scholarly journals Smoking and Inequalities in Mortality in 11 European Countries: A Birth Cohort Analysis

2020 ◽  
Author(s):  
Di Long ◽  
Wilma Nusselder ◽  
Pekke Martikainen ◽  
Olle Lundberg ◽  
Henrik Brønnum-Hansen ◽  
...  
Keyword(s):  
Cohort Analysis ◽  
Total Mortality ◽  
Lung Cancer Mortality ◽  
European Countries ◽  
Attributable Mortality ◽  
Mortality Data ◽  
Birth Cohorts ◽  
Low Educated ◽  
Rate Ratios ◽  
Inequalities In Mortality

Abstract Purpose: To study the trends of smoking-attributable mortality among the low- and high-educated in consecutive birth cohorts in 11 European countries. Methods: Register-based mortality data were collected among adults aged 30 to 79 years in 11 European countries between 1971 and 2012. Smoking-attributable deaths were estimated indirectly from lung cancer mortality rates using the Preston-Glei-Wilmoth method. Rate ratios and rate differences among the low and high-educated were estimated and used to estimate the contribution of inequality in smoking-attributable mortality to inequality in total mortality.Results: In most countries, smoking-attributable mortality decreased in consecutive birth cohorts born between 1906 and 1961 among low and high-educated men and high-educated women, but not among low-educated women among whom it increased. Relative educational inequalities in smoking-attributable mortality increased among both men and women with no signs of turning points. Absolute inequalities were stable among men but slightly increased among women. The contribution of inequality in smoking-attributable mortality to inequality in total mortality decreased in consecutive generations among men but increased among women. Conclusions: Generations born during the twentieth century are at different stages of the smoking epidemic. Smoking might become less important as a driver of inequalities in total mortality among men in the future. However, among women, smoking threatens to further widen inequalities in total mortality.

scholarly journals Smoking and inequalities in mortality in 11 European countries: a birth cohort analysis

2021 ◽  
Author(s):  
Di Long ◽  
Johan Mackenbach ◽  
Pekka Martikainen ◽  
Olle Lundberg ◽  
Henrik Brønnum-Hansen ◽  
...  
Keyword(s):  
Cohort Analysis ◽  
Total Mortality ◽  
Lung Cancer Mortality ◽  
European Countries ◽  
Attributable Mortality ◽  
Mortality Data ◽  
Birth Cohorts ◽  
Low Educated ◽  
Rate Ratios ◽  
Inequalities In Mortality

Abstract Purpose: To study the trends of smoking-attributable mortality among the low- and high-educated in consecutive birth cohorts in 11 European countries. Methods: Register-based mortality data were collected among adults aged 30 to 79 years in 11 European countries between 1971 and 2012. Smoking-attributable deaths were estimated indirectly from lung cancer mortality rates using the Preston-Glei-Wilmoth method. Rate ratios and rate differences among the low and high-educated were estimated and used to estimate the contribution of inequality in smoking-attributable mortality to inequality in total mortality.Results: In most countries, smoking-attributable mortality decreased in consecutive birth cohorts born between 1906 and 1961 among low and high-educated men and high-educated women, but not among low-educated women among whom it increased. Relative educational inequalities in smoking-attributable mortality increased among both men and women with no signs of turning points. Absolute inequalities were stable among men but slightly increased among women. The contribution of inequality in smoking-attributable mortality to inequality in total mortality decreased in consecutive generations among men but increased among women. Conclusions: Smoking might become less important as a driver of inequalities in total mortality among men in the future. However, among women, smoking threatens to further widen inequalities in total mortality.

scholarly journals Smoking and inequalities in mortality in 11 European countries: a birth cohort analysis

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Di Long ◽  
Johan Mackenbach ◽  
Pekka Martikainen ◽  
Olle Lundberg ◽  
Henrik Brønnum-Hansen ◽  
...  
Keyword(s):  
Cohort Analysis ◽  
Total Mortality ◽  
Lung Cancer Mortality ◽  
European Countries ◽  
Attributable Mortality ◽  
Mortality Data ◽  
Birth Cohorts ◽  
Low Educated ◽  
Rate Ratios ◽  
Inequalities In Mortality

Abstract Purpose To study the trends of smoking-attributable mortality among the low and high educated in consecutive birth cohorts in 11 European countries. Methods Register-based mortality data were collected among adults aged 30 to 79 years in 11 European countries between 1971 and 2012. Smoking-attributable deaths were estimated indirectly from lung cancer mortality rates using the Preston-Glei-Wilmoth method. Rate ratios and rate differences among the low and high-educated were estimated and used to estimate the contribution of inequality in smoking-attributable mortality to inequality in total mortality. Results In most countries, smoking-attributable mortality decreased in consecutive birth cohorts born between 1906 and 1961 among low- and high-educated men and high-educated women, but not among low-educated women among whom it increased. Relative educational inequalities in smoking-attributable mortality increased among both men and women with no signs of turning points. Absolute inequalities were stable among men but slightly increased among women. The contribution of inequality in smoking-attributable mortality to inequality in total mortality decreased in consecutive generations among men but increased among women. Conclusions Smoking might become less important as a driver of inequalities in total mortality among men in the future. However, among women, smoking threatens to further widen inequalities in total mortality.

