EUGLOREH project
THE STATUS OF HEALTH IN THE EUROPEAN UNION:
TOWARDS A HEALTHIER EUROPE

FULL REPORT

PART II - HEALTH CONDITIONS

4. OVERALL HEALTH TRENDS

4.2. Life expectancy and causes of death

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4.2. Life expectancy and causes of death

 

 

Since 1970, in the EU15 countries life expectancy at birth has increased, on average, by about 2 years per decade. In several Central and Eastern European (i.e. Bulgaria, the Czech Republic, Estonia, Latvia, Lithuania, Hungary, Poland, Romania, Slovenia and Slovakia) countries life expectancy has developed less favourably, particularly for men, but in recent years life expectancy has been increasing in the latter countries as well. Behind the overall increasing trend in life expectancy at birth there have been different patterns of change in mortality rates. The decline in mortality rates has not been the same for young and old age groups; there have been differences between men and women, and the underlying pattern of causes of death has changed.

When discussing the future development of life expectancy, one important question is whether we approach an upper limit to the growth in life expectancy. Since in recent years the decline in mortality rates at old ages has become the main cause of the increase in life expectancy, this question comes down to whether mortality at old ages has been slowing down in recent years, which would suggest that an upper limit may be near.

Even though life expectancy has risen in most European countries during the last decades, the question raises whether inequalities in life expectancy across European countries has become smaller or larger.

 

The Arriaga decomposition method has been applied to data from the EUROSTAT database to examine whether changes in life expectancy at birth across EU countries can be attributed to the same changes in age patterns and in causes of death. This method is a well-known technique to calculate the contribution of changes in mortality rates at different ages and of different causes of death to the increase in life expectancy at birth and at other ages. The analysis of mortality trends is limited to some Countries only, due to the availability of data for the analysed decades.

 

 

Pattern of life expectancy changes by age groups. Based on the (unweighted) average of the EU15 countries during the last decades, life expectancy at birth has increased by 2.3 years per decade for both men and women. However, the pattern of change has differed for both sexes. For men, the rate of increase has risen over time. Life expectancy increased by 1.8 years in the 1970s, 2.1 years in the 1980s and 3.0 years in the 1990s. For women, the rate of increase in the 1980s (1.9 years) was lower than in the 1970s (2.3 years), but similarly to men the highest increase was observed in the 1990s (2.7 years).

 

Table 4.2.1 shows the contribution of age groups to the increase in life expectancy at birth during the last three decades for the EU15 average. For both men and women during the 1970s the decline in mortality at very young age contributed the most to the increase in life expectancy at birth: for men one third of the increase in life expectancy and for women one fourth. During the 1980s, mortality at young age still was an important cause of the increase in life expectancy, but increasingly declines in mortality for the elderly contributed to the increase in life expectancy. For men, age groups 65-74 contributed almost one fourth to the increase in life expectancy at birth, and for women the age groups 70-84 even contributed one third of the total increase in life expectancy. In the 1990s, the contribution of the oldest age groups to the increase in life expectancy at birth was large: one fifth of the increase for men was caused by the decline in mortality for age groups 80 and over, reaching even 40% for women.

 

Table 4.2.1. Arriaga decomposition of changes in life expectancy, EU 15 average.

 

These age patterns in mortality decline were visible in most EU countries. In all countries, the decline in mortality at the youngest ages contributed most to the increase in life expectancy in the 1970s. In the 1980s there was slightly more variation in changes in mortality across age groups, even though in most countries the decline of mortality for elderly people became the dominant cause of the rise of life expectancy. In most countries, mortality decline was larger for men in their sixties and for women in their seventies. However, in the Southern European countries Spain, Portugal, Greece and Italy the decline in mortality at the youngest ages continued to have a large impact on the increase in life expectancy in the 1980s, even though in Spain the decline in mortality at higher ages had a larger effect on life expectancy than in the other three Southern European countries. In the 1990s, mortality at the youngest ages continued to decline, but had only a small impact on the increase in life expectancy in all EU countries. In most countries, the increase in life expectancy was mainly caused by a decline in mortality at elderly ages, at slightly higher ages than in the 1980s. The largest contribution to the increase in life expectancy can be attributed to men in their sixties and seventies and women in their seventies and eighties. Among Western European countries Denmark showed a deviating pattern. In the 1990s, mortality of women aged between 65 and 75 hardly decreased. This seems to be a temporary deviation, as since 2000 mortality of women aged 65-74 has declined considerably. In Eastern EU countries, life expectancy had developed less favourably than in the Western EU countries, particularly for men. In several Eastern countries mortality of men in their fifties and sixties increased in the 1980s and 1990s.

