Old-age Mortality Research Articles

Assessment of shifts in mortality age profile of adult population in Moscow during pandemic

Introduction. The COVID-19 pandemic induced the global crisis of mortality. Delayed medical care and reduced availability under quarantine restrictions have led to an increase in mortality not only from Covid-19, but also from chronic non-communicable diseases, affecting men and women of different ages to varying degrees. The study purpose is to assess shifts in mortality age profile of population aged 20+ in Moscow during COVID-19 pandemic. Materials and methods. Official vital statistics of Rosstat, operational information from civil registration database on death causes in Moscow. Results. The gain in mortality rate caused primarily by deaths from COVID-19 interrupted in 2020 the positive demographic dynamics that had developed over the previous years. In 2021, the increase in the mortality rate continued, but the loss of life expectancy was lower due to a decrease in mortality in older ages and the return of most indicators to the level of 2019. However, from a socio-economic point of view, the situation in 2021 developed more negatively, since the age structure of life expectancy losses is younger than in 2020. Limitations. The study results are based on operational information of the Moscow civil registration office and could be used for the development of managerial decisions for Moscow only. Conclusion. Against the pandemic demographic situation in Moscow has worsened. Due to mortality gain in the Russia’s capital first in the past years recorded natural population decline.

Inequalities in Retirement Life Span in the United States.

The length of retirement life may be highly unequal due to persistent and significant discrepancies in old-age mortality. This study assesses gender and educational differences in the average retirement life span and the variation in retirement life span, taking into account individual labor force exit and reentry dynamics. We used longitudinal data from the Health and Retirement Study from 1996 to 2016, focusing on respondents aged 50 and older (N=32,228). Multistate life tables were estimated using discrete-time event history models. The average retirement life span, as well as absolute and relative variation in retirement life span, were calculated analytically. Among women, we found a persistent educational gradient in average retirement life span over the whole period studied; among men, the relationship between education and retirement expectancy differed across periods. Women and the lower-educated had higher absolute variation in retirement life span than men and the higher-educated-yet these relationships were reversed when examined by relative variation. Our multistate approach provides an accurate and comprehensive picture of the retirement life span of older Americans over the past two decades. Such findings should be considered in high-level discussions on Social Security. Potential reforms such as raising the eligibility age or cutting benefits may have unexpected implications for different social groups due to their differential effects on retirement initiation and reentry dynamics.

Marital Status, Living Arrangements and Mortality at Older Ages in Chile, 2004-2016.

The risk of mortality in old age is associated with marital status and living arrangements. There is still little knowledge about this in Latin America. Our objectives are to examine the association between marital status, living arrangements and mortality of older adults (>60 years) in Chile, and to test whether this association varies when demographic, socioeconomic and health factors are included. We used data from the Social Protection Survey, and mortality data were linked to the Civil Registry. We estimate a series of Poisson regression models. Our results show a clear association between marriage and longevity, since even controlling for demographic, socioeconomic and health factors, we found that separated or divorced, widowed, and unmarried people showed higher relative mortality compared to married people (IRR1.24, IRR1.33, IRR1.35, respectively). Considering only living arrangements, the results show that living alone, alone with children, with children and other relatives or in other arrangements is associated with higher mortality (IRR1.22, IRR1.27, IRR1.35, IRR1.35, respectively) compared to those living with their partners and children. However, considering marital status and living arrangements together, we find that survival among older adults was strongly associated with marital status. Marital status continues to be a direct measure of living arrangements among older adults in Chile.

In utero exposure to natural disasters and later-life mortality: Evidence from earthquakes in the early twentieth century

A growing body of research explores the effects of prenatal insults caused by natural disasters on life-cycle outcomes. This paper joins the literature by exploring the long-run effects of prenatal exposure to earthquakes on adulthood and old-age mortality. Using Social Security Administration death records (1975–2005) linked with the full-count 1940 US census and implementing a difference-in-difference methodology, I show that exposure during the first trimester is associated with 1.8 months lower longevity, conditional on survival up to age 34. This effect is equivalent to 22 percent of the white-nonwhite gap in the outcome. The results implicate the relevance of the in-utero period and specifically the onset of pregnancy for later-life health outcomes.

Life-Course Transitions in Rural Residence and Old-Age Mortality in Iowa, 1930-2014.

