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Johan P. Mackenbach - One of the best experts on this subject based on the ideXlab platform.
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a closer look at the role of healthcare in the recent Mortality Decline in the netherlands results of a record linkage study
Journal of Epidemiology and Community Health, 2015Co-Authors: Frederick Peters, Wilma J. Nusselder, Johan P. MackenbachAbstract:Background Since 2002, Dutch Mortality rates decreased rapidly after decades of stagnation. On the basis of indirect evidence, previous research has suggested that this Decline was due to a sudden expansion of healthcare. We tested two corollaries of this hypothesis—first, that the Decline was concentrated among those with ill-health and second, that the Decline can be statistically accounted for by increases in healthcare utilisation. Methods We linked the Dutch health interview survey to the Mortality register and constructed two cohorts, consisting of 7691 persons interviewed in 2001/2002 and 8362 persons interviewed in 2007/2008, each with a 5-year Mortality follow-up (659 deaths in total). The change in Mortality between both cohorts was computed using Cox proportional hazard models. We estimated the change in Mortality by severity of chronic conditions and with respect to the inclusion of indicators of healthcare utilisation. Results Between the two study cohorts, Mortality Declined by 15% (95% CI 2% to 29%), and Mortality reduction was greatest for those suffering from fatal and non-fatal conditions with a Decline of 58% (95% CI 35% to 78%). Even after adjustment for health status and risk factors, most indicators of healthcare utilisation were associated with higher instead of lower Mortality and changes in healthcare utilisation did not explain the Decline in Mortality. Conclusions Our results only partly confirm the hypothesis that an expansion of healthcare explains the recent Mortality Decline in the Netherlands. Owing to confounding by health status, it is difficult to reproduce the Mortality-lowering effects of healthcare utilisation of individual level studies in the open population.
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Variations in the pace of old-age Mortality Decline in seven European countries, 1950-1999 : the role of smoking and other factors earlier in life
European Journal of Population Revue européenne de Démographie, 2007Co-Authors: Fanny Janssen, Anton E. Kunst, Johan P. MackenbachAbstract:We examine the variations in the pace of old-age (80+) Mortality Decline in seven European countries, from 1950 to 1999. Marked variations were found between countries, periods and sexes. While Mortality Declines were strong in France and England and Wales, modest or no Mortality Declines were seen in the 1950s and 1960s in the Nordic countries, and since the 1980s in Denmark, the Netherlands and Norway (men only). For non-smoking-related Mortality, a high and consistent pace of Mortality Decline was observed. Mortality Decline stagnated among men born between 1890 and 1899, but persisted among women born between 1847 and 1937. The pace of old-age Mortality Decline correlated with the pace of Mortality Decline at ages 60-69 among the same cohorts, but only among men and not for non-smoking-related Mortality. Smoking, thus, seems more important than other factors originating earlier in life. Our results furthermore indicate substantial future Declines in old-age Mortality.
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Stagnation in Mortality Decline Among Elders in The Netherlands
The Gerontologist, 2003Co-Authors: Fanny Janssen, Wilma J. Nusselder, Caspar W. N. Looman, Johan P. Mackenbach, Anton E. KunstAbstract:Purpose: This study assesses whether the stagnation of old-age (80+) Mortality Decline observed in The Netherlands in the 1980s continued in the 1990s and determines which factors contributed to this stagnation. Emphasis is on the role of smoking. Design and Methods: Poisson regression analysis with linear splines was applied to total and cause-specific Mortality data by age, year of death (19501999), and sex. An age-period-cohort analysis was carried out to determine whether the trends followed period or cohort patterns. ICD revisions were bridged by use of a concordance table. Results: A sudden reversal in old-age Mortality Decline occurred around 1980, leading to a stagnation of the Decline and even increases in Mortality thereafter. Smoking-related cancers, chronic obstructive pulmonary disease, and diseases specifically related to old age contributed to this stagnation. Trends in smoking-related cancers and chronic obstructive pulmonary disease showed a cohort pattern - especially for men. When these smoking-related diseases were excluded, the trends in old-age Mortality in The Netherlands showed an increasing stagnation for both sexes. Implications: Smoking behavior can only partly explain the stagnation of Mortality. Other factors such as increased frailty and changes in medical and social services for elderly people probably played a more decisive role in the recent stagnation.
