Changes in educational differentials in old-age mortality in Finland and Sweden between 1971-1975 and 1996-2000

The majority of the studies on developed countries confirm that socioeconomic mortality inequalities have been persisting or even widening. It has also been suggested that inequalities have been becoming increasingly important for old ages. The vast majority of the findings on mortality differentials rely on life table or aggregated mortality measures. However, conventional mean lifespan (life expectancy) hides important characteristics of the distribution of lifespan. Modal age at death and measures of disparity provide additional important insights on longevity, especially when focusing on mortality and survival at old ages. In this paper, using high quality census-linked data and both conventional life expectancy and distribution of life span measures, we systematically assess the direction and magnitude of changes in mortality differences at old ages in Sweden and Finland over the period 1971 to 2000. We found that educational gap in life expectancy at age 65 increased in both countries. Although the results suggest that life expectancy gap was largely explained by differential mortality due to cardiovascular system diseases, the role of other causes of death (especially cancers) has also increased. The educational gap in the modal age at death for Swedish males and Finnish females decreased, whereas it remained at the same level or slightly increased for Finnish males and Swedish females. Life span disparity was initially lower in low education groups, but eventually became higher than in high education group

Mortality by education level at late-adult ages in Turin: a survival analysis using frailty models with period and cohort approaches

OBJECTIVES: Neglecting the presence of unobserved heterogeneity in survival analysis models has been showed to potentially lead to underestimating the effect of the covariates included in the analysis. This study aimed to investigate the role of unobserved heterogeneity of frailty on the estimation of mortality differentials from age 50 on by education level. DESIGN: Longitudinal mortality follow-up of the census-based Turin population linked with the city registry office. SETTING: Italian North-Western city of Turin, observation window 1971–2007. POPULATION: 391 170 men and 456 216 women followed from age 50. PRIMARY OUTCOME MEASURES: Mortality rate ratios obtained from survival analysis regression. Models were estimated with and without the component of unobserved heterogeneity of frailty and controlling for mortality improvement over time from both cohort and period perspectives. RESULTS: In the majority of cases, the models without frailty estimated a smaller educational gradient than the models with frailty. CONCLUSIONS: The results draw the attention of the potential underestimation of the mortality inequalities by socioeconomic levels in survival analysis models when not controlling for unobserved heterogeneity of frailty

Fertility decline and the emergence of excess female survival in post-reproductive ages in Italy

In Italy, at least in the cohorts born up to the beginning of the twentieth century, women's mortality in post-reproductive ages was influenced by fertility, with large progenies (and, to a lesser extent, childlessness) leading to markedly lower survival chances. This relationship proved strong enough to affect the female-to-male ratio in old age as fertility declined. In this paper, we show that various measures of extra female survival at high ages are closely connected to the fertility transition in Italy, and to its peculiar historical and geographical evolution

Health care system efficiency and life expectancy: A 140-country study.

Despite the evidence of links between health expenditure and health care efficiency, it is still unclear why countries with similar levels of health expenditures experience different outputs in terms of life expectancy at birth. Health care system efficiency might shed some light on the question. Using output-oriented data envelopment analysis, we compared the health systems of 140 countries in terms of attained life expectancy. Efficiency is determined by the distance from the closest country on the best practice frontier, which identifies the highest attainable life expectancy observed for any given level of health care spending. By using national data form the Human Development Data, we built the efficiency frontier and computed the potential life expectancy increase for each country. The potential improvement was, on average, 5.47 years [95%CI: 4.71-6.27 years]. The least efficient countries (10th percentile of the efficiency score) could improve by 11.78 years, while the most efficient countries (90th percentile of the efficiency score) could only improve by 0.83 years. We then analyzed, with regression analysis stratified by average education level, and by the role of health-related variables in differentiating efficient and inefficient countries from each other. The results suggest that, among countries with lower levels of education, decreasing unemployment and income inequality increases average life expectancy, without increasing health expenditure levels

Divergent trends in lifespan variation during mortality crises.

BACKGROUND: Lifespan variation has been attracting attention as a measure of population health and mortality. Several studies have highlighted its strong inverse relationship with life expectancy during periods of steady mortality decline, but this association weakens, and even reverses, when mortality does not improve equally over age. To date no study has comprehensively explored the behaviour of lifespan variation when mortality increases significantly. OBJECTIVE: We investigate lifespan variation trends around various mortality crises, focusing on agespecific contributions and sex differences. METHODS: Drawing data from the Human Mortality Database and Meslé and Vallin’s Ukrainian lifetables, we analyse five European epidemics and famines across three centuries. We use six measures of lifespan variation and adopt the linear integral method of decomposition. RESULTS: During these crises, relative lifespan variation increases, while absolute variation declines, and subsequently both quickly revert to pre-crisis levels. We show that mortality at older ages leads to a temporary increase in absolute - but not relative - variation. The lifespan variation of females is less affected than that of males, because of differences in the impact of infant and child mortality. CONCLUSIONS: Even when infant mortality is high, mortality at older ages can influence lifespan variation. Our results also underscore the sex differences in the vulnerability of young individuals in periods of extreme mortality. CONTRIBUTION: By underlining different trends of lifespan variation by sex and indicator, we offer new insight into the consequences of mortality crises. Contrary to what is often asserted, we show that the choice of lifespan variation indicator is not always inconsequential