TY - JOUR
AU - Mackenbach,, JP
AB - Abstract Background Several countries have reported an increase in life expectancy at advanced ages. This paper analyses recent changes in life expectancy at age 60 and 85 in The Netherlands, a low mortality country with reliable mortality data. Methods We used data on the population and the number of deaths by age, sex and underlying cause of death for 1970–1994. Life expectancy at age 60 and 85 was estimated using standard life-table techniques. The contribution of different ages and causes of death to the change in life expectancy during the 1970s (1970/74– 1980/84) and the 1980s (1980/84–1990/94) were estimated with a decomposition technique developed by Arriaga. Results Life expectancy at age 60 increased in the 1970s and 1980s, whereas life expectancy at age 85 decreased (men) and stagnated (women) in the 1980s, and has decreased in both sexes since 1985/89. The decomposition by age showed that constant mortality rates in women aged 85–89, and increasing mortality rates at ages 85+ (men) and 90+ (women) have caused this lack of increase in life expectancy. The decomposition by cause of death showed that smaller mortality reductions from other cardiovascular and cerebrovascular diseases, which contributed most to the increase in life expectancy at age 85 in the 1970s, and mortality increases from, amongst others, chronic obstructive pulmonary disease (COPD), mental disorders and diabetes mellitus produced the decrease (men) and plateau (women) in life expectancy at age 85. Conclusions Life expectancy at advanced ages stopped increasing during the 1980s in The Netherlands due to mortality increases at ages 85+ (men) and 90+ (women). Cause-specific trends suggest that, in addition to (past) smoking behaviour in men, changes in the distribution of morbidity and frailty in the population might have contributed to this stagnation. Old-age mortality, life expectancy, cause-of-death, decomposition by age, decomposition by cause of death Nowadays, in low mortality countries, increases in life expectancy are often taken for granted. Life expectancy has risen since the eighteenth century in some European countries, including England, France and Scandinavia.1–3 In The Netherlands, mortality reductions are likely to have started in the nineteenth century.2 From 1840/51 to 1990/94 life expectancy increased from 36.1 to 74.2 years in men and from 38.5 to 80.2 years in women.4 This impressive increase in length of life has been accompanied by substantial changes in the age-at-death and cause-of-death patterns. Changes in the cause-of-death pattern from mainly infectious diseases to chronic diseases were accompanied by a shift in the age pattern of mortality from younger ages to older ages.5 Since the early 1970s, declines in mortality from chronic diseases at older ages have caused sharp rises in life expectancy of the elderly population.5–7 Uncertainty abounds as to whether the decline in mortality at older ages will continue to generate substantial increases in life expectancy. Two opinions are prevalent. One group of researchers, known as the proponents of ‘the limited-lifespan paradigm’, believes that average life expectancy will not increase beyond 85 years of age.8–10 Further substantial reductions in death rates at advanced ages are constrained by biological barriers (e.g. senescence) and/or by societal barriers (e.g. environmental deterioration). The increasingly rectangular shape of the survival curve, seen as a manifestation of the fact that the natural limit to human life has almost been completed,9 and the enormous reductions in mortality rates which would be needed to achieve a life expectancy at birth of 85 years10 are used as arguments in support of this view. Others, known as proponents of ‘the mortality-reduction paradigm’,11–15 argue that the decline in mortality rates will continue and may even accelerate, including also the most advanced ages. A life expectancy at birth of 100 years or more is considered to be within reach somewhere in the near future.12,13 The observed decrease in mortality at advanced ages of 1–2% per year, and the very low mortality rates in subpopulations with healthy life styles, are used as arguments in favour of substantial future increases in life expectancy.11,13 Several studies have reported rapid declines in oldest-old mortality.7,11,16–18 In the Netherlands, too, a country with traditionally low mortality and reliable mortality data at advanced ages,19 life expectancy of the elderly (65+) and the oldest old (85+) has increased.20 This study aims at obtaining a better understanding at the recent changes in mortality in the Dutch elderly population. The central questions are: (1) did the increase in life expectancy of the elderly population accelerate, continue or stagnate in past years and (2) which age- and cause-specific mortality dynamics underlay these recent changes in the life expectancy? We will use total and cause-specific Dutch mortality data of the population aged ≥60 in 1970/74–1990/94. Methods Data Data on the population and the number of deaths by age, sex and underlying cause of death for 1970–1994 were obtained from Statistics Netherlands.21,22 Total mortality and population data had originally been derived from municipal population registers and can be considered reliable and consistent. Population and total mortality data by single year-of-age were used, whereas cause-specific mortality data were only available by 5-year age groups, with age ≥95 as the oldest age group. In 1970–1994 causes of death were classified according to two different revisions of the International Classification of Diseases, Injuries and Causes of Death: the Eighth Revision (ICD-8) for 1970–1978 and the Ninth Revision (ICD-9) for 1979–1994. In order to maximize the comparability over both ICD classifications, we regrouped the causes classified in both revisions into 26 cause-of-death groups (Appendix 1). Methods We started with a description of the change in life expectancy at age 60 and age 85 in The Netherlands in 1970/74–1990/94. Life expectancies were estimated from complete life tables with age 105 as oldest age group. These life tables, each covering five calendar years, were constructed for both sexes from total mortality and population data, using standard demographic techniques.23,24 Next, we looked for explanations of the change in life expectancy at age 60 and 85 in the 1970s (1970/74–1980/84) and the 1980s (1980/84–1990/94) by examining the contribution of different age groups and causes of death to the change in life expectancy. This contribution was estimated from ageand cause-specific mortality data using a method developed by Arriaga,25,26 which decomposes the change in life expectancy into the contribution to this change of different age groups and/ or causes of death. Although changes in age and cause-specific mortality rates also give an indication of the contribution of different ages and causes to the change in life expectancy, we prefer the Arriaga method for two reasons. First, this method takes into account substitution between competing causes of death. Second, it takes into account the fact that similar changes in mortality rates at different ages influence life expectancy—being a population health measure—to a different extent. The magnitude of the effect of (changes in) age- and cause-specific mortality rates on life expectancy is weighted (1) by the size of the life-table population in a certain age group exposed to the (changed) rate, and (2) the remaining life expectancy of that age group. Due to this implicit weighting in the life table, changes in mortality rates that are not important for the health of the population, for instance because the population at risk being exposed to these rates is rather small, are not weighted heavily. In general, changes at young ages have a larger impact on life expectancy than changes