THE DECLINE OF MORTALITY IN THE SECOND HALF OF THE 20 TH CENTURY Victor R. Fuchs Henry J. Kaiser Jr. Professor Emeritus Stanford University Department of Health London 8 May 2003

Standard Deviation of Log of Age-adjusted Death Rate: All Causes, countries 12 countries (excluding Japan) 0 standard deviation

Percent Per Annum Rate of Change of Age-adjusted Death Rate: Diseases of Circulatory System U.S. vs. U.K. (5 year moving average centered on middle year) percent

Annual Consumption of Fluid Cream Products in U.S , Half Pints Per Person (5 year moving average centered on middle year) Half pints per person

Annual Consumption of Eggs in U.S , Number Per Person (5 year moving average centered on middle year) Eggs per person

Pork, Beef, Chicken and Fish Consumption in U.S.: Boneless, trimmed (edible) weight, pounds per capita per year Beef Pork Chicken Total fish and shellfish pounds per capita

Percent Per Annum Rate of Change of U.S. Age-adjusted Death Rate Lung Cancer & All Maglinant Neoplasms: Men & Women (5 year moving average centered on middle year) Lung Cancer Men Lung Cancer Women Malignant Neoplasms Men Malignant Neoplams Women percent

Percent Per Annum Rate of Change of U.S. Age-adjusted Death Rate Heart Disease, Men & Women(r = 0.86) (5 year moving average centered on middle year) Men Women Percent

Percent Per Annum Rate of Change of U.S. Age-adjusted Death Rate Stroke, Men & Women (r = 0.98) (5 year moving average centered on middle year) Men Women %

Percent of Population with Systolic Blood Pressure >=160 & >=180 Ages (Age-standardized) Systolic >=160 Men Systolic >=160 Women Systolic >=180 Men Systolic >=180 Women Percent

Age, Period and Birth Cohort

Approximate a Cohort-to-Cohort Change in Age-specific Mortality, England & Wales (percent per annum)

Correlation Coefficient (r) Among 13 Countries Across 42 Age-specific Cohort-to-Cohort Changes in Mortality , Age 35-64

OLS Regression Across 42 Age-Specific Cohort-to-Cohort Rates of Change of Mortality (percent per annum) M = k + aC bC cC dC eP fP gP hP iP91-95 Cohorts in excluded class: and Periods in excluded class: and

Cohort a of Maximum Rate of Decline b in Age-Specific Mortality For Each Country

Period a of Maximum Rate of Decline b in Age-Specific Mortality For Each Country

Summary Age-adjusted mortality declined by more than one percent per annum in most “western” countries in the second half of the 20 th century The rate of decline was more rapid for females than males, for the young than for the old, and for circulatory diseases than for other causes The rate of decline was much more rapid for some countries than for others, (not just convergence) and much more rapid during some periods than in other periods

Summary (continued) The U.S. had a particularly rapid rate of decline in mortality from circulatory diseases in the 1970s. Of the three principal explanations that have been offered: change in diet, reduction in cigarette smoking, and control of hypertension, aggregate data provides most support for control of hypertension Regression analyses of age-specific cohort-to- cohort rates of decline show considerable variation in the timing of decline across countries. The maximum rate of decline for England & Wales was in

Summary (continued) The maximum rate of decline for cohorts in 10 countries was highly concentrated for the birth cohort For England & Wales, the maximum was for the cohort born in An understanding of why the birth cohort (and to a more limited extent the cohort) experienced particularly large rates of decline in mortality could contribute to a more comprehensive explanation of mortality trends in the second half of the 20 th century