Cause of Death Mortality: International Trends by Socio-Economic Group

Size: px

Start display at page:

Download "Cause of Death Mortality: International Trends by Socio-Economic Group"

Abner Lynch
5 years ago
Views:

1 Cause of Death Mortality: International Trends by Socio-Economic Group Andrew J.G. Cairns Heriot-Watt University Edinburgh Director Actuarial Research Centre IFoA Joint work with C. Redondo D. Blake K. Dowd M. Kallestrup-Lamb C. Rosenskjold Society of Actuaries Annual Meeting October 2018 Andrew J.G. Cairns Cause of Death Mortality 1 / 39

2 Outline Motivation and long term goals Data Comparison of US Denmark and England US: deeper dive; cohort effects Andrew J.G. Cairns Cause of Death Mortality 2 / 39

3 Purpose of looking at cause of death data What are the key drivers of all-cause mortality? How are the key drivers changing over time? Which causes of death have high levels of inequality: by education; by affluence? Can we point to specific causes of death as responsible for growing inequality? Leading to: insight into mortality underpinning life insurance and pensions Andrew J.G. Cairns Cause of Death Mortality 3 / 39

4 Drivers Medical advances Health spending Public health initiatives Individual risk factors: Controllable e.g. smoking diet exercise alcohol sun drugs hygeine risky sex stress environment... leading to cohort effects Not (easily) controllable e.g. genetic affluence education character/personality traits... Andrew J.G. Cairns Cause of Death Mortality 4 / 39

5 Socio-economic datasets Cause of death data for: US (males and females) by education level: low ( high school); high Denmark (males only): by education level: low; medium; high (cohorts > 1920 only) by individual affluence: 10 deciles England (males and females) by small area income deprivation: 10 deciles by region: 9 areas Andrew J.G. Cairns Cause of Death Mortality 5 / 39

6 Cause of Death Groupings US1.1 Infectious diseases excl. HIV/AIDS US 1.2 HIV/AIDS 1 Infectious diseases 2 Cancer: mouth gullet stomach 3 Cancer: gut rectum 4.1 Cancer: larynx 4.2 Cancer: trachea 4.3 Cancer: lung bronchus 5 Cancer: breast 6.1 Cancer: uterus cervix 6.2 Cancer: ovary 6.3 Cancer: other female genital 7.1 Cancer: prostate 7.2 Cancer: other male genital 8 Cancer: skin bones and certain organs 9 Cancer: lymphatic 10 Benign tumours 11 Diseases: blood 12 Diabetes 13 Mental illness 14.1 Diseases of nervous system excl. Alzh Alzheimers 15 Blood pressure + rheumatic fever 16 Ischaemic heart diseases 17 Other heart diseases 18 Diseases: cerebrovascular 19 Diseases: circulatory 20 Diseases: lungs breathing 21 Diseases: digestive (excl. alcohol: 27) 22 Diseases: urine kidney Diseases: skin bone tissue 24(DU) Senility without mental illness 25 Road/other accidents 26 Other causes 27 Alcohol liver disease 28 Suicide 29 Accidental Poisonings Detail able to separate causes with and without significant risk factors or inequality Andrew J.G. Cairns Cause of Death Mortality 6 / 39

7 Data Other Details US Deaths subdivided into 30 CoD groups Single ages and born between 1914 and 1970 Single years Denmark 29 CoD groups Age groups Five-year blocks England 34 CoD groups Age groups Single years Andrew J.G. Cairns Cause of Death Mortality 7 / 39

8 Multi-Country: Year 2007 Males Ischaemic Heart Disease US By Education 2007 Ischaemic heart diseases Denmark By Education 2007 Ischaemic heart diseases Medium Denmark By Affluence 2007 Ischaemic heart diseases Age US: slightly wider than Denmark England by Deprivation 2007 Ischaemic heart diseases Age England similar to Denmark but higher Andrew J.G. Cairns Cause of Death Mortality 8 / 39

9 Multi-Country: Age 68 Males Ischaemic Heart Disease US by Education Age 68 Ischaemic heart diseases Denmark by Education Age 68 Ischaemic heart diseases 5e 04 2e 03 1e 02 5e 04 2e 03 1e 02 Medium Denmark by Affluence Age 68 Ischaemic heart diseases England by Deprivation Age 68 Ischaemic heart diseases 5e 04 2e 03 1e 02 5e 04 2e 03 1e Year Significant improvements but not throughout Year Andrew J.G. Cairns Cause of Death Mortality 9 / 39

