Slowdown in Life Expectancy Improvements for European Countries From 2000 to 2019

Abstract Life expectancy improvements have slowed across Europe since around 2010 for unknown reasons. We aimed to assess the contribution of specific conditions and risk factors to changes in life expectancy. We compared Global Burden of Disease (GBD) 2019 estimates for life expectancy at birth, years of life lost to premature mortality (YLLs) and population attributable fractions (PAFs) for risk factors, for 17 European Economic Area (EEA) countries from 2000 to 2010 and from 2010 to 2019. All 17 countries experienced a slowdown in life expectancy improvements after 2010, after decades of improvement. Denmark experienced the smallest drop in improvement from 2000 to 2010 compared to 2010 to 2019 (0.75 years drop), followed by Norway (0.79), Iceland (0.86), Finland and Sweden (both 0.89). The 5 countries with the largest drop in improvement were Spain (1.6 years drop), the Netherlands (1.88), Portugal (1.92), the United Kingdom (UK) (2.13), and Ireland (2.77). Ischaemic heart disease and stroke made the biggest contribution to the slowdown in life expectancy. Important risk factors for mortality varied by country and included tobacco, drug and alcohol use, and high fasting plasma glucose. The Nordic countries have maintained improvements in life expectancy substantially better than other European countries. The different patterns in different countries suggest multiple factors are contributing to the changes, including specific conditions, risks and behaviours, and broader societal determinants of health. Large scale, international, co-ordinated research is needed to better understand these changes and inform policy actions, particularly as the COVID-19 pandemic will increase international differences.

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Slowing improvements in life expectancy across European Economic Area countries

European Journal of Public Health ◽

10.1093/eurpub/ckz185.160 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

J Ford ◽

N Steel ◽

E Aasheim ◽

B Devleesschauwer ◽

A Gallay ◽

...

Keyword(s):

Risk Factors ◽

Lung Cancer ◽

Life Expectancy ◽

Data Availability ◽

Years Of Life Lost ◽

European Economic Area ◽

European Economic ◽

Economic Area ◽

Self Harm ◽

The Uk

Abstract Background Life expectancy improvements have slowed down in several European countries since around 2011. The relative contributions from changes in specific conditions (e.g. cancers) and broader risk factors (e.g. smoking or austerity) remain unclear. We aimed to explore the different potential causes in 17 European Economic Area (EEA) countries. Methods We compared Global Burden of Disease (GBD) study estimates for life expectancy, years of life lost (YLLs) and population attributable fractions (PAFs) for risk factors, for 2005-2011 and 2011-2017 for 17 EEA countries. Three countries with the largest absolute improvements and three with the smallest were selected for analysis by gender, age, condition and risk factors. Results Norway, France and Belgium had the largest improvement in life expectancy (+1.5, +1.2 and +1.2 years respectively) from 2011 to 2017, and Germany, Iceland and the UK the smallest (+0.1, +0.2 and +0.2 years). Life expectancy reduced slightly for women aged over 80 in Germany and UK, men aged over 50 in Germany, and for men in all age groups up to 90 years in Iceland. Norway, France and Belgium saw faster improvements in YLLs from lung cancer and Norway and France for COPD in both men and women, and from self-harm in men, after 2011 than before. PAF for tobacco declined faster after 2011. Germany, Iceland and the UK saw slower improvements in cardiovascular disease and in Germany and the UK lung cancer. In Iceland, YLLs for cancers, self harm, respiratory disease, cirrhosis and dementia all worsened after 2011. PAF for tobacco remained high or declined less after 2011 in all 3 countries. PAFs for alcohol and drug use remained high in Iceland and UK. Conclusions Differential changes in major fatal diseases and risk factors help explain national changes in life expectancies, but national differences in data availability may affect results. Further research is needed into the ‘causes of the causes’, such as the 2008 economic crash in Iceland. Key messages Differential changes in major fatal diseases and risk factors help explain national changes in life expectancies. Norway, France and Belgium had the largest improvement in life expectancy from 2011 to 2017, and Germany, Iceland and the UK the smallest.