at advanced ages.27,28 This is due to the fact that (1) only a small proportion of the population is exposed to changes in mortality rates at advanced ages, as not everyone survives up to these ages and (2) the remaining life expectancy at older ages is much smaller, reflecting the high risks of mortality at older ages. It merits attention that life expectancy (and thus changes in life expectancy) is unaffected by the age distribution of the actual population, which enables comparisons to be made over time and between groups (e.g. by sex). The age distribution of the life-table population is only determined by the mortality rates. Notwithstanding the favourable properties of life table based methods like the Arriaga method, examining changes in age- and cause-specific mortality rates is useful as well. Having assessed which age groups and causes of death contributed most to the change in life expectancy, looking at changes in age- and cause-specific rates will provide more insight into the exact changes. Therefore we also calculated directly standardized death rates (using the population of 1990/94 by 5-year of age up to age 95+ as standard) for each 5-year period. We expressed changes in standardized mortality rates as ratios of comparative mortality figures (CMF). To assess whether these changes in the ratios of CMF were statistically significant, we calculated 95% CI of the CMF ratios.29 In the presentation of the outcomes of the age-specific changes in total mortality, we focus on the change in CMF by 10-year age groups since 1970/74. Results for specific cause-of-death groups are not shown separately in Tables or Figures. Only cause-specific changes in mortality are presented separately for the age group 85+ in the 1980s, because changes in mortality in the oldest old have been striking since 1980/84 in The Netherlands30 and deserve a closer inspection. Results Change in life expectancy During the past two decades, life expectancy of the elderly and oldest-old population has increased in The Netherlands. Table 1 shows that life expectancy at age 60 increased from 16.95 to 18.22 years in men and from 20.87 to 23.14 years in women in the period 1970/74–1990/94. Life expectancy at age 85 increased from 4.46 to 4.63 years in men and from 4.96 to 5.82 years in women in the same period. A closer inspection of Table 1 indicates that the gain in life expectancy was not evenly spread across the different 5-year periods. In men, the increase in life expectancy at age 60 was slightly larger in the 1980s (0.7 years) than in the previous decade (0.6 years), whereas in women the opposite was true (1970s 1.8 years; 1980s 0.4 years). The trend in life expectancy at age 85 was even more remarkable: a gain was seen until 1980/84 (men) and 1985/89 (women), but since then life expectancy at age 85 has declined. Contribution of different age groups and causes of death to the change in life expectancy Because changes in age- and cause-specific mortality might give clues to changes in the determinants of mortality, we first assessed the extent to which mortality declines or increases in different age groups and cause-of-death groups contributed to the described change in life expectancy. Table 2 shows the contribution of different age groups to the change in life expectancy at ages 60 and 85 calculated with the Arriaga method. A ‘positive’ contribution indicates that a mortality reduction in the relevant age group contributes to an increase in life expectancy, whereas a ‘negative’ contribution indicates that a mortality increase contributes to a reduction of life expectancy. In the 1970s mortality reductions in all age groups contributed to the increase in life expectancy at age 60 and age 85, although the size of these contributions differed. The most striking development in the 1980s was that mortality changes at age ≥85 (men) and at age ≥90 (women) contributed negatively to the increase in life expectancy at age 60. At age 85, the same changes in mortality were responsible for the stagnating increase in life expectancy among women (–0.02 years) and for the decline in life expectancy among men (–0.22 years). That life expectancy at age 60 continued to increase was due to mortality reductions in the age groups between 60 and 84 years of age, which have a larger impact on life expectancy at age 60. For men, larger mortality declines at ages 65–79 produced an even larger increase in life expectancy at age 60 in the 1980s, despite the unfavourable developments at older ages. For women the increase in life expectancy at age 60 was smaller than in the 1970s because the positive impact of mortality reductions below age 90 also shrank. The contributions of the five causes of death which contributed most, both in a positive and negative sense, to the change in life expectancy at age 60 and age 85 in the 1970s and 1980s are presented in Tables 3a, 3b. Table 3b shows that in the 1980s mortality increases from chronic obstructive pulmonary disease (COPD), mental disorders and diabetes mellitus (and to a lesser extent other cancers [men] and lung cancer [women]) contributed ‘negatively’ to the increase in life expectancy at age 60. Mortality increases from these diseases, together with those from prostate cancer (men) and ill-defined conditions (women), were also largely responsible for the decline (men) and plateau (women) in life expectancy at age 85 in this period. At age 60, these effects were counterbalanced by mortality reductions from, in particular, ischaemic heart disease (IHD) and cerebrovascular diseases, and from lung cancer (men) and other heart diseases (women). However, at age 85, the negative effect of mortality increases outweighed the positive effect of mortality reductions from other causes. Compared to the 1980s, the 1970s had shown both larger positive contributions (1970s: 0.64 [men] and 1.03 [women] versus 1980s: 0.27 [men] and 0.37 [women]) and smaller negative contributions (1970s: –0.25 [men] and –0.15 [women] versus 1980s: –0.48 [men] and –0.39 [women]) to the life expectancy at age 85, which on balance produced the increase in life expectancy at age 85 in the 1970s, and the decrease (men) or stagnation (women) in the 1980s (Tables 3a,3b). Both smaller mortality reductions (or sometimes even an increase in mortality) from cerebrovascular diseases and other cardiovascular diseases—which contributed largely to the increase in life expectancy at age 85 in the 1970s—and (larger) mortality increases from e.g. COPD, mental disorders and diabetes mellitus, together with those from cancer (prostate and other cancers) and ill-defined conditions, explain the reversal of the trend in life expectancy at age 85. Changes in age- and cause-specific mortality Figure 1 shows the ratios of the standardized mortality rates (CMF) by 10-year age groups since 1970/74, using 1970/74 as reference (i.e. 1970/74 = 1). The developments in the 1970s and 1980s in mortality for each age group are clear at a glance. Whereas in the 1970s, mortality rates in all age groups decreased, in the 1980s only mortality rates in the age groups 60–69 and 70–79 continued to decline. In the age groups 80–89 mortality rates stagnated (women) or increased slightly, but not significantly (men). Above 90+ a significant increase was observed in both men and women in the 1980s. As could be expected, the age groups which showed a mortality increase or a decline, are the same as those picked out by means of the Arriaga method. However, comparison of Figure 1 and Table 2 makes it clear that caution should be exercised when looking at changes in mortality rates in order to explain changes in life expectancy. For example, Figure 1 shows that the reduction in the CMF for age group 90+ was largest for men in the 1970s, whereas Table 2 shows that this age group did not contribute most to the increase in life expectancy at age 60. After all, the contribution of age