10 Multi-Country: Age 68 Males Lung Cancer US by Education Age 68 Cancer: lung larynx.. Denmark by Education Age 68 Cancer: lung larynx.. 5e 04 2e 03 1e 02 5e 04 2e 03 1e 02 Medium Denmark by Affluence Age 68 Cancer: lung larynx.. England by Deprivation Age 68 Cancer: lungs bronchus 5e 04 2e 03 1e 02 5e 04 2e 03 1e Year Year Significant inequality; improvements might be driven by smoking prevalence Andrew J.G. Cairns Cause of Death Mortality 10 / 39

11 Multi-Country: Age 68 Females Lung Cancer US by Education Age 68 Cancer: lung larynx.. England by Deprivation Age 68 Cancer: lungs bronchus 5e 04 2e 03 5e 03 2e 02 5e 04 2e 03 5e 03 2e Year Significant inequality; deterioration driven by smoking prevalence Andrew J.G. Cairns Cause of Death Mortality 11 / 39

12 Deaths of Despair: A Growing Problem? 2002/07/12 US By Education 2002 Accidental Poisonings Denmark By Education 2002 Accidental Poisonings Medium Denmark By Affluence 2002 Accidental Poisonings Age US Denmark: significant England by Deprivation 2002 Accidental poisonings Age Andrew J.G. Cairns Cause of Death Mortality 12 / 39

13 Deaths of Despair: A Growing Problem? 2002/07/12 US By Education 2007 Accidental Poisonings Denmark By Education 2007 Accidental Poisonings Medium Denmark By Affluence 2007 Accidental Poisonings Age England by Deprivation 2007 Accidental poisonings Age Andrew J.G. Cairns Cause of Death Mortality 13 / 39

14 Deaths of Despair: A Growing Problem? 2002/07/12 US By Education 2012 Accidental Poisonings Denmark By Education 2012 Accidental Poisonings Medium Denmark By Affluence 2012 Accidental Poisonings Age Growth: England > US > DK England by Deprivation 2012 Accidental poisonings Age US: evidence of a cohort effect Andrew J.G. Cairns Cause of Death Mortality 14 / 39

15 Deaths of Despair: A Growing Problem? 2002/07/12 US By Education 2002 Alcohol induced liver disease Denmark By Education 2002 Alcohol induced liver disease Medium Denmark By Affluence 2002 Alcohol induced liver disease Age Affluence a much bigger driver England by Deprivation 2002 Alcohol related liver disease Age Andrew J.G. Cairns Cause of Death Mortality 15 / 39

16 Deaths of Despair: A Growing Problem? 2002/07/12 US By Education 2007 Alcohol induced liver disease Denmark By Education 2007 Alcohol induced liver disease Medium Denmark By Affluence 2007 Alcohol induced liver disease Age England by Deprivation 2007 Alcohol related liver disease Age Andrew J.G. Cairns Cause of Death Mortality 16 / 39

17 Deaths of Despair: A Growing Problem? 2002/07/12 US By Education 2012 Alcohol induced liver disease Denmark By Education 2012 Alcohol induced liver disease Medium Denmark By Affluence 2012 Alcohol induced liver disease Age US: possible cohort effect England by Deprivation 2012 Alcohol related liver disease Age Andrew J.G. Cairns Cause of Death Mortality 17 / 39

18 Impact of Controllable Risk Factors Risk factors (controllable and not controllable) Impact on cause of death rates Some risk factors big impact on some causes e.g. smoking lung cancer e.g. several risk factors ischaemic heart disease significant inequality gaps Some causes of death: no known (significant) controllable risk factors e.g. prostate cancer breast cancer Andrew J.G. Cairns Cause of Death Mortality 18 / 39

19 Multi-Country: Age 68 Males Prostate Cancer US by Education Age 68 Cancer: prostate testicular Denmark by Education Age 68 Cancer: prostate testicular 5e 04 2e 03 1e 02 5e 04 2e 03 1e 02 Medium Denmark by Affluence Age 68 Cancer: prostate testicular England by Deprivation Age 68 Cancer: prostate 5e 04 2e 03 1e 02 5e 04 2e 03 1e Year Year No controllable risk factors; US improvements; DK vs US genetic factors? Andrew J.G. Cairns Cause of Death Mortality 19 / 39

20 Multi-Country: Age 68 Females Breast Cancer US by Education Age 68 Cancer: breast England by Deprivation Age 68 Cancer: breast 5e 04 2e 03 5e 03 2e 02 5e 04 2e 03 5e 03 2e Year No controllable risk factors; US inequalities; England equality (?) Andrew J.G. Cairns Cause of Death Mortality 20 / 39