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A VARIED PATTERN OF CHANGE OF THE SEX DIFFERENTIAL IN SURVIVAL IN THE G7 COUNTRIES

Journal of Biosocial Science ◽

10.1017/s0021932005007212 ◽

2005 ◽

Vol 38 (3) ◽

pp. 391-401 ◽

Cited By ~ 40

Author(s):

FRANK TROVATO ◽

NILS B. HEYEN

Keyword(s):

Sex Differences ◽

Life Expectancy ◽

Point Of View ◽

Industrialized Countries ◽

Circulatory Disease ◽

G7 Countries ◽

Death Rates ◽

The United Kingdom ◽

Life Expectancy At Birth ◽

The Difference

Over the course of the 20th century the sex differential in life expectancy at birth in the industrialized countries has widened considerably in favour of women. Starting in the early 1970s, the beginning of a reversal in the long-term pattern of this differential has been noted in some high-income countries. This study documents a sustained pattern of narrowing of this measure into the later part of the 1990s for six of the populations that comprise the G7 countries: Canada, France, Germany, Italy, England and Wales (as representative of the United Kingdom) and USA. For Japan, a persistence of widening sex differences in survival is noted. The sex differences in life expectancy are decomposed over roughly three decades (early 1970s to late 1990s) from the point of view of four major cause-of-death categories: circulatory diseases, cancers, accidents/violence/suicide, and ‘other’ (residual) causes. In the six countries where the sex gap has narrowed, this has resulted primarily from reduced sex differences in circulatory disease mortality, and secondarily from reduced differences in male and female death rates due to accidents, violence and suicide combined. In some of the countries sex differentials in cancer mortality have been converging lately, and this has also contributed to a narrowing of the difference in life expectancy. In Japan, males have been less successful in reducing their survival disadvantage in relation to Japanese women with regard to circulatory disease and cancer; and in the case of accidents/violence/suicide, male death rates increased during the 1990s. These trends explain the divergent pattern of the sex difference in life expectation in Japan as compared with the other G7 nations.

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Contribution of avoidable causes of death to premature mortality in Poland and selected European countries

Studia Demograficzne ◽

10.33119/sd.2020.2.4 ◽

2020 ◽

Author(s):

Bogdan Wojtyniak ◽

Jakub Stokwiszewski

Keyword(s):

Life Expectancy ◽

Central Europe ◽

Causes Of Death ◽

Average Rate ◽

Premature Mortality ◽

European Countries ◽

Annual Percent Change ◽

Death Rates ◽

Central European ◽

The Difference

Our study, availing the new, agreed by the OECD and Eurostat, lists of preventable and treatable causes of death, seeks to quantify the contribution of avoidable causes to premature mortality and its dynamics in Poland and Central European countries – Czechia, Hungary, Lithuania and Slovenia, in comparison with Sweden serving as a benchmark country in 1999–2017. We calculated age standardised death rates for the broad groups of avoidable causes and more specific ones, which comprised preventable and treatable cancer and diseases of the circulatory system (DCS), preventable injuries and alcohol-related diseases. Deaths from not avoidable causes were also analysed. The analysis of time trends in the death rates and calculation of the Average Annual Percent Change (AAPC) for the overall trend were performed with joint-point models. The contribution of changes in mortality from avoidable causes to increase life expectancy during 1999–2017 and contribution of the difference in mortality from these causes to the difference in life expectancy between five countries and Sweden were based on the decomposition of temporary life expectancy between birth and age 75 [e(0-75)]. For the calculation of life expectancy, we used the classic Chiang method and the decomposition of life expectancy by the death causes and age was conducted with the Arriaga method. The AAPC of death rates from avoidable causes in 1999–2017 was similar in all the countries but Lithuania, where the decline started later. The decline in the death rates from not avoidable causes is much slower than the rates from avoidable causes. Mortality from treatable causes was decreasing faster than from preventable causes in most populations. In 1999–2017, the average rate of mortality decline for preventable cancer was greater among men than among women, while for treatable cancer the sex-related differences were much smaller and in favour of women. As for preventable and treatable death from DCS, their decrease was faster among women than men in all the countries but Sweden. Improvements in mortality from causes that could be avoided through prevention or treatment made substantial positive contributions to the overall change in life expectancy in all the countries. The differences in temporary life expectancy e(0-75) between the analysed Central European countries and Sweden were much smaller in 2017 than in 1999, due to the reduction of the gap in mortality from avoidable causes. Our results show that among men, and to a lesser extent among women, mortality from preventable causes contributes more than mortality from causes that can be effectively treated to shorter life expectancy in the countries of Central Europe than in Sweden. This indicates that in reducing the health gap between the inhabitants of Central Europe and Western Europe, the healthcare system should consider disease prevention even to a greater extent than just treating them.

