Transcript cohort - unece

Increasing longevity and decreasing
gender mortality differentials: new
perspectives from a study on Italian
cohorts
Graziella Caselli
Dipartimento di Scienze Sociali, Economiche, Attuariali e Demografiche
[email protected]
Marco Marsili
Direzione Centrale Statistiche e Indagini sulle Istituzioni Sociali
[email protected]
Joint Eurostat-UNECE Work Session on Demographic Projections
Lisbon (Portugal), 28-30 April 2010
Outline
1. More long-lived, less different
2. Data and method
3. Cohort mortality models: why elderly today are
different from elderly in the past and in the
future?
4. Adults and elderly: what causes of death have
been, or could be, responsible for their low
mortality and their increasing longevity?
5. Are women losing some of their advantage or men
recouping their disadvantage?
6. Some conclusions
Life expectancy at birth by sex and gender differences
from 1886 to 2007
e0
e0F-e0M
90
7
1979
6
ΔG = 6.9
e0F-e0M
80
Women
70
5
Men
60
1886
e0=35.5
M and W
4
50
3
40
2
30
1
20
0
10
-1
0
-2
Life expectancy1886
at birth
1896 1906
1916 1926 1936 1946 1956 1966 1976 1986 1996 2006
Year
Men Women
ΔG
1979
70.4
77.3
6.9
2007
78.7
84.0
5.3
ΔP
8.3
6.7 -1.6
Years
More long-lived…
2007
ΔG = 5.3
Trends of gender differences in life expectancy at
birth, at age 65 and 80, from 1886 to 2007
Differences in Life expectancy :
W-M
Year
1979
Differences
LE
LE at age
8 at
birth
65
7
LE at
age 80
3.7
1.3
2007
6.9
6
5.3
3.7
1.9
ΔP
-1.6
0.0
0.6
5
4
e0
e65
3
e80
2
1
0
-1
1886 1896 1906 1916 1926 1936 1946 1956 1966 1976 1986 1996 2006
Years
More long-lived
AND less different
Age specific Sex ratios – over male mortality – in
the years 1886, 1979 and 2007
(qxM/qxF)*100
400
350
2007
300
1979
250
200
150
100
1886
50
0
0
5
10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 100
Age
1-14 years
40-69 years
The leading ages of a
new mortality model
How should we interpret the reduction
of the female advantage in adulthood?
 A particularly fortunate period for men?
 A problem in survival trends of women?
 Which causes of death are responsible for?
As we know, different life histories influence the
final outcome, anticipating or postponing the age
at death. Studies of mortality that start from
macro-data claim that the different mortality
histories of the cohorts are the result of different
life experiences.
Analysing mortality models by age and by cause
for succeeding cohorts may be helpful in better
understanding the characteristics of the last thirty
years in the history of mortality in Italy.
Completing some cohort mortality histories may help
us see in which direction the recent mortality
trends might be going.
The aim of this presentation
is to analyze the developing characteristics of the mortality
of the cohorts that entered adult age (45-64 years) at
the end of the 1970s and that have become elderly more
recently.
The intention is to compare their mortality histories – total
and by cause – with those of adults of today, who will
be the elderly of tomorrow.
Predictions will be necessary to complete the mortality
histories of these cohorts, considering the cause of death
too. A cohort perspective will be adopted to study
longevity, BUT PARTICULARLY to analyze the changes
of gender survival differences
Data
Mortality rates and/or probabilities by Sex, Leading
causes of death, Age (0-100), Period and Cohort
SOURCES:
From 1861 to 1973 - Department of Demography Rome (Human mortality database)
From 1974 to 2007 - ISTAT
Cohorts up to 1907 EXTINCT
Cohorts from 1908 to 1965 PARTIALLY OBSERVED
Leading causes of death and corresponding codes
in IX ICD Rev.
Infectious diseases
1-139; 279.1
Cancers
140-239
Circulatory system diseases
390-459
Respiratory system diseases
460-519
Digestive system diseases
520-579
Violent causes
800-999
Other causes
Remainder
Harmonized database in time according to IX ICD REVISION
REFERENCES:
Caselli G., Long Term Trends in European Mortality, Studies on Medical and
Population Subjects, N. 56, OPCS, London.