group 70–79 (0.1) was higher than that of 90+ (0.03). Table 4 focuses on recent changes in mortality rates above age 85 from specific causes. For the ease of interpretation, we expressed the change as the ratio of the CMF in 1990/94 to that in 1980/84 (i.e. 1980/84 = 1). A ratio larger than 1 indicates an increase in mortality as compared to 1980/84, whereas a ratio smaller than 1 indicates a decline. Some causes of death showed mortality declines in the 1980s, but overall the situation was one of mortality increase. Significant increases in mortality above age 85 from mental disorders, diabetes mellitus and other endocrine, nutritional and metabolic diseases, COPD, diseases of the nervous system, diseases of blood and blood-forming organs, ill-defined conditions, prostate and other cancers, infectious/ parasitic diseases and pneumonia/influenza took place. These causes also contributed in a negative sense to the decline (men) and plateau (women) in life expectancy at age 85 (Tables 3a, 3b). Discussion This study examined recent mortality changes in the elderly population of The Netherlands in the 1970s and in the 1980s. Our results showed that life expectancy at age 60 increased in the 1970s and 1980s, whereas life expectancy at age 85 has declined since 1980/84 (men) and 1985/89 (women). Constant mortality rates in women at ages 85–89, and an increase in mortality rates above age 85 (men) and above age 90 (women) underlay this trend in life expectancy at age 85. Decomposition of the change in life expectancy by cause of death showed that both smaller mortality reductions (or sometimes even an increase in mortality) from cerebrovascular diseases and other cardiovascular diseases—which contributed largely to the increase in life expectancy at age 85 in the 1970s—and mortality increases from e.g. COPD, mental disorders and diabetes mellitus, together with those from cancer (prostate and other cancers) and ill-defined conditions produced the decrease (men) and plateau (women) in life expectancy at age 85. The continuing rise in life expectancy at age 60, on the other hand, was caused by mortality reductions at ages 60–84 which have a relatively large impact on life expectancy at age 60. Before turning to the meaning and implications of our results, it must be emphasized that the findings, which are based on underlying cause-of-death data, might be subject to coding and classification errors. First, at advanced ages, underlying causes of death are difficult to assess and may therefore be unreliable.31 Furthermore, estimates of the magnitude of the effects of IHD and other heart diseases might be biased, due to the ICD Revision of 1979. The number of deaths from these causes by calendar year showed a small increase for other heart diseases mirrored by a decrease for IHD between 1978 and 1979. Finally, the effect of diabetes mellitus and mental disorders might be overestimated due to a more frequent classification of diabetes mellitus32 and senile dementia (part of mental disorders; personal communication Statistics Netherlands) as underlying cause of death in The Netherlands since 1983 and 1992, respectively. The number of deaths from diabetes by calendar year showed an increase in diabetes deaths in the years immediately after 1982. For senile dementia the increase started before and continued after the change in classification. Despite these uncertainties related to cause-of-death data, our findings indicating a lack of improvement in life expectancy at advanced ages are based on Dutch total mortality rates. Total mortality rates in The Netherlands are considered to be very reliable even for the oldest-old age groups,19 because mortality and population data are derived from municipal population registers that have been kept in The Netherlands since 1850.22 At birth a personal card based on the birth certificate is made and all changes in vital status, including death, are recorded on this card. This guarantees a high validity of age recording and since population registers not only provide data on mortality, but also on the population at risk by single year of age and sex, a single source is used to estimate mortality rates, which avoids biases. Moreover, differences in the contribution of each age group to the change in life expectancy (based on the Arriaga method) and changes in age-specific mortality rates (based on the CMF method) merit attention. The outcomes of both methods might not always lead to the same conclusion. Comparison of the contribution of different age groups to the change in life expectancy (Arriaga) and the standardizd mortality rates (CMF) by 10-year age groups shows that although the direction of the effect is the same, its relative importance can differ. For a full understanding of the changes in mortality, information derived from both approaches is needed. To explain changes in life expectancy, which was the primary focus of this paper, the Arriaga method is the most appropriate of the two, because, like life expectancy, it takes into account the fact that changes in mortality in different age groups affect life expectancy to a different extent. The magnitude of the effect depends upon the size of the population in a certain age group being exposed to the (changed) mortality rate and the remaining life expectancy of this age group. On the other hand, changes in age-specific mortality rates provide more insight into changes in the age structure and size of the elderly population. In addition, looking at changes in age- and cause-specific mortality rates is indispensable to discovering possible determinants of the changes in mortality. Studies for other low mortality countries have found no rises in mortality in the oldest old.6,11,18 Only in Norway did mortality at advanced ages increase slightly between 1986/90 and 1991/94.33 Explanations for the recent rise in old-age mortality in The Netherlands (and Norway) are still being sought. More research on this topic is needed. As a start, we will elaborate on possible explanations for the recent rise in old-age mortality in The Netherlands. First, the increase in old-age mortality might have been caused by excess mortality due to influenza epidemics in 1989/90 and 1993.34,35 This is not likely, however. In 1975 and 1978, influenza also produced substantial excess mortality34 without seriously interrupting the mortality decline among the oldest old. In addition, our results are not very sensitive to annual perturbations due to influenza epidemics, for we used quinquennial data. Second, the alleged liberalization of euthanasia policy could have brought forward the average age at death. However, considering the low frequency of physician assistance in death at advanced ages (only 1.8% [1.3–2.5%] of all deaths above age 80) and the estimated small decrease in the length of life due to euthanasia (less than one week in 76% of these cases),36 we do not consider euthanasia a significant factor. Third, the increase in mortality from (lung) cancer and COPD among the oldest old suggests that (past) smoking behaviour might have contributed to the increase in mortality. A reconstruction of smoking prevalence by birth cohort37 showed that the percentage of (ex)smokers in men aged ≥85 was probably higher in 1990/94 than in 1980/84. However, although past smoking behaviour might have played a role, the evidence is not conclusive. After all, this factor cannot explain the increase in female mortality at advanced ages, as the percentage of (ex)smokers aged ≥85 was too small to have had a significant effect on old-age mortality. The causes discussed so far cannot fully explain the increase in mortality at advanced ages and thus we should consider other causes, such as those relating to changes in the distribution of morbidity and frailty in the population. Less selection due to decreased mortality may have produced a frailer oldest-old population.38 The subsequent