Changes in the age-at-death distribution in four low mortality countries: A nonparametric approach

Since the beginning of the twentieth century, important transformations have occurred in the age-at-death distribution within human populations. We propose a flexible nonparametric smoothing approach based on P-splines to refine the monitoring of these changes. Using data from the Human Mortality Database for four low mortality countries, namely Canada (1921-2007), France (1920-2009), Japan (1947-2009), and the USA (1945-2007), we find that the general scenario of compression of mortality no longer describes appropriately some of the recent adult mortality trends recorded. Indeed, reductions in the variability of age at death above the mode have stopped since the early 1990s in Japan and since the early 2000s for Canadian, US, and French women, while their respective modal age at death continued to increase. These findings provide additional support to the shifting mortality scenario, using an alternative method free from any assumption on the shape of the age-at-death distribution.modal age of death, old-age mortality compression, P-spline smoothing, shifting mortality

Changements dans la répartition des décès selon l'âge : une approche non paramétrique pour l'étude de la mortalité adulte

Au cours du siècle dernier, nous avons pu observer une diminution remarquable de la mortalité dans toutes les régions du monde, en particulier dans les pays développés. Cette chute a été caractérisée par des modifications importantes quant à la répartition des décès selon l'âge, ces derniers ne se produisant plus principalement durant les premiers âges de la vie mais plutôt au-delà de l'âge de 65 ans. Notre étude s'intéresse spécifiquement au suivi fin et détaillé des changements survenus dans la distribution des âges au décès chez les personnes âgées. Pour ce faire, nous proposons une nouvelle méthode de lissage non paramétrique souple qui repose sur l'utilisation des P-splines et qui mène à une expression précise de la mortalité, telle que décrite par les données observées. Les résultats de nos analyses sont présentés sous forme d'articles scientifiques, qui s'appuient sur les données de la Human Mortality Database, la Base de données sur la longévité canadienne et le Registre de la population du Québec ancien reconnues pour leur fiabilité. Les conclusions du premier article suggèrent que certains pays à faible mortalité auraient récemment franchi l'ère de la compression de la mortalité aux grands âges, ère durant laquelle les décès au sein des personnes âgées tendent à se concentrer dans un intervalle d'âge progressivement plus court. En effet, depuis le début des années 1990 au Japon, l'âge modal au décès continue d'augmenter alors que le niveau d'hétérogénéité des durées de vie au-delà de cet âge demeure inchangé. Nous assistons ainsi à un déplacement de l'ensemble des durées de vie adultes vers des âges plus élevés, sans réduction parallèle de la dispersion de la mortalité aux grands âges. En France et au Canada, les femmes affichent aussi de tels développements depuis le début des années 2000, mais le scénario de compression de la mortalité aux grands âges est toujours en cours chez les hommes. Aux États-Unis, les résultats de la dernière décennie s'avèrent inquiétants car pour plusieurs années consécutives, l'âge modal au décès, soit la durée de vie la plus commune des adultes, a diminué de manière importante chez les deux sexes. Le second article s'inscrit dans une perspective géographique plus fine et révèle que les disparités provinciales en matière de mortalité adulte au Canada entre 1930 et 2007, bien décrites à l'aide de surfaces de mortalité lissées, sont importantes et méritent d'être suivies de près. Plus spécifiquement, sur la base des trajectoires temporelles de l'âge modal au décès et de l'écart type des âges au décès situés au-delà du mode, les différentiels de mortalité aux grands âges entre provinces ont à peine diminué durant cette période, et cela, malgré la baisse notable de la mortalité dans toutes les provinces depuis le début du XXe siècle. Également, nous constatons que ce sont précisément les femmes issues de provinces de l'Ouest et du centre du pays qui semblent avoir franchi l'ère de la compression de la mortalité aux grands âges au Canada. Dans le cadre du troisième et dernier article de cette thèse, nous étudions la longévité des adultes au XVIIIe siècle et apportons un nouvel éclairage sur la durée de vie la plus commune des adultes à cette époque. À la lumière de nos résultats, l'âge le plus commun au décès parmi les adultes canadiens-français a augmenté entre 1740-1754 et 1785-1799 au Québec ancien. En effet, l'âge modal au décès est passé d'environ 73 ans à près de 76 ans chez les femmes et d'environ 70 ans à 74 ans chez les hommes. Les conditions de vie particulières de la population canadienne-française à cette époque pourraient expliquer cet accroissement.Over the course of the last century, we have witnessed major improvements in the level of mortality in regions all across the globe, in particular in developed countries. This remarkable mortality decrease has also been characterized by fundamental changes in the mortality profile by age. Indeed, deaths are no longer occurring mainly at very young ages but rather at advanced ages such as above age 65. Our research focuses on monitoring and understanding historical changes in the age-at-death distribution among the elderly population. We propose a new flexible nonparametric smoothing approach based on P-splines leading to detailed mortality representations, as described by actual data. The results are presented in three scientific papers, which rest upon reliable data taken from the Human Mortality Database, the Canadian Human Mortality Database, and the Registre de la population du Québec ancien. Findings from the first paper suggest that some low mortality countries may have recently reached the end of the old-age compression of mortality era, where deaths among the elderly population tend to concentrate into a progressively shorter age interval over time. Indeed, since the early 1990s in Japan, the modal age at death continues to increase while reductions in the variability of age at death above the mode have stopped. Thus, the distribution of age at death at older ages has been sliding towards higher ages without changing its shape. In France and Canada, women show such developments since the early 2000s, whereas men are still boldly engaged in an old-age mortality compression regime. In the USA, the picture for the latest decade is worrying because for several consecutive years in that timeframe, women and men have both recorded important declines in their modal age at death, which corresponds to the most common age at death among adults. The second paper takes a look within national boundaries and examines regional adult mortality differentials in Canada between 1930 and 2007. Smoothed mortality surfaces reveal that provincial disparities among adults in general and among the elderly population in particular are substantial in this country and deserve to be monitored closely. More specifically, based on modal age at death and standard deviation above the mode time trends, provincial disparities at older ages have barely reduced during the period studied, despite the great mortality improvements recorded in all provinces since the early XXth century. Also, we find that women who have reached the end of the old-age compression of mortality era in Canada are respectively those of Western and Central provinces. The last paper focuses on adult longevity during the XVIIIth century in historical Quebec and provides new insight on the most common adult age at death. Indeed, our analysis reveals that the modal age at death increased among French-Canadian adults between 1740-1754 and 1785-1799. In 1740-1754, it was estimated at 73 years among females and at about 70 years among males. By 1785-1799, modal age at death estimates were almost 3 years higher for females and 4 years higher for males. Specific living conditions of the French-Canadian population at the time could explain these results

