Diversification in causes of death in low-mortality countries: emerging patterns and implications

Abstract

IntroductionAn important role of public health organisations is to monitor indicators of variation, so as to disclose underlying inequality in health improvement. In industrialised societies, more individuals than ever are reaching older ages and have become more homogeneous in their age at death. This has led to a decrease in lifespan variation, with substantial implications for the reduction of health inequalities. We focus on a new form of variation to shed further light on our understanding of population health and ageing: variation in causes of death.MethodsData from the WHO Mortality Database and the Human Mortality Database are used to estimate cause-of-death distributions and life tables in 15 low-mortality countries. Cause-of-death variation, using 19 groups of causes, is quantified using entropy measures and analysed from 1994 to 2017.ResultsThe last two decades have seen increasing diversity in causes of death in low-mortality countries. There have been important reductions in the share of deaths from diseases of the circulatory system, while the share of a range of other causes, such as diseases of the genitourinary system, mental and behavioural disorders, and diseases of the nervous system, has been increasing, leading to a more complex cause-of-death distribution.ConclusionsThe diversification in causes of death witnessed in recent decades is most likely a result of the increase in life expectancy, together with better diagnoses and awareness of certain diseases. Such emerging patterns bring additional challenges to healthcare systems, such as the need to research, monitor and treat a wider range of diseases. It also raises new questions concerning the distribution of health resources.

The Cross-sectional Average Inequality in Lifespan (CAL†): A Lifespan Variation Measure That Reflects the Mortality Histories of Cohorts

“…Older birth cohorts were at higher risk than youn ger cohorts of dying dur ing the first years of life. More recently, mor tal ity decline in mod ern devel oped countries has been achieved mainly by reduc tions in cir cu la tory and other chronic dis eases at adult and older ages (BergeronBoucher et al 2020). As a result of these his tor i cal changes, the cur rent pop u la tion is a mix of sev eral birth cohorts that faced a vastly dif fer ent set of agespe cific death rates through their life.…”

The cross-sectional average inequality in lifespan (CAL†): A lifespan variation measure that reflects the mortality histories of cohorts

“…Older birth cohorts were at higher risk than younger cohorts of dying during the first years of life. More recently, mortality decline in modern developed countries has been mainly achieved by reductions in circulatory and other chronic diseases at adult and older ages (Bergeron-Boucher et al 2020). As a result of these historical changes, the current population is a mix of several birth cohorts that faced a vastly different set of age-specific death rates through their life.…”

Gini coefficient decomposition-based and mortality-rate-difference-based description of mortality causes in the Chinese population from 1991 to 2019: a retrospective cross-sectional surveillance study

“…The marked improvement in the registration of mortality causes and the accessibility of insight into variations in mortality causes have generated more unpredictable mortality patterns in the Chinese population. 6 Previous studies have focused on high-ranking causes that implicitly obscured the complex picture of varying mortality causes and changes in their relative importance over time. 7 Despite stable rates, certain mortality causes increased in rank due to the decline of other causes.…”