How lifespan and life years lost equate to unity

BACKGROUND Life expectancy at birth (e0), life years lost at death (e †), and lifetable entropy (H) are key indicators that capture average lifespan and lifespan variation. Expressions and relationships among these summary measures form the basis to analytically derive a range of formal demographic relationships, that build on each other and together help create new insights. Even though many elegant relationships are known, new ones are still to be discovered. RESULTS The sum of life expectancy and life years lost at death, scaled by the level and rate parameters a and b of the Gompertz mortality model, equals one. This plain relationship has mathematical beauty and connects key demographic measures. It directly implies further relationships, and allows connecting existing ones. It can be interpreted as a pace–shape decomposition of lifespan. CONTRIBUTION We contribute a useful relationship to complement analytical tools for studying life expectancy and lifespan variation. It can reveal macro-level regularities that may aid development of novel forecasting methods in the future. It could also support more comparative research across species by quantifying the relative impact of the environment on species’ life histories. We also propose the ratio a/b as a potential metric to signal major trend changes in mortality improvements

Dynamics of the coefficient of variation of the age at death distribution

BACKGROUND Indicators of lifespan inequality, such as the life table entropy or variance of age at death, provide a measure of inequality in the timing of death. A range of indicators of relative and absolute inequality exist, and their evolution over time and sensitivity to changes in age-specific mortality have been studied. However, the coefficient of variation, a relative indicator defined as the standard deviation divided by the mean of the age at death distribution, has yet to be studied, and the existence and form of the threshold age has not been determined. RESULTS As with other lifespan inequality indicators, changes in the coefficient of variation can be written as a weighted sum of changes in age-specific mortality rates, and a unique threshold age exists. The threshold for the coefficient of variation occurs later than that of its absolute counterpart, the standard deviation, a result verified for other pairs of relative and absolute indicators. Empirical applications show differing trajectories over time of the threshold age for different countries and different educational groups. CONCLUSION Change over time of the coefficient of variation can be expressed in a similar way to other indicators and provides a way to study the sensitivity of the indicator to changes in mortality. Although empirical applications show a similar trajectory for the threshold age of the coefficient of variation as for other indicators, the differences between them can be substantial. CONTRIBUTION We formally determine the threshold age for the coefficient of variation and contextualize the sensitivities and threshold ages of lifespan inequality indicators

Trends in avoidable mortality over the life course in Mexico 1990-2015: a cross-sectional demographic analysis

Objective To analyse average lifespan and quantify the effect of avoidable/amenable mortality on the difference between state-specific mortality and a low-mortality benchmark in Mexico during 1990–2015. Design Retrospective cross-sectional demographic analysis using aggregated data. Setting Vital statistics from the Mexican civil registration system. Participants Aggregated national data (from 91.2 million people in 1995 to 119.9 in 2015) grouped in 64 populations (32 Mexican states (including Mexico City) by sex) with cause-of-death data. Main outcome measures Cause-specific contributions to the gap in life expectancy with a low-mortality benchmark in three age groups (0–14, 15–49 and 50–84 years). Results Infants and children under the age of 15 years show improvements towards maximal survival in all states. However, adult males aged 15 to 49 years show deterioration after 2006 in almost every state due to increasing homicides, and a slow recovery thereafter. Out of 35 potential years, females and males live on average 34.57 (34.48 to 34.67) and 33.80 (33.34 to 34.27), respectively. Adults aged 50 to 84 years show an unexpected decrease in the low mortality benchmark, indicating nationwide deterioration among older adults. Females and males in this age group show an average survival of 28.59 (27.43 to 29.75) and 26.52 (25.33 to 27.73) out of 35 potential years, respectively. State gaps from the benchmark were mainly caused by ischaemic heart diseases, diabetes, cirrhosis and homicides. We find large health disparities between states, particularly for the adult population after 2005. Conclusions Mexico has succeeded in reducing mortality and between-state inequalities in children. However, adults are becoming vulnerable as they have not been able to reduce the burden of violence and conditions amenable to health services and behaviours, such as diabetes, ischaemic heart diseases and cirrhosis. These trends have led to large health disparities between Mexican states in the last 25 years.This study was supported by Syddansk Universitet, Max-PlanckGesellschaft (ERC grant no: 716323) and European Doctoral School of Demograph

