

Educational inequalities in cause-specific mortality in middle-aged and older men and women in eight western European populations

Background Studies of socioeconomic disparities in patterns of cause of death have been limited to single countries, middle-aged people, men, or broad cause of death groups. We assessed contribution of specific causes of death to disparities in mortality between groups with different levels of education, in men and women, middle-aged and old, in eight western European populations. Methods We analysed data from longitudinal mortality studies by cause of death, between Jan 1, 1990, and Dec 31, 1997. Data were included for more than 1 million deaths in 51 million person years of observation. Findings Absolute educational inequalities in total mortality peaked at 2127 deaths per 100 000 person years in men, and at 1588 deaths per 100 000 person years in women aged 75 years and older. In this age-group, rate ratios were greater than 1·00 for total mortality and all specific causes of death, apart form prostate cancer in men and lung cancer in women, showing increased mortality in low versus high eductational groups. In men, cardiovascular diseases accounted for 39% of the difference between low and high eductational groups in total mortality, cancer for 24%, other diseases for 32%, and external causes for 5%. Among women, contributions were 60%, 11%, 30%, and 0%, respectively. The contributions of cerebrovascular disease, other cardiovascular diseases, pneumonia, and COPD strongly increased by age, whereas those of cancer and external causes declined. Although relative inequalities in total mortality were closely similar in all populations, we noted striking differences in the contribution of specific causes to these inequalities. Interpretation Research needs to be broadened to include older populations, other diseases, and populations from different parts of Europe. Effective interventions should be developed and implemented to reduce exposure to cardiovascular risk factors in low-educational groups. Studies of socioeconomic disparities in patterns of cause of death have been limited to single countries, middle-aged people, men, or broad cause of death groups. We assessed contribution of specific causes of death to disparities in mortality between groups with different levels of education, in men and women, middle-aged and old, in eight western European populations. We analysed data from longitudinal mortality studies by cause of death, between Jan 1, 1990, and Dec 31, 1997. Data were included for more than 1 million deaths in 51 million person years of observation. Absolute educational inequalities in total mortality peaked at 2127 deaths per 100 000 person years in men, and at 1588 deaths per 100 000 person years in women aged 75 years and older. In this age-group, rate ratios were greater than 1·00 for total mortality and all specific causes of death, apart form prostate cancer in men and lung cancer in women, showing increased mortality in low versus high eductational groups. In men, cardiovascular diseases accounted for 39% of the difference between low and high eductational groups in total mortality, cancer for 24%, other diseases for 32%, and external causes for 5%. Among women, contributions were 60%, 11%, 30%, and 0%, respectively. The contributions of cerebrovascular disease, other cardiovascular diseases, pneumonia, and COPD strongly increased by age, whereas those of cancer and external causes declined. Although relative inequalities in total mortality were closely similar in all populations, we noted striking differences in the contribution of specific causes to these inequalities. Research needs to be broadened to include older populations, other diseases, and populations from different parts of Europe. Effective interventions should be developed and implemented to reduce exposure to cardiovascular risk factors in low-educational groups.

Educational inequalities in cause-specific mortality in middle-aged and older men and women in eight western European populations

Studies of socioeconomic disparities in patterns of cause of death have been limited to single countries, middle-aged people, men, or broad cause of death groups. We assessed contribution of specific causes of death to disparities in mortality between groups with different levels of education, in men and women, middle-aged and old, in eight western European populations. We analysed data from longitudinal mortality studies by cause of death, between Jan 1, 1990, and Dec 31, 1997. Data were included for more than 1 million deaths in 51 million person years of observation. Absolute educational inequalities in total mortality peaked at 2127 deaths per 100000 person years in men, and at 1588 deaths per 100000 person years in women aged 75 years and older. In this age-group, rate ratios were greater than 1.00 for total mortality and all specific causes of death, apart form prostate cancer in men and lung cancer in women, showing increased mortality in low versus high educational groups. In men, cardiovascular diseases accounted for 39% of the difference between low and high educational groups in total mortality, cancer for 24%, other diseases for 32%, and external causes for 5%. Among women, contributions were 60%, 11%, 30%, and 0%, respectively. The contributions of cerebrovascular disease, other cardiovascular diseases, pneumonia, and COPD strongly increased by age, whereas those of cancer and external causes declined. Although relative inequalities in total mortality were closely similar in all populations, we noted striking differences in the contribution of specific causes to these inequalities. Research needs to be broadened to include older populations, other diseases, and populations from different parts of Europe. Effective interventions should be developed and implemented to reduce exposure to cardiovascular risk factors in low-educational groups.