Early-life conditions are associated with mortality in men, but not studied to the same extent in women. We add new evidence by studying a cohort of women born between 1916 and 1931 and followed for mortality between 1986 and 2013. Our sample from Iowa includes a significant number of rural women, from both farms and small towns. The long-term effects of growing up in a rural area were mixed: farmers' daughters lived longer than women growing up off-farm in rural areas. Daughters of farm laborers and skilled or semi-skilled trades workers fared worst, when considering early-life socioeconomic status. We also find evidence that migrating to small-town Iowa was associated with lower life expectancy after age fifty-five. Considering social class and farm-nonfarm status is important for understanding the health of rural America.

Risk factors and clustering of mortality among older adults in the India Human Development Survey

With wide socioeconomic mortality differential among older adults in India, a constant question of death clustering across high-risk families and communities arises. The present study uses a follow-up survey from India to investigate the socioeconomic, demographic and health predictors of old-age mortality clustering. Data of 16,964 older adults nested within 12,981 households from 2352 communities were used from India Human Development Survey (IHDS) round-I (2005) who were further tracked down in round-II (2012). Bivariate association between the determinants of old-age mortality was investigated using the log-rank test. The multivariate analysis involved estimating the random-intercept Weibull proportional hazard model with three levels—individual (level 1), family (level 2) and community (level 3). We analyzed the sensitivity of multivariate results to unobservable variable and selection biases using the e-value method. The empirical analysis confirms that the risk of mortality is significantly heterogeneous between the families. The health status of older adults and the family’s socioeconomic status in the early years emerged as prominent predictors of a longer lifespan. With a strong association between household income and mortality hazard risk, the present study urges early life interventions as those started in late-life might have negligible impact on keeping the older adults alive and healthy.

Chronic Obstructive Pulmonary Disease-Related Mortality in Brazil, 2000–2019: A Multiple-Cause-of-Death Study

Chronic obstructive pulmonary disease (COPD) remains a compelling cause of morbidity and mortality; however, it is underestimated and undertreated in Brazil. Using multiple causes of death data from the Information System on Mortality, we evaluated, from 2000 to 2019, national proportional mortality; trends in mortality rates stratified by age, sex, and macro-region; and causes of death and seasonal variation, considering COPD as an underlying and associated cause of death. COPD occurred in 1,132,968 deaths, corresponding to a proportional mortality of 5.0% (5.2% and 4.7% among men and women), 67.6% as the underlying, and 32.4% as an associated cause of death. The standardized mortality rate decreased by 25.8% from 2000 to 2019, and the underlying, associated, male and female, Southeast, South, and Center-West region deaths revealed decreasing standardized mortality trends. The mean age at death increased from 73.2 (±12.5) to 76.0 (±12.0) years of age. Respiratory diseases were the leading underlying causes, totaling 69.8%, with COPD itself reported for 67.6% of deaths, followed by circulatory diseases (15.8%) and neoplasms (6.24%). Respiratory failure, pneumonia, septicemia, and hypertensive diseases were the major associated causes of death. Significant seasonal variations, with the highest proportional COPD mortality during winter, occurred in the southeast, south, and center-west regions. This study discloses the need and value to accurately document epidemiologic trends related to COPD in Brazil, provided its burden on mortality in older age as a significant cause of death, aiming at effective planning of mortality prevention and control.

Study protocol: MyoFit46\u2014the cardiac sub-study of the MRC National Survey of Health and Development

BackgroundThe life course accumulation of overt and subclinical myocardial dysfunction contributes to older age mortality, frailty, disability and loss of independence. The Medical Research Council National Survey of Health and Development (NSHD) is the world’s longest running continued surveillance birth cohort providing a unique opportunity to understand life course determinants of myocardial dysfunction as part of MyoFit46–the cardiac sub-study of the NSHD.MethodsWe aim to recruit 550 NSHD participants of approximately 75 years+ to undertake high-density surface electrocardiographic imaging (ECGI) and stress perfusion cardiovascular magnetic resonance (CMR). Through comprehensive myocardial tissue characterization and 4-dimensional flow we hope to better understand the burden of clinical and subclinical cardiovascular disease. Supercomputers will be used to combine the multi-scale ECGI and CMR datasets per participant. Rarely available, prospectively collected whole-of-life data on exposures, traditional risk factors and multimorbidity will be studied to identify risk trajectories, critical change periods, mediators and cumulative impacts on the myocardium.DiscussionBy combining well curated, prospectively acquired longitudinal data of the NSHD with novel CMR–ECGI data and sharing these results and associated pipelines with the CMR community, MyoFit46 seeks to transform our understanding of how early, mid and later-life risk factor trajectories interact to determine the state of cardiovascular health in older age.Trial registration: Prospectively registered on ClinicalTrials.gov with trial ID: 19/LO/1774 Multimorbidity Life-Course Approach to Myocardial Health- A Cardiac Sub-Study of the MCRC National Survey of Health and Development (NSHD).

