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Stagnation in mortality decline among elders in the Netherlands
Fanny Janssen1, Wilma J Nusselder, Caspar W N Looman
1Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands. f.janssen@erasmusmc.nl
The Gerontologist
|October 23, 2003
Summary
Old-age mortality decline stagnated in the Netherlands after 1980, with smoking-related diseases contributing only partially. Other factors like frailty and healthcare changes likely played a larger role.
Area of Science:
- Gerontology
- Public Health
- Epidemiology
Background:
- Old-age mortality decline stagnated in The Netherlands during the 1980s.
- This study investigates if this stagnation continued into the 1990s and its contributing factors.
Purpose of the Study:
- To assess the continuation of old-age mortality stagnation in The Netherlands during the 1990s.
- To identify factors contributing to this stagnation, with a focus on smoking's role.
Main Methods:
- Poisson regression analysis with linear splines applied to mortality data (1950-1999).
- Age-period-cohort analysis to distinguish period and cohort effects.
- ICD revisions harmonized using a concordance table.
Main Results:
- Mortality decline reversal around 1980 led to stagnation and increases in old-age mortality.
- Smoking-related cancers and COPD, particularly in men, showed cohort patterns.
- Excluding smoking-related diseases revealed increasing stagnation in old-age mortality for both sexes.
Conclusions:
- Smoking behavior partially explains the observed mortality stagnation.
- Increased frailty and changes in medical/social services for the elderly are probable key factors.