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The global burden of premature mortality due to the Middle East respiratory syndrome (MERS) using standard expected years of life lost, 2012 to 2019

BMC Public Health ◽

10.1186/s12889-019-7899-2 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 6

Author(s):

Maryam Salamatbakhsh ◽

Kazhal Mobaraki ◽

Sara Sadeghimohammadi ◽

Jamal Ahmadzadeh

Keyword(s):

Middle East ◽

Age Groups ◽

International Study ◽

Premature Mortality ◽

Middle East Respiratory Syndrome ◽

Global Burden ◽

Years Of Life Lost ◽

Life Expectancy At Birth ◽

First Case ◽

Disease Study

Abstract Background It has been 8 years since the first case of Middle East respiratory syndrome coronavirus (MERS-CoV) was reported in Saudi Arabia and the disease is still being reported in 27 countries; however, there is no international study to estimate the overall burden related of this emerging infectious disease. The present study was conducted to assess the burden of premature mortality due to Middle East respiratory syndrome (MERS) worldwide. Methods In this retrospective analysis, we have utilized publicly available data from the WHO website related to 1789 MERS patients reported between September 23, 2012 and May 17, 2019. To calculate the standard expected years of life lost (SEYLL), life expectancy at birth was set according to the 2000 global burden of disease study on levels 25 and 26 of West model life tables from Coale-Demeny at 82.5 and 80 years for females and males, respectively. Results Overall, the total SEYLL in males and females was 10,702 and 3817.5 years, respectively. The MERS patients within the age range of 30–59 year-olds had the highest SEYLL (8305.5 years) in comparison to the patients within the age groups 0–29 (SEYLL = 3744.5 years) and ≥ 60 years (SEYLL = 2466.5 years). The total SEYLL in all age groups in 2012, 2013, 2014, 2015, 2016, 2017, 2018, and 2019 were 71.5, 2006.5, 3162, 4425.5, 1809.5, 878, 1257.5 and 909 years, respectively. The most SEYLL related to MERS-CoV infection was in the early four years of the onset of the pandemic (2012 to 2015) and in the last four years of the MERS-CoV pandemic (216 to 2019), a significant reduction was observed in the SEYLL related to MERS-CoV infection in the MERS patients. Conclusion We believe that the findings of this study will shed light about the burden of premature mortality due to MERS infection in the world and the results may provide necessary information for policy-makers to prevent, control, and make a quick response to the outbreak of MERS-CoV disease.

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Caste, religion and regional differentials in life expectancy at birth in India: cross-sectional estimates from recent National Family Health Survey

BMJ Open ◽

10.1136/bmjopen-2019-035392 ◽

2020 ◽

Vol 10 (8) ◽

pp. e035392

Author(s):

Meena Kumari ◽

Sanjay K Mohanty

Keyword(s):

Life Expectancy ◽

Health Survey ◽

Family Health ◽

Premature Mortality ◽

Adult Mortality ◽

National Family Health Survey ◽

Cross Sectional ◽

Registration System ◽

Life Expectancy At Birth ◽

National Family

ObjectiveThough estimates of longevity are available by states, age, sex and place of residence in India, disaggregated estimates by social and economic groups are limited. This study estimates the life expectancy at birth and premature mortality by caste, religion and regions of India.DesignThis study primarily used cross-sectional data from the National Family Health Survey (NFHS-4), 2015–2016 and the Sample Registration System (SRS), 2011–2015. The NFHS-4 is the largest ever demographic and health survey covering 601 509 households and 811 808 individuals across all states and union territories in India.MeasuresThe abridged life table is constructed to estimate the life expectancy at birth, adult mortality (45q15) and premature mortality (70q0) by caste, religion and region.ResultsLife expectancy at birth was estimated at 63.1 years (95% CI 62.60 -63.64) for scheduled castes (SC), 64.0 years (95% CI 63.25 - 64.88) for scheduled tribes (ST), 65.1 years (95% CI 64.69 - 65.42) for other backward classes (OBC) and 68.0 years (95% CI 67.44 - 68.45) for others. The life expectancy at birth was higher among o Christians 68.1 years (95% CI 66.44 - 69.60) than Muslims 66.0 years (95% CI 65.29 - 66.54) and Hindus 65.0 years (95% CI 64.74 -65.22). Life expectancy at birth was higher among females than among males across social groups in India. Premature mortality was higher among SC (0.382), followed by ST (0.381), OBC (0.344) and others (0.301). The regional variation in life expectancy by age and sex is large.ConclusionIn India, social and religious differentials in life expectancy by sex are modest and need to be investigated among poor and rich within these groups. Premature mortality and adult mortality are also high across social and religious groups.