Caselli G., Health transition and cause specific mortality, in. The decline of mortality
in Europe (Edited by R. Schofield, D. Reher and A. Bideau), Clarendon Press, Oxford;
Caselli G., National differences in the Health transition in Europe, Historical Methods,
Vol. 29, n. 3;
THE PROJECTION MODEL
To project the risk of death, a model taking account of age,
period and cohort components of mortality (APC model) was
used.
*
t , x ,t  x
log( y
)  a  a( x)  p(t )  c(t  x)
That is:
log( yt*, x ,t  x )  a  i bi  ( x)i   j c j  (t ) j  k d k  (t  x) k
a; b ,..,b ; c ,..,c ; d ,.., d
1
h
1
h
1
h
1
2
3
Parameters to be
estimated
i  1,.., h1 ; j  1,.., h2 ; k  1,.., h3
PROJECTION STRATEGY
Projections carried out for each cause of death and sex.
The sum of the projected rates represents the overall
mortality (“by cause” approach).
Approach = deterministic - single variant
Single Age = 0,1,2,….,100
Jump-off year = 2008
Last projected year = 2065
Last fully projected cohort = 1965
We mainly focus our study on cohorts from 1865 to
1965
Schema for identifying some interesting cohorts, from
those of adult age (45-64) in 1967, now extinct, to those
who were adult in 2007, who will be extinct in 2037-2047.
The cohorts to be followed at the various ages are those
aged 45-64 on the blue diagonal
Cohorts
Years
1947
1957
1967
1977
1987
1997
1903-1922
25-44
35-54
45-64
55-74
65-84
75-94
1913-1932
15-34
25-44
35-54
45-64
55-74
65-84
75-94
1923-1942
05-24
15-34
25-44
35-54
45-64
55-74
65-84
75-94
1933-1952
00-14
05-24
15-34
25-44
35-54
45-64
55-74
65-84
75-94
00-14
05-24
15-34
25-44
35-54
45-64
55-74
65-84
75-94
00-14
05-24
15-34
25-44
35-54
45-64
55-74
65-84
75-94
00-14
05-24
15-34
25-44
35-54
45-64
55-74
65-84
1943-1962
1953-1972
1963-1982
2007
2017
2027
2037
2047
2057
75-94
For a synthesis of the main results
we will refer to the intermediate cohorts
of the various groups, and in particular,
the cohorts born in the years 1912,
1922, 1932, 1942 and 1952, also
considering the cohorts of 1865 and
1890, now extinct, and the one born in
1965, whose history of mortality in
adult and old age is projected from the
age 42 years and beyond.
Life expectancy at birth by sex and cohort,
1865-1965, Men and Women
Cohort
1902
M= 42.1
W= 49.8
Cohort
1912
M= 51.4
W= 56.2
e0
90
Cohort
1965
M=81.3
W=87.6
Women
80
70
60
Men
Cohort
1917
M= 44.3
W= 49.4
50
40
30
20
10
Life expectancy
at birth
0
1865
1875
1885
1895
ΔG
Cohort
Men
Women
1932
61,8
69,2
7.4
1952
74.9
81.7
6.8
1965
81.3
87.6
6.3
1905
1915
Cohorts
1925
1935
1945
1955
1965
Contributions by age (30+) of the leading causes of death to
differences in life expectancy at birth between two selected
cohorts, MEN
Cohort
CANCERS
(ALL
AGES)
18901912
-0.3
19121932
-0.2
19321952
1.3
CIRC.
