Suchergebnisse

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 ...

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 ...

En Europe, l'épidémie de tabac a influé sur les niveaux et tendances de la mortalité, ainsi que sur les différences entre les sexes et entre les pays. En 2014, le tabac réduit l'espérance de vie des hommes de 2,7 ans en moyenne et celle des femmes de 1,0 an. Le tabac explique 28 % de l'écart d'espérance de vie entre les sexes. L'épidémie de tabac est la plus avancée dans le Nord-Ouest de l'Europe. L'effet du tabac y est en recul chez les hommes, mais n'a pas encore atteint son pic chez les femmes, et leurs mortalités dues au tabac sont proches. Sans le tabac, l'espérance de vie n'aurait pas stagné dans des pays comme le Danemark et les Pays-Bas chez les hommes dans les années 1950-1960, et chez les femmes dans les années 1980-1990. Elle aurait augmenté en général de façon plus importante, et les évolutions des hommes et des femmes auraient été plus proches.

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 SAMF(35-99), estimated using weighting and smoothing, were compared. RESULTS: Among men in all countries except Bulgaria, a clear wave pattern was observed, with SAMF(35-99) peaking, on average, at 33.4% in 1986. Eastern European men experienced the highest (40%) and Swedish men the lowest (16%) peak. Among women, SAMF(35-99) 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 ...

SummaryIn India, nearly one million women of childbearing age are infected with HIV. This study sought to examine the biological effect of HIV on the fertility of HIV-infected Indian women. This is relevant for the provision of pregnancy-related counselling and care to the infected women, and for estimating the HIV prevalence among women and children. The study used retrospectively collected data from the National Family Health Survey (2005–2006) and applied a matched case control study design to compare the effect of HIV on conception, pregnancy rates and pregnancy outcomes among HIV-infected (N=69) and HIV-non-infected (N=345) women, both unaware of their HIV status. Pregnancy rates and pregnancy outcomes were compared through non-parametric statistical tests, whereas the effect of HIV on fecundity was studied by analysing the interval between last two pregnancies using Cox regression. The pregnancy rate was observed to be lower among HIV-infected than HIV-non-infected women (RR=0.77). The difference, however, was not statistically significant (p=0.064). There was also no statistically significant difference in the interval between last two pregnancies (p=0.898). Significantly higher number of pregnancies among HIV-infected women resulted in termination because of miscarriage or stillbirths (p=0.004). Therefore, while providing clinical care and counselling to infected women, the possibility of adverse pregnancy outcomes should be considered. Due to the higher rate of adverse pregnancy outcomes, attendance of HIV-infected women at antenatal clinics might be greater, which could lead to overestimation of HIV prevalence derived from antenatal care surveillance sites.

AbstractWhen seeking to describe the age patterns of mortality for ancient populations, researchers are often confronted with small sample sizes or with missing data for several age groups. The traditional approach to dealing with these challenges is to smooth or complement such patterns by matching them to a model life table, either directly or through the Brass logit transformation. This procedure requires an appropriate model life table, which may not be available. We propose a hazard model that is both flexible enough to accurately describe an age pattern of mortality in ancient Northwestern Europe and restrictive enough to complement incomplete data. This paper presents a hazard function that contains four free-to-choose parameters. Tested against a large collection of life tables for northwestern European countries from the 17th to the 21st century, the number of free-to-choose parameters is stepwise reduced from four to only two. Compared with the Brass logit transformation with the Princeton Model West as its reference, the presented two-parameter hazard model is shown to fit the abovementioned dataset much better. The mean fitting error is found to be half the size. Moreover, this model is shown to fit a 13th-century mortality age pattern much better. The proposed two-parameter hazard model is capable of fitting a wide range of age patterns of mortality more closely than the traditional approach can. We therefore conclude that the proposed model facilitates the smoothing and the completion of age patterns of mortality in ancient Northwestern Europe even if they deviate substantially from well-documented patterns.

Abstract

Aim
To forecast age- and sex-specific alcohol-attributable mortality in France for the period 2015–2050 using a novel generalizable methodology that includes different scenarios regarding period and cohort change.


Methods
For the French national population aged 25–90 years (1979–2014), we estimated alcohol-attributable mortality by mortality from the main causes of death wholly attributable to alcohol, plus liver cirrhosis mortality. We modelled sex-specific alcohol-attributable mortality by adjusting for age, period and birth cohort. We forecasted the model parameters to obtain future age- and sex-specific alcohol-attributable mortality up until 2050 using a conventional baseline, scenario I (favourable period change) and scenario II (unfavourable cohort change).


Results
Alcohol-attributable mortality is clearly declining in France, with the decline decelerating from 1992 onwards. In 2014, the age-standardized alcohol-attributable mortality rates, in deaths per 100,000, were 34.7 among men and 9.9 among women. In 2050, the estimated rates are between 10.5 (prediction interval: 7.6–14.4; scenario I) and 17.6 (13.1–23.7; scenario II) among men, and between 1.1 (0.7–1.7; scenario I) and 1.8 (1.2–2.9; scenario II) among women; which implies declines of 58% for men and 84% for women (baseline).