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The burden of disease among Brazilian older adults and the challenge for health policies. Results of the Global Burden of Disease Study 2017

10.21203/rs.3.rs-27806/v1 ◽

2020 ◽

Author(s):

VALÉRIA MARIA DE AZEREDO PASSOS ◽

Ana Paula Silva Champs ◽

Renato Teixeira ◽

Maria Fernanda Furtado Lima-Costa ◽

Renata Kirkwood ◽

...

Keyword(s):

Older Adults ◽

Information System ◽

Life Expectancy ◽

Burden Of Disease ◽

Health Policies ◽

Global Burden Of Disease ◽

Global Burden ◽

Years Of Life Lost ◽

Life Expectancy At Birth ◽

Life Years

Abstract Background Brazil is the world’s fifth most populous nation, and is currently experimenting a fast demographic ageing process in a context of scarce resources and social inequalities. To understand the health profile of older adults in Brazil is fundamental for planning public policies. Methods The estimates were derived from data obtained through the collaboration between Brazilian Ministry of Health with the Institute of Health Metrics and Evaluation of the University of Washington. The Brazilian Institute of Geography and Statistics provided the population estimates. Data on causes of death came from the Mortality Information System. To calculate morbidity, population-based studies on the prevalence of diseases in Brazil were comprehensively searched, in addition to information obtained from national databases such as the Hospital Information System, the Outpatient Information System, and the Injury Information System. We presented the Global Burden of Disease (GBD) 2017 estimates among Brazilian older adults (60 + years old) for life expectancy at birth (LE), healthy life expectancy (HALE), cause-specific mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs), from 2000 to 2017. Results LE at birth significantly increased from 71.3 years (95%UI to 70.9–71.8) to 75.2 years (95%UI 74.7–75.7). There was a trend of increasing HALE, from 62.2 years (95%UI 59.54–64.5) to 65.5 years (95%UI 62.6–68.0). The proportion of DALYs among older adults increased from 7.3–10.3%. Chronic noncommunicable diseases are the leading cause of death among middle-aged and older adults, while Alzheimer's disease is a leading cause only among older adults. Mood disorders, musculoskeletal pain and hearing or vision losses are among the leading causes of disability. Conclusions The increase in LE and the decrease of the DALYs rates are probably results of the improvement of social conditions and health policies. However, the smaller increase of HALE than LE means that despite living more, people spend a substantial time of their old age with disability and illness. Preventable or potentially controllable diseases are responsible for most of the burden of disease among Brazilian older adults. Health investments are necessary to obtain longevity with quality of life in Brazil.

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1491Impact of COVID19 on years of life lost with and without disability across 18 European-countries

International Journal of Epidemiology ◽

10.1093/ije/dyab168.017 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

Author(s):

Sara Ahmadi-Abhari ◽

Piotr Bandosz ◽

Mika Kivimaki ◽

Lefkos Middleton

Keyword(s):