 

Pattern of life expectancy changes by causes of death. Table 4.2.2 shows the contribution of 13 selected causes of death to the increase in life expectancy at birth in the EU15 since 1970. In the 1970s for men the decline in mortality by respiratory disease was responsible for one fourth of the rise in life expectancy at birth. In addition, the decline in mortality in heart disease and cerebrovascular disease together caused one fourth in the rise of life expectancy as well. Smoking related neoplasms had a negative impact on life expectancy in the 1970s. For women, heart and cerebrovascular disease caused 40% of the increase in life expectancy. The negative impact of smoking related cancers for women was considerably smaller than for men. A considerable part of the increase in life expectancy could not be attributed to one specific cause of death, as the large contribution of the categoryremaining causes of deathshows. In the 1980s, the contribution of the decline in mortality by heart and cerebrovascular diseases to the rise in life expectancy increased to 50% for both men and women. Whereas for men the decrease in mortality by ischemic heart disease was particularly large, for women the decrease of mortality by cerebrovascular disease was large. In the 1990s, the decrease in mortality by ischemic heart disease continued to be the most important cause of the increase in life expectancy for men. In addition, in the 1990s for men the decline in mortality by various types of cancer started to contribute to the increase in life expectancy. Whereas smoking related cancer had a negative impact on life expectancy in the 1970s, due to the strong decline in the percentage of men smoking since the 1970s, mortality by cancer declined in the 1990s. For women the decrease in mortality by heart and cerebrovascular disease contributed almost 60% to the increase in life expectancy in the 1990s. In addition, there was a decline in mortality by cancer. However, mortality by smoking related cancer continued to increase for women in contrast with men, due to the fact that number of smokers among women continued to increase (or stagnated at very high level), while the one among men decreased.

 

Table 4.2.2. Arriaga decomposition of changes in life expectancy at birth by cause of death, EU15 average.

 

Table 4.2.3 shows the Arriaga decomposition of life expectancy by cause of death for selected EU countries for the periods 1980-1990 and 1990-2000. These countries were selected on the basis of availability of data on causes of death for both periods. They include countries in North, Western, South, Central and Eastern Europe. Therefore, they may be regarded as representative for the different patterns of change in mortality across the countries of the European Union.

 

Table 4.2.3. Arriaga decomposition of changes in life expectancy at birth by cause of death, selected countries.

 

In most EU countries, the decline in mortality by circulatory diseases (causes 6, 7 and 8 in table 3) has contributed most to the increase in life expectancy since the 1980s, even though there are some differences among countries in the relative importance of ischemic and other heart diseases and strokes. Changes in mortality by the other main cause of death, cancer (causes 2, 3, 4 and 5 in table 3), had a smaller impact on the increase in life expectancy than circulatory diseases. One important part of mortality by cancer is caused by smoking. Mortality by gynaecological cancers (cause 4 in table 3) had a negative impact on the life expectancy of women in the 1980s in several countries, but in the 1990s the decline in mortality by these cancers had a positive impact on life expectancy of women in almost all countries. Infectious diseases (cause 1 in table 3) did not have a large effect on life expectancy in the 1980s and 1990s. In the 1990s they had a negative impact on life expectancy of men in 9 out of the 13 countries. In several countries, infectious diseases had a negative effect on mortality at young and old ages, but in Spain and Portugal they had a negative effect on mortality of men in their thirties and forties. Mortality by respiratory diseases (cause 9 in table 3) declined in most countries. This may be related to the decrease in smoking prevalence. Mortality by external causes (causes 10, 11 and 12 in table 3) has decreased in most countries. One remarkable exception is that in Eastern countries mortality by traffic accidents increased during the 1980s. In the 1990s mortality by traffic accidents decreased strongly for men in Greece and Portugal. In general, the effect of transport accidents on the mortality of men is larger than that on women. Alcohol related mortality (cause 13 in table 3) had a negative effect on life expectancy in the Eastern European countries. There are remarkable differences across countries in the size of the contribution of the categoryremaining causes of death’ (cause 14 in table 3) across European countries. For example, the effect of remaining causes was relatively large in Southern and Eastern European countries and relatively small in Northern European countries. It is not clear to what extent this may have to do with differences in the practice of coding causes of death across countries. In spite of these differences across European countries, the overall patterns in the effect of changes in the cause of death on life expectancy seems to be similar. The main cause of the increase in life expectancy since the 1980s has been the decrease in mortality of circulatory diseases. Smoking has had a negative impact on mortality due to cancer, for men more than for women, and for men earlier than for women. Note that the effect of smoking on mortality is larger than mortality by lung cancer and other smoking related cancers, as smoking also affects mortality by circulatory and respiratory diseases.

 

Table 4.2.4 shows by how many years life expectancy at birth increased between 1980 and 2000 due to a decline in mortality by circulatory diseases and its share in the total increase in life expectancy at birth. The table shows that for men in 7 out of the 13 selected countries the decline in mortality by circulatory diseases caused more than half of the increase in life expectancy; the same occurred for women even in 9 out of the 13 countries. For Polish men and Dutch women the effect of the decline in mortality by circulatory disease was even larger than the total increase in life expectancy.

