Diverging trends in female old-age mortality: A reappraisal

Over the second half of the 20th century a number of divergences and convergences of mortality schedules were observed across the world. Some of these developments remain incompletely understood. In recent overviews of old-age female mortality Mesle and Vallin (2006, Population and Development Review) and Rau, Soroko, Jasilionis, and Vaupel (2008, Population and Development Review) describe two contrasting patterns of mortality change between the mid-1980s and the end of the 20th century: a pattern of a large decrease in mortality exhibited by France and Japan and a pattern of a smaller decrease, stability or a certain increase in mortality shown by Denmark, the United States and the Netherlands. No satisfactory explanation of this phenomenon has been proposed so far. This paper shows that the divergence is, to a very significant extent, due to the differential impact of smoking related mortality on female populations of France and Japan versus Denmark, the United States and the Netherlands. The end to the diverging trends is demonstrated. Other lifestyle factors potentially implicated in the divergence are also discussed.convergence, divergences, health transition, mortality, smoking

Unusually small sex differentials in mortality of Israeli Jews: What does the structure of causes of death tell us?

Since the establishment of Israel sex differentials in life expectancy at birth exhibited by Israeli Jews have been very low in comparison to other developed countries as a result of relatively high male and relatively low female life expectancy. To advance understanding of this phenomenon this paper explores cause-specific contributions to the difference in life expectancy between Israeli Jews and Western countries, for each sex, and to sex differentials in mortality in both populations. We quantify the major types of behaviourally induced mortality to show that it is especially low among Israeli Jewish males. We also investigate mortality in certain subgroups of Israeli Jews to gain a better understanding of female mortality in this population.Israel, Jews, migration, mortality, sex differentials

Should measures of patient experience in primary care be adjusted for case mix? Evidence from the English General Practice Patient Survey.

OBJECTIVES: Uncertainties exist about when and how best to adjust performance measures for case mix. Our aims are to quantify the impact of case-mix adjustment on practice-level scores in a national survey of patient experience, to identify why and when it may be useful to adjust for case mix, and to discuss unresolved policy issues regarding the use of case-mix adjustment in performance measurement in health care. DESIGN/SETTING: Secondary analysis of the 2009 English General Practice Patient Survey. Responses from 2 163 456 patients registered with 8267 primary care practices. Linear mixed effects models were used with practice included as a random effect and five case-mix variables (gender, age, race/ethnicity, deprivation, and self-reported health) as fixed effects. MAIN OUTCOME MEASURES: Primary outcome was the impact of case-mix adjustment on practice-level means (adjusted minus unadjusted) and changes in practice percentile ranks for questions measuring patient experience in three domains of primary care: access; interpersonal care; anticipatory care planning, and overall satisfaction with primary care services. RESULTS: Depending on the survey measure selected, case-mix adjustment changed the rank of between 0.4% and 29.8% of practices by more than 10 percentile points. Adjusting for case-mix resulted in large increases in score for a small number of practices and small decreases in score for a larger number of practices. Practices with younger patients, more ethnic minority patients and patients living in more socio-economically deprived areas were more likely to gain from case-mix adjustment. Age and race/ethnicity were the most influential adjustors. CONCLUSIONS: While its effect is modest for most practices, case-mix adjustment corrects significant underestimation of scores for a small proportion of practices serving vulnerable patients and may reduce the risk that providers would 'cream-skim' by not enrolling patients from vulnerable socio-demographic groups.The study was funded by a grant from the UK Department of Healt

Improving Access to Mental Health Care in an Orthodox Jewish Community: A Critical Reflection Upon the Accommodation of Otherness

The English National Health Service (NHS) has significantly extended the supply of evidence based psychological interventions in primary care for people experiencing common mental health problems. Yet despite the extra resources, the accessibility of services for ‘under-served’ ethnic and religious minority groups, is considerably short of the levels of access that may be necessary to offset the health inequalities created by their different exposure to services, resulting in negative health outcomes. This paper offers a critical reflection upon an initiative that sought to improve access to an NHS funded primary care mental health service to one ‘under-served’ population, an Orthodox Jewish community in the North West of England

Sex differentials in mortality among Israeli Jews in international perspective

Since the establishment of Israel sex differentials in the life expectancy at birth exhibited by Israeli Jews have been very low in comparison to other countries. This paper investigates the age and sex structure of sex differentials in mortality among Israeli Jews comparing them to the populations of Western and Eastern European countries. It also explores the similarities and differences between Israeli Jews and other Jewish populations in relation to sex differentials in mortality, relying on the published sources. This investigation reveals that small sex differentials in mortality of Israeli Jews, measured as a difference between female and male life expectancy at birth, are due to a stable pattern of low male and somewhat elevated female mortality at old ages, mainly 60/65 years and over. The differences between mortality schedules of younger males and females (25-64 years) are also relatively small. Selected features of Israeli Jewish sex differentials in mortality (but not all features) resemble those found in Jewish Diaspora communities.Detailed examination of levels and trends in age-specific male and female mortality in different subgroups of Israeli and Diaspora Jews provides the basis for two hypotheses regarding the origins of small sex differentials among Israeli Jews. The first hypothesis links low male mortality to health protective behaviour of Israeli Jewish males, the second hypothesis places the source of elevated mortality of Israeli Jewish females in the migrant origin of this population