Dynamic Modelling of Mortality Via Mixtures of Skewed Distribution Functions

Abstract There has been growing interest on forecasting mortality. In this article, we propose a novel dynamic Bayesian approach for modelling and forecasting the age-at-death distribution, focusing on a three-component mixture of a Dirac mass, a Gaussian distribution and a skew-normal distribution. According to the specified model, the age-at-death distribution is characterized via seven parameters corresponding to the main aspects of infant, adult and old-age mortality. The proposed approach focuses on coherent modelling of multiple countries, and following a Bayesian approach to inference we allow to borrow information across populations and to shrink parameters towards a common mean level, implicitly penalizing diverging scenarios. Dynamic modelling across years is induced through an hierarchical dynamic prior distribution that allows to characterize the temporal evolution of each mortality component and to forecast the age-at-death distribution. Empirical results on multiple countries indicate that the proposed approach outperforms popular methods for forecasting mortality, providing interpretable insights on its evolution.

Do changes in frailty, physical functioning, and cognitive functioning predict mortality in old age? Results from the Longitudinal Aging Study Amsterdam

BackgroundThe ability to accurately predict survival in older adults is crucial as it guides clinical decision making. The added value of using various health indicators as well as changes in these indicators for predicting mortality remains unclear. The aim of this study was to investigate whether changes in health indicators such as frailty and physical performance improve mortality predictions in old age.MethodsThis is a population based prospective cohort study on 995 community-dwelling people aged 68–92 years from the Longitudinal Aging Study Amsterdam. Two measurements at a three-year interval (1995/1996 and 1998/1999) were available for the frailty index, frailty phenotype, grip strength, walking speed, and Mini-Mental State Examination (MMSE). Cox regression was used to analyze mortality risks associated with the current health status and changes in health, with mortality data up to 2017. The extent to which these health indicators improved mortality predictions compared to models with age and sex only was assessed by the area under the receiver operating characteristic curve (AUC).ResultsThe AUC of age and sex for five-year mortality was 72.8% (95% CI 69.0 – 76.5) and was the lowest in the oldest old (age > 80.5 years). The added AUC of the current status of health indicators ranged from 0.7 to 3.3%. The added AUC of the three-year change was lower, ranging from -0.0 to 1.1%, whereas the added AUC of three-year change and current status combined was similar to current status alone, ranging from 0.6 to 3.2%. Across age, the added AUC of current status was highest in the oldest old, however there was no such pattern using three-year change. Overall, the frailty index appeared to improve mortality predictions the most, followed by the frailty phenotype, MMSE, grip strength, and walking speed.ConclusionsCurrent health status improved mortality predictions better than changes in health. Its contribution was highest in the oldest old, but the added value to models with age and sex only was limited.

Urban–rural disparities in old-age mortality vary systematically with age: evidence from Germany and England & Wales

ObjectivesPopulation aging — which tends to be more pronounced in rural than in urban areas — poses important challenges for facilitating equal opportunities for aging well and ‘aging in place.’ Unmet health care needs among the older rural population may result in poorer health and higher mortality, but the scientific evidence of a systematic rural mortality disadvantage at older ages is scarce. We argue that systematic urban–rural mortality differences by age may be found if the confounding effect of life expectancy is considered. Study designNationwide population-based study. MethodsWe draw on age- and sex-specific data for the population aged 60+ years in NUTS-3 regions in Germany (2016–2018) and LAU-1 regions in England & Wales (2017–2019). To account for the confounding effect of life expectancy, we compare age-specific mortality only across urban and rural regions with similar life expectancy levels. We quantify statistical uncertainty with bootstrapping. ResultsThe results show a remarkable shift from higher mortality in urban regions to higher mortality in rural regions with increasing age, when controlling for the confounding effect of life expectancy. That is, the urban mortality disadvantage is strongest for the population aged 60–79 years, whereas the pattern shifts toward a rural mortality disadvantage for the population aged 80 years and older. This pattern is present at all levels of life expectancy, for both sexes and in both countries. ConclusionThe shift from urban to rural excess mortality over age suggests that regions may vary in their capability to respond to arising health issues across older ages. This systematic mortality disadvantage is of high public health relevance and should be considered in designing policies to reduce regional mortality disparities.