SYSTEM
(ALL AGES)
ALL
CAUSES
(ALL
AGES)
1.0
13.0
0,6
0,5
0,4
0,3
0,2
1.7
10.3
0,1
0
-0,1
Respiratory system Infectious
Cancersdiseases
Digestive system
Violent causes
Circulatory
diseases
Other diseases
90-94
95+
90-94
95+
85-89
80-84
75-79
70-74
65-69
60-64
55-59
50-54
45-49
Infectious
diseases
Respiratory system
Respiratory system
Cancers
diseases
Digestive systemCirculatory
Violent
causes Digestive system
Other diseases
85-89
80-84
-0,2
75-79
-0,2
70-74
-0,2
65-69
-0,1
95+
60-64
-0,1
90-94
55-59
-0,1
85-89
50-54
0
80-84
45-49
0
75-79
40-44
0
70-74
35-39
0,1
60-64
0,1
95+
55-59
0,1
90-94
50-54
0,2
85-89
45-49
0,2
80-84
40-44
0,2
75-79
35-39
0,3
70-74
30-34
0,3
65-69
0,3
60-64
0,4
55-59
0,4
50-54
0,4
45-49
0,5
40-44
0,5
35-39
0,6
65-69
30-34
Contributions
Cohort 1932 vs 1952 - Men
Cohort 1932 vs
1952 - Men
Infectious diseases
Respiratory system
Cancers
0,6
Circulatory diseases Digestive system
Violent causes
0,5
Other diseases
0,6
Infectious diseases
Circulatory diseases
Other diseases
40-44
-0,2
35-39
13.2
30-34
2.2
Cohort 1912 vs 1932
- Men
Contributions
Contributions
30-34
Cohort 1890 vs 1912 - Men
Contributions
Cancers
Violent causes
Contributions by age (30+) of the leading causes of death to
differences in life expectancy at birth between two selected
cohorts, WOMEN
Cohort
CANCERS
(ALL
AGES)
CIRC.
SYSTEM
(ALL AGES)
Contributions
ALL
CAUSES
(ALL
AGES)
Cohort 1890 vs 1912 - Women
0,6
0,5
0,4
0,3
18901912
0.0
19121932
0.1
19321952
0.8
2.1
14.0
0,2
0,1
2.4
13.0
0
-0,1
Cohort 1912 vs 1932
- Women
Contributions
Infectious diseases
Circulatory diseases
Other diseases
Respiratory system
Digestive system
Cancers diseases
Infectious
Violent causes
Circulatory
diseases
Other diseases
95+
90-94
85-89
80-84
75-79
70-74
65-69
60-64
55-59
50-54
45-49
40-44
35-39
Respiratory system
Cancers
Infectious
diseases
Respiratory system
Digestive system
Violent
causes Digestive system
Circulatory
diseases
Other diseases
Cancers
Violent causes
95+
90-94
85-89
80-84
-0,2
75-79
-0,2
70-74
-0,2
65-69
-0,1
95+
60-64
-0,1
90-94
55-59
-0,1
85-89
50-54
0
80-84
45-49
0
75-79
40-44
0
60-64
0,1
95+
55-59
0,1
90-94
50-54
0,1
85-89
45-49
0,2
80-84
40-44
0,2
75-79
35-39
0,2
70-74
30-34
0,3
65-69
0,3
60-64
0,3
55-59
0,4
50-54
0,4
45-49
0,4
40-44
0,5
35-39
0,5
30-34
0,6
70-74
35-39
CohortRespiratory
1932 vs 1952
- Women
Cohort 1932 Contributions
vs 1952 Infectious
- Men
diseases
system
Cancers
0,6
Circulatory diseases Digestive system
Violent causes
0,5
Other diseases
0,6
65-69
30-34
Contributions
-0,2
12.5
30-34
2.2
Contributions by age (30+) of the leading causes of death to
differences in life expectancy at birth between cohorts 1932-1952,
MEN and WOMEN
Contributions
Cohort 1932 vs 1952 - Men
MEN
Adult in the Past
vs
Adult Today
0,6
0,5
0,4
0,3
0,2
0,1
0
-0,1
90-94
95+
90-94
95+
85-89
80-84
75-79
70-74
65-69
60-64
55-59
50-54
45-49
40-44
85-89
90-94
Elderly Today
vs
Elderly Tomorrow
35-39
30-34
-0,2
WOMEN
Contributions
Cohort
1932
vs vs
1952
- Women
Contributions
Cohort
1932
1952
- Men
Infectious diseases
Respiratory
system
Cancers
0,6 0,6
Circulatory diseases Digestive system
Violent causes
0,5 0,5
Other diseases
0,4 0,4
0,3 0,3
0,2 0,2
Infectious
diseases Respiratory
Respiratory
system Cancers
Cancers
Infectious
diseases
system
Circulatory
diseasesDigestive
Digestive
system Violent
Violent
causes
Circulatory
diseases
system
causes
Other
diseases
Other
diseases
95+
80-84
85-89
12.5
75-79
80-84
2.2
70-74
75-79
0.8
65-69
70-74
WOMEN
-0,2 -0,2
60-64
65-69
13.2
-0,1 -0,1
55-59
60-64
2.2
0
50-54
55-59
1.3
0
45-49
50-54
MEN
0,1 0,1
40-44
45-49
ALL
CAUSES
(ALL
AGES)
35-39
40-44
CIRC.