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Mortality Decline IN THE NETHERLANDS IN THE PERIOD 1850-1992: A TURNING POINT ANALYSIS
Social science & medicine (1982), 1998Co-Authors: Judith H. Wolleswinkel-van Den Bosch, Frans Van Poppel, Ewa Tabeau, Johan P. MackenbachAbstract:The aim of this paper is to give a detailed and fairly objective description of rapid Mortality Decline in The Netherlands between 1850 and 1992 with respect to the start, end, and phases of the Decline. Turning points were estimated for the standardized Mortality trend, and for age and sex-specific trends between 1850-1992. The technique used was derived from spline functions. The turning points divided the trends into phases with diAerent paces of Decline. Standardized Mortality started to Decline rapidly in The Netherlands around 1880. Four phases in the period of Decline could be distinguished: 1880-1917 (1.2% annually), 1917-1955 (1.6%), 1955-1970 (0.4%), 1970-1992 (1.1%). For nearly all age groups, the most rapid Decline occurred in a period comparable to 1917-1955. Causes of death which might have shaped the standardized Mortality trend are, among others, respiratory tuberculosis (1917), heart disease (except ischemic) (1955), and ischemic heart disease (1970). Causes of death that shaped the Mortality trend are related to trends of determinants of Mortality Decline. The technique used in this paper can also be applied to other trends e.g. fertility Decline. # 1998 Elsevier Science Ltd. All rights reserved
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The contribution of medical care to Mortality Decline: McKeown revisited
Journal of clinical epidemiology, 1996Co-Authors: Johan P. MackenbachAbstract:In St. James’s Church (Sussex Gardens, London, U.K.) there is a stained glass window, which shows Sir Alexander Fleming at work in his laboratory. Fleming’s laboratory was located in the vicinity of this church, and it was there that he discovered the hactericida1 effects of penicillin. This church window perhaps is an illustration of the almost religious role of medicine in our modern society. In any case, it shows a deep respect for the advances of medicine, which in the popular opinion has become a master of life and death. The contrast hetween this popular opinion and the current scientific view of the effects of medical care on the health of populations is enormous. This is due to a large extent to the work of the late Thomas McKeown. His famous analyses of the history of Mortality in England and Wales, which originally appeared in a number of journal articles, were summarized in 1976 in two hooks, of which The Role of Medicine--Dream, Mirage or Nemesis has heen very influential [I ,2]. In this hook he showed that the Decline in mortalit) since the middle of the nineteenth century was the result main11 of a Decline in Mortality from infectious diseases. The latter Decline for the most part antedated the introduction of specific medical therapies, including Fleming’s penicillin. From these analyses McKeown has drawn two conclusions, which both have generally heen accepted by the scientific community, particularly hy epidemiologists. The first was that medical care has not made a substantial contribution to Mortality Decline since the middle of the nineteenth century. The second, and more far-reaching, conclusion was that today’s health problems are also more likely to be controlled by changing the environment than hy medical care. Since the publication of McKeown’s findings important criticisms have been voiced, which together with more recent evidence suggest that some modifications of these conclusions may be necessary. The objective of this article is to review McKeown’a analysis and the more recent evidence, and to investigate whether the scientific opinion should or should not he reshifted a hit toward the popular opinion. Throughout this article data from The Netherlands, a country with abundant data of relatively high quality, are used as illustrations.
Ronald Lee - One of the best experts on this subject based on the ideXlab platform.
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Extending the Lee-Carter Method to Model the Rotation of Age Patterns of Mortality Decline for Long-Term Projections
Demography, 2013Co-Authors: Ronald Lee, Patrick GerlandAbstract:In developed countries, Mortality Decline is decelerating at younger ages and accelerating at old ages, a phenomenon we call "rotation." We expect that this rotation will also occur in developing countries as they attain high life expectancies. But the rotation is subtle and has proved difficult to handle in Mortality models that include all age groups. Without taking it into account, however, long-term Mortality projections will produce questionable results. We simplify the problem by focusing on the relative magnitude of death rates at two ages (0 and 15-19) while making assumptions about changes in rates of Decline at other ages. We extend the Lee-Carter method to incorporate this subtle rotation in projection. We suggest that the extended Lee-Carter method could provide plausible projections of the age pattern of Mortality for populations, including those that currently have very high life expectancies. Detailed examples are given using data from Japan and the United States.
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Mortality Decline and long-run economic growth
Journal of Public Economics, 2001Co-Authors: Junsen Zhang, Jie Zhang, Ronald LeeAbstract:This paper examines the impacts of Mortality Decline on long-run growth in a dynastic family, two-sector growth model with social security. A rise in longevity has direct effects on fertility, human capital investment, and growth, as well as indirect effects through increasing unfunded social security contributions. Both the direct and indirect effects depend on the relative strength of the tastes for the number and welfare of children and may have different signs. The net effects of rising longevity on fertility tend to be negative, but positive on human capital investment and growth. (C) 2001 Elsevier Science S.A. All rights reserved.
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will aging baby boomers bust the federal budget
Journal of Economic Perspectives, 1999Co-Authors: Ronald Lee, Jonathan S SkinnerAbstract: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.
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Death and Taxes: Longer life, consumption, and social security
Demography, 1997Co-Authors: Ronald Lee, Shripad TuljapurkarAbstract: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.