21 Variation in Reporting Practice: e.g. Mental Illness US By Education 2007 Mental illness Denmark By Education 2007 Mental illness Medium Denmark By Affluence 2007 Mental illness Age England by Deprivation 2007 Mental illnesses Age Alcohol & drug abuse; mental disorders; vascular dementia Andrew J.G. Cairns Cause of Death Mortality 21 / 39

22 US Males Age 60: Stagnation Males Age 60 All Cause Mortality? Females Age 60 All Cause Mortality US low education US high education US low education US high education Year Year Andrew J.G. Cairns Cause of Death Mortality 22 / 39

23 US Drivers of Change Males Age 60 Education: Absolute changes in mortality Absolute Change in CoD Death Rate e 03 5e 04 0e+00 5e 04 1e 03 Accidental Poisonings US Males Aged 60 Education Changes in CoD Death Rates Benign tumours Diseases: skin bone tissue HIV/AIDS Diseases: blood Nervous system incl. A Infectious Diseases Mental illness Diseases: urine kidney... 1e 05 2e 05 5e 05 1e 04 2e 04 5e 04 1e 03 2e 03 5e 03 Suicide Cancer: Other causes prostate testicula Blood pressure + rheumatic fever Cancer: lymphatic blood forming tissue Alcohol related liver disease Diseases: digestive Diseases: circulatory Diabetes Cancer: Road/other gut rectum accidents Cancer: mouth gullet stomach Cerebrovascular diseases incl. stroke Cancer: skin & certain Respiratory diseases Other heart diseases Cancer: lung larynx.. Ischaemic heart diseases Death Rate in (log scale) Three big gains many small losers Andrew J.G. Cairns Cause of Death Mortality 23 / 39

24 US Drivers of Change Males Age 60 Education: Absolute changes in mortality Absolute Change in CoD Death Rate e 03 5e 04 0e+00 5e 04 1e 03 Cancer: breast US Males Aged 60 Education Changes in CoD Death Rates Accidental Poisoni Benign tumours Diseases: skin bone tissue HIV/AIDS Mental illness Cancer: Diseases: prostate blood testicular urine kidney... Diseases: circulatory Diseases: Blood Infectious digestive pressure Diseases + rh Cancer: lymphatic blood fo Cancer: gut rectum Alcohol related liv 1e 05 2e 05 5e 05 1e 04 2e 04 5e 04 1e 03 2e 03 5e 03 Other causes Suicide Nervous system incl. Alzheimers Cancer: Road/other mouth accidents gullet stomach Cerebrovascular diseases Diabetes Death Rate in (log scale) Other heart diseases Respiratory diseases Cancer: skin & c Cancer: lung larynx.. Ischaemic heart diseases Some continued gains but several more substantial losers: no single bad CoD Andrew J.G. Cairns Cause of Death Mortality 24 / 39

25 US Drivers of Change Females Age 60 Education: Absolute changes in mortality Absolute Change in CoD Death Rate e 03 5e 04 0e+00 5e 04 1e 03 HIV/AIDS Accidental Poisonings US Females Aged 60 Education Changes in CoD Death Rates Benign tumours Mental illness Cancer: Diabetes gut rectum Cerebrovascular diseases Suicide Diseases: skin bone tissue 5e 06 1e 05 2e 05 5e 05 1e 04 2e 04 5e 04 1e 03 2e 03 Diseases: blood Other causes Diseases: Nervous Infectious system urine Diseases kidney incl. A e Cancer: uterus cervix Cancer: mouth gullet stomach Diseases: circulatory Death Rate in (log scale) Alcohol Road/other related accidents liver disease Diseases: digestive Blood pressure + rheumatic fever Cancer: lymphatic blood forming tissue Other Cancer: heart Respiratory breast diseases diseases Cancer: skin & certain organs Cancer: lung larynx.. Ischaemic heart diseases Much smaller improvements than males Andrew J.G. Cairns Cause of Death Mortality 25 / 39