SYSTEM
(ALL
AGES)
30-34
35-39
CANCERS
(ALL
AGES)
30-34
Cohort
Life expectancy at birth by sex and gender
differences - Cohorts 1865-1965
W-M
Cohort
1902=7.7
W-M
e0
90
9
Women
80
8
W-M
70
7
60
6
Men
50
5
40
4
30
3
20
2
10
1
0
0
1865
1875
1885
1895
1905
1915
1925
1935
1945
1955
W-M
Cohort
1965=6.3
W-M
Cohort
1917=5.1
1965
Cohorts
Life expectancy at birth
Cohort
Men
Women
ΔG
1932
61.8
69.2
7.4
1952
74.9
81.7
6.8
1965
81.3
87.6
6.3
Deep change in gender
differences trend as a
result of cohort dynamics
in life expectancy at birth
Life expectancy at birth by sex and gender
differences – Cohort and Period
Cohorts aged 45-64 in
1979, showing an
increase of gender
differences, are those
born in 1915-1934
9
Women
80
70
7
60
6
Men
50
5
40
4
30
3
20
2
10
1
0
1865
W-M
Women
80
1875
9
8
Men
60
7
6
W-M
50
5
40
4
30
3
20
2
10
1
0
1925
1935
1945
1955
1965
1975
Years
1985
1995
8
W-M
e0
70
W-M
90
PERIOD 1925-2025
90
COHORTS 1865-1965
e0
2005
2015
0
2025
1885
1895
1905
1915
Cohorts
1925
1935
1945
1955
0
1965
Sex ratios, observed and projected by age
and for some cohorts
Differences in
life expectancy
at birth
(qxM/qxF)*100
400
350
300
1952
1865=1.4
1922
250
1890=3.7
200
1890
1912=4.8
150
1922=6.9
100
1932=7.4
50
1865
0
1952=6.8
1965=6.3
1912
1932
10
20
The leading adult ages
of cohort mortality
model
30
40
50
60
Age
45-64 years
70
80
90
100
SMR’s for ages 45-64 years by Circulatory diseases
and Cancers, MEN and WOMEN (per 1000)
Ages 45-64 years
SR x 1000
5
Men - Cardiov. diseases
4
Men - Cancers
3
2
Women - Cancers
1
Women - Cardiov. diseases
0
1865
1875
1885
1895
1905
1915
Cohorts
1925
1935
1945
1955
1965
SMR’s for ages 45-64, 65-79 and 80+ years by Circulatory
diseases and Cancers, MEN and WOMEN (per 1000)
Ages 45-64 years
SR x 1000
45-64 years
5
65-79 years
SR x 1000
35
Ages 65-79 years
Ages 65-79 years
Men - Cardiov. diseases
30
4
Men - Cardiov. diseases
Men - Cancers
25
3
20
Women - Cardiov. diseases
15
2
Women - Cancers
Men - Cancers
10
1
0
1865
Women - Cardiov. diseases
5
1905
0
1865
Women - Cancers
1875
1885
1895
1915
Cohorts
1925
1935
1945
1955
1965
1875
1885
1895
1915
1925
1935
1945
1955
1965
1935
1945
1955
1965
Cohorts
Ages
80 and over
80+ years
SR x 1000
120
Cohort circulatory mortality
at ages 80+ showing the
same trend by gender.
