[Stagnation in mortality decline among elderly in The Netherlands]

To assess whether the stagnation in old age (80+) mortality decline observed in the Netherlands in the 1980s, continued in the 1990s and which factors contributed to this stagnation. Emphasis is on the role of smoking.

Poisson regression with linear splines was applied to total and cause-specific (3-digit) mortality data by age, year of death (1950-1999) and sex. Age-period-cohort analysis was conducted to determine whether the trends followed period and/or cohort patterns. ICD Revisions were bridged using a concordance table.

A sudden reversal in old age mortality occurred around 1980, leading to a stagnation in the decline and even an increase during the 1980s and 1990s. Smoking related cancers, COPD and diseases specifically related to old age contributed to this stagnation. Trends in smoking-related cancers and COPD showed a cohort pattern--especially for males. When excluding these smoking related diseases, the trends in old-age mortality in the Netherlands showed an increasing stagnation for both sexes.

Generation-wise changes in smoking can only partly explain the stagnation in mortality. Other factors like increased frailty and changes in medical and social services for the elderly probably have played a more decisive role in explaining the recent stagnation.