Approximation de la distribution de la distance entre deux courbes empiriques

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal

Revue de la littérature sur l’évolution future de l’espérance de vie et de l’espérance de vie en santé

Like many industrialized countries, Canada is experiencing significant population aging and this phenomenon, inherited from the demographic transition, will intensify in the coming years. Mortality changes, especially at older ages, will contribute greatly to this phenomenon, hence the importance to be aware of the latest and forthcoming developments. It is also imperative to uncover recent and future health trends in the elderly population, and to investigate whether extra years of life gained through increased longevity will be spent in good or bad health. Thus, through this literature review, we first outline the academic debate on the future of mortality, and more specifically of life expectancy at birth. Since the debate essentially crystallized around two main competing views, one that supports sustained mortality gains in the future and one that expect instead these gains to peak, the arguments of each group and the main criticisms they face are exposed. We then provide a detailed account of a concomitant debate on the quality rather than the quantity of years lived. The three competing theories on the future of morbidity - compression of morbidity, expansion of morbidity and dynamic equilibrium - are presented and their relevance is discussed on the basis of empirical data. The difficulties inherent in defining the concepts of health and illness, and to obtain comparable indicators over time and space are highlighted.mortality, morbidity, life expectancy, healthy life expectancy, limit to the human life span, Canada, industrialized countries

Determinants of Influenza Mortality Trends: Age-Period-Cohort Analysis of Influenza Mortality in the United States, 1959-2016.