Observed cancer mortality
trend at ages 80+ still
increasing for men
1905
100
Men - Cardiov. diseases
80
60
Women - Cardiov. diseases
40
Men - Cancers
20
Women - Cancers
0
1865
1875
1885
1895
1905
1915
Cohorts
1925
Contributions by age (45+) of the leading causes of death to
increase or decrease gender differences between two selected
cohorts in life expectancy at birth
0.3
Respiratory system
Cancers
Circulatory diseases
Digestive system
Violent causes
Infectious diseases
0,5
Cohort 1952 vs 1965
Other diseases
0,4
Circulatory diseases
Cohorts
95+
90-94
85-89
75-79
80-84
Cancers
Violent causes
CANCERS
CIRC.
(ALL
SYSTEM
AGES)
(ALL
AGES)
Digestive system
Other diseases
0,3
0,2
0,1
Cohort 1932 vs 1952 - Men
Respiratory system
0.2
0.1
70-74
65-69
60-64
50-54
Contributions
0,6
Infectious diseases
45-49
-0.3
95+
-0.3
90-94
-0.2
85-89
-0.2
80-84
-0.1
75-79
-0.1
70-74
0
65-69
0
60-64
0.1
55-59
0.1
50-54
0.2
45-49
0.2
POSITIVE BAR:
contribution to
increasing the
distance from male
life expectancy at
birth
NEGATIVE BAR:
contribution to
bridging the distance
from female life
expectancy at birth
Cohort 1932 vs 1952
0.3
55-59
Cohort 1912 vs 1932
0.3
ALL
CAUSES
(ALL
AGES)
1912-1932
0.3
0.8
2.7
1932-1952
0.1
-0.6
-0.7
1952-1965
-0.1
-0.5
-0.5
0
0
-0,1
-0.2
Infectious diseases
Respiratory system
Cancers
95+
90-94
85-89
80-84
75-79
70-74
65-69
60-64
55-59
50-54
45-49
-0.3
Infectious diseases
Circulatory diseases
Other diseases
Respiratory system
Digestive system
Cancers
Violent causes
95+
90-94
85-89
80-84
75-79
70-74
65-69
60-64
55-59
50-54
45-49
40-44
30-34
-0.1
35-39
-0,2
Conclusions
 Making projections by cohort has the advantage of starting from
a mortality history, partially already observed, and so limiting
predictions to just one part of the whole story.
 Cohort analysis allow us to see the final result of a whole history
of survival and so to interpret some of the differences that can
be seen between cohorts as the effects of having experienced
different life histories.
 Important modifications of the longevity between cohorts and
between genders, and, above all, a rapid bridging of the gap
between men and women.
 Gender gaps in survival are often the result of a life history that
penalized men (World War I and II) with adoption of dangerous
life styles such as cigarette smoking. At the same time, for years
Italian women, who had been marginalized from the world of
work and protected by a traditional culture, were protected from
more harmful life styles and so were able to gain more years of
life, gradually increasing the gap from men.
Conclusions / 2
 In other countries the reduction in the gender gap for the most
recent cohorts was caused by a worsening in female survival due
to the new life styles of women, which became more and more
similar, negatively, to those of men. This was not true in Italy.
 Men in the most recent cohorts, by contrast, reduce some risks
of illness and death that are typically male. Greater care for their
bodies, for example, leads them directly or indirectly to follow
the path of prevention and to detect in advance some illnesses.
 In conclusion, we would like to interpret the GRADUAL
CLOSENING of male and female survival as the result of a
FEMINIZING OF MALE BEHAVIOUR. We might conclude that
Italian males in the younger generations seem to have
understood that they need to study women if they want to live
longer, hoping that Italian women do not imitate the men of the
previous generations!