scholarly journals Progress against inequalities in mortality: register-based study of 15 European countries between 1990 and 2015

2019 ◽  
Vol 34 (12) ◽  
pp. 1131-1142 ◽  
Author(s):  
Johan P. Mackenbach ◽  
José Rubio Valverde ◽  
Matthias Bopp ◽  
Henrik Brønnum-Hansen ◽  
Giuseppe Costa ◽  
...  
Keyword(s):  
Health Care ◽  
Fixed Effects ◽  
Causes Of Death ◽  
Health Care Expenditure ◽  
European Countries ◽  
Mortality Data ◽  
Factors Associated ◽  
Country Level ◽  
Low Educated ◽  
Inequalities In Mortality

AbstractSocioeconomic inequalities in mortality are a challenge for public health around the world, but appear to be resistant to policy-making. We aimed to identify European countries which have been more successful than others in narrowing inequalities in mortality, and the factors associated with narrowing inequalities. We collected and harmonised mortality data by educational level in 15 European countries over the last 25 years, and quantified changes in inequalities in mortality using a range of measures capturing different perspectives on inequality (e.g., ‘relative’ and ‘absolute’ inequalities, inequalities in ‘attainment’ and ‘shortfall’). We determined which causes of death contributed to narrowing of inequalities, and conducted country- and period-fixed effects analyses to assess which country-level factors were associated with narrowing of inequalities in mortality. Mortality among the low educated has declined rapidly in all European countries, and a narrowing of absolute, but not relative inequalities was seen in many countries. Best performers were Austria, Italy (Turin) and Switzerland among men, and Spain (Barcelona), England and Wales, and Austria among women. Ischemic heart disease, smoking-related causes (men) and amenable causes often contributed to narrowing inequalities. Trends in income inequality, level of democracy and smoking were associated with widening inequalities, but rising health care expenditure was associated with narrowing inequalities. Trends in inequalities in mortality have not been as unfavourable as often claimed. Our results suggest that health care expansion has counteracted the inequalities widening effect of other influences.

scholarly journals Similarities and Differences Between Sexes and Countries in the Mortality Imprint of the Smoking Epidemic in 34 Low-Mortality Countries, 1950–2014

2019 ◽  
Vol 22 (7) ◽  
pp. 1210-1220 ◽  
Author(s):  
Fanny Janssen
Keyword(s):  
North American ◽  
Epidemic Model ◽  
Lung Cancer Mortality ◽  
Wave Pattern ◽  
Attributable Mortality ◽  
Mortality Data ◽  
The North ◽  
Country Differences ◽  
Similarities And Differences ◽  
Disease Study

Abstract Introduction The smoking epidemic greatly affected mortality levels and trends, especially among men in low-mortality countries. The objective of this article was to examine similarities and differences between sexes and low-mortality countries in the mortality imprint of the smoking epidemic. This will provide important additions to the smoking epidemic model, but also improve our understanding of the differential impact of the smoking epidemic, and provide insights into its future impact. Methods Using lung-cancer mortality data for 30 European and four North American or Australasian countries, smoking-attributable mortality fractions (SAMF) by sex, age (35–99), and year (1950–2014) were indirectly estimated. The timing and level of the peak in SAMF35-99, estimated using weighting and smoothing, were compared. Results Among men in all countries except Bulgaria, a clear wave pattern was observed, with SAMF35-99 peaking, on average, at 33.4% in 1986. Eastern European men experienced the highest (40%) and Swedish men the lowest (16%) peak. Among women, SAMF35-99 peaked, on average, at 18.1% in 2007 in the North American/Australasian countries and five Northwestern European countries, and increased, on average, to 7.5% in 2014 in the remaining countries (4% in Southern and Eastern Europe). The average sex difference in the peak is at least 25.6 years in its timing and at most 22.9 percentage points in its level. Conclusions Although the progression of smoking-attributable mortality in low-mortality countries was similar, there are important unexpected sex and country differences in the maximum mortality impact of the smoking epidemic driven by cross-country differences in economic, political, and emancipatory progress. Implications The formal, systematic, and comprehensive analysis of similarities and differences between sexes and 34 low-mortality countries in long-term time trends (1950–2014) in smoking-attributable mortality provided important additions to the Global Burden of Disease study and the descriptive smoking epidemic model (Lopez et al.). Despite a general increase followed by a decline, the timing of the maximum mortality impact differs more between sexes than previously anticipated, but less between regions. The maximum mortality impact among men differs considerably between countries. The observed substantial diversity warrants country-specific tobacco control interventions and increased attention to the current or expected higher smoking-attributable mortality shares among women compared to men.

