Low Mortality Populations Research Articles

Levels, trends, and determinants of cause-of-death diversity in a global perspective: 1990–2019

BackgroundWhile much is known about the leading causes of death (CoD) and how they have evolved over time, much less is known about the diversity of such causes of death. CoD diversity is an important marker of population health heterogeneity that has been largely overlooked in the study of contemporary health dynamics.MethodsWe provide regional and national estimates of CoD diversity from 1990 to 2019. We rely on data from the Global Burden of Disease project, using information on 21 CoD. Results are presented for 204 countries and territories, for women and men separately. CoD diversity is measured with the index of Fractionalization. Results are disaggregated by age and cause of death.ResultsCoD diversity has declined across world regions, except for Latin America and the Caribbean, the region of High-income countries and women in Central Europe, Eastern Europe, and Central Asia. Changes in mortality at adult and older ages have been mostly responsible for CoD diversity dynamics, except for the regions of South Asia and Sub-Saharan Africa, where infant and child mortality still play a non-negligible role. The relationship between CoD diversity, life expectancy, and lifespan inequality is strongly non-monotonic, with turning points differing by sex and indicator. Among longevity vanguard countries, further increases in life expectancy are associated with decreasing lifespan inequality but increasing CoD diversity.ConclusionAs mortality declines, there is no universal pathway toward low CoD diversity, thus casting doubts on the ability of Epidemiological Transition Theory to predict prospective CoD dynamics among high- and middle-mortality countries. Despite the postponement and increasing predictability of the ages at which individuals die, low-mortality populations are composed of an increasingly heterogenous mix of robust and frail individuals, thus increasing the diversity of health profiles among older persons – an issue that could potentially complicate further improvements in longevity.

Smoothing, Decomposing and Forecasting Mortality Rates.

The Lee-Carter (LC) model represents a landmark paper in mortality forecasting. While having been widely accepted and adopted, the model has some limitations that hinder its performance. Some variants of the model have been proposed to deal with these drawbacks individually, none coped with them all at the same time. In this paper, we propose a Three-Component smooth Lee-Carter (3C-sLC) model which overcomes many of the issues simultaneously. It decomposes mortality development into childhood, early-adult and senescent mortality, which are described, individually, by a smooth variant of the LC model. Smoothness is enforced to avoid irregular patterns in projected life tables, and complexity in the forecasting methodology is unaltered with respect to the original LC model. Component-specific schedules are considered in projections, providing additional insights into mortality forecasts. We illustrate the proposed approach to mortality data for ten low-mortality populations. The 3C-sLC captures mortality developments better than a smooth improved version of the LC model, and it displays wider prediction intervals. The proposed approach provides actuaries, demographers, epidemiologists and social scientists in general with a unique and valuable tool to simultaneously smooth, decompose and forecast mortality.

Tracking progress in mean longevity: The Lagged Cohort Life Expectancy (LCLE) approach

Cohort life expectancy is an important but rarely used indicator of mean longevity. In this paper, we show that there are specific advantages in lagging this indicator in time by its own value, an approach termed Lagged Cohort Life Expectancy (LCLE). We discuss the usefulness of LCLE as an indicator for tracking progress in mean longevity and introduce a new interpretation of LCLE as a reference age separating ‘early’ deaths from ‘late’ deaths, or, equivalently, as the age above which individuals in a population can be considered ‘above-average’ survivors. Using data from 15 countries in the Human Mortality Database, we show that current LCLE can be estimated with a relatively high degree of certainty, at least in these low-mortality populations. Results shed new light on levels and trends in mean longevity in these populations.

Meeting the Institute of Medicine's 2030 US Life Expectancy Target.

To quantify the improvement in US life expectancy required to reach parity with high-resource nations by 2030, to document historical precedent of this rate, and to discuss the plausibility of achieving this rate in the United States. We performed a demographic analysis of secondary data in 5-year periods from 1985 to 2015. To achieve the United Nations projected mortality estimates for Western Europe in 2030, the US life expectancy must grow at 0.32% a year between 2016 and 2030. This rate has precedent, even in low-mortality populations. Over 204 country-periods examined, nearly half exhibited life-expectancy growth greater than 0.32%. Of the 51 US states observed, 8.2% of state-periods demonstrated life-expectancy growth that exceeded the 0.32% target. Achieving necessary growth in life expectancy over the next 15 years despite historical precedent will be challenging. Much all-cause mortality is structured decades earlier and, at present, older-age mortality reductions in the United States are decelerating. Addressing mortality decline at all ages will require enhanced political will and a strong commitment to equity improvement in the US population.