T. Paul Schultz - One of the best experts on this subject based on the ideXlab platform.
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Mortality Decline in the low-income world causes and consequences
The American Economic Review, 1993Co-Authors: T. Paul SchultzAbstract:The causes and consequences of the Mortality Decline that has occurred in developing countries over the course of the twentieth century are reviewed. Influential factors identified include female education and improved nutrition. (ANNOTATION)
Jonathan Chapman - One of the best experts on this subject based on the ideXlab platform.
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The contribution of infrastructure investment to Britain's urban Mortality Decline, 1861–1900
The Economic History Review, 2018Co-Authors: Jonathan ChapmanAbstract:It is well‐recognized that both improved nutrition and sanitation infrastructure are important contributors to Mortality Decline. However, the relative importance of the two factors is difficult to quantify since most studies are limited to testing the effects of specific sanitary improvements. This article uses new historical data regarding total investment in urban infrastructure, measured using the outstanding loan stock, to estimate the extent to which the Mortality Decline in England and Wales between 1861 and 1900 can be attributed to government expenditure. Fixed effects regressions indicate that infrastructure investment explains approximately 30 per cent of the Decline in Mortality between 1861 and 1900. Since these specifications may not fully account for the endogeneity between investment and Mortality, additional specifications are estimated using lagged investment as an instrument for current investment. These estimates suggest that government investment was the major contributor to Mortality Decline, explaining up to 60 per cent of the reduction in total urban Mortality between 1861 and 1900. Additional results indicate that investment in urban infrastructure led to Declines in Mortality from both waterborne and airborne diseases.
Jacques Vallin - One of the best experts on this subject based on the ideXlab platform.
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The Recent Mortality Decline in Russia: Beginning of the Cardiovascular Revolution?
Population and Development Review, 2014Co-Authors: Pavel Grigoriev, Vladimir M Shkolnikov, Evgeny Andreev, Agnieszka Fihel, Marketa Pechholdova, Jacques VallinAbstract:The health situation in Russia has often been characterized as a long-running crisis. From the 1960s until the beginning of the 2000s, the declining life expectancy trend was substantially interrupted only twice: once in the mid-1980s as a result of Gorbachev's anti-alcohol campaign, and again at the end of the 1990s as a result of the “rebound” effect following the dramatic rise in Mortality associated with the acute socioeconomic crisis. In both cases, the progress made proved to be short-lived. A third Mortality Decline in Russia began in 2003 and is still ongoing. We investigate the components and driving forces of this new development, in particular the role played by cardiovascular diseases. Using cause-specific Mortality data, we identify the main features of the recent improvements and compare these features with those observed in selected European countries, specifically France, Poland, and Estonia. Our aim is to gauge whether the features of the improvements in these countries are similar to those of the recent advancements made in Russia. Although the recent improvements in Russia have features in common with initial stages of prior Mortality Declines in other countries and may support optimism about the future, a return to Mortality stagnation cannot be ruled out.
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the recent Mortality Decline in russia beginning of the cardiovascular revolution
Population and Development Review, 2014Co-Authors: Pavel Grigoriev, Vladimir M Shkolnikov, Evgeny Andreev, Agnieszka Fihel, Marketa Pechholdova, Jacques VallinAbstract:type="main"> The health situation in Russia has often been characterized as a long-running crisis. From the 1960s until the beginning of the 2000s, the declining life expectancy trend was substantially interrupted only twice: once in the mid-1980s as a result of Gorbachev's anti-alcohol campaign, and again at the end of the 1990s as a result of the “rebound” effect following the dramatic rise in Mortality associated with the acute socioeconomic crisis. In both cases, the progress made proved to be short-lived. A third Mortality Decline in Russia began in 2003 and is still ongoing. We investigate the components and driving forces of this new development, in particular the role played by cardiovascular diseases. Using cause-specific Mortality data, we identify the main features of the recent improvements and compare these features with those observed in selected European countries, specifically France, Poland, and Estonia. Our aim is to gauge whether the features of the improvements in these countries are similar to those of the recent advancements made in Russia. Although the recent improvements in Russia have features in common with initial stages of prior Mortality Declines in other countries and may support optimism about the future, a return to Mortality stagnation cannot be ruled out.
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The role of vaccination in the Mortality Decline
1999Co-Authors: Jacques Vallin, Mesle FAbstract:This is an attempt to estimate the impact of the use of vaccinations against certain infectious diseases on the Mortality Decline and to isolate this specific factor from the many other medical advances which also helped to bring about that Decline. The authors first present a comparative analysis of the relationship between vaccination and Mortality in developed countries for which the data needed for such an analysis are available focusing in particular on the data available for France. The extent to which the results of such an analysis can be applied to the current situation in Africa South of the Sahara is then considered.