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

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.

scholarly journals Why Does Child Mortality Decrease With Age? Modeling the Age-Associated Decrease in Mortality Rate Using WHO Metadata From 25 Countries

2021 ◽  
Vol 9 ◽  
Author(s):  
Josef Dolejs ◽  
Helena Homolková
Keyword(s):  
Mortality Rate ◽  
Child Mortality ◽  
Total Mortality ◽  
Population Heterogeneity ◽  
European Countries ◽  
Mortality Data ◽  
Inverse Proportion ◽  
Child Mortality Rate ◽  
First Year Of Life ◽  
Age Range

Background: Our previous study analyzed the age trajectory of mortality (ATM) in 14 European countries, while this study aimed at investigating ATM in other continents and in countries with a higher level of mortality. Data from 11 Non-European countries were used.Methods: The number of deaths was extracted from the WHO mortality database. The Halley method was used to calculate the mortality rates in all possible calendar years and all countries combined. This method enables us to combine more countries and more calendar years in one hypothetical population.Results: The age trajectory of total mortality (ATTM) and also ATM due to specific groups of diseases were very similar in the 11 non-European countries and in the 14 European countries. The level of mortality did not affect the main results found in European countries. The inverse proportion was valid for ATTM in non-European countries with two exceptions.Slower or no mortality decrease with age was detected in the first year of life, while the inverse proportion model was valid for the age range (1, 10) years in most of the main chapters of ICD10.Conclusions: The decrease in child mortality with age may be explained as the result of the depletion of individuals with congenital impairment. The majority of deaths up to the age of 10 years were related to congenital impairments, and the decrease in child mortality rate with age was a demonstration of population heterogeneity. The congenital impairments were latent and may cause death even if no congenital impairment was detected.

scholarly journals Long-Term Trends of Liver Cancer Incidence and Mortality in China 1990–2017: A Joinpoint and Age–Period–Cohort Analysis

2019 ◽  
Vol 16 (16) ◽  
pp. 2878 ◽  
Author(s):  
Fang Wang ◽  
Sumaira Mubarik ◽  
Yu Zhang ◽  
Lu Wang ◽  
Yafeng Wang ◽  
...  
Keyword(s):  
Liver Cancer ◽  
Cancer Incidence ◽  
Cohort Analysis ◽  
Cohort Effects ◽  
Mortality Data ◽  
Period Effect ◽  
Birth Cohorts ◽  
Incidence And Mortality ◽  
Long Term Trends

Liver cancer (LC) is one of the most common causes of cancer-related deaths: this study aims to present the long-term trends and age–period–cohort effects of the incidence of and mortality from LC in China during 1990–2017. Incidence and mortality data were obtained from the Global Burden of Disease Study 2017. We determined trends in the age-standardized incidence rate (ASIR) and mortality rate (ASMR) using Joinpoint regression. An age–period–cohort (APC) analysis was performed to describe the long-term trends with intrinsic estimator methods. The ASMR decreased markedly before 2013 and increased thereafter, with overall average annual percent change (AAPC) values of −0.5% (95% confidence interval (CI): −0.6%, −0.3%) for men and −1.3% (−1.6%, −1.0%) for women during 1990–2017. The ASIR significantly increased by 0.2% (0.1%, 0.3%) in men and decreased by 1.1% (−1.2%, −1.0%) in women from 1990 to 2017. The risks of LC incidence and mortality increased with age in both genders. The period effect risk ratios (RRs) of incidence and mortality displayed similar monotonic increasing trends in men and remained stable in women. The cohort effect showed an overall downward trend and almost overlapping incidence and mortality in both genders, and later birth cohorts experienced lower RRs than previous birth cohorts. Older age, recent period, and birth before 1923 were associated with a higher risk of liver cancer incidence and mortality. The net age and period effects showed an increasing trend, while the cohort effects presented a decreasing trend in incidence and mortality risk. As China’s population aging worsens and with the popularization of unhealthy lifestyles, the burden caused by liver cancer will remain a huge challenge in China’s future.

scholarly journals Impact of obesity on life expectancy among different European countries: secondary analysis of population-level data over the 1975–2012 period

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e028086 ◽  
Author(s):  
Nikoletta Vidra ◽  
Sergi Trias-Llimós ◽  
Fanny Janssen
Keyword(s):  
Life Expectancy ◽  
Secondary Analysis ◽  
Population Level ◽  
European Countries ◽  
Attributable Mortality ◽  
Mortality Data ◽  
Weighted Sum Method ◽  
All Cause Mortality ◽  
The Usa ◽  
The Impact