increase in mortality from mental disorders, ill-defined conditions and influenza/pneumonia might be a manifestation of this increased frailty. In addition, decreased mortality from circulatory diseases might have created a pool of people with circulatory diseases, who run a higher risk of developing severe stages of these diseases and dying from them.39,40 Finally, reduced mortality from circulatory diseases might have increased the prevalence of diseases that share the same risk factors or are themselves a risk factor for circulatory diseases, such as some cancers or diabetes mellitus. Although it is plausible that these factors have contributed to the increase in old-age mortality, it is not clear why these mechanisms, which may be expected to operate in other countries as well, have not (yet) caused old-age mortality to rise in these countries. Further investigation into the determinants of the old-age mortality is necessary and may benefit from empirical data on the current developments in old-age mortality in The Netherlands and other low mortality countries. Monitoring of old-age mortality and cross-national comparisons should therefore receive high priority. In addition, an important, but in terms of data requirements very demanding step, would be to disentangle the changes in incidence, disease progression, and fatality of chronic diseases which have caused the mortality increases in the oldest old in The Netherlands. Table 1 Life expectancy at age 60 and age 85, The Netherlands, by sex . Men . Women . . At age 60 years . At age 85 years . At age 60 years . At age 85 years . 1970/74 16.95 4.46 20.87 4.96 1975/79 17.15 4.74 21.89 5.45 1980/84 17.52 4.85 22.72 5.84 1985/89 17.78 4.74 23.01 5.86 1990/94 18.22 4.63 23.14 5.82 . Men . Women . . At age 60 years . At age 85 years . At age 60 years . At age 85 years . 1970/74 16.95 4.46 20.87 4.96 1975/79 17.15 4.74 21.89 5.45 1980/84 17.52 4.85 22.72 5.84 1985/89 17.78 4.74 23.01 5.86 1990/94 18.22 4.63 23.14 5.82 Open in new tab Table 1 Life expectancy at age 60 and age 85, The Netherlands, by sex . Men . Women . . At age 60 years . At age 85 years . At age 60 years . At age 85 years . 1970/74 16.95 4.46 20.87 4.96 1975/79 17.15 4.74 21.89 5.45 1980/84 17.52 4.85 22.72 5.84 1985/89 17.78 4.74 23.01 5.86 1990/94 18.22 4.63 23.14 5.82 . Men . Women . . At age 60 years . At age 85 years . At age 60 years . At age 85 years . 1970/74 16.95 4.46 20.87 4.96 1975/79 17.15 4.74 21.89 5.45 1980/84 17.52 4.85 22.72 5.84 1985/89 17.78 4.74 23.01 5.86 1990/94 18.22 4.63 23.14 5.82 Open in new tab Table 2 Decomposition of the change in life expectancy at age 60 and age 85 in 1970/74–1980/84 and 1980/84–1990/94, The Netherlands, by sexa . Men . Women . . At age 60 years . At age 85 years . At age 60 years . At age 85 years . a Figures are rounded to 0.01. 1970/74–1980/84 60–64 +0.20 – +0.14 – 65–69 +0.17 – +0.25 – 70–74 +0.07 – +0.38 – 75–79 +0.03 – +0.41 – 80–84 +0.03 – +0.37 – 85–89 +0.04 +0.20 +0.20 +0.59 90–94 +0.02 +0.12 +0.07 +0.22 95+ +0.01 +0.07 +0.02 +0.07 Total +0.58 +0.39 +1.85 +0.88 1980/84–1990/94 60–64 +0.22 – +0.02 – 65–69 +0.23 – +0.05 – 70–74 +0.18 – +0.10 – 75–79 +0.10 – +0.16 – 80–84 +0.01 – +0.11 – 85–90 –0.02 –0.08 +0.03 +0.07 90–94 –0.02 –0.08 –0.02 –0.05 95+ –0.01 –0.05 –0.02 –0.05 Total +0.70 –0.22 +0.42 –0.02 . Men . Women . . At age 60 years . At age 85 years . At age 60 years . At age 85 years . a Figures are rounded to 0.01. 1970/74–1980/84 60–64 +0.20 – +0.14 – 65–69 +0.17 – +0.25 – 70–74 +0.07 – +0.38 – 75–79 +0.03 – +0.41 – 80–84 +0.03 – +0.37 – 85–89 +0.04 +0.20 +0.20 +0.59 90–94 +0.02 +0.12 +0.07 +0.22 95+ +0.01 +0.07 +0.02 +0.07 Total +0.58 +0.39 +1.85 +0.88 1980/84–1990/94 60–64 +0.22 – +0.02 – 65–69 +0.23 – +0.05 – 70–74 +0.18 – +0.10 – 75–79 +0.10 – +0.16 – 80–84 +0.01 – +0.11 – 85–90 –0.02 –0.08 +0.03 +0.07 90–94 –0.02 –0.08 –0.02 –0.05 95+ –0.01 –0.05 –0.02 –0.05 Total +0.70 –0.22 +0.42 –0.02 Open in new tab Table 2 Decomposition of the change in life expectancy at age 60 and age 85 in 1970/74–1980/84 and 1980/84–1990/94, The Netherlands, by sexa . Men . Women . . At age 60 years . At age 85 years . At age 60 years . At age 85 years . a Figures are rounded to 0.01. 1970/74–1980/84 60–64 +0.20 – +0.14 – 65–69 +0.17 – +0.25 – 70–74 +0.07 – +0.38 – 75–79 +0.03 – +0.41 – 80–84 +0.03 – +0.37 – 85–89 +0.04 +0.20 +0.20 +0.59 90–94 +0.02 +0.12 +0.07 +0.22 95+ +0.01 +0.07 +0.02 +0.07 Total +0.58 +0.39 +1.85 +0.88 1980/84–1990/94 60–64 +0.22 – +0.02 – 65–69 +0.23 – +0.05 – 70–74 +0.18 – +0.10 – 75–79 +0.10 – +0.16 – 80–84 +0.01 – +0.11 – 85–90 –0.02 –0.08 +0.03 +0.07 90–94 –0.02 –0.08 –0.02 –0.05 95+ –0.01 –0.05 –0.02 –0.05 Total +0.70 –0.22 +0.42 –0.02 . Men . Women . . At age 60 years . At age 85 years . At age 60 years . At age 85 years . a Figures are rounded to 0.01. 1970/74–1980/84 60–64 +0.20 – +0.14 – 65–69 +0.17 – +0.25 – 70–74 +0.07 – +0.38 – 75–79 +0.03 – +0.41 – 80–84 +0.03 – +0.37 – 85–89 +0.04 +0.20 +0.20 +0.59 90–94 +0.02 +0.12 +0.07 +0.22 95+ +0.01 +0.07 +0.02 +0.07 Total +0.58 +0.39 +1.85 +0.88 1980/84–1990/94 60–64 +0.22 – +0.02 – 65–69 +0.23 – +0.05 – 70–74 +0.18 – +0.10 – 75–79 +0.10 – +0.16 – 80–84 +0.01 – +0.11 – 85–90 –0.02 –0.08 +0.03 +0.07 90–94 –0.02 –0.08 –0.02 –0.05 95+ –0.01 –0.05 –0.02 –0.05 Total +0.70 –0.22 +0.42 –0.02 Open in new tab Table 3a Decomposition of the contribution of selected causes of death to the change in life expectancy at age 60 and 85 in 1970/74–1980/84, The Netherlands, by sexa Men . Women . . a Figures are rounded to 0.001. b Available from authors on request. At age 60 years All causes +0.577 All causes +1.847 Increase in life expectancy +0.961 Increase in life expectancy +1.915 Ischaemic heart disease +0.257 Cerebrovascular diseases +0.417 Cerebrovascular diseases +0.197 Ischaemic heart disease +0.391 Pneumonia/influenza +0.091 Other cardiovascular disease +0.186 Stomach cancer +0.083 Pneumonia/influenza +0.137 Traffic accidents +0.065 Other heart diseases +0.134 Restb +0.268 Restb +0.650 Decrease in life expectancy –0.384 Decrease in life expectancy –0.068 Lung cancer –0.177 Lung cancer –0.040 Other heart diseases –0.079 Other causes –0.014 Other cancers –0.052 Breast cancer –0.006 Prostate cancer –0.022 Diseases of nervous system –0.006 Chronic obstructive pulmonary disease –0.017 Other endocrine –0.002 Restb –0.038 Restb –0.000 At age 85 years All causes +0.387 All causes +0.878 Increase in life expectancy +0.641 Increase in life expectancy +1.031 Other cardiovascular diseases +0.133 Ischaemic heart disease +0.193 Cerebrovascular diseases +0.129 Cerebrovascular diseases +0.182 Ischaemic heart disease +0.119 Other cardiovascular diseases +0.180 Ill-defined conditions +0.078 Other accidents +0.110 Pneumonia/influenza +0.066 Ill-defined conditions +0.101 Restb +0.116 Restb +0.265 Decrease in life expectancy –0.254 Decrease in life expectancy –0.153 Lung cancer –0.054 Genito-urinary –0.048 Chronic obstructive pulmonary disease –0.050 Diseases of digestive system –0.031 Other heart diseases –0.037 Other causes –0.026 Diseases of digestive system –0.028 Other endocrine –0.021 Diseases of nervous system –0.017 Diseases of nervous system –0.014 Restb –0.068 Restb –0.013 Men . Women . . a Figures are rounded to 0.001. b Available from authors on request. At age 60 years All causes +0.577 All causes +1.847 Increase in life expectancy +0.961 Increase in life expectancy +1.915 Ischaemic heart disease +0.257 Cerebrovascular diseases +0.417 Cerebrovascular diseases +0.197 Ischaemic heart disease +0.391 Pneumonia/influenza +0.091 Other cardiovascular disease +0.186 Stomach cancer +0.083 Pneumonia/influenza +0.137 Traffic accidents +0.065 Other heart diseases +0.134 Restb +0.268 Restb +0.650 Decrease in life expectancy –0.384 Decrease in life expectancy –0.068 Lung cancer –0.177 Lung cancer –0.040 Other heart diseases –0.079 Other causes –0.014 Other cancers –0.052 Breast cancer –0.006 Prostate cancer –0.022 Diseases of nervous system –0.006 Chronic obstructive pulmonary disease –0.017 Other endocrine –0.002 Restb –0.038 Restb –0.000 At age 85 years All causes +0.387 All causes +0.878 Increase in life expectancy +0.641 Increase in life expectancy +1.031 Other cardiovascular diseases +0.133 Ischaemic heart disease +0.193 Cerebrovascular diseases +0.129 Cerebrovascular diseases +0.182 Ischaemic heart disease +0.119 Other cardiovascular diseases +0.180 Ill-defined conditions +0.078 Other accidents +0.110 Pneumonia/influenza +0.066 Ill-defined conditions +0.101 Restb +0.116 Restb +0.265 Decrease in life expectancy –0.254 Decrease in life expectancy –0.153 Lung cancer –0.054 Genito-urinary –0.048 Chronic obstructive pulmonary disease –0.050 Diseases of digestive system –0.031 Other heart diseases –0.037 Other causes –0.026 Diseases of digestive system –0.028 Other endocrine –0.021 Diseases of nervous system –0.017 Diseases of nervous system –0.014 Restb –0.068 Restb –0.013 Open in new tab Table 3a Decomposition of the contribution of selected causes of death to the change in life expectancy at age 60 and 85 in 1970/74–1980/84, The Netherlands, by sexa Men . Women . . a Figures are rounded to 0.001. b Available from authors on request. At age 60 years All causes +0.577 All causes +1.847 Increase in life expectancy +0.961 Increase in life expectancy +1.915 Ischaemic heart disease +0.257 Cerebrovascular diseases +0.417 Cerebrovascular diseases +0.197 Ischaemic heart disease +0.391 Pneumonia/influenza +0.091 Other cardiovascular disease +0.186 Stomach cancer +0.083 Pneumonia/influenza +0.137 Traffic accidents +0.065 Other heart diseases +0.134 Restb +0.268 Restb +0.650 Decrease in life expectancy –0.384 Decrease in life expectancy –0.068 Lung cancer –0.177 Lung cancer –0.040 Other heart diseases –0.079 Other causes –0.014 Other cancers –0.052 Breast cancer –0.006 Prostate cancer –0.022 Diseases of nervous system –0.006 Chronic obstructive pulmonary disease –0.017 Other endocrine –0.002 Restb –0.038 Restb –0.000 At age 85 years All causes +0.387 All causes +0.878 Increase in life expectancy +0.641 Increase in life expectancy +1.031 Other cardiovascular diseases +0.133 Ischaemic heart disease +0.193 Cerebrovascular diseases +0.129 Cerebrovascular diseases +0.182 Ischaemic heart disease +0.119 Other cardiovascular diseases +0.180 Ill-defined conditions +0.078 Other accidents +0.110 Pneumonia/influenza +0.066 Ill-defined conditions +0.101 Restb +0.116 Restb +0.265 Decrease in life expectancy –0.254 Decrease in life expectancy –0.153 Lung cancer –0.054 Genito-urinary –0.048 Chronic obstructive pulmonary disease –0.050 Diseases of digestive system –0.031 Other heart diseases –0.037 Other causes –0.026 Diseases of digestive system –0.028 Other endocrine –0.021 Diseases of nervous system –0.017 Diseases of nervous system –0.014 Restb –0.068 Restb –0.013 Men . Women . . a Figures are rounded to 0.001. b Available from authors on request. At age 60 years All causes +0.577 All causes +1.847 Increase in life expectancy +0.961 Increase in life expectancy +1.915 Ischaemic heart disease +0.257 Cerebrovascular diseases +0.417 Cerebrovascular diseases +0.197 Ischaemic heart disease +0.391 Pneumonia/influenza +0.091 Other cardiovascular disease +0.186 Stomach cancer +0.083 Pneumonia/influenza +0.137 Traffic accidents +0.065 Other heart diseases +0.134 Restb +0.268 Restb +0.650 Decrease in life expectancy –0.384 Decrease in life expectancy –0.068 Lung cancer –0.177 Lung cancer –0.040 Other heart diseases –0.079 Other causes –0.014 Other cancers –0.052 Breast cancer –0.006 Prostate cancer –0.022 Diseases of nervous system –0.006 Chronic obstructive pulmonary disease –0.017 Other endocrine –0.002 Restb –0.038 Restb –0.000 At age 85 years All causes +0.387 All causes +0.878 Increase in life expectancy +0.641 Increase in life expectancy +1.031 Other cardiovascular diseases +0.133 Ischaemic heart disease +0.193 Cerebrovascular diseases +0.129 Cerebrovascular diseases +0.182 Ischaemic heart disease +0.119 Other cardiovascular diseases +0.180 Ill-defined conditions +0.078 Other accidents +0.110 Pneumonia/influenza +0.066 Ill-defined conditions +0.101 Restb +0.116 Restb +0.265 Decrease in life expectancy –0.254 Decrease in life expectancy –0.153 Lung cancer –0.054 Genito-urinary –0.048 Chronic obstructive pulmonary disease –0.050 Diseases of digestive system –0.031 Other heart diseases –0.037 Other causes –0.026 Diseases of digestive system –0.028 Other endocrine –0.021 Diseases of nervous system –0.017 Diseases of nervous system –0.014 Restb –0.068 Restb –0.013 Open in new tab Table 3b Decomposition of the contribution of selected causes of death to the change in life expectancy at ages 60 and 85 in 1980/84–1990/94, The Netherlands, by sexa Men . Women . a Figures are rounded to 0.001. b Available from authors on request. At age 60 years All causes +0.701 All causes +0.423 Increase in life expectancy +1.131 Increase in life expectancy +0.996 Ischaemic heart disease +0.596 Ischaemic heart disease +0.442 Lung cancer +0.144 Cerebrovascular diseases +0.186 Cerebrovascular diseases +0.132 Other heart diseases +0.137 Stomach cancer +0.072 Stomach cancer +0.054 Genito-urinary +0.048 Other accidents +0.047 Restb +0.138 Restb +0.130 Decrease in life expectancy –0.430 Decrease in life expectancy –0.573 COPD –0.079 Mental disorders –0.131 Diabetes Mellitus –0.078 Diabetes Mellitus –0.120 Other cancers –0.065 Chronic obstructive pulmonary disease –0.098 Mental disorders –0.053 Lung cancer –0.085 Other cardiovascular diseases –0.039 Diseases of the nervous system –0.022 Restb –0.117 Restb –0.118 At age 85 years All causes –0.215 All causes –0.022 Increase in life expectancy +0.266 Increase in life expectancy +0.371 Ischaemic heart disease +0.091 Ischaemic heart disease +0.118 Other heart diseases +0.081 Other heart diseases +0.110 Genito-urinary +0.046 Other accidents +0.042 Cerebrovascular diseases +0.018 Cerebrovascular diseases +0.028 Stomach cancer +0.016 Stomach cancer +0.021 Restb +0.014 Restb +0.053 Decrease in life expectancy –0.481 Decrease in life expectancy –0.393 Chronic obstructive pulmonary disease –0.102 Mental disorders –0.152 Mental disorders –0.064 Diabetes mellitus –0.062 Prostate cancer –0.047 Ill-defined conditions –0.036 Other cancers –0.044 Chronic obstructive pulmonary disease –0.031 Diabetes mellitus –0.039 Other endocrine –0.023 Restb –0.184 Restb –0.089 Men . Women . a Figures are rounded to 0.001. b Available from authors on request. At age 60 years All causes +0.701 All causes +0.423 Increase in life expectancy +1.131 Increase in life expectancy +0.996 Ischaemic heart disease +0.596 Ischaemic heart disease +0.442 Lung cancer +0.144 Cerebrovascular diseases +0.186 Cerebrovascular diseases +0.132 Other heart diseases +0.137 Stomach cancer +0.072 Stomach cancer +0.054 Genito-urinary +0.048 Other accidents +0.047 Restb +0.138 Restb +0.130 Decrease in life expectancy –0.430 Decrease in life expectancy –0.573 COPD –0.079 Mental disorders –0.131 Diabetes Mellitus –0.078 Diabetes Mellitus –0.120 Other cancers –0.065 Chronic obstructive pulmonary disease –0.098 Mental disorders –0.053 Lung cancer –0.085 Other cardiovascular diseases –0.039 Diseases of the nervous system –0.022 Restb –0.117 Restb –0.118 At age 85 years All causes –0.215 All causes –0.022 Increase in life expectancy +0.266 Increase in life expectancy +0.371 Ischaemic heart disease +0.091 Ischaemic heart disease +0.118 Other heart diseases +0.081 Other heart diseases +0.110 Genito-urinary +0.046 Other accidents +0.042 Cerebrovascular diseases +0.018 Cerebrovascular diseases +0.028 Stomach cancer +0.016 Stomach cancer +0.021 Restb +0.014 Restb +0.053 Decrease in life expectancy –0.481 Decrease in life expectancy –0.393 Chronic obstructive pulmonary disease –0.102 Mental disorders –0.152 Mental disorders –0.064 Diabetes mellitus –0.062 Prostate cancer –0.047 Ill-defined