Measuring selective constraint on fertility in human life histories

Human life histories combine late age at first reproduction, long reproductive span, relatively high fertility, and substantial postreproductive survival. However, even among the most fecund populations, human fertility falls far below its theoretical maximum. The extent of parental care required for successful offspring recruitment and widespread fertility decline under proper economic conditions suggest that selection on fertility is constrained by trade-offs with recruitment. Here we measure the trade-offs between life history traits under selection by approximating the slope of the selective constraint curve on two traits at the observed values. Using a selection of populations that span human demographic space, we find that the substitution elasticity of fertility for infant survival shows age-related patterns, with minimum substitution elasticities ranging from 14 to 22 for the four populations. The age of this minimum occurs earlier in the high-mortality populations relative to generation time than it does in the low-mortality populations. The human curves are qualitatively similar to one of two comparable nonhuman primate age-specific substitution elasticity curves. The curve for rhesus macaques has a similar shape but is shifted down, meaning that the threshold for switching from investing in survival to fertility is lower at all ages. The magnitude of the substitution elasticities is similar between chimpanzees and humans but the shape is quite different, rising more slowly for a longer fraction of the chimpanzee life cycle. The steeply rising substitution elasticities with age in humans has clear implications for the evolution of reproductive senescence.

Water status of isolated Negev desert populations of Acacia raddiana with different mortality levels

Many populations of native Acacia raddiana trees in ephemeral riverbeds in the Negev desert are suffering from high mortality. Road-building techniques that cut off water to trees in downstream populations and the pumping of aquifers for agriculture have been mooted as causes of this mortality. We studied the water relations of nine isolated populations of these trees using a pressure chamber and stable carbon isotopes in order to determine whether current water stress could be the cause of this mortality. High mortality populations had more negative water potentials, lower relative water contents, and lower cell water volumes at full turgor than low mortality populations. Thus, mortality is correlated with current inter-population differences in water stress. However, there was no difference in water potentials between trees upstream and downstream of roads. Furthermore, greater water stress in trees after a dry winter than in the previous summer indicates that these trees are largely drawing on surface floods for water. Thus, road-building practices and aquifer pumping are unlikely causes of current water stress. Hence, water stress is linked to mortality in these trees, although our results indicate that irregular water stress (perhaps in drought years only) is probably the cause of this mortality.

Mortality differences by APOE genotype estimated from demographic synthesis.

The 4 allele of apolipoprotein E (APOE) is associated with increased risk of two major causes of death in low-mortality populations: ischemic heart disease and Alzheimer's disease. It is less common among centenarians than at younger ages. Therefore, it is likely that it is associated with excess risk of death. This article extends demographic models that estimate relative mortality risks from changes in gene frequencies with age. The resulting demographic synthesis combines gene frequencies with data on mortality by genotype from cohort studies. The model was applied to data from Denmark, Finland, France, Italy, Sweden, and the United States. Near age 50, the 3/4 genotype is associated with a risk of death of 1.34 times that of the 3/3 (95% CI 1.18-1.67). The relative risk for 4/4 is the square of the relative risk for 3/4, 1.81. The 2/3 genotype is protective with a relative risk of 0.84 (0.68-0.93) near age 50. These relative risks move toward 1.0 at the oldest ages and APOE genotype is associated with little variation in mortality over age 100. There are no significant differences in the relative risks by sex. There is little evidence of differences within Europe in the effects of APOE. This approach can be generalized to combine data on genetic risk factors for disease from a wide variety of study designs and sample characteristics.

Widening Regional Inequality in Premature Mortality Rates in Manitoba

To describe regional trends in premature mortality in Manitoba. Comparison of all-cause and cause-specific mortality of persons less than age 75 in 11 Regional Health Authority populations over two time periods: 1985-89 and 1990-94. The provincial premature mortality rate declined over the two time periods (4.00/1,000 to 3.72/1,000). Declines were also observed in 9 of 11 regional populations. Premature mortality increased, however, in the 2 regional populations with the highest mortality rates in the first observation period. Declining premature mortality in low mortality populations and rising premature mortality in high mortality populations has resulted in a widening of regional mortality rates in Manitoba. Recent policy initiatives in many provinces, including the devolution of authority for the management and delivery of health services and the implementation of population need-based funding formulas to share health care resources among regional health authorities, if implemented, have the potential to partially mitigate the processes producing these widening regional health inequalities.

Will Aging Baby Boomers Bust the Federal Budget?

The authors analyze in three steps the influence of the projected mortality decline on the long-run finances of the Social Security System. First, mortality decline adds person years of life which are distributed across the life cycle. The interaction of this distribution with the age distribution of taxes minus benefits determines the steady state financial consequences of mortality decline. Second, examination of past mortality trends in the United State and of international trends in low mortality populations, suggests that mortality will decline much faster than foreseen by the SSA's forecasts. Third, based on work on stochastic demographic forecasting, stochastic forecasts of the system's actuarial balance are derived, indicating a broader range of demographic uncertainty than in the latest SSA forecasts, and a relatively greater contribution to uncertainty from fertility than mortality.

