Patterns of Birth Cohort–Specific Smoking Histories, 1965–2009 (original) (raw)
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Birth cohort patterns suggest that infant survival predicts adult mortality rates
Journal of Developmental Origins of Health and Disease, 2010
Dramatic improvements in life expectancy during the 20th century are commonly attributed to improvements in either health care services or the social and economic environment. We evaluated the hypothesis that improving infant survival produces improvements in adult (>40 years) mortality rates. We used generalizations of age-period-cohort models of mortality that explicitly account for the exponential increase of adult mortality rates with age (Gompertz model) to determine whether year of birth or year of death better correlate with observed patterns of adult mortality. We used data from Canada and nine other countries obtained from the Human Mortality Database. Five-year birth cohorts between 1900 and 1944 showed consistent improvements in age-specific mortality rates. According to the akaike information criteria, Gompertz-Cohort models significantly better predicted the observed patterns of adult mortality than Gompertz-Period models, demonstrating that year of birth correlates better with adult mortality than year of death. Infant mortality strongly correlated with the initial set point of adult mortality in a Gompertz-period-cohort. Selected countries exhibited elevated adult mortality rates for the 1920 and 1944 birth cohorts, suggesting that the period before the first year of life may be uniquely vulnerable to environmental influences. These findings suggest that public health investments in the health of mothers and children can be a broad primary prevention strategy to prevent the chronic diseases of the adult years.
Does the Impact of the Tobacco Epidemic Explain Structural Changes in the Decline of Mortality?
European Journal of Population
Since 1950, most developed countries have exhibited structural changes in mortality decline. This complicates extrapolative forecasts, such as the commonly used Lee-Carter model, that require the presence of a steady long-term trend. This study tests whether the impact of the tobacco epidemic explains the structural changes in mortality decline, as it is presumed in earlier studies. For this purpose, the time index of the Lee-Carter model in males was investigated in 20 developed countries between 1950 and 2011 for possible structural changes. It was found that removing the impact of smoking from mortality trends took away more than half of the 12 detected trend breaks. For the remaining trend breaks, adjusting for smoking attenuated the degree of change in mortality decline. Taking the tobacco epidemic into account should become standard procedure in mortality forecasts to avoid a misleading extrapolation of trends. Nevertheless, more research is needed to identify additional factors, such as health-care policies and innovations in medical treatment, to explain the remaining structural changes.
Journal of Epidemiology & Community Health, 2014
Background A large part of the socioeconomic mortality gradient can be statistically accounted for by social patterning of adult health behaviours. However, this statistical explanation does not consider the early life origins of unhealthy behaviours and increased mortality risk. Methods Analysis is based on 2132 members of the MRC National Survey of Health and Development with mortality follow-up and complete data. Smoking behaviour was summarised by pack-years of exposure. Socioeconomic circumstances were measured in childhood (father's social class (age 4), maternal education (age 6)) and age 26 (education attainment, home ownership, head of household social class). We estimated the direct effect of early circumstances, the indirect effect through smoking and the independent direct effect of smoking on inequality in all-cause mortality from age 26 to 66. Results Mortality risk was higher in those with lower socioeconomic position at age 26, with a sex-adjusted HR (relative index of inequality) of 1.97 (95% CI 1.18 to 3.28). Smoking and early life socioeconomic indicators together explained 74% of the socioeconomic gradient in mortality (the gradient). Early life circumstances explained 47% of the gradient, 23.5% directly and 23.0% indirectly through smoking. The explanatory power of smoking behaviour for the gradient was reduced from 50.8% to 28% when early life circumstances were added to the model. Conclusions Early life socioeconomic circumstances contributed importantly to social inequality in adult mortality. Our life-course model focusing on smoking provides evidence that social inequalities in health will persist unless prevention strategies tackle the intergenerational transmission of disadvantage and risk.
Changes in the Age Distribution of Mortality Over the 20th Century
2001
Mortality has declined continuously in the United States over the course of the 20th century, and at relatively constant rates. But the constancy of mortality reductions masks significant heterogeneity by age, cause, and source. Using historical data on death by age and cause, this paper describes the characteristics of mortality decline over the 20th century. Early in the 20th century, mortality declines resulted from public health and economic measures that improved peoples' ability to withstand disease.
