Les causes de décès aux grands âges en France, évolution récente

Dans les pays les plus avancés, la mort survient de plus en plus aux grands âges. En France, par exemple, en 2016, 73 % des décès féminins se sont produits après 85 ans, alors que ce n’était le cas que de 41 % en 1975 et même seulement 25 % en 1950. Alors que le sujet paraissait jadis anecdotique, des chercheurs s’interrogent de plus en plus sur ce que peuvent être les causes de décès aux grands âges. Beaucoup, cependant, estiment que la question est relativement vaine car plus l’âge avance, plus les causes sont multiples ce qui rend d’autant plus difficile la détermination d’une cause principale tandis que de leur côté les médecins déclarants posent souvent des diagnostics flous. Il est vrai que le nombre de décès dont la cause est mal définie, voire non déclarée, augmente avec l’âge, mais il nous semble néanmoins que les certificats médicaux de cause de décès portent de plus en plus d’informations exploitables jusqu’à des âges très avancés dans beaucoup de pays, dont la France. Dans le même temps, la précision des âges au décès recueillis par la statistique de l’état civil, longtemps assez défaillante aux grands âges, s’est beaucoup améliorée au cours des dernières décennies. Nous tentons donc ici de suivre l’évolution de la mortalité française par cause et par âge au-delà de 90 ans, depuis la fin des années 1970, tant pour les hommes que pour les femmes. Non seulement, l’étude confirme que la mortalité diminue à tous les âges, y compris les plus élevés, et quel que soit le sexe. Elle nous permet aussi d’évaluer le poids de chacun des grands groupes de causes (cancers, maladies du cœur, autres maladies de l’appareil circulatoire, maladies infectieuses et respiratoires, diabète, démences et maladies neuro-dégénératives, autres maladies, accidents et sénilité), dans ce recul de la mortalité aux âges élevés et donc dans la montée des espérances de vie à 90 ans, ainsi que le rôle qu’ils jouent dans la différence d’espérance de vie entre les sexes dont l’évolution, même aux grands âges s’est récemment retournée

Mortality in the Caucasus

With the collapse of the Soviet Union, Caucasian countries experienced remarkable migration flows, political conflicts, and deterioration of civil registration systems. The reassessment of Armenian and Georgian population after censuses carried out in the early 2000s enables to re-estimate recent mortality levels in both countries. Vital statistics since the 1980s are presented and discussed. Infant mortality is corrected according to sample surveys, and mortality above age 60 estimated through model life tables. On the basis of these estimates, trends in life expectancy were similar in the two countries, unfavourable during the 1990s, especially for males for whom the health progress, notably in Georgia, is still low.administrative data, Armenia, estimation, Georgia, life expectancy, mortality, reliability, survey data

Is East-West Life Expectancy Gap Narrowing in the Enlarged European Union?

The fall of the Berlin Wall in 1990 and EU enlargement in 2004 are two major political events in the recent history of the Central and Eastern European region. By systematically comparing the changes and differences in life expectancy at birth between the seven new member countries from Central and Eastern Europe and more advanced countries of the EU-15, this article attempts to identify the vanguards and laggards in the health convergence process before and after the 2004 EU enlargement. The results of decomposition analysis highlight the changing patterns of age- and cause-specific contributions to the differences in life expectancy. Finally, we focus on the variations in the progress in reducing the burden of cardiovascular diseases and external causes of death, which were known to be responsible for the long-term mortality crisis during the period of communist rule. Our findings suggest that the collapse of the communist regimes led to immediate positive changes in the Central European countries. At the same time, health disadvantages persisted and even worsened in the Baltic countries. Later on, joining the EU in 2004 was not accompanied by immediate systematic convergence of life expectancy. However, very rapid progress in the initially worst performing Baltic countries after 2007 and especially during the 2010s, may suggest a delayed positive impact of EU enlargement leading to decreasing longevity disadvantage. The convergence process after 2004 was generally slower in the initially better-performing four Central European countries. Despite these country-specific variations, Czechia, Poland, and, especially, Estonia remain clear health vanguards in the region. Further progress requires much more systematic efforts to combat cardiovascular diseases and the persisting burden of excess male mortality at adult working ages. * This article belongs to a special issue on “Demographic Developments in Eastern and Western Europe Before and After the Transformation of Socialist Countries”

Mortality in Belarus, Lithuania, and Russia: divergence in recent trends and possible explanations