Causes of America's Lagging Life Expectancy: An International Comparative Perspective.

ObjectivesThis study assesses how American life expectancy compares to other high-income countries and identifies key age groups and causes of death responsible for the U.S. life expectancy shortfall.MethodsData from the Human Mortality Database, World Health Organization Mortality Database, and vital statistics agencies for 18 high-income countries are used to examine trends in U.S. life expectancy gaps and how American age-specific death rates compare to other countries. Decomposition is used to estimate the contribution of 19 age groups and 16 causes to the U.S. life expectancy shortfall.ResultsIn 2018, life expectancy for American men and women was 5.18 and 5.82 years lower than the world leaders and 3.60 and 3.48 years lower than the average of the comparison countries. Americans aged 25–29 experience death rates nearly 3 times higher than their counterparts. Together, injuries (drug overdose, firearm-related deaths, motor vehicle accidents, homicide), circulatory diseases, and mental disorders/nervous system diseases (including Alzheimer’s disease) account for 86% and 67% of American men’s and women’s life expectancy shortfall, respectively.DiscussionAmerican life expectancy has fallen far behind its peer countries. The U.S.’s worsening mortality at the prime adult ages and eroding old-age mortality advantage drive its deteriorating performance in international comparisons.

Why we should monitor disparities in old-age mortality with the modal age at death.

Indicators based a fixed “old” age threshold have been widely used for assessing socioeconomic disparities in mortality at older ages. Interpretation of long-term trends and determinants of these indicators is challenging because mortality above a fixed age that in the past would have reflected old age deaths is today mixing premature and old-age mortality. We propose the modal (i.e., most frequent) age at death, M, an indicator increasingly recognized in aging research, but which has been infrequently used for monitoring mortality disparities at older ages. We use mortality and population exposure data by occupational class over the 1971-2017 period from Finnish register data. The modal age and life expectancy indicators are estimated from mortality rates smoothed with penalized B-splines. Over the 1971-2017 period, occupational class disparities in life expectancy at 65 and 75 widened while disparities in M remained relatively stable. The proportion of the group surviving to the modal age was constant across time and occupational class. In contrast, the proportion surviving to age 65 and 75 has roughly doubled since 1971 and showed strong occupational class differences. Increasing socioeconomic disparities in mortality based on fixed old age thresholds may be a feature of changing selection dynamics in a context of overall declining mortality. Unlike life expectancy at a selected fixed old age, M compares individuals with similar survival chances over time and across occupational classes. This property makes trends and differentials in M easier to interpret in countries where old-age survival has improved significantly.

Simple Nutrition Screening Tool (SNST) in Nutritional Assessment as a Risk Factor for Cardiovascular Disease in the Elderly

The elderly with nutritional disorders requires healing complications in their disease. Nutrient intake for the elderly with illness is needed for the healing process and to prevent further complications. One of the biggest factors of mortality in old age is non-communicable diseases, namely cardiovascular disease. This study aims to determine the relationship between the Simple Nutritional Screening Tool (SNST) in nutritional assessment and risk factors for cardiovascular disease in the elderly. This study used a cross-sectional method which was conducted for three months with a total of 51 respondents. Primary data collection was done by an interview with a questionnaire guide. Anthropometric and biochemical data from medical records. The results showed that SNST data showed that 92.20% were not at risk of malnutrition, and 7.80% were at risk of malnutrition. Chi-Square test between body mass index (BMI), blood pressure, LDL, HDL, blood sugar, smoking behavior, food intake, diet, and eating frequency as cardiovascular risk factors with SNST was not significant (p>0.05). The research concludes that there is no relationship between SNST and body mass index (BMI), blood pressure, LDL, HDL, blood sugar, smoking behavior, food intake, eating patterns, and eating frequency as cardiovascular risk factors in the elderly.

Is there a link between all-cause mortality and economic fluctuations?

Background: All-cause mortality is a global indicator of the overall health of the population, and its relation to the macro economy is thus of vital interest. The main aim was to estimate the short-term and the long-term impact of macroeconomic change on all-cause mortality. Variations in the unemployment rate were used as indicator of temporary fluctuations in the economy. Methods: We used time-series data for 21 OECD countries spanning the period 1960–2018. We used four outcomes: total mortality (0+), infant mortality (<1), mortality in the age-group 20–64, and old-age mortality (65+). Data on GDP/capita were obtained from the Maddison Project. Unemployment data (% unemployed in the work force) were sourced from Eurostat. We applied error correction modelling to estimate the short-term and the long-term impact of macroeconomic change on all-cause mortality. Results: We found that increases in unemployment were statistically significantly associated with decreases in all mortality outcomes except old-age mortality. Increases in GDP were associated with significant lowering long-term effects on mortality. Conclusions: Our findings, based on data from predominantly affluent countries, suggest that an increase in unemployment leads to a decrease in all-cause mortality. However, economic growth, as indicated by increased GDP, has a long-term protective health impact as indexed by lowered mortality.

