Mortality Rate Before the common era and During the common era
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Mortality Rate Improvements – End of an Era, For Now…
Contacts:
Achim Regenauer, Chief Medical Officer, Life & Health
Alan Ryder, Chief Executive Officer, North America LifeMay 31, 2018
Improvements in mortality rates characterized the twentieth century – the trend of living ever longer and healthier lives seemed assured.
Recent mortality rates, however, point to a change. The positive trend has slowed. But why? Are all ages affected? And surely medical advances will anyway have us back on track asap?
To answer those questions, we look at high-level developments in the main causes of mortality and their relevant risk factors. The recommendation is for caution: The future will remain less rosy, for now at least…
A slowing improvement in mortality rates
Figure 1 shows the overall trends in mortality rates and life expectancy at birth for the US population. US data is predominantly used throughout this paper as detailed mortality data is available for the US.
The graph shows that the positive trends of the past began to level off in 2010. Comparing 2000-2010 to 2010-2016, mortality rate improvements deteriorated across all ages, with the worst deterioration in males aged 35-441. Similar trends are mirrored in other developed markets: e.g. in the UK, male mortality improvements averaged 3.1% per year from 2000-2011, falling to 0.7% a year from 2011-20162.
Figure 1: Age-adjusted mortality rates (blue line) and life expectancy at birth (orange line), both sexes, all races, US population, 1900-2015. Mortality rates show steady improvement (reduction) over the period, but in fact began to level off in 2010. Life expectancy at birth has likewise increased, but shows a similar levelling off in recent years. Looking far back, the impact of the 1918 flu pandemic is clearly visible, as is the bounce back in rates and life expectancy after this event. Source: CDC3.
We now break down this data by cause-of-death (leading causes, US); coronary heart disease, stroke and cancer, see figure 2. For each cause, we consider which, if any, age groups are most impacted by slowing mortality rate improvements, and how the evolving medical expectations and relevant risk factors for each cause might impact the future trends for these diseases.
Figure 2: Age-adjusted mortality rates by major cause of death, US population, both sexes, all races, 1960-2015. Most notably, heart disease rates (green line) fell significantly since the 1960s, being the major contributor to overall population mortality improvements during that time period, but flattened out in the last five years. Cancer rates (red line) continue to steadily fall. ‘Accidents’ refers to ‘unintentional injuries’, i.e. excludes suicide. After these main causes of death, Alzeimer’s disease and diabetes were the next two leading causes in the US in 2015-164. Source: CDC3.
The trends for the main natural causes of death
Coronary heart disease and stroke (28% of deaths5): Five decades of mortality rate improvement from these diseases in the US across all age groups was a major contributor to falling overall population mortality rates. In the UK, for example, 70% of all improvements from 1968-2010 were due to the decline in deaths from circulatory diseases2.
“In the UK, 70% of all improvements from 1968-2010 were due to the decline in deaths from circulatory diseases.”
However, over the last few years, rate improvements from coronary heart disease and stroke have reduced (figure 2); for heart disease (US population, age-adjusted, both sexes, all races), the average annual mortality improvement rate for the period 1999-2016 was 2.7%, whereas this fell to 0.9% for the more recent five-year period 2011-2016. This is important given that this is the leading cause of death. The only age groups not seeing a deterioration were ages 1-4 and 25-34. Ages 65-74 were worst affected, with improvements of 3.4% for 1999-2016, versus just 0.3% for 2011-20165.
Age-adjusted mortality rates (blue line) and life expectancy at birth (orange line), both sexes, all races, US population, 1900-2015. Mortality rates show steady improvement (reduction) over the period, but in fact began to level off in 2010. Life expectancy at birth has likewise increased, but shows a similar levelling off in recent years. Looking far back, the impact of the 1918 flu pandemic is clearly visible, as is the bounce back in rates and life expectancy after this event. Source: CDC3.