Before the collapse of the Soviet Union, Belarus, Lithuania, and Russia were quite comparable in terms of their socioeconomic development. Despite some differences in overall mortality levels, the three former Soviet republics were also very close to each other in terms of directions of mortality trends and age- and cause-specific mortality patterns. After 1991, all the three countries experienced substantial political and social transformations, and the challenges associated with the transition from a socialist to a market economy system. The sudden changes brought numerous problems, such as rapid growth in unemployment, falling standards of living, and growing social and income inequalities. These factors contributed to the significant deterioration of the health situation in all the countries, but the size and the nature of the mortality crisis was different in Belarus than it was in Lithuania and Russia. The marked similarities in socioeconomic and mortality trends in the countries up to 1991 contrast with their notable divergence during the subsequent years. The nature and success of market reforms seems to be the most plausible explanation for these differences. Russia and Lithuania have chosen more radical forms of economic and political transformations, which have led to massive privatization campaigns. The reforms were more sustainable and systematic in Lithuania than in Russia. By contrast, Belarus has chosen a gradual and slow transition path. Recent mortality trends in Belarus are explored in detail here, and are contrasted with those observed in Lithuania and Russia. Including a cause-of-death analysis sheds more light on the plausible determinants of the variations in mortality levels between the countries.Avant la chute de l’Union Soviétique, la Biélorussie, la Lituanie et la Russie étaient tout à fait comparables en termes de développement socio-économique. En dépit de quelques différences de taux de mortalité générale, les ex-Républiques Soviétiques étaient également très proches en termes de tendances et de variations de la mortalité par cause et par âge. Après 1991, les 3 pays ont connu des bouleversements politiques et sociaux, et ont dû faire face aux défis associés au passage d’une économie socialiste à l’économie de marché. Ces changements soudains ont provoqué de nombreux problèmes, tels qu’une montée rapide du chômage, la baisse du niveau de vie et le développement d’inégalités sociales et de revenu. L’ensemble de ces facteurs a contribué à une détérioration significative de la situation sanitaire dans tous les pays, mais la crise de mortalité en Biélorussie était différente de celles de la Lituanie et de la Russie, à la fois en termes d’étendue et de nature. Les grandes similitudes des tendances socio-économiques et de mortalité dans ces pays jusqu’en 1991 contrastent avec leur divergence notable au cours des années qui ont suivi. La nature et le succès des réformes liées au passage à l’économie de marché est l’explication la plus plausible de ces différences. La Russie et la Lituanie ont choisi des formes plus radicales de transformation économique et politique, qui ont mené à des campagnes de privatisation massives. Les réformes étaient plus durables et systématiques en Lituanie qu’en Russie. La Biélorussie, en revanche, a choisi la voie d’une transformation graduelle et lente. Les tendances récentes de la mortalité en Biélorussie sont examinées en détail dans cette étude, et comparées à celles observées en Lituanie et en Russie. Une analyse des causes de décès éclaire sur les déterminants plausibles des variations de niveau de mortalité entre ces pays

Long-term trends in the longevity of scientific elites: evidence from the British and the Russian academies of science.

National science academies represent intellectual elites and vanguard groups in the achievement of longevity. We estimated life expectancy (LE) at age 50 of members of the British Royal Society (RS) for the years 1670-2007 and of members of the Russian Academy of Sciences (RAS) for the years 1750-2006. The longevity of academicians was higher than that of their corresponding national populations, with the gap widening from the 1950s. Since the 1980s, LE in the RS has been higher than the maximum LE among all high-income countries. In each period, LE in the RS was greater than in the RAS, although since the 1950s it has risen in parallel in the two academies. This steep increase shared by academicians in Britain and Russia suggests that general populations have the potential for a substantial increase in survival to high ages

Convergence or Divergence? Life Expectancy Patterns in Post-communist Countries, 1959–2010

In the 1960s and 1970s, the countries of Central and Eastern Europe and the Soviet Union experienced an unanticipated stagnation in the process of mortality reduction that was accelerating in the west. This was followed by even starker fluctuations and overall declines in life expectancy during the 1980s and 1990s. We identify statistically the extent to which, since the 1990s, the countries of the post-communist region have converged as a group towards other regional or cross-regional geopolitical blocks, or whether there are now multiple steady emerging among these countries. We apply a complex convergence club methodology, including a recursive analysis, to data on 30 OECD countries (including 11 post-communist countries) drawn from the Human Mortality Database and spanning the period 1959-2010. We find that, rather than converging uniformly on western life expectancy levels, the post-communist countries have diverged into multiple clubs, with the lowest seemingly stuck in low-level equilibria, while the best performers (e.g. Czech Republic) show signs of catching-up with the leading OECD countries. As the post-communist period has progressed, the group of transition countries themselves has become more heterogeneous and it is noticeable that distinctive gender and age patterns have emerged. We are the first to employ an empirical convergence club methodology to help understand the complex long-run patterns of life expectancy within the post-communist region, one of very few papers to situate such an analysis in the context of the OECD countries, and one of relatively few to interpret the dynamics over the long-term

Why are supercentenarians so frequently found in French Overseas Departments? The cases of Guadeloupe and Martinique

Many more cases of supercentenarians are observed in the French Départements d’Outre-Mer (DOM) than in metropolitan France. A first possible explanation is that the standard French protocol for validating age does not sufficiently cover DOMs. However, if additional checks can confirm the verity of this phenomenon, forming explanatory hypotheses can be relevant and quite interesting. Thanks to an INED research funding, a special protocol of deep age checking has been established to be applied to the two DOMs where the phenomenon is the most pronounced: Guadeloupe and Martinique. First results not only show that combining several additional checks does not leave much room for further doubting the ages of supercentenarians but they also support some arguments in favor of a possible fundamental explanation: genetic selection due to the extreme severity of mortality inflicted on their slave ancestors