ObjectiveThis study assesses the impact of obesity on life expectancy for 26 European national populations and the USA over the 1975–2012 period.DesignSecondary analysis of population-level obesity and mortality data.SettingEuropean countries, namely Austria, Belarus, Belgium, the Czech Republic, Denmark, Estonia, Finland, France, Hungary, Iceland, Ireland, Italy, Latvia, Lithuania, Luxembourg, the Netherlands, Norway, Poland, Portugal, the Russian Federation, Slovakia, Spain, Sweden, Switzerland, Ukraine and the UK; and the USA.ParticipantsNational populations aged 18–100 years, by sex.MeasurementsUsing data by age and sex, we calculated obesity-attributable mortality by multiplying all-cause mortality (Human Mortality Database) with obesity-attributable mortality fractions (OAMFs). OAMFs were obtained by applying the weighted sum method to obesity prevalence data (non-communicable diseases (NCD) Risk Factor Collaboration) and European relative risks (Dynamic Modeling for Health Impact Assessment (DYNAMO- HIA)). We estimated potential gains in life expectancy (PGLE) at birth by eliminating obesity-attributable mortality from all-cause mortality using associated single-decrement life tables.ResultsIn the 26 European countries in 2012, PGLE due to obesity ranged from 0.86 to 1.67 years among men, and from 0.66 to 1.54 years among women. In all countries, PGLE increased over time, with an average annual increase of 2.68% among men and 1.33% among women. Among women in Denmark, Switzerland, and Central and Eastern European countries, the increase in PGLE levelled off after 1995. Without obesity, the average increase in life expectancy between 1975 and 2012 would have been 0.78 years higher among men and 0.30 years higher among women.ConclusionsObesity was proven to have an impact on both life expectancy levels and trends in Europe. The differences found in this impact between countries and the sexes can be linked to contextual factors, as well as to differences in people’s ability and capacity to adopt healthier lifestyles.

scholarly journals The Role of Smoking in Country Differences in Life Expectancy Across Europe, 1985–2014

2020 ◽  
Author(s):  
Fanny Janssen
Keyword(s):  
Life Expectancy ◽  
Weighted Average ◽  
European Countries ◽  
Attributable Mortality ◽  
Mortality Data ◽  
Relative Contribution ◽  
Life Expectancy At Birth ◽  
Long Run ◽  
Country Differences

Abstract Introduction Smoking contributes substantially to mortality levels and trends. Its role in country differences in mortality has, however, hardly been quantified. The current study formally assesses the—so far unknown—changing contribution of smoking to country differences in life expectancy at birth (e0) across Europe. Methods Using all-cause mortality data and indirectly estimated smoking-attributable mortality rates by age and sex for 30 European countries from 1985 to 2014, the differences in e0 between each individual European country and the weighted average were decomposed into a smoking- and a nonsmoking-related part. Results In 2014, e0 ranged from 70.8 years in Russia to 83.1 years in Switzerland. Men exhibited larger country differences than women (variance of 21.9 and 7.0 years, respectively). Country differences in e0 increased up to 2005 and declined thereafter. Among men, the average contribution of smoking to the country differences in e0 was highest around 1990 (47%) and declined to 35% in 2014. Among women, the average relative contribution of smoking declined from 1991 to 2011, and smoking resulted in smaller differences with the average e0 level in the majority of European countries. For both sexes combined, the contribution of smoking to country differences in e0 was higher than 20% throughout the period. Conclusions Smoking contributed substantially to the country differences in e0 in Europe, their increases up to 1991, and their decreases since 2005, especially among men. Policies that discourage smoking can help to reduce inequalities in mortality levels across Europe in the long run. Implications Smoking contributes substantially to country differences in life expectancy at birth (e0) in Europe, particularly among men, for whom the contribution was highest around 1990 (47%) and declined to 35% in 2014. In line with the anticipated progression of the smoking epidemic, the differences between European countries in e0 due to smoking are expected to further decline among men, but to increase among women. The role of smoking in mortality convergence since 2005 illustrates that smoking policies can help to reduce inequalities in life expectancy levels across Europe, particularly when they target smoking in countries with low e0.

scholarly journals Past trends in obesity-attributable mortality in eight European countries: an application of age–period–cohort analysis

2018 ◽  
Vol 63 (6) ◽  
pp. 683-692 ◽  
Author(s):  
Nikoletta Vidra ◽  
Maarten J. Bijlsma ◽  
Sergi Trias-Llimós ◽  
Fanny Janssen
Keyword(s):  
Cohort Analysis ◽  
European Countries ◽  
Attributable Mortality
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