Convergence and divergence in mortality: A global study from 1990 to 2030

An empirical question that has motivated demographers is whether there is convergence or divergence in mortality/longevity around the world. The epidemiological transition is the starting point for studying a global process of mortality convergence. This manuscript aims to provide an update on the concept of mortality convergence/divergence. We perform a comprehensive examination of nine different mortality indicators from a global perspective using clustering methods in the period 1990-2030. In addition, we include analyses of projections to provide insights into prospective trajectories of convergence clubs, a dimension unexplored in previous work. The results indicate that mortality convergence clubs of 194 countries by sex resemble the configuration of continents. These five clubs show a common steady upward trend in longevity indicators, accompanied by a progressive reduction in disparities between sexes and between groups of countries. Furthermore, this paper shows insights into the historical evolution of the convergence clubs in the period 1990-2020 and expands their scope to include projections of their expected future evolution in 2030

Subnational contribution to life expectancy and life span variation changes: Evidence from the United States

BACKGROUND The US life expectancy has been stagnating in recent decades, and along with this, the time trends of life span variation have shown stagnation and even increases with respect to historical levels. OBJECTIVE We aim to disentangle contributions from subnational levels (US regions) to national changes in life expectancy and life span variation in 2010–2019 and 2019–2020. METHODS A decomposition of the change in the national life expectancy and life disparity into the contribution of changing mortality and population structure among subnational regions is presented. The US Census regions are the Midwest, Northeast, South, and West. RESULTS From 2010 to 2019, the South substantially contributed to the life span variation increase due to increasing mortality contributions. The old-age survival improvements across all regions further contributed to increasing life span variation at the national level. Different population growth patterns across regions, especially at older ages, are a further source of change in national life span variation and life expectancy. From 2019 to 2020, during the COVID-19 pandemic, an increase in life span variation and a decrease in life expectancy across all regions were observed. CONTRIBUTION We present continuous-time decompositions for changes in life expectancy and life span variation. When decomposing subnational contributions to national changes, we also demonstrate the role of the composition effect through subnational–national growth differences. This paper quantifies and highlights the specific contributions of regions and age groups to the national mortality increase in the United States between 2010 and 2019, as well as between 2019 and 2020

The lifetime risk of maternal near miss morbidity in Asia, Africa, the Middle East, and Latin America: a cross-country systematic analysis

Background: Life-threatening maternal near miss (MNM) morbidity can have long-term consequences for the physical, psychological, sexual, social, and economic wellbeing of female individuals. The lifetime risk of MNM (LTR-MNM) quantifies the probability that a female individual aged 15 years will have an MNM before age 50 years, given current mortality and fertility rates. We compare the LTR-MNM globally to reveal inequities in the cumulative burden of severe maternal morbidity across the reproductive life course. Methods: We estimated the LTR-MNM for 40 countries with multifacility, regional, or national data on the prevalence of MNM morbidity measured using WHO or modified WHO criteria of organ dysfunction from 2010 onwards (Central and Southern Asia=6, Eastern and Southeastern Asia=9, Latin America and the Caribbean=10, Northern Africa and Western Asia=2, sub-Saharan Africa=13). We also calculated the lifetime risk of severe maternal outcome (LTR-SMO) as the lifetime risk of maternal death or MNM. Findings: The LTR-MNM ranges from a 1 in 269 risk in Viet Nam (2010) to 1 in 6 in Guatemala (2016), whereas the LTR-SMO ranges from a 1 in 201 risk in Malaysia (2014) to 1 in 5 in Guatemala (2016). The LTR-MNM is a 1 in 20 risk or higher in nine countries, seven of which are in sub-Saharan Africa. The LTR-SMO is a 1 in 20 risk or higher in 11 countries, eight of which are in sub-Saharan Africa. The relative contribution of the LTR-MNM to the LTR-SMO ranges from 42% in Angola to 99% in Japan. Interpretation: There exist substantial global and regional disparities in the cumulative burden of severe maternal morbidity across the reproductive life course. The LTR-MNM is an important indicator to highlight the magnitude of inequalities in MNM morbidity, once accounting for obstetric risk, fertility rates, and mortality rates. The LTR-SMO can be used to highlight variation in the relative importance of morbidity to the overall burden of maternal ill-health across the female reproductive life course, given countries’ stage in the obstetric transition. Both the LTR-MNM and LTR-SMO can serve as important indicators to advocate for further global commitment to end preventable maternal morbidity and mortality. Funding: UK Economic and Social Research Council, EU Horizon 2020 Marie Curie Fellowship, and Leverhulme Trust Large Centre Grant