conditions –0.036 Other cancers –0.044 Chronic obstructive pulmonary disease –0.031 Diabetes mellitus –0.039 Other endocrine –0.023 Restb –0.184 Restb –0.089 Open in new tab Table 3b Decomposition of the contribution of selected causes of death to the change in life expectancy at ages 60 and 85 in 1980/84–1990/94, The Netherlands, by sexa Men . Women . a Figures are rounded to 0.001. b Available from authors on request. At age 60 years All causes +0.701 All causes +0.423 Increase in life expectancy +1.131 Increase in life expectancy +0.996 Ischaemic heart disease +0.596 Ischaemic heart disease +0.442 Lung cancer +0.144 Cerebrovascular diseases +0.186 Cerebrovascular diseases +0.132 Other heart diseases +0.137 Stomach cancer +0.072 Stomach cancer +0.054 Genito-urinary +0.048 Other accidents +0.047 Restb +0.138 Restb +0.130 Decrease in life expectancy –0.430 Decrease in life expectancy –0.573 COPD –0.079 Mental disorders –0.131 Diabetes Mellitus –0.078 Diabetes Mellitus –0.120 Other cancers –0.065 Chronic obstructive pulmonary disease –0.098 Mental disorders –0.053 Lung cancer –0.085 Other cardiovascular diseases –0.039 Diseases of the nervous system –0.022 Restb –0.117 Restb –0.118 At age 85 years All causes –0.215 All causes –0.022 Increase in life expectancy +0.266 Increase in life expectancy +0.371 Ischaemic heart disease +0.091 Ischaemic heart disease +0.118 Other heart diseases +0.081 Other heart diseases +0.110 Genito-urinary +0.046 Other accidents +0.042 Cerebrovascular diseases +0.018 Cerebrovascular diseases +0.028 Stomach cancer +0.016 Stomach cancer +0.021 Restb +0.014 Restb +0.053 Decrease in life expectancy –0.481 Decrease in life expectancy –0.393 Chronic obstructive pulmonary disease –0.102 Mental disorders –0.152 Mental disorders –0.064 Diabetes mellitus –0.062 Prostate cancer –0.047 Ill-defined conditions –0.036 Other cancers –0.044 Chronic obstructive pulmonary disease –0.031 Diabetes mellitus –0.039 Other endocrine –0.023 Restb –0.184 Restb –0.089 Men . Women . a Figures are rounded to 0.001. b Available from authors on request. At age 60 years All causes +0.701 All causes +0.423 Increase in life expectancy +1.131 Increase in life expectancy +0.996 Ischaemic heart disease +0.596 Ischaemic heart disease +0.442 Lung cancer +0.144 Cerebrovascular diseases +0.186 Cerebrovascular diseases +0.132 Other heart diseases +0.137 Stomach cancer +0.072 Stomach cancer +0.054 Genito-urinary +0.048 Other accidents +0.047 Restb +0.138 Restb +0.130 Decrease in life expectancy –0.430 Decrease in life expectancy –0.573 COPD –0.079 Mental disorders –0.131 Diabetes Mellitus –0.078 Diabetes Mellitus –0.120 Other cancers –0.065 Chronic obstructive pulmonary disease –0.098 Mental disorders –0.053 Lung cancer –0.085 Other cardiovascular diseases –0.039 Diseases of the nervous system –0.022 Restb –0.117 Restb –0.118 At age 85 years All causes –0.215 All causes –0.022 Increase in life expectancy +0.266 Increase in life expectancy +0.371 Ischaemic heart disease +0.091 Ischaemic heart disease +0.118 Other heart diseases +0.081 Other heart diseases +0.110 Genito-urinary +0.046 Other accidents +0.042 Cerebrovascular diseases +0.018 Cerebrovascular diseases +0.028 Stomach cancer +0.016 Stomach cancer +0.021 Restb +0.014 Restb +0.053 Decrease in life expectancy –0.481 Decrease in life expectancy –0.393 Chronic obstructive pulmonary disease –0.102 Mental disorders –0.152 Mental disorders –0.064 Diabetes mellitus –0.062 Prostate cancer –0.047 Ill-defined conditions –0.036 Other cancers –0.044 Chronic obstructive pulmonary disease –0.031 Diabetes mellitus –0.039 Other endocrine –0.023 Restb –0.184 Restb –0.089 Open in new tab Table 4 Ratio of comparative mortality figurea (CMF) of 1990/94 to CMF of 1980/84 at age ≥85, by sex . Men . 95% CI . Women . 95% CI . a CMF using the 1990/94 population as standard population. – Not applicable. Infectious + parasitic diseases 1.63 1.38–1.93 1.51 1.33–1.71 Stomach cancer 0.77 0.70–0.85 0.67 0.62–0.73 Colorectal cancer 0.96 0.88–1.04 0.91 0.86–0.96 Lung cancer 1.21 1.14–1.29 0.97 0.84–1.11 Breast cancer 0.74 0.32–1.71 1.05 0.98–1.12 Prostate cancer 1.34 1.26–1.42 – – Other cancers 1.20 1.15–1.26 1.06 1.03–1.10 Diabetes Mellitus 2.22 1.98–2.49 1.98 1.85–2.12 Endocr. + Nutritional 1.52 1.30–1.77 1.71 1.55–1.88 Blood + blood forming 1.88 1.56–2.27 1.56 1.36–1.80 Mental disorders 4.88 4.22–5.64 4.93 4.54–5.35 Nervous system 1.52 1.36–1.70 1.48 1.35–1.62 Ischaemic heart disease 0.85 0.83–0.88 0.83 0.81–0.85 Cerebrovascular diseases 0.96 0.93–1.00 0.97 0.94–0.99 Other cardiovascular diseases 1.14 1.07–1.22 0.91 0.86–0.95 Other heart diseases 0.86 0.84–0.89 0.87 0.85–0.89 Pneumonia/influenza 1.15 1.09–1.20 1.06 1.02–1.10 Chronic obstructive pulmonary disease 1.52 1.45–1.60 1.39 1.31–1.48 Other respiratory 1.17 1.01–1.35 1.04 0.91–1.18 Digestive system 1.06 0.99–1.13 1.03 0.99–1.07 Genito-urinary 0.75 0.71–0.80 0.89 0.85–0.93 Ill-defined 1.28 1.20–1.35 1.20 1.15–1.25 Traffic accidents 0.72 0.56–0.93 0.86 0.57–1.30 Other accidents 0.95 0.88–1.03 0.77 0.73–0.81 Other external causes 0.87 0.71–1.07 0.65 0.51–0.84 Other causes 1.32 1.15–1.51 1.19 1.11–1.27 Total 1.06 1.05–1.08 1.02 1.01–1.03 . Men . 95% CI . Women . 95% CI . a CMF using the 1990/94 population as standard population. – Not applicable. Infectious + parasitic diseases 1.63 1.38–1.93 1.51 1.33–1.71 Stomach cancer 0.77 0.70–0.85 0.67 0.62–0.73 Colorectal cancer 0.96 0.88–1.04 0.91 0.86–0.96 Lung cancer 1.21 1.14–1.29 0.97 0.84–1.11 Breast cancer 0.74 0.32–1.71 1.05 0.98–1.12 Prostate cancer 1.34 1.26–1.42 – – Other cancers 1.20 1.15–1.26 1.06 1.03–1.10 Diabetes Mellitus 2.22 1.98–2.49 1.98 1.85–2.12 Endocr. + Nutritional 1.52 1.30–1.77 1.71 1.55–1.88 Blood + blood forming 1.88 1.56–2.27 1.56 1.36–1.80 Mental disorders 4.88 4.22–5.64 4.93 4.54–5.35 Nervous system 1.52 1.36–1.70 1.48 1.35–1.62 Ischaemic heart disease 0.85 0.83–0.88 0.83 0.81–0.85 Cerebrovascular diseases 0.96 0.93–1.00 0.97 0.94–0.99 Other cardiovascular diseases 1.14 1.07–1.22 0.91 0.86–0.95 Other heart diseases 0.86 0.84–0.89 0.87 0.85–0.89 Pneumonia/influenza 1.15 1.09–1.20 1.06 1.02–1.10 Chronic obstructive pulmonary disease 1.52 1.45–1.60 1.39 1.31–1.48 Other respiratory 1.17 1.01–1.35 1.04 0.91–1.18 Digestive system 1.06 0.99–1.13 1.03 0.99–1.07 Genito-urinary 0.75 0.71–0.80 0.89 0.85–0.93 Ill-defined 1.28 1.20–1.35 1.20 1.15–1.25 Traffic accidents 0.72 0.56–0.93 0.86 0.57–1.30 Other accidents 0.95 0.88–1.03 0.77 0.73–0.81 Other external causes 0.87 0.71–1.07 0.65 0.51–0.84 Other causes 1.32 1.15–1.51 1.19 1.11–1.27 Total 1.06 1.05–1.08 1.02 1.01–1.03 Open in new tab Table 4 Ratio of comparative mortality figurea (CMF) of 1990/94 to CMF of 1980/84 at age ≥85, by sex . Men . 95% CI . Women . 95% CI . a CMF using the 1990/94 population as standard population. – Not applicable. Infectious + parasitic diseases 1.63 1.38–1.93 1.51 1.33–1.71 Stomach cancer 0.77 0.70–0.85 0.67 0.62–0.73 Colorectal cancer 0.96 0.88–1.04 0.91 0.86–0.96 Lung cancer 1.21 1.14–1.29 0.97 0.84–1.11 Breast cancer 0.74 0.32–1.71 1.05 0.98–1.12 Prostate cancer 1.34 1.26–1.42 – – Other cancers 1.20 1.15–1.26 1.06 1.03–1.10 Diabetes Mellitus 2.22 1.98–2.49 1.98 1.85–2.12 Endocr. + Nutritional 1.52 1.30–1.77 1.71 1.55–1.88 Blood + blood forming 1.88 1.56–2.27 1.56 1.36–1.80 Mental disorders 4.88 4.22–5.64 4.93 4.54–5.35 Nervous system 1.52 1.36–1.70 1.48 1.35–1.62 Ischaemic heart disease 0.85 0.83–0.88 0.83 0.81–0.85 Cerebrovascular diseases 0.96 0.93–1.00 0.97 0.94–0.99 Other cardiovascular diseases 1.14 1.07–1.22 0.91 0.86–0.95 Other heart diseases 0.86 0.84–0.89 0.87 0.85–0.89 Pneumonia/influenza 1.15 1.09–1.20 1.06 1.02–1.10 Chronic obstructive pulmonary disease 1.52 1.45–1.60 1.39 1.31–1.48 Other respiratory 1.17 1.01–1.35 1.04 0.91–1.18 Digestive system 1.06 0.99–1.13 1.03 0.99–1.07 Genito-urinary 0.75 0.71–0.80 0.89 0.85–0.93 Ill-defined 1.28 1.20–1.35 1.20 1.15–1.25 Traffic accidents 0.72 0.56–0.93 0.86 0.57–1.30 Other accidents 0.95 0.88–1.03 0.77 0.73–0.81 Other external causes 0.87 0.71–1.07 0.65 0.51–0.84 Other causes 1.32 1.15–1.51 1.19 1.11–1.27 Total 1.06 1.05–1.08 1.02 1.01–1.03 . Men . 