This study examines the roles of age, period, and cohort in influenza mortality trends over the years 1959-2016 in the United States. First, we use Lexis surfaces based on Serfling models to highlight influenza mortality patterns as well as to identify lingering effects of early-life exposure to specific influenza virus subtypes (e.g., H1N1, H3N2). Second, we use age-period-cohort (APC) methods to explore APC linear trends and identify changes in the slope of these trends (contrasts). Our analyses reveal a series of breakpoints where the magnitude and direction of birth cohort trends significantly change, mostly corresponding to years in which important antigenic drifts or shifts took place (i.e., 1947, 1957, 1968, and 1978). Whereas child, youth, and adult influenza mortality appear to be influenced by a combination of cohort- and period-specific factors, reflecting the interaction between the antigenic experience of the population and the evolution of the influenza virus itself, mortality patterns of the elderly appear to be molded by broader cohort factors. The latter would reflect the processes of physiological capital improvement in successive birth cohorts through secular changes in early-life conditions. Antigenic imprinting, cohort morbidity phenotype, and other mechanisms that can generate the observed cohort effects, including the baby boom, are discussed

Pandemic Paradox: Early Life H2N2 Pandemic Influenza Infection Enhanced Susceptibility to Death during the 2009 H1N1 Pandemic.

Recent outbreaks of H5, H7, and H9 influenza A viruses in humans have served as a vivid reminder of the potentially devastating effects that a novel pandemic could exert on the modern world. Those who have survived infections with influenza viruses in the past have been protected from subsequent antigenically similar pandemics through adaptive immunity. For example, during the 2009 H1N1 "swine flu" pandemic, those exposed to H1N1 viruses that circulated between 1918 and the 1940s were at a decreased risk for mortality as a result of their previous immunity. It is also generally thought that past exposures to antigenically dissimilar strains of influenza virus may also be beneficial due to cross-reactive cellular immunity. However, cohorts born during prior heterosubtypic pandemics have previously experienced elevated risk of death relative to surrounding cohorts of the same population. Indeed, individuals born during the 1890 H3Nx pandemic experienced the highest levels of excess mortality during the 1918 "Spanish flu." Applying Serfling models to monthly mortality and influenza circulation data between October 1997 and July 2014 in the United States and Mexico, we show corresponding peaks in excess mortality during the 2009 H1N1 "swine flu" pandemic and during the resurgent 2013-2014 H1N1 outbreak for those born at the time of the 1957 H2N2 "Asian flu" pandemic. We suggest that the phenomenon observed in 1918 is not unique and points to exposure to pandemic influenza early in life as a risk factor for mortality during subsequent heterosubtypic pandemics.IMPORTANCE The relatively low mortality experienced by older individuals during the 2009 H1N1 influenza virus pandemic has been well documented. However, reported situations in which previous influenza virus exposures have enhanced susceptibility are rare and poorly understood. One such instance occurred in 1918-when those born during the heterosubtypic 1890 H3Nx influenza virus pandemic experienced the highest levels of excess mortality. Here, we demonstrate that this phenomenon was not unique to the 1918 H1N1 pandemic but that it also occurred during the contemporary 2009 H1N1 pandemic and 2013-2014 H1N1-dominated season for those born during the heterosubtypic 1957 H2N2 "Asian flu" pandemic. These data highlight the heretofore underappreciated phenomenon that, in certain instances, prior exposure to pandemic influenza virus strains can enhance susceptibility during subsequent pandemics. These results have important implications for pandemic risk assessment and should inform laboratory studies aimed at uncovering the mechanism responsible for this effect

