Analysing causes of death to understand trends and differentials

The post communist transition brought along a significant decrease in mortality rates and improvement in health indicators in some Central European countries. That was the case of the Czech Republic and Poland, that witnessed sudden and systematic shift in life expectancy trends. Within two decades, from 1990 to 2009, life expectancies in both countries have increased considerably, by 5.8 years in the Czech Republic (reaching 77.3 for both sexes) and by 5.1 years in Poland (reaching 75.8). The aim of this paper is to present the most important tendencies in mortality by cause of death which allowed for this extension of life expectancies. We present a comparison to France where mortality rates remain at relatively low levels and that constitutes a good frame of reference. On the basis of the single cause-of-death time series restored for the period 1970-2009, it is possible to prove crucial importance of diseases of the circulatory system for the recent mortality developments in Czech Republic and Poland and to point at other specific health issues of the region.

Over the last forty-five years, Moldova failed to progress in life expectancy at birth. Disregarding the wide fluctuations linked to the 1985 anti-alcohol campaign and the social and economic crisis of the 1990s, the general trend in life expectancy is stagnating among males and slightly improving among females. Interpreting recent mortality changes in the light of long-term trends provides an insight into the reasons of the health crisis affected Moldova like other former USSR republics from the mid-1960s. However, the periodic changes in classification of causes of death break the continuity of death time series. To assure their consistency we used a special reconstruction method (Meslé and Vallin, INED). Moreover, unlike other European countries of the former USSR, the quality of death registration in Moldova in infancy and at older ages for the 1960s and 1970s is rather questionable. The analysis of cause-specific mortality trends will be produced here after corrections for under-registration. After a long period of deterioration mixed with large fluctuations as in other former USSR countries, the recent favorable trends give hope but not yet the proof of a start of sustainable positive trajectory.

Infectious and parasitic diseases nowadays represent a very small share of the total mortality of developed countries which mortality profile is dominated by cancers and diseases of the circulatory system. It has been suggested that, due to old people’s frailty, population aging may result in a fresh upsurge in infectious diseases. Routine indicators of cause-specific mortality are likely to underestimate the role played by these diseases in mortality because 1) the chapter “certain infectious and parasitic diseases“ of the 10th ICD includes only part of these diseases 2) these indicators only account for the underlying cause of the death. In a previous study, we have shown that roughly 3 out of 4 mentions of an infectious/parasitic disease are not selected as the underlying cause. Multiple (both contributing and underlying) cause-of-death data have been used in order to re-evaluate mortality levels attributed to a given condition, as well as to examine what are the most frequent associations of causes involving this condition. We use this approach to analyse the mortality involving infectious/parasitic diseases of France and Italy. The analysis is performed on an extended list of the infectious and parasitic diseases.

We assess the changing age pattern of mortality in India and bigger states by applying a mortality model during 1970-2006. Using survey data from India and a two dimensional system of model life table, we provide further evidence about changes in country and state-level patterns mortality differentials by sex and assess the potential role of major causes of death. We also study the contribution of major causes of death to the female-male mortality gap. The preliminary findings confirm that since the 1980s, health advantage of the Indian females against males has been growing. This occurred despite persisting female disadvantage below age 5. The biggest contribution to the life expectancy gap between females and males in the second half of the 1990s came from non-communicable diseases and external causes of death. We also found a notable geographical variation in sex-specific mortality patterns. While more advanced states showed female longevity advantages already in the 1970s, the laggard states displayed similar mortality levels for males and females even during the most recent periods. In order to better understand the path and timing of health transition and its determinants in India, it is necessary to consider changing sex-specific mortality patterns and their geographical diversity.