95% CI . Women . 95% CI . a CMF using the 1990/94 population as standard population. – Not applicable. Infectious + parasitic diseases 1.63 1.38–1.93 1.51 1.33–1.71 Stomach cancer 0.77 0.70–0.85 0.67 0.62–0.73 Colorectal cancer 0.96 0.88–1.04 0.91 0.86–0.96 Lung cancer 1.21 1.14–1.29 0.97 0.84–1.11 Breast cancer 0.74 0.32–1.71 1.05 0.98–1.12 Prostate cancer 1.34 1.26–1.42 – – Other cancers 1.20 1.15–1.26 1.06 1.03–1.10 Diabetes Mellitus 2.22 1.98–2.49 1.98 1.85–2.12 Endocr. + Nutritional 1.52 1.30–1.77 1.71 1.55–1.88 Blood + blood forming 1.88 1.56–2.27 1.56 1.36–1.80 Mental disorders 4.88 4.22–5.64 4.93 4.54–5.35 Nervous system 1.52 1.36–1.70 1.48 1.35–1.62 Ischaemic heart disease 0.85 0.83–0.88 0.83 0.81–0.85 Cerebrovascular diseases 0.96 0.93–1.00 0.97 0.94–0.99 Other cardiovascular diseases 1.14 1.07–1.22 0.91 0.86–0.95 Other heart diseases 0.86 0.84–0.89 0.87 0.85–0.89 Pneumonia/influenza 1.15 1.09–1.20 1.06 1.02–1.10 Chronic obstructive pulmonary disease 1.52 1.45–1.60 1.39 1.31–1.48 Other respiratory 1.17 1.01–1.35 1.04 0.91–1.18 Digestive system 1.06 0.99–1.13 1.03 0.99–1.07 Genito-urinary 0.75 0.71–0.80 0.89 0.85–0.93 Ill-defined 1.28 1.20–1.35 1.20 1.15–1.25 Traffic accidents 0.72 0.56–0.93 0.86 0.57–1.30 Other accidents 0.95 0.88–1.03 0.77 0.73–0.81 Other external causes 0.87 0.71–1.07 0.65 0.51–0.84 Other causes 1.32 1.15–1.51 1.19 1.11–1.27 Total 1.06 1.05–1.08 1.02 1.01–1.03 Open in new tab Appendix 1 Classification in cause-of-death groups according to the International Classification of Disease Name of disease category . ICD-Chapter . ICD-8 1970–1978 . ICD-9 1979– . Infectious and parasitic diseases 1 001–136 001–139 Cancer of stomach 2 151 151 Cancer of colorectum 2 153–154 153–154 Cancer of trachea, bronchus and lung 2 162–163 162–163;165 Cancer of breast 2 174 174–175 Cancer of prostate 2 185 185 Other neoplasms 2 r(140–239) r(140–239) Diabetes mellitus 3 250 250 Other endocrine, nutritional and metabolic diseases 3 240–246;251–269;270–279 240–246;251–259;260–279 Diseases of blood and bloodforming organs 4 280–289 280–289 Mental disorders 5 290–315 290–319 Diseases of the nervous system and sense organs 6 320–389 320–389 Ischaemic heart diseases 7 410–414 410–414 Cerebrovascular diseases 7 430–438 430–438 Other cardiovascular diseases 7 440–448;450–458 440–448;415;417;451–459 Other heart diseases 7 390–398;400–404;420–429 390–398;401–405;416;420–429 Pneumonia/influenza 8 470–474;480–484;486 487;480–486 Chronic obstructive pulmonary disease 8 490–493 490–494;496 Other diseases of the respiratory system 8 r(460–519) r(460–519);495 Diseases of the digestive system 9 520–577 520–579 Diseases of the genito-urinary system 10 580–629 580–629 Symptoms and ill-defined conditions 16 780–796 780–799 Traffic accidents 17 E800–845;E940–941 E800-E848 Other accidents 17 E880–887;E890–909; E911–929;E943–946;E980–989 E880–888;E890–909; E911–929;E980–989 Other external causes 17 E850–877; E910; E930–999 excl. E940–941 excl. E943–946 excl. E980–989 E850–869;E910; E870–879; E930–999; excl. E980–989 Other causes 11–15 630–678; 680–686;690–709;710–738; 740–759; 760–776 630–676; 680–686;690–709;710–739; 740–759; 760–779 Name of disease category . ICD-Chapter . ICD-8 1970–1978 . ICD-9 1979– . Infectious and parasitic diseases 1 001–136 001–139 Cancer of stomach 2 151 151 Cancer of colorectum 2 153–154 153–154 Cancer of trachea, bronchus and lung 2 162–163 162–163;165 Cancer of breast 2 174 174–175 Cancer of prostate 2 185 185 Other neoplasms 2 r(140–239) r(140–239) Diabetes mellitus 3 250 250 Other endocrine, nutritional and metabolic diseases 3 240–246;251–269;270–279 240–246;251–259;260–279 Diseases of blood and bloodforming organs 4 280–289 280–289 Mental disorders 5 290–315 290–319 Diseases of the nervous system and sense organs 6 320–389 320–389 Ischaemic heart diseases 7 410–414 410–414 Cerebrovascular diseases 7 430–438 430–438 Other cardiovascular diseases 7 440–448;450–458 440–448;415;417;451–459 Other heart diseases 7 390–398;400–404;420–429 390–398;401–405;416;420–429 Pneumonia/influenza 8 470–474;480–484;486 487;480–486 Chronic obstructive pulmonary disease 8 490–493 490–494;496 Other diseases of the respiratory system 8 r(460–519) r(460–519);495 Diseases of the digestive system 9 520–577 520–579 Diseases of the genito-urinary system 10 580–629 580–629 Symptoms and ill-defined conditions 16 780–796 780–799 Traffic accidents 17 E800–845;E940–941 E800-E848 Other accidents 17 E880–887;E890–909; E911–929;E943–946;E980–989 E880–888;E890–909; E911–929;E980–989 Other external causes 17 E850–877; E910; E930–999 excl. E940–941 excl. E943–946 excl. E980–989 E850–869;E910; E870–879; E930–999; excl. E980–989 Other causes 11–15 630–678; 680–686;690–709;710–738; 740–759; 760–776 630–676; 680–686;690–709;710–739; 740–759; 760–779 Open in new tab Appendix 1 Classification in cause-of-death groups according to the International Classification of Disease Name of disease category . ICD-Chapter . ICD-8 1970–1978 . ICD-9 1979– . Infectious and parasitic diseases 1 001–136 001–139 Cancer of stomach 2 151 151 Cancer of colorectum 2 153–154 153–154 Cancer of trachea, bronchus and lung 2 162–163 162–163;165 Cancer of breast 2 174 174–175 Cancer of prostate 2 185 185 Other neoplasms 2 r(140–239) r(140–239) Diabetes mellitus 3 250 250 Other endocrine, nutritional and metabolic diseases 3 240–246;251–269;270–279 240–246;251–259;260–279 Diseases of blood and bloodforming organs 4 280–289 280–289 Mental disorders 5 290–315 290–319 Diseases of the nervous system and sense organs 6 320–389 320–389 Ischaemic heart diseases 7 410–414 410–414 Cerebrovascular diseases 7 430–438 430–438 Other cardiovascular diseases 7 440–448;450–458 440–448;415;417;451–459 Other heart diseases 7 390–398;400–404;420–429 390–398;401–405;416;420–429 Pneumonia/influenza 8 470–474;480–484;486 487;480–486 Chronic obstructive pulmonary disease 8 490–493 490–494;496 Other diseases of the respiratory system 8 r(460–519) r(460–519);495 Diseases of the digestive system 9 520–577 520–579 Diseases of the genito-urinary system 10 580–629 580–629 Symptoms and ill-defined conditions 16 780–796 780–799 Traffic accidents 17 E800–845;E940–941 E800-E848 Other accidents 17 E880–887;E890–909; E911–929;E943–946;E980–989 E880–888;E890–909; E911–929;E980–989 Other external causes 17 E850–877; E910; E930–999 excl. E940–941 excl. E943–946 excl. E980–989 E850–869;E910; E870–879; E930–999; excl. E980–989 Other causes 11–15 630–678; 680–686;690–709;710–738; 740–759; 760–776 630–676; 680–686;690–709;710–739; 740–759; 760–779 Name of disease category . ICD-Chapter . ICD-8 1970–1978 . ICD-9 1979– . Infectious and parasitic diseases 1 001–136 001–139 Cancer of stomach 2 151 151 Cancer of colorectum 2 153–154 153–154 Cancer of trachea, bronchus and lung 2 162–163 162–163;165 Cancer of breast 2 174 174–175 Cancer of prostate 2 185 185 Other neoplasms 2 r(140–239) r(140–239) Diabetes mellitus 3 250 250 Other endocrine, nutritional and metabolic diseases 3 240–246;251–269;270–279 240–246;251–259;260–279 Diseases of blood and bloodforming organs 4 280–289 280–289 Mental disorders 5 290–315 290–319 Diseases of the nervous system and sense organs 6 320–389 320–389 Ischaemic heart diseases 7 410–414 410–414 Cerebrovascular diseases 7 430–438 430–438 Other cardiovascular diseases 7 440–448;450–458 440–448;415;417;451–459 Other heart diseases 7 390–398;400–404;420–429 390–398;401–405;416;420–429 Pneumonia/influenza 8 470–474;480–484;486 487;480–486 Chronic obstructive pulmonary disease 8 490–493 490–494;496 Other diseases of the respiratory system 8 r(460–519) r(460–519);495 Diseases of the digestive system 9 520–577 520–579 Diseases of the genito-urinary system 10 580–629 580–629 Symptoms and ill-defined