Cardiovascular Disease ◽

Life Expectancy ◽

Mortality Rates ◽

European Countries ◽

Accurate Estimation ◽

Years Of Life Lost ◽

Incidence And Mortality ◽

The Impact ◽

Prevalence Of Dementia ◽

Incidence Of Dementia

Abstract Background To accurately assess the impact of COVID19 on life-expectancy, years of life lost, and prevalence of dementia and disability, a model integrating calendar-trends in cardiovascular-disease, dementia, disability and mortality is required. We estimated these impacts in Austria, Belgium, Czech-Republic, Denmark, Estonia, France, Germany, Greece, Hungary, Italy, The Netherlands, Poland, Portugal, Slovenia, Spain, Sweden, Switzerland, and the UK. Methods Data to inform the ten-state Monte-Carlo Markov-model for the 18 European countries were derived from official-statistics for population-numbers and mortality-rates (age&sex-specific) and from Survey for Health, Ageing and Retirement in Europe for prevalence-estimates and transition-probabilities. Impact of COVID19 was measured comparing the estimates derived from incorporating expected mortality rates assuming calendar-trends in mortality and incidence of dementia, disability, and cardiovascular-disease continue those of the past two-decades, and those incorporating excess COVID19 mortality. Results Assuming COVID-19 vaccination and termination of the pandemic will be accomplished by the end of 2021, the pandemic will have resulted in a loss of 9.3M (95% Uncertainty-Interval 1.3M-29.8M) person-years of life, including 7.1M person-years of dementia-free life and 5.2M person-years of disability-free life among the 289M population (as of 2019) above age-35. The effects on prevalence of dementia, disability and life-expectancy will be presented. Conclusions The impact of the pandemic on disability-free person-years of life lost are devastating, marking a need for more rapid actions to halt the spread of epidemics. Key messages Accurate estimation of future prevalence of dementia and disability to quantify the impact of the pandemic on years of life lost needs to simultaneously account for the declining trends in incidence of dementia and the decline in cardiovascular disease incidence and mortality resulting in increased life-expectancy and a larger pool susceptible to dementia and disability. The COVID19 pandemic is estimated to result in 9.3million person-years of life lost in 18 European countries including a loss of 7.1M person-years of dementia-free life and 5.2M person-years of disability-free life.

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The burden of disease among Brazilian older adults and the challenge for health policies: results of the Global Burden of Disease Study 2017

Population Health Metrics ◽

10.1186/s12963-020-00206-3 ◽

2020 ◽

Vol 18 (S1) ◽

Author(s):

Valéria Maria de Azeredo Passos ◽

Ana Paula Silva Champs ◽

Renato Teixeira ◽

Maria Fernanda Furtado Lima-Costa ◽

Renata Kirkwood ◽

...

Keyword(s):

Older Adults ◽

Information System ◽

Life Expectancy ◽

Burden Of Disease ◽

Health Policies ◽

Global Burden Of Disease ◽

Global Burden ◽

Years Of Life Lost ◽

Life Expectancy At Birth ◽

Life Years

Abstract Background Brazil is the world’s fifth most populous nation, and is currently experimenting a fast demographic aging process in a context of scarce resources and social inequalities. To understand the health profile of older adults in Brazil is fundamental for planning public policies. Methods The estimates were derived from data obtained through the collaboration between the Brazilian Ministry of Health and the Institute of Health Metrics and Evaluation of the University of Washington. The Brazilian Institute of Geography and Statistics provided the population estimates. Data on causes of death came from the Mortality Information System. To calculate morbidity, population-based studies on the prevalence of diseases in Brazil were comprehensively searched, in addition to information obtained from national databases such as the Hospital Information System, the Outpatient Information System, and the Injury Information System. We presented the Global Burden of Disease (GBD) 2017 estimates among Brazilian older adults (60+ years old) for life expectancy at birth (LE), healthy life expectancy (HALE), cause-specific mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs), from 2000 to 2017. Results LE at birth significantly increased from 71.3 years (95% UI to 70.9-71.8) to 75.2 years (95% UI 74.7-75.7). There was a trend of increasing HALE, from 62.2 years (95% UI 59.54-64.5) to 65.5 years (95% UI 62.6-68.0). The proportion of DALYs among older adults increased from 7.3 to 10.3%. Chronic noncommunicable diseases are the leading cause of death among middle aged and older adults, while Alzheimer’s disease is a leading cause only among older adults. Mood disorders, musculoskeletal pain, and hearing or vision losses are among the leading causes of disability. Conclusions The increase in LE and the decrease of the DALYs rates are probably results of the improvement of social conditions and health policies. However, the smaller increase of HALE than LE means that despite living more, people spend a substantial time of their old age with disability and illness. Preventable or potentially controllable diseases are responsible for most of the burden of disease among Brazilian older adults. Health investments are necessary to obtain longevity with quality of life in Brazil.