The impact of early-life economic conditionson cause-specific mortality during adulthood
Journal of Population Economics, 2014
The aim of this study is to assess the effects of economic conditions in early life on causespecific mortality during adulthood. The analyses are performed on a unique historical sample of 14,520 Dutch individuals born in 1880-1918, who are followed throughout life. The economic conditions in early life are characterized using cyclical variations in annual real per capital Gross Domestic Product during pregnancy and the first year of life. Exposure to recessions during pregnancy and/or the first year of life appears to significantly increase allcause mortality risks and cancer mortality risks of older males and females. It also significantly increases mortality risks due to cardiovascular diseases and chronic respiratory diseases of older females. The residual life expectancies are up to 4.5 to 8% lower for allcause mortality and up to 1.5 to 7.8% lower for cause-specific mortality. Our analyses show that cardiovascular and cancer mortality risks are related and that not taking this association into account leads to biased inference.
The German East-West Mortality Difference: Two Crossovers Driven by Smoking
Demography
Before the fall of the Berlin Wall, mortality was considerably higher in the former East Germany than in West Germany. The gap narrowed rapidly after German reunification. The convergence was particularly strong for women, to the point that Eastern women aged 50-69 now have lower mortality despite lower incomes and worse overall living conditions. Prior research has shown that lower smoking rates among East German female cohorts born in the 1940s and 1950s were a major contributor to this crossover. However, after 1990, smoking behavior changed dramatically, with higher smoking intensity observed among women in the eastern part of Germany. We forecast the impact of this changing smoking behavior on East-West mortality differences and find that the higher smoking rates among younger East German cohorts will reverse their contemporary mortality advantage. Mortality forecasting methods that do not account for smoking would, perhaps misleadingly, forecast a growing mortality advantage for East German women. Experience from other countries shows that smoking can be effectively reduced by strict anti-smoking policies. Instead, East Germany is becoming an example warning of the consequences of weakening anti-smoking policies and changing behavioral norms. 3 Rising differences (increasingly lower mortality in the East) were observed in Lee-Carter forecasts for East and West German women aged 50-64, based on observed all-cause mortality. This was noted regardless of whether the fitting period included only the post-reunification period with high rates of mortality improvement in the East or included periods of pre-reunification stagnation. Results are not shown but are available from the authors.
Preventive medicine, 2011
Objective-An extensive literature uses reconstructed historical smoking rates by birth-cohort to inform anti-smoking policies. This paper examines whether and how these rates change when one adjusts for differential mortality of smokers and non-smokers. generate life-course smoking prevalence rates by age-cohort. With cause-specific death rates from secondary sources and an improved method, we correct for differential mortality, and we test whether adjusted and unadjusted rates statistically differ. With US data (National Health Interview Survey, 1967, we also compare contemporaneously measured smoking prevalence rates with the equivalent rates from retrospective data.
Age Patterns and Trends in Mortality by Cause of Death and Implications for Modeling Longevity Risk
SSRN Electronic Journal, 2000
Mortality rates have shown signicant improvements in countries around the world over a lengthy period. Trends have varied by country and by age, despite common improvements. An analysis of changes in causes of death provides a better understanding of the underlying changes in mortality rates and provides information about potential future improvements. This paper provides an analysis of mortality rate age patterns and trends for the main causes of death (circulatory system, cancer, respiratory system, accidents, infectious diseases) for nine major countries (USA, Australia, Switzerland, Japan, Singapore, Italy, Norway, Sweden, United Kingdom) over approximately the last 50 years. The pattern by age and the trends in mortality rates dier signicantly by cause. Mortality rates from diseases of the circulatory system have decreased over the last 50 years, while mortality rates due to cancer have shown some decreases for younger ages although they have increased at the older ages. Death rates from external causes have generally decreased especially at the young ages although not for all countries. It is unlikely that the trends in circulatory death rates will continue and the importance and uncertainty of future changes in cancer death rates are critical to any longevity risk model.