26 US Drivers of Change Females Age 60 Education: Absolute changes in mortality Absolute Change in CoD Death Rate e 03 5e 04 0e+00 5e 04 1e 03 US Females Aged 60 Education Changes in CoD Death Rates HIV/AIDS Accidental Poisonings Benign tumours Mental illness Suicide Cancer: breast Respiratory diseases Cancer: lung Ischaemic heart diseases larynx.. 5e 06 1e 05 2e 05 5e 05 1e 04 2e 04 5e 04 1e 03 2e 03 Diseases: skin bone tissue Other causes Cancer: mouth gullet stomach Diseases: blood Cancer: uterus cervix Alcohol related liver dis Road/other Diseases: urine accidents kidney... Blood pressure + rheum Nervous Diseases: system digestive incl. Alzheimers Cancer: Infectious lymphatic Diseases blood ex Death Rate in (log scale) Diseases: circulatory Cancer: gut rectum Cerebrovascular diseases incl. stroke Other heart diseases Diabetes Cancer: skin & certain organs Some cancer progress Andrew J.G. Cairns Cause of Death Mortality 26 / 39

27 US Drivers of Change Males Age 60 Education: Absolute changes in mortality Absolute Change in CoD Death Rate e 03 5e 04 0e+00 5e 04 1e 03 Accidental Poisonings Diseases: skin bone tis US Males Aged 60 Education Changes in CoD Death Rates Benign tumours Mental illness Diseases: blood Diseases: urine kidney... Nervous system incl. Alz Infectious Diseases excl HIV Other causes HIV/AIDS Blood pressure + rheumatic fever Diseases: digestive Diseases: Cancer: Suicide prostate circulatory testicular Diabetes 1e 05 2e 05 5e 05 1e 04 2e 04 5e 04 1e 03 2e 03 5e 03 Alcohol related liver disease Cerebrovascular Road/other accidents diseases incl. stroke Cancer: lymphatic blood forming tissue Cancer: mouth gullet stomach Cancer: gut rectum Death Rate in (log scale) Respiratory diseases Other heart Cancer: diseases skin & certain organ Cancer: lung larynx.. Ischaemic heart diseases Same three big gains but many fewer losers Andrew J.G. Cairns Cause of Death Mortality 27 / 39

28 US Drivers of Change Males Age 60 Education: Absolute changes in mortality Absolute Change in CoD Death Rate e 03 5e 04 0e+00 5e 04 1e 03 Cancer: breast US Males Aged 60 Education Changes in CoD Death Rates Accidental Poisonings Diseases: skin bone tissue Benign tumours HIV/AIDS Mental illness Diseases: urine kidney... Other causes Infectious Diseases ex Blood pressure + rheum Alcohol Suicide related liver dis 5e 06 1e 05 2e 05 5e 05 1e 04 2e 04 5e 04 1e 03 2e 03 Diseases: blood Cancer: Diseases: prostate circulatory testicular Diseases: Nervous system digestive incl. Alzheimers Suicide Cancer: Cancer: lymphatic gut rectum blood f Cerebrovascular diseases incl. stroke Cancer: mouth gullet stomach Diabetes Road/other accidents Respiratory Other heart diseases diseases Death Rate in (log scale) Cancer: lung larynx.. Cancer: skin & certain organs Ischaemic heart diseases More modest gains but still no significant losers Andrew J.G. Cairns Cause of Death Mortality 28 / 39

29 US Drivers of Change Females Age 60 Education: Absolute changes in mortality Absolute Change in CoD Death Rate e 03 5e 04 0e+00 5e 04 1e 03 Accidental Poisonings US Females Aged 60 Education Changes in CoD Death Rates HIV/AIDS Benign tumours Mental illness Diseases: skin bone tis Suicide Diseases: urine blood kidney. Infectious Diseases exc 2e 06 5e 06 1e 05 2e 05 5e 05 1e 04 2e 04 5e 04 1e 03 Other causes Nervous system incl. Alz Cancer: Diseases: mouth uterus circulatory digestive gullet cervix Blood pressure + rheumatic stomach fever Alcohol related liver disease Road/other accidents Diabetes Cancer: lymphatic blood forming tissue Cerebrovascular diseases incl. stroke Cancer: gut rectum Other heart diseases Respiratory diseases Ischaemic heart diseases Cancer: Cancer: breast lung skin larynx & certain.. organ Death Rate in (log scale) Much smaller improvements than males Andrew J.G. Cairns Cause of Death Mortality 29 / 39