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Changing contribution of smoking to the sex differences in life expectancy in Europe, 1950–2014

European Journal of Epidemiology ◽

10.1007/s10654-020-00602-x ◽

2020 ◽

Vol 35 (9) ◽

pp. 835-841

Author(s):

Fanny Janssen

Keyword(s):

Sex Differences ◽

Life Expectancy ◽

Sex Difference ◽

Western Europe ◽

Decomposition Analysis ◽

European Countries ◽

Attributable Mortality ◽

Mortality Data ◽

Life Expectancy At Birth ◽

Related Part

Abstract This article provides a detailed and overarching illustration of the contribution of smoking to sex differences in life expectancy at birth (e0) in Europe, focusing on changes over time and differences between both European countries and European regions. For this purpose, the sex difference in e0 for 31 European countries over the 1950–2014 period was decomposed into a smoking- and a non-smoking-related part, using all-cause mortality data and indirectly estimated smoking-attributable mortality rates by age and sex, and a formal decomposition analysis. It was found that smoking-attributable mortality contributed, on average, 3 years (43.5%) to the 7-year life expectancy difference between women and men in 2014. This contribution, was largest in 1995, at 5.2 out of 9.0 years, and subsequently declined in parallel with the average sex difference in life expectancy. The average contribution of smoking-attributable mortality was especially large in North-Western Europe around 1975; in Southern Europe around 1985; and in Eastern Europe around 1990–1995, when smoking-attributable mortality reached maximum levels among men, but was still low among women. The observed parallel decline from 1995 onwards in the sex differences in e0 and the absolute contribution of smoking to this sex difference suggests that this recent decline in the sex difference in e0 can be almost fully explained by historical changes in sex differences in smoking, and, consequently, smoking-attributable mortality. In line with the progression of the smoking epidemic, the sex differences in life expectancy in Europe are expected to further decline in the future.

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Excess mortality in patients with schizophrenia spectrum disorders in Malaga (Spain): A cohort study

Epidemiology and Psychiatric Sciences ◽

10.1017/s2045796020001146 ◽

2021 ◽

Vol 30 ◽

Author(s):

Berta Moreno-Küstner ◽

Jose Guzman-Parra ◽

Yolanda Pardo ◽

Yolanda Sanchidrián ◽

Sebastián Díaz-Ruiz ◽

...

Keyword(s):

Life Expectancy ◽

Excess Mortality ◽

Years Of Life Lost ◽

Schizophrenia Spectrum Disorders ◽

Case Register ◽

Factors Associated ◽

Life Expectancy At Birth ◽

Schizophrenia Spectrum ◽

Causes Of Mortality ◽

Spectrum Disorders

Abstract Aims There is evidence that patients with schizophrenia spectrum disorders present higher mortality in comparison with the general population. The aim of this study was to analyse the causes of mortality and sociodemographic factors associated with mortality, standardised mortality ratios (SMRs), life expectancy and potential years of life lost (YLL) in patients with schizophrenia spectrum disorders in Spain. Methods The study included a cohort of patients from the Malaga Schizophrenia Case Register (1418 patients; 907 males; average age 42.31 years) who were followed up for a minimum of 10 years (median = 13.43). The factors associated with mortality were analysed with a survival analysis using Cox's proportional hazards regression model. Results The main causes of mortality in the cohort were circulatory disease (21.45%), cancer (17.09%) and suicide (13.09%). The SMR of the cohort was more than threefold that of the population of Malaga (3.19). The life expectancy at birth was 67.11 years old, which is more than 13 years shorter than that of the population of Malaga. The YLL was 20.74. The variables associated with a higher risk of mortality were age [adjusted hazard ratio (AHR) = 1.069, p < 0.001], male gender (AHR = 1.751, p < 0.001) and type of area of residence (p = 0.028; deprived urban zone v. non-deprived urban area, AHR = 1.460, p = 0.028). In addition, receiving welfare benefit status in comparison with employed status (AHR = 1.940, p = 0.008) was associated with increased mortality. Conclusions There is excess mortality in patients with schizophrenia spectrum disorders and also an association with age, gender, socioeconomic inequalities and receiving welfare benefits. Efforts directed towards improved living conditions could have a positive effect on reducing mortality.

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