Unintentional childhood injury mortality in Europe 1984–93: a report from the EURORISC Working Group

Objective—To examine recent trends in unintentional childhood injury mortality in Europe, and to identify the contribution of specific causes. Setting—The 15 current member countries of the European Union. Methods—Analysis of...

The contribution of specific causes of death to mortality differences by marital status in the Netherlands

The purpose of this study was to describe the differences in mortality by marital status in the Netherlands in the period 1986–1990 for specific causes of death and to estimate the contribution of each specific cause to the differences in total mortality. We have used mortality and population data from Statistics Netherlands. Poisson regression was used to calculate relative risks of dying from the specific causes of death. The relative risks and the overall mortality rates were used to estimate the contribution of the specific causes of death to the differences in total mortality by marital status. For men the general pattern was that the divorced had the highest risks, followed by the never-married and that the widowed had risks closest to married men. For women the general pattern was that the divorced had the highest risks, while widowed and never-married women alternately had risks closest to married women. Important exceptions to these risk patterns were found for, among others, infectious and parasitic diseases among men and breast cancer among women. External causes of death in particular, contributed more to the excess mortality of the 3 unmarried groups of men and women than expected, while the contributions of malignant neoplasms and diseases of the circulatory system were lower than expected on the basis of the percentages of these causes of death in mortality in the married population. Since the causes of death that contributed disproportionately to the excess mortality of the unmarried almost all have unhealthy lifestyles as important risk factors, we argue that the majority of the mortality differences by marital status can be explained by social causation (marital status affects health through lifestyle differences). However, longitudinal data are necessary to rule out selection effects (effect of health on marital status), preferably controlling for sociodemographic confounders such as socioeconomic status and taking into account living arrangements.

Seasonal variation in mortality in The Netherlands.

The aim was to describe the pattern of seasonal variation in all cause mortality in The Netherlands, and to analyse the contribution of specific causes of death to the winter excess of all cause mortality. Daily numbers of deaths in The Netherlands, by cause, were obtained for the period 1979-1987. Patterns of variation were analysed using Poisson regression. The model related the observed number of deaths to (1) the number expected for that day on the basis of person-days at risk by age and sex, (2) secular trend, and (3) first and higher order cosine terms where appropriate. All cause mortality has a bimodal peak in the first months of the year. After that it declines to reach a plateau in late spring. Mortality is lowest at the end of August, after which it rises steeply again. The winter excess of all cause mortality is primarily due to cardiovascular diseases (66%) and respiratory conditions (13%). Cardiovascular mortality peaks before respiratory mortality, suggesting different lag times in the effects of winter. There was an episode of exceptionally high mortality (above the normal winter excess) in early 1986, which was primarily due to cardiovascular diseases (39%) and respiratory conditions (25%). This episode was probably caused by a severe influenza epidemic, and was not followed by a compensatory lowering of mortality. The pattern of variation of mortality within the year suggests that it is not based on a simple relationship with climatological circumstances, because the latter fluctuate according to a less complex pattern. Cause specific data suggest an instantaneous effect of "winter" on the cardiovascular system, and a delayed effect mediated by respiratory infections.

Stillbirth in the city of Bombay.

Stillbirth is to be encountered in every human population and its causes are the same everywhere, although the magnitude of the contribution of specific causes differs in time and place. In countries where the medical and social services available to the expectant mother have recently undergone a rapid development and where records relating to stillbirth have been maintained for many years, it has been observed that as the standard of living has risen the stillbirth rate has fallen, and it is reasonable to assume that in the future the rate will fall in other countries when the standard of living and of medical care has improved. The stillbirth ratio in the Indian population as a whole cannot be given. In India, as also for example in Egypt, the figures given in the Demographic Yearbook of the United Nations for 1957 (Table I) relate to certain selected registration areas only.