 

Table 4.2.4. Contribution of change in mortality by circulatory diseases to changes in life expectancy at birth 1980-2000, selected countries

 

Table 4.2.5 shows that cancers caused by smoking had a negative impact on life expectancy in the 1980s for men in 8 out of the 13 selected countries and for women in 12 countries, even though for women in most countries the effect was smaller than for men. As in most countries men started to smoke less in the 1970s, the negative impact of smoking related cancers reduced in the 1990s, even though the effect was still negative in 7 out of the 13 countries. As women started to smoke later than men, the negative effect of smoking related cancers for women occurred later than for men. For women in the 1990s, smoking related cancers had a negative impact on life expectancy in 12 of the 13 countries. In 9 of these countries the negative impact in the 1990s was larger than in the 1980s.

 

Table 4.2.5. The effect of smoking related cancers on life expectancy at birth, selected countries.

 

The decline in mortality rates for the elderly has become the main cause of the increase in life expectancy at birth since the 1980s. One important question is whether mortality at old ages will continue to decline or whether we will approach an upper limit to the growth in life expectancy, which will manifest itself by a stagnation of the decline in mortality at the oldest ages. In order to analyse developments in mortality for the elderly (65+) in recent decades, table 6 shows the average change in life expectancy at 65 for selected EU countries. Only countries for which there was data on the change in life expectancy at 65 during at least three successive decades were selected.

 

Table 4.2.6. Average annual change in life expectancy at 65, selected countries.

 

Table 4.2.6 shows that in 11 out of the 17 selected countries the increase in life expectancy at 65 for men in the 1990s was higher than in the 1980s and in most other countries there was no big difference between both decades. In several Eastern EU countries there was a negative development in the 1990s. For those countries for which we also know the average change in the 2000-2005 period, the pattern is similar: an acceleration in most countries except for the Eastern EU countries. Thus it can be concluded that apart from the Eastern EU countries for men there is no indication at all of a stagnation in the decline of mortality for the elderly.

 

For women in several countries, the increase in life expectancy for the elderly in the 1990s was smaller than for men, whereas in all countries the increase for women in the 1980s was higher than for men. Also after 2000 the increase for women appears to be smaller than for men. Thus there seems to be some converging tendency between the sexes: the levels of mortality rates at older ages for women are considerably lower than for men, but in recent years the increase for men is larger than that for women.

 

Table 4.2.7 shows the development of mortality for the oldest old (80+). Since the 1990s the development in Eastern EU countries has been negative. In most other EU countries, life expectancy has increased for the oldest old. In contrast with the pattern at 65, for the oldest old there is hardly any difference between men and women.

 

Table 4.2.7. Average annual change in life expectancy at the age of 80, selected countries.

 

The conclusion is that the development of mortality at the oldest ages in the last decades do not give any indication that we are approaching an upper limit of life expectancy as there is no sign of a stagnation in mortality at high ages.

 

Figure 4.2.1. Standardized death rates in EU27 in 2005

 

Inequalities in life expectancy. One important question for making projections of life expectancy for European countries is whether differences are likely to become smaller or whether they are persistent. If in countries where life expectancy used to be rather low, the rate of increase has been higher than in countries where life expectancy has been relatively high for some time already, one may expect a converging tendency. If one compares the level of life expectancy at birth across European countries in 1970 with the average annual increase in life expectancy since 1970 it turns out that for women there is a negative relationship between the level of life expectancy in 1970 and the average increase (Fig. 4.2.2). This indicates that there is some convergence. However, the relationship is not very strong. The regression coefficient equals -.020, which implies that if life expectancy in 1970 is one year higher, the average annual increase is .02 lower. This implies that it will take 50 years until convergence is completed.

 

Figure 4.2.2. Relationship between the level of life expectancy at birth in 1970 and the annual average increase since 1970, women

 

For men there appears to be no significant relationship (Figure 4.2.3). However, this is mainly due to the negative development in mortality for men in Eastern European countries.

 

Figure 4.2.3. Relationship between the level of life expectancy at birth in 1970 and the annual average increase since 1970, men.

 

If Eastern European countries are excluded, there appears to be a negative relationship between the level of life expectancy in 1970 and the increase since 1970 for menl (Figure 4.2.4). The regression coefficient equals -.024, implying that convergence will take some 40 years.

 

Figure 4.2.4. Relationship between the level of life expectancy at birth in 1970 and the annual average increase since 1970, excluding Eastern European Countries, men.

 

If we exclude Eastern European countries for women as well, the relationship becomes stronger (if we compare Figure 4.2.5 with Figure 4.2.2). In that case the regression coefficient equals -.034, implying that convergence will take 30 years.

 

Figure 4.2.5. Relationship between the level of life expectancy at birth in 1970 and the annual average increase since 1970, excluding Eastern European Countries, women.

 

Thus apart from Eastern European countries we may conclude that there has been a converging trend in life expectancy at birth since 1970. If the rate of convergence will continue, for men it will take some 40 years to reach convergence, while for women it will take about 30 years.