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      Life expectancy and disparity: an international comparison of life table data

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      1 , , 1 , 1 , 2
      BMJ Open
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          Abstract

          Objectives

          To determine the contribution of progress in averting premature deaths to the increase in life expectancy and the decline in lifespan variation.

          Design

          International comparison of national life table data from the Human Mortality Database.

          Setting

          40 developed countries and regions, 1840–2009.

          Population

          Men and women of all ages.

          Main outcome measure

          We use two summary measures of mortality: life expectancy and life disparity. Life disparity is a measure of how much lifespans differ among individuals. We define a death as premature if postponing it to a later age would decrease life disparity.

          Results

          In 89 of the 170 years from 1840 to 2009, the country with the highest male life expectancy also had the lowest male life disparity. This was true in 86 years for female life expectancy and disparity. In all years, the top several life expectancy leaders were also the top life disparity leaders. Although only 38% of deaths were premature, fully 84% of the increase in life expectancy resulted from averting premature deaths. The reduction in life disparity resulted from reductions in early-life disparity, that is, disparity caused by premature deaths; late-life disparity levels remained roughly constant.

          Conclusions

          The countries that have been the most successful in averting premature deaths have consistently been the life expectancy leaders. Greater longevity and greater equality of individuals' lifespans are not incompatible goals. Countries can achieve both by reducing premature deaths.

          Article summary

          Article focus
          • We examined the relationship between high life expectancy and low life disparity.

          • We determined the relative importance of premature versus late deaths in increasing life expectancy and reducing life disparity.

          • We examined whether policies to increase life expectancy were compatible with those to reduce lifespan variation.

          Key messages
          • Most of the gains in life expectancy are the result of reducing disparities in how long people live, by averting premature mortality.

          • Progress in reducing death rates for people who live longer than average has had little effect on life disparity levels and has contributed only modestly to life expectancy gains.

          • The countries that have been most successful at reducing premature mortality enjoy the highest life expectancies and the greatest equality in individuals' lifespans.

          Strengths and limitations
          • We are the first to examine this issue using a large, comparable database of 40 developed countries from 1840 to 2009 containing 7056 life tables.

          • Our analysis was limited to countries with data of high enough quality to be included in the database.

          • Although this database contains high mortality life tables from historic populations, it is unknown whether the patterns we observed would also be seen in contemporary emerging and developing countries.

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          Most cited references15

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          Demography. Broken limits to life expectancy.

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            Mortality from tobacco in developed countries: indirect estimation from national vital statistics.

            Prolonged cigarette smoking causes even more deaths from other diseases than from lung cancer. In developed countries, the absolute age-sex-specific lung cancer rates can be used to indicate the approximate proportions due to tobacco of deaths not only from lung cancer itself but also, indirectly, from vascular disease and from various other categories of disease. Even in the absence of direct information on smoking histories, therefore, national mortality from tobacco can be estimated approximately just from the disease mortality statistics that are available from all major developed countries for about 1985 (and for 1975 and so, by extrapolation, for 1995). The relation between the absolute excess of lung cancer and the proportional excess of other diseases can only be approximate, and so as not to overestimate the effects of tobacco it has been taken to be only half that suggested by a recent large prospective study of smoking and death among one million Americans. Application of such methods indicates that, in developed countries alone, annual deaths from smoking number about 0.9 million in 1965, 1.3 million in 1975, 1.7 million in 1985, and 2.1 million in 1995 (and hence about 21 million in the decade 1990-99: 5-6 million European Community, 5-6 million USA, 5 million former USSR, 3 million Eastern and other Europe, and 2 million elsewhere, [ie, Australia, Canada, Japan, and New Zealand]). More than half these deaths will be at 35-69 years of age: during the 1990s tobacco will in developed countries cause about 30% of all deaths at 35-69 (making it the largest single cause of premature death) plus about 14% of all at older ages. Those killed at older ages are on average already almost 80 years old, however, and might have died soon anyway, but those killed by tobacco at 35-69 lose an average of about 23 years of life. At present just under 20% of all deaths in developed countries are attributed to tobacco, but this percentage is still rising, suggesting that on current smoking patterns just over 20% of those now living in developed countries will eventually be killed by tobacco (ie, about a quarter of a billion, out of a current total population of just under one and a quarter billion).
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              Rectangularization revisited: variability of age at death within human populations.

              Rectangularization of human survival curves is associated with decreasing variability in the distribution of ages at death. This variability, as measured by the interquartile range of life table ages at death, has decreased from about 65 years to 15 years since 1751 in Sweden. Most of this decline occurred between the 1870s and the 1950s. Since then, variability in age at death has been nearly constant in Sweden, Japan, and the United States, defying predictions of a continuing rectangularization. The United States is characterized by a relatively high degree of variability, compared with both Sweden and Japan. We suggest that the historical compression of mortality may have had significant psychological and behavioral impacts.
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                Author and article information

                Journal
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2011
                29 July 2011
                29 July 2011
                : 1
                : 1
                : e000128
                Affiliations
                [1 ]Max Planck Institute for Demographic Research, Rostock, Germany
                [2 ]Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
                Author notes
                Correspondence to James W Vaupel; jwv@ 123456demogr.mpg.de
                Article
                bmjopen-2011-000128
                10.1136/bmjopen-2011-000128
                3191439
                22021770
                d35880c0-3141-4567-9a13-c6b80cf84674
                © 2011, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

                History
                : 23 March 2011
                : 17 June 2011
                Categories
                Epidemiology
                Research
                1506
                1692
                1724
                1699

                Medicine
                Medicine

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