Conclusion
Alcohol-attributable mortality in France is expected to further decline in the coming decades, accompanied by age pattern changes. However, France's levels are not expected to reach the current lower levels in Italy and Spain for 15 years or more. Our results point to the value of implementing preventive policy measures that discourage alcohol consumption among people of all ages, but especially among adolescents.

Existing research suggests adverse short-term health effects of economic crises during early life, yet, the long-term health effects for children and adolescents exposed to economic crises are still understudied. We investigated the early-adult health implications of experiencing the post-reunification economic crisis in East Germany in the early 1990s during infancy, childhood and adolescence. Using data from the German Socio-Economic Panel (SOEP) and its linkage with German pension records (SOEP-RV), we applied entropy balancing and conditional quantile regression to assess the relationship between the experience of the economic crisis during early life (ages 0-17) and physical and mental health effects (SF-12 summary scores) in N = 2,337 young adults (aged 17-30) from East and West Germany. Our results indicate mainly no significant physical health effects, yet, significant adverse mental health effects for respondents exposed to the economic crisis in East Germany, especially in young women of average and better mental health. Parental unemployment was an additional risk factor for young women's mental health. Thus, we suggest women who experienced economic crises during early life are at increased risk of adverse mental health effects already early in their adulthood. Support for families in times of economic crisis and early prevention for infants, children and adolescents exposed to economic adversities is warranted.

Although European integration can be expected to result in mortality convergence (reduced mortality differences), a life expectancy divide persists in the European Union (EU) between the old Member States (OMS) in the west and the new Member States (NMS) in the east. Studies investigating the impact of European integration on mortality convergence are rare and did not consider regional differences. We examine the short-term effects of the 2004 enlargement on mortality convergence at the supranational, national, and subnational levels. Using sex-specific life expectancies for 23 Member States (1990–2017) and the NUTS 2 regions in Czechia, Hungary, and Poland for 1992–2016, we examined the trend in sigma and beta mortality convergence measures at the country and regional levels using joinpoint regression. We found no compelling evidence that EU accession influenced the process of mortality convergence between OMS and NMS, or within the three NMS, over the short term. While there was overall beta and sigma convergence at the national level during 1990–2017, no regional convergence showed, and the trends in convergence did not significantly change at the time of EU accession or soon after (2004–2007). The accession in 2004 did not visibly impact the overall process of mortality convergence over the short term, likely because of the greater influence of country and region-specific policies and characteristics. The interaction of Member State and regional contexts with the mechanisms of European integration requires further study. Future enlargement procedures should emphasise tailored support to ensure more equitable gains from European integration. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10680-021-09596-y.

Although European integration can be expected to result in mortality convergence (reduced mortality differences), a life expectancy divide persists in the European Union (EU) between the old Member States (OMS) in the west and the new Member States (NMS) in the east. Studies investigating the impact of European integration on mortality convergence are rare and did not consider regional differences. We examine the short-term effects of the 2004 enlargement on mortality convergence at the supranational, national, and subnational levels. Using sex-specific life expectancies for 23 Member States (1990–2017) and the NUTS 2 regions in Czechia, Hungary, and Poland for 1992–2016, we examined the trend in sigma and beta mortality convergence measures at the country and regional levels using joinpoint regression. We found no compelling evidence that EU accession influenced the process of mortality convergence between OMS and NMS, or within the three NMS, over the short term. While there was overall beta and sigma convergence at the national level during 1990–2017, no regional convergence showed, and the trends in convergence did not significantly change at the time of EU accession or soon after (2004–2007). The accession in 2004 did not visibly impact the overall process of mortality convergence over the short term, likely because of the greater influence of country and region-specific policies and characteristics. The interaction of Member State and regional contexts with the mechanisms of European integration requires further study. Future enlargement procedures should emphasise tailored support to ensure more equitable gains from European integration.

BACKGROUND: The high mortality rates in the European Union (EU) Member States that acceded in 2004 sparked political interest in mortality convergence. Whether mortality is converging in the EU remains unclear. We reviewed the literature on mortality convergence in the post-2004 EU territory as a whole. We also explored whether the study designs influenced the results and whether any determinants of mortality convergence had been empirically examined. METHODS: A systematic literature review was performed. Our search included scientific databases and the websites of international governmental institutions and European demographic research institutes. RESULTS: We uncovered 94 unique records and included seven studies that reported on 36 analyses. There was marked methodological heterogeneity, including in the convergence measures (beta and sigma convergence). All of the beta convergence analyses found narrowing mortality differentials, whereas most of the sigma convergence analyses found widening mortality differentials. The results are robust to the units of analysis and mortality and dispersion measures. Our results also suggest that there is a lack of evidence on the determinants of mortality convergence in the EU. CONCLUSIONS: There is general agreement that the EU regions and the Member States with high initial mortality rates improved the fastest, but this trend did not lead to overall mortality convergence in the EU. The harmonization of mortality convergence measures and research into determinants of mortality convergence are needed to support future EU cohesion policy. Policy-makers should consider supporting areas that have moderate but stagnant mortality rates, in addition to those with high mortality rates.