People started dying earlier. Not by much maybe 2 or 3 months earlier but
it was significant. The first wave of national statistics was quickly followed
by questions as to why. The first explanation related to local conditions, relating
the upturn in death to local economic or weather conditions. Until it emerged this
increase was not just a national event but an international phenomenon. Most
industrialized countries showed a similar spike in death but for different population
groups. This was global.
And the surprising detail that came out of all these
countries mortality was that the increase in death seem to affect primarily
older AND younger adult populations. With some exceptions, however, older
people were dying earlier than at previous years. Small but significant
increases in early death among older adults throughout industrialized
countries.
For example, according to the Russian State Statistics
Service (Rosstat), in the first quarter of 2015 they saw death grow by 5.2
percent compared to the same period last year, with a 22-percent rise in the
death rate among those suffering from respiratory illnesses followed by
diseases of the digestive system (10 percent), infectious diseases (6.5
percent), and blood circulation disorders (5 percent). While infant death, and death
from murder and suicide, were falling. One of the clues for this increased death
was that most of the deaths were brought about by respiratory diseases caused
by common cold, flu and pneumonia.
In the United States, Anne Case and Angus Deaton wrote about
the long-term increase specifically for one group of Americans, White adults.
Although from 1978 to 1998, the mortality rate for US Whites aged 45–54 fell by
2% per year on average—which matched the average for other industrialized
countries—after 1998, while the rest of the industrialized countries continued
to show a 2% annual decline in mortality, in the USA the 45-54 age group showed
half a percent annual increase. Reversing decades of progress in lowering
mortality, there was a marked increase in death of middle-aged White men and
women in the United States between 1999 and 2013. For three groups in
particular those aged (with highest mortality first) 45-49, 56-59 and
50-54. Among American older adults, mortality
held constant or improved over this period. This increase for Whites was
largely accounted for by increasing death from drug and alcohol poisonings,
suicide, and chronic liver diseases including cirrhosis and was especially severe
for those with less education.
Ill health in the United States remains an individual economic
issue. Where for example maternal death is twice that of our neighbors in
Canada despite the fact that we pay twice as much on health than Canadians. Americans
get a very poor return for their health care contribution. The increase in death
reflected an underlying decline in self-reported health, mental health and ability
to conduct activities of daily living. Furthermore, there was an increases in reports
of chronic pain and inability to work, as well as clinically measured deteriorations
in liver function. All these indicators point to growing distress in this White
population. Although there are some
methodological criticisms—age adjustment as populations change—the central
thesis is solid, that in the USA middle-aged Whites have higher mortality increases
than other populations. And surprisingly phenomenon is that this increase is
still growing.
Across the Atlantic, in the United Kingdom, 2015 saw the
largest rise in the number of recorded deaths in England and Wales in over a
decade. Although the higher mortality peaked during winter it remained slightly
above the five-year average for the rest of the year. By 2016 mortality was
running at around 3.8% above the 5-year average, but again without accounting
for population age changes. This increase was driven largely by increased
mortality in over 75 year olds (83% of the increase). The cause being ascribed
to dementia and respiratory diseases, including colds, flu and pneumonia. A similar increase was experienced in many
other European countries. It is normal for mortality to peak during winter
season, especially for older populations—older adults are more prone to cold
weather—but it is not only cold weather that was killing older adult. In Europe
in July 2016 there has been observed a slight increased mortality among elderly
in all countries, the most significant being in France and in Portugal since
the beginning of July, increases which started during high temperatures.
Although we need to be cautious about extrapolating form
single year data or using single methodologies as this might be an errant fluctuation.
Something spikes in mortality occur naturally because of a convergence of many separate
factors. Because this is a reversal of a trend—where other than increases in
mortality due to wars, life expectancy has been improving for nearly a century—any
reversal warrants attention.
Some researchers have argued for a social status/class causing
the increase in deaths. Especially in the USA where the spike in deaths
occurred among less educated White residents. The downturn in the economy after
2008—although it affected minorities more severely—for the White population the
change was dramatic and unexpected. Minorities have had some time to become
acclimatized to this depression. This is a good argument except that it does
not explain all of the data, especially the U.K. data.
The U.K. mortality spike occurred in all areas of the
country except for London. If the deaths were primarily driven by poverty then
we should see poorer counties reporting higher deaths, which they do, but not
consistently. Because of the inconsistency in deaths, there seem to be other
variables at play. Since the increase in deaths is also a global phenomenon it
could be the start of a growing trend and it might be worthwhile exploring
other global factors other than economic—which is important but not a
comprehensive answer.
Since these increased deaths are primarily caused by influenza
and pneumonia—the main killers for older adults—there might be environmental
factors at play. Although we should see a growing increase in deaths because
our population is aging, these yearly fluctuations might be made worse by an
increase in both the prevalence of bacteria and viruses and our reduced
resilient to these new infections.
Global climate change and less effective anti-biotics together
with a more vulnerable population—both older and perhaps less resilient because
of poverty—might accelerate deaths. Again,
although these are small shifts in trends they are unique enough to warrant
serious monitoring. The reversal of half a century of progress in life
expectancy might herald a new way of looking at diseases that embraces a more
central public health role. We might see that to address health we might have
to look at the environment better. We shall have to wait and see how and when
we continue to die.
___________________
Additional resources:
The role of excess winter mortality in recent years Stephen
Richards (Longevitas)
Russian statistics from:
http://rbth.com/society/2015/05/26/experts_puzzled_by_sudden_rise_in_russias_mortality_rate_46363.html
References
Case, A., & Deaton, A. (2015). Rising morbidity and
mortality in midlife among white non-Hispanic Americans in the 21st century.
Proceedings of the National Academy of Sciences, 112(49), 15078-15083.
Gelman, A., & Auerbach, J. (2016). Age-aggregation bias
in mortality trends. Proceedings of the National Academy of Sciences, 113(7),
E816-E817.
© USA Copyrighted 2016 Mario D. Garrett
No comments:
Post a Comment