conditions 16 780–796 780–799 Traffic accidents 17 E800–845;E940–941 E800-E848 Other accidents 17 E880–887;E890–909; E911–929;E943–946;E980–989 E880–888;E890–909; E911–929;E980–989 Other external causes 17 E850–877; E910; E930–999 excl. E940–941 excl. E943–946 excl. E980–989 E850–869;E910; E870–879; E930–999; excl. E980–989 Other causes 11–15 630–678; 680–686;690–709;710–738; 740–759; 760–776 630–676; 680–686;690–709;710–739; 740–759; 760–779 Open in new tab Figure 1a Open in new tabDownload slide Comparative Mortality Figure (CMF) by 5-year period as a ratio of the CMF in 1970/74 by 10-year age group, The Netherlands, men Figure 1a Open in new tabDownload slide Comparative Mortality Figure (CMF) by 5-year period as a ratio of the CMF in 1970/74 by 10-year age group, The Netherlands, men Figure 1b Open in new tabDownload slide Comparative Mortality Figure (CMF) by 5-year period as a ratio of the CMF in 1970/74 by 10-year age group, The Netherlands, women Figure 1b Open in new tabDownload slide Comparative Mortality Figure (CMF) by 5-year period as a ratio of the CMF in 1970/74 by 10-year age group, The Netherlands, women This project was supported by the Priority Programme on Population Research of the Netherlands Organization for Scientific Research (NWO). We wish to thank Nico Keilman for providing published data on old-age mortality in Norway. References 1 Wrigley EA, Schofield RS. English population history from family reconstitution: summary results 1600–1799. Popul Stud 1983 ; 37: 157 –84. 2 Mackenbach JP. De Veren van Icarus. Over Achtergronden van twee Eeuwen Epidemiologische Transitie in Nederland. Utrecht, The Netherlands: Wetenschappelijke Uitgeverij Bunge, 1992. 3 Mackenbach JP. De epidemiologische transitie in Nederland [The epidemiological transition in The Netherlands]. Ned Tijdschr Geneeskd 1993 ; 137: 132 –38. 4 Statistics Netherlands. Overlevingstafels 1994 en 1990–1994 [Life tables 1994 and 1990–1994]. ‘s-Gravenhage, the Netherlands, 1995. 5 Olshansky SJ, Ault AB. The fourth stage of the epidemiologic transition: the age of delayed degenerative diseases. Milbank Q 1986 ; 64: 355 –91. 6 Myers JC. Comparative mortality trends among older persons in developed countries. In: Caselli G, Lopez AD (eds). Health and Mortality among Elderly Populations. Oxford, UK: Clarendon Press, 1996, pp.87–111. 7 Grundy E. Mortality and morbidity among the old. Br Med J 1984 ; 288: 663 –64. 8 Keyfitz N. Improving life expectancy: an uphill road ahead. Am J Public Health 1978 ; 68: 654 –56. 9 Fries JF. Aging, natural death, and the compression of morbidity. N Engl J Med 1980 ; 303: 130 –35. 10 Olshansky SJ, Carnes BA, Cassel C. In search of Methuselah: estimating the upper limits to human longevity. Science 1990 ; 250: 634 –40. 11 Vaupel JW, Lundstrom H. The future of mortality at older ages in developed countries. In: Lutz W (ed.). The Future Population of the World. What Can We Assume Today? London, UK: Earthscan Publications, 1994, pp.295–315. 12 Vaupel JW, Gowan AE. Passage to Methuselah: some demographic consequences of continued progress against mortality. Am J Public Health 1986 ; 76: 430 –33. 13 Manton KG, Stallard E, Tolley HD. Limits to human life expectancy: evidence, prospects and implications. Popul Dev Rev 1991 ; 17: 603 –37. 14 Guralnik JM, Yanagishita M, Schneider EL. Projecting the older population of the United States: lessons from the past and prospects for the future. Milbank Q 1988 ; 66: 283 –308. 15 Schneider EL, Brody JA. Aging, natural death, and the compression of morbidity: another view. N Engl J Med 1983 ; 309: 854 –56. 16 Manton KG. Changing concepts of morbidity and mortality in the elderly population. Milbank Mem Fund Q Health Soc 1982 ; 60: 183 –244. 17 Rothenberg R, Lentzner HR, Parker RA. Population aging patterns: the expansion of mortality. J Gerontol 1991 ; 46: S66 –70. 18 Kannisto V, Lauristen J, Thatcher AR, Vaupel JW. Reductions in mortality at advanced ages: several decades of evidence from 27 countries. Popul Dev Rev 1994 ; 20: 793 –809. 19 Condran GA, Himes CL, Preston SH. Old-age mortality patterns in low mortality countries: an evaluation of population and death data at advanced ages, 1950 to the present. Popul Bull United Nations 1991 ; 30: 23 –60. 20 Statistics Netherlands. Vijfennegentig Jaren Statistiek in Tijdreeksen: 1899–1994. ‘s-Gravenhage, The Netherlands: SDU/uitgeverij, 1994. 21 Statistics Netherlands. Overlevingstafels naar Leeftijd en Geslacht [Life Tables by Age and Sex]. ‘s-Gravenhage, The Netherlands: State Publishers/Statistics Netherlands, multiple years. 22 Tabeau E, van Poppel F, Willekens F. Mortality in the Netherlands: The Data Base. The Hague, The Netherlands: Netherlands Interdisciplinary Demographic Institute, 1994. 23 Manton KG, Stallard E. Recent Trends in Mortality Analysis. Orlando, FL: Academic Press, 1984. 24 Namboodiri K, Suchindran CM. Life Tables and their Applications. Orlando, FL: Academic Press, 1987. 25 Arriaga EE. Measuring and explaining the change in life expectancies. Demography 1984 ; 21: 83 –96. 26 Arriaga EE. Changing trends in mortality decline during the last decades. In: Ruzicka L, Wunsch G, Kane P (eds). Differential Mortality. Methodological Issues and Biosocial Factors. Oxford, UK: Cladendon Press, 1989, pp.105–29. 27 Olshansky SJ, Rudberg MA, Carnes BA, Cassel CK, Brody JA. Trading off longer life for worsening health. J Aging Health 1991 ; 3: 194 –216. 28 Keyfitz N. What difference would it make if cancer were eradicated? An examination of the Taeuber paradox. Demography 1977 ; 14: 411 –18. 29 Breslow NE, Day NE. Statistical Methods in Cancer Research II. The Design and Analysis of Cohort Studies. Lyon, France: International Agency for Research on Cancer, 1987. 30 Van Hoorn WD. Sterfte: trends, achtergronden en prognose [Mortality: trends, background and forecast]. Maandstatistiek voor de Bevolking (Month Bull Popul Stat) 1997 ; 45: 10 –17. 31 Smith DWE. Human Longevity. New York, NY: Oxford University Press, 1993. 32 Mackenbach JP, Snels IA, Friden-Kill LM. Diabetes Mellitus als doodsoorzaak [Diabetes mellitus as cause of death]. Ned Tijdschr Geneesk 1991 ; 135: 1492 –96. 33 Mamelund S, Borgan J. Kohort- og Periodedodelighet i Norge 1846–1994 [Cohort and Period Mortality in Norway 1846–1994]. Oslo, Norway: Oslo-Kongsvinger, 1996. 34 Prins CJM. Hoge sterfte rond jaarwisseling door griep [Many influenza deaths at the turn of the year]. Maandstatistiek voor de Bevolking [Month Bull Popul Stat] 1990 ; 38: 8 –9. 35 Prins CJM. Sterftepiek in maart en april van dit jaar [Many deaths in March and April of this year]. Maandstatistiek voor de Bevolking [Month Bull Popul Stat] 1993 ; 41: 6 –8. 36 Van der Wal G, Van der Maas PJ. Euthanasie en andere beslissingen rond het levenseinde. De praktijk en de meldingsprocedure. Den Haag, the Netherlands: SDU Uitgevers, 1996. 37 Gunning-Schepers LJ. The Health Benefits of Prevention. A Simulation Approach. Rotterdam: Erasmus University Rotterdam, 1988. 38 Vaupel JW, Manton KG, Stallard E. The impact of heterogeneity in individual frailty on the dynamics of mortality. Demography 1979 ; 16: 439 –54. 39 Bonneux L, Barendregt JJ, Meeter K, Bonsel GJ, van der Maas PJ. Estimating clinical morbidity due to ischemic heart disease and congestive heart failure: the future rise of heart failure. Am J Public Health 1994 ; 84: 20 –28. 40 Bonneux L, Looman CW, Barendregt JJ, Van der Maas PJ. Regression analysis of recent changes in cardiovascular morbidity and mortality in The Netherlands. Br Med J 1997 ; 314: 789 –92. © International Epidemiological Association 2000
TI - Lack of improvement of life expectancy at advanced ages in The Netherlands
JO - International Journal of Epidemiology
DO - 10.1093/ije/29.1.140
DA - 2000-04-01
UR - https://www.deepdyve.com/lp/oxford-university-press/lack-of-improvement-of-life-expectancy-at-advanced-ages-in-the-U7fyg2dUBM
SP - 140
VL - 29
IS - 1
DP - DeepDyve
ER -