Genome-wide gene expression profiling analysis of Leishmania major and Leishmania infantum developmental stages reveals substantial differences between the two species

<p>Abstract</p> <p>Background</p> <p><it>Leishmania </it>parasites cause a diverse spectrum of diseases in humans ranging from spontaneously healing skin lesions (e.g., <it>L. major</it>) to life-threatening visceral diseases (e.g., <it>L. infantum</it>). The high conservation in gene content and genome organization between <it>Leishmania major </it>and <it>Leishmania infantum </it>contrasts their distinct pathophysiologies, suggesting that highly regulated hierarchical and temporal changes in gene expression may be involved.</p> <p>Results</p> <p>We used a multispecies DNA oligonucleotide microarray to compare whole-genome expression patterns of promastigote (sandfly vector) and amastigote (mammalian macrophages) developmental stages between <it>L. major </it>and <it>L. infantum</it>. Seven per cent of the total <it>L. infantum </it>genome and 9.3% of the <it>L. major </it>genome were differentially expressed at the RNA level throughout development. The main variations were found in genes involved in metabolism, cellular organization and biogenesis, transport and genes encoding unknown function. Remarkably, this comparative global interspecies analysis demonstrated that only 10–12% of the differentially expressed genes were common to <it>L. major </it>and <it>L. infantum</it>. Differentially expressed genes are randomly distributed across chromosomes further supporting a posttranscriptional control, which is likely to involve a variety of 3'UTR elements.</p> <p>Conclusion</p> <p>This study highlighted substantial differences in gene expression patterns between <it>L. major </it>and <it>L. infantum</it>. These important species-specific differences in stage-regulated gene expression may contribute to the disease tropism that distinguishes <it>L. major </it>from <it>L. infantum.</it></p

The demography of Canada and the United States from the 1980s to the 2000s. A summary of changes and a statistical assessment

Canada and the United States have enjoyed vigorous population growth since the early 1980s. Although mortality is slightly higher in the United States than in Canada, this is largely offset by much higher fertility, with a total fertility rate at replacement level, compared with just 1.5 children per woman in Canada. The United States is also the world's largest immigrant receiving country, although its immigration rate is only half that of Canada, where today one person in five is foreign-born, versus one in eight in the United States. Based on recent trends in fertility, mortality and international migration, the populations of these two North American countries will continue to grow over the next five decades, but at a progressively slower pace. The most acute demographic issue today is not, as in Europe, that of imminent population decline, but rather of the geographic and social inequalities which have increased steadily since the early 1980s and which are reflected in major fertility and health differentials between regions and social groups

La démographie du Canada et des États-Unis des années 1980 aux années 2000. Synthèse des changements et bilan statistique

La démographie du Canada et des États-Unis se caractérise par son dynamisme depuis le début des années 1980. Une mortalité un peu plus élevée aux États-Unis qu'au Canada est largement compensée par une fécondité beaucoup plus forte, dont l'indicateur conjoncturel atteint actuellement le seuil de remplacement des générations, contre seulement 1,5 enfant par femme au Canada. Par ailleurs, les États-Unis accueillent le plus grand nombre d'immigrants du monde, mais leur taux d'immigration est deux fois moindre que celui observé au Canada, où une personne sur cinq est aujourd'hui née à l'étranger, contre une sur huit aux États-Unis. L'évolution récente de la fécondité, de la mortalité et des migrations internationales dans les deux pays d'Amérique du Nord leur garantit une croissance démographique qui restera positive au cours des cinq décennies à venir, bien que de moins en moins vigoureuse. Le problème démographique le plus aigu actuellement n'y est donc pas, comme en Europe, un déclin annoncé de la population, mais des inégalités géographiques et sociales qui n'ont cessé de croître depuis le début des années 1980 et se traduisent par des différences considérables en matière de fécondité et de santé entre grandes régions et entre groupes sociaux