International Trends in Health Expectancies: a Review

Abstract. Are we living longer but in worse health? Are the increases in life expectancy at older ages in developed countries occurring because we are keeping sick or disabled people alive longer or because we are saving people from death but leaving them in states of disability and handicap? This question was addressed in a symposium entitled International Trends in Health Expectancies. This review paper summarises the international evidence presented at that symposium on trends in health expectancies in developed countries. Health expectancies provide a powerful tool for monitoring the health of older populations, testing hypotheses about the evolution of health, and developing public policy. The available international evidence of time series of health expectancies for older people suggests that increases in disability prevalence began in the late 1960s and 1970s at the time when mortality rates at older ages began to decline significantly, but that these increases were confined to the less severe end of the disability spectrum. There is no evidence of expansion of morbidity based on more severe measures of disability prevalence. Recently emerging evidence from Europe and North America suggests that disability prevalence rates among older people may be starting to decline and we may actually be starting to see compression of morbidity in low mortality populations.

Death and Taxes: Longer life, consumption, and social security

We analyze in three steps the influence of the projected mortality decline on the long run finances of the Social Security System. First, on a theoretical level, mortality decline adds person years of life which are distributed across the life cycle. The interaction of this distribution with the age distribution of labor earnings minus consumption, or of taxes minus benefits, partially determines the corresponding steady state financial consequences of mortality decline. The effect of mortality decline on population growth rates also matters, but is negligible in low mortality populations. Second, examination of past mortality trends in the United States and of international trends in low mortality populations, suggests that mortality will decline faster than foreseen by the Social Security Administration's forecasts. Third, we combine the work of the first two parts in dynamic simulations to examine the implications of mortality decline and of alternative forecasts of mortality for the finances of the social security system. Also, we use stochastic population forecasts to assess the influence of uncertainty about mortality decline on uncertainty about finances; we find that uncertainty about fertility still has more important implications than uncertainty about mortality, contrary to sensitivity tests in the official forecasts.

Revised Regional Model Life Tables at Very Low Levels of Mortality

This paper presents and discusses new model life tables at very low mortality, which make use of age-specific death rates from the 1960s, 1970s, and 1980s. These life tables fit recorded death rates in very low mortality populations better than do the existing ones at expectations of life of 77.5 and 80 years. The old tables incorporate too-high mortality at the higher ages and in infancy and they incorporate regional differences that no longer exist. The new tables "close out" the mortality schedules above age 80 more realistically. The convergence of age patterns of mortality at very high life expectancies in populations that used to conform to different families is in itself of demographic interest. Some convergence may perhaps be expected. Sullivan (1973) found that, in Taiwan, the comparison of mortality at ages 1-5 to mortality at 5-35 in the late 1950s showed higher mortality at the younger ages relative to the ensuing 30-year age interval than was found in any of the models, including the South model, which has the highest relative mortality from ages 1-5 among the 4 regional patterns. Then, in the late 1960s, the relation of mortality at 1-5 to mortality at 5-35 in Taiwan fell to a position intermediate between the West and South tables. Sullivan found in data on mortality by cause of death a large reduction in mortality from diarrhea and enteritis, no doubt as a result of environmental sanitation. Mortality from these causes is concentrated among young children, and reduction in deaths from these causes would naturally diminish the excess mortality in this age interval. The East pattern, characterized by very high mortality in infancy (but not from 1-5), may be the result of the prevalence of early weaning or avoidance of breast feeding altogether in the populations characterized by this pattern. As health conditions have improved, evidenced by the overall design of mortality, these special factors are diminished or erased. Model life tables at these very low mortality levels have different uses from most applications of model life tables at higher mortality. The use of model tables to estimate accurate schedules of mortality when the basic data are incomplete or inaccurate is less relevant in this range of mortality levels.

On the minimum size of endogamous populations.

Abstract The survival of small endogamous human populations is investigated by computer simulation. It is shown that (1) populations practicing strict monogamy with no extramarital pregnancy are less likely to survive as endogamous groups than are those in which marriage is not a prerequisite for childbearing ; (2) low fertility—low mortality populations can survive with fewer individuals than can populations subject to high fertility and mortality; (3) avoidance of close consanguinity reduces the probability of population survival, but the effect is much greater when fertility and mortality are low. In addition, an attempt is made to determine which demographic characteristics are likely to be the best predictors of potential population decline or disruption.