The Importance of Education for Middle- and Old-Age Mortality in Chile: Estimates From Panel Data Linked to Death Records.

To examine the association between education and mortality by age and gender in Chile. We drew data from 10,147 adults aged 40years and over from the Chilean Social Protection Survey linked to the national death records. We specify five Cox regression models to estimate the main and interaction effects for education levels, age, sex, and mortality. The hazard ratios reduce with increasing education. Secondary and tertiary education levels are associated, respectively, with 34% and 41% lower hazard rates than 0-4years of schooling. Also, the educational gradient in mortality is significantly weaker at older ages, and it does not differ by gender. Our findings endorse the negative association of formal education with adult mortality, uncovering Chile's structural problems despite the economic improvements underway. It also corroborates the importance of novel longitudinal data for mortality analyses in Latin America.

Grandparenting, Social Relations, and Mortality in Old Age.

Guided by a convoy model of social relations, this study investigates the relationships between grandparenting status, social relations, and mortality among community-dwelling grandparents age 65 and older who are caring for their grandchildren. The data were drawn from the 2008 and 2016 waves of the Health and Retirement Study (N = 564). Latent class analysis was used to identify the social network structure based on six indicators of interpersonal relationships and activities. A series of hierarchical Weibull hazard models estimated the associations between grandparent caregiving, social relations, and mortality risk. Results of survival analyses indicate that co-parenting and custodial grandparents had higher all-cause mortality risk than grandparents who babysat occasionally; however, for custodial grandparents, the association was not significant once social relation variables were added to the model. This study suggests that community-based support may be beneficial to older grandparents and improved relationship quality is integral to the well-being of older adults.

The role of reductions in old-age mortality in old-age population growth

The variable-r model provides demographers with a way to explore the contributions of demographic components (fertility, mortality, migration) to changes in populations’ age structures. However, traditional variable-r methods require extremely long mortali

Gompertz law revisited: Forecasting mortality with a multi-factor exponential model

This paper provides a flexible way to address some ongoing challenges in mortality modeling, with a special focus on the mortality curvature and possible mortality plateau for extremely old ages. In particular, we extend the Gompertz law by proposing a multi-factor exponential model, a framework that is able to capture flexible mortality patterns, and allows for a convenient estimation and prediction algorithm. An extensive empirical analysis is conducted using the proposed framework with a merged mortality database containing a large number of countries and regions with credible old-age mortality data. We find that the proposed exponential model leads to superior goodness-of-fit to historical data, and better out-of-sample forecasting performance. Moreover, the exponential model predicts more balanced mortality improvements across ages, and thus leads to higher projected remaining life expectancy for the old ages than existing Gompertz-based mortality models. Finally, the modeling capacity of the proposed exponential model is further demonstrated by a multi-population extension, and an illustrative example of estimation and forecast is provided.

Links Between Mortality and Socioeconomic Characteristics, Disease Burden, and Biological and Physical Functioning in the Aging Chinese Population.

Determinants of mortality may depend on the time and place where they are examined. China provides an important context in which to study the determinants of mortality at older ages because of its unique social, economic, and epidemiological circumstances. This study uses a nationally representative sample of persons in China to determine how socioeconomic characteristics, early-life conditions, biological and physical functioning, and disease burden predict 4-year mortality after age 60. We used data from the China Health and Retirement Longitudinal Study. We employed a series of Cox proportional hazard models based on exact survival time to predict 4-year all-cause mortality between the 2011 baseline interview and the 2015 interview. We found that rural residence, poor physical functioning ability, uncontrolled hypertension, diabetes, cancer, a high level of systemic inflammation, and poor kidney functioning are strong predictors of mortality among older Chinese. The results show that the objectively measured indicators of physical functioning and biomarkers are independent and strong predictors of mortality risk after accounting for several additional self-reported health measures, confirming the value of incorporating biological and performance measurements in population health surveys to help understand health changes and aging processes that lead to mortality. This study also highlights the importance of social and historical context in the study of old-age mortality.