Reversals in past long-term trends in educational inequalities in life expectancy for selected European countries

BACKGROUND: Across Europe, socioeconomic inequalities in mortality are large and persistent. To better understand the drivers of past trends in socioeconomic mortality inequalities, we identified phases and potential reversals in long-term trends in educational inequalities in remaining life expectancy at age 30 (e30), and assessed the contributions of mortality changes among the low-educated and the high-educated at different ages. METHODS: We used individually linked annual mortality data by educational level (low, middle and high), sex and single age (30+) from 1971/1972 onwards for England and Wales, Finland and Italy (Turin). We applied segmented regression to trends in educational inequalities in e30 (e30 high-educated minus e30 low-educated) and employed a novel demographic decomposition technique. RESULTS: We identified several phases and breakpoints in the trends in educational inequalities in e30. The long-term increases (Finnish men, 1982–2008; Finnish women, 1985–2017; and Italian men, 1976–1999) were driven by faster mortality declines among the high-educated aged 65–84, and by mortality increases among the low-educated aged 30–59. The long-term decreases (British men, 1976–2008, and Italian women, 1972–2003) were driven by faster mortality improvements among the low-educated than among the high-educated at age 65+. The recent stagnation of increasing inequality (Italian men, 1999) and reversals from increasing to decreasing inequality (Finnish men, 2008) and from decreasing to increasing inequality (British men, 2008) were driven by mortality trend changes among the low-educated aged 30–54. CONCLUSION: Educational inequalities are plastic. Mortality improvements among the low-educated at young ages are imperative for achieving long-term decreases in educational inequalities in e30

Reversals in past long-term trends in educational inequalities in life expectancy for selected European countries

Background: Across Europe, socioeconomic inequalities in mortality are large and persistent. To better understand the drivers of past trends in socioeconomic mortality inequalities, we identified phases and potential reversals in long-term trends in educational inequalities in remaining life expectancy at age 30 (e30), and assessed the contributions of mortality changes among the low-educated and the high-educated at different ages. Methods: We used individually linked annual mortality data by educational level (low, middle and high), sex and single age (30+) from 1971/1972 onwards for England and Wales, Finland and Italy (Turin). We applied segmented regression to trends in educational inequalities in e30 (e30 high-educated minus e30 low-educated) and employed a novel demographic decomposition technique. Results: We identified several phases and breakpoints in the trends in educational inequalities in e30. The long-term increases (Finnish men, 1982–2008; Finnish women, 1985–2017; and Italian men, 1976–1999) were driven by faster mortality declines among the high-educated aged 65–84, and by mortality increases among the low-educated aged 30–59. The long-term decreases (British men, 1976–2008, and Italian women, 1972–2003) were driven by faster mortality improvements among the low-educated than among the high-educated at age 65+. The recent stagnation of increasing inequality (Italian men, 1999) and reversals from increasing to decreasing inequality (Finnish men, 2008) and from decreasing to increasing inequality (British men, 2008) were driven by mortality trend changes among the low-educated aged 30–54. Conclusion: Educational inequalities are plastic. Mortality improvements among the low-educated at young ages are imperative for achieving long-term decreases in educational inequalities in e30

Latin American convergence and divergence towards the mortality profiles of developed countries

It is uncertain whether Latin America and Caribbean (LAC) countries are approaching a single mortality regime. Over the last three decades, LAC has experienced major public health interventions and the highest number of homicides in the world. However, these interventions and homicide rates are not evenly shared across countries. This study documents trends in life expectancy and lifespan variability for 20 LAC countries, 2000–14. By extending a previous method, we decompose differences in lifespan variability between LAC and a developed world benchmark into cause-specific effects. For both sexes, dispersion of amenable diseases through the age span makes the largest contribution to the gap between LAC and the benchmark. Additionally, for males, the concentration of homicides, accidents, and suicides in mid-life further impedes mortality convergence. Great disparity exists in the region: while some countries are rapidly approaching the developed regime, others remain far behind and suffer a clear disadvantage in population health