30 US Drivers of Change Females Age 60 Education: Absolute changes in mortality Absolute Change in CoD Death Rate e 03 5e 04 0e+00 5e 04 1e 03 US Females Aged 60 Education Changes in CoD Death Rates HIV/AIDS Accidental Poisonings Benign tumours Mental illness Alcohol related liver dise Blood pressure + rheum Cancer: Diseases: Infectious uterus digestive Diseases cervix exc Diseases: skin bone tissue Other causes Cancer: Diseases: mouth circulatory gullet stomach Diseases: urine kidney... Diseases: blood Nervous system incl. Alzheimers Road/other accidents Diabetes Cancer: Other heart gut rectum diseases Cerebrovascular diseases incl. stroke 2e 06 5e 06 1e 05 2e 05 5e 05 1e 04 2e 04 5e 04 1e 03 Death Rate in (log scale) Suicide Cancer: lymphatic blood Respiratory diseases Cancer: Cancer: Ischaemic lung breast heart larynx diseases.. Cancer: skin & certain org Some cancer progress Andrew J.G. Cairns Cause of Death Mortality 30 / 39

31 US Males: A Possible Cohort Effect Males Age 45 All Cause Mortality Males Age 50 All Cause Mortality Males Age 55 All Cause Mortality Males Age 60 All Cause Mortality cohort US low education US high education cohort US low education US high education cohort US low education US high education US low education US high education 1950 cohort Year Year Year Year Cohort effect: cohorts born around 1950 have poorer mortality than those born before or after. Suggests: Weakens the hypothesis that the situation is generally bad for low educated males. Andrew J.G. Cairns Cause of Death Mortality 31 / 39

32 Identifying Cohort Effects Modelling approach: Model death rates for individual causes of death Step 1: estimate age and period effects log m(cod t x) = age effect period effect Step 2: estimate CoD-specific cohort effect log m(cod t x) = age effect period effect +cohort effect Cohort effects capture heterogeneity in the underlying population: e.g. smoking prevalence Andrew J.G. Cairns Cause of Death Mortality 32 / 39

33 Cohort Effects: Educated Males All causes of death in one plot Fitted Cohort Effects: All Causes of Death Cohort Effect Year of Birth Very messy! Different underlying risk factors. Andrew J.G. Cairns Cause of Death Mortality 33 / 39

34 Drivers of Mortality Medical advances Health spending Public health initiatives Individual risk factors: Controllable e.g. smoking diet exercise alcohol sun drugs hygeine risky sex stress environment... leading to cohort effects and socio-economic differences Not (easily) controllable e.g. genetic affluence education character/personality traits... Andrew J.G. Cairns Cause of Death Mortality 34 / 39

35 Cohort Effects: Educated Males Specific causes of death Educated Males Cohort Effects: Deaths of Despair Educated Males Cohort Effects: Diet and Exercise Cohort Effect Alcohol Acc. Poisoning Cohort Effect Diabetes Digestive diseases Genitourinary Year of Birth Year of Birth Common risk factor similar cohort effect Andrew J.G. Cairns Cause of Death Mortality 35 / 39

36 Identifying Cohort Effects Educated Females Cohort Effects: Smoking Educated Females Cohort Effects: Smoking Cohort Effect Lung cancer Respiratory diseases Cohort Effect Lung cancer Respiratory diseases Year of Birth Year of Birth 1960 peak consistent with known smoking prevalence for females by cohort Note: age-period effects can absorb steady trends in prevalence Andrew J.G. Cairns Cause of Death Mortality 36 / 39

37 Summary Work in progress! Cause of death data can provide insight into all cause mortality time trends inequality between groups growing inequality US England Denmark Many similarities Some differences No controllable risk factors Wider US inequality gap: accessible healthcare The US slow down is complex Partly due to a s cohort effect Shape of cohort effect varies by cause of death linked to different underlying risk factors by cohort Andrew J.G. Cairns Cause of Death Mortality 37 / 39

38 Thank You! Questions? E: W: andrewc/arcresources Andrew J.G. Cairns Cause of Death Mortality 38 / 39

39 The Actuarial Research Centre (ARC) A gateway to global actuarial research The Actuarial Research Centre (ARC) is the Institute and Faculty of Actuaries (IFoA) network of actuarial researchers around the world. The ARC seeks to deliver cutting-edge research programmes that address some of the significant global challenges in actuarial science through a partnership of the actuarial profession the academic community and practitioners. The Modelling Measurement and Management of Longevity and Morbidity Risk research programme is being funded by the ARC the SoA and the CIA. Andrew J.G. Cairns Cause of Death Mortality 39 / 39

Cause of Death Mortality: International Trends by Socio-Economic Group

Cause of Death Mortality: International Trends by Socio-Economic Group Andrew J.G. Cairns Heriot-Watt University Edinburgh Director Actuarial Research Centre IFoA Joint work with C. Redondo D. Blake K.