Where there are no data: what has happened to life expectancy in Georgia since 1990?

In recent years there has been a considerable increase in understanding of changes in mortality in Russia and some other former Soviet republics. However, the situation in the republics of the Caucasus remains poorly understood. Information on Georgia is especially fragmentary as a fifth of the country remains outside government control, there has been large scale migration since 1991, and the introduction of fees for vital registration has compromised the quality of official statistics. The aim of the study is to produce plausible estimates for life expectancy in Georgia for the period 1990-1998 and thus to assess whether Georgia has undergone changes similar to other former Soviet republics in the post-independence period. Four models were used to construct life tables. Model 1 used officially published statistics on deaths and population. Model 2 applied new estimates of population derived from household surveys to the observed deaths. Model 3 adjusted model 2 for under-registration at extremes of life, with parameter estimates derived from a survey of infant mortality and comparison of observed rates with Coale-Demeny standard life tables. Model 4 arose following inspection of death rates by cause that revealed implausible discontinuities in cancer mortality rates and involved applying the estimates of under-registration that this finding implied to model 3.The four models produce quite different estimates of life expectancy, differing by 7.8 y for men and 6.8 y for women by 1998. In any of the models, however, Georgia does not appear to have experienced the marked deterioration in life expectancy seen in Russia following the transition to independence. Importantly, Georgia had also not experienced a marked improvement in life expectancy during the 1985 Soviet anti-alcohol campaign, again unlike other Soviet republics.Official statistics substantially over-estimate life expectancy at birth in Georgia. Despite undergoing a civil war, life expectancy in Georgia has been less affected by the transition than has Russia and the overall trends in mortality since the mid 1980s suggest that this may be because alcohol has played a smaller role in these changes than it did in Russia.     

Mortality: life and health expectancy of Canadian women

HEALTH ISSUE: The sex differences in mortality, life expectancy, and, to a lesser extent, health expectancy, are well recognized in Canada and internationally. However, the factors explaining these differences between women and men are not well understood. This chapter explores the contribution of various causes of death (such as preventable, and sex-specific deaths) on these differences between women and men. KEY FINDINGS: "External" preventable causes of death (e.g. smoking-related, injuries, etc.) were responsible for a large portion of the sex gap in mortality and life expectancy. When excluding these causes from the calculations, the sex gap in life expectancies were largely reduced, decreasing from approximately 5.5 years (life expectancy being 81.4, years in women, and 75.9 years in men) to approximately 2.2 years (84.9 in women and 82.7 in men). Sex gaps in corresponding health expectancies entirely disappeared when these preventable causes of death were excluded. Moreover, a larger death burden was observed among women than men for sex-specific causes of death (eg. excess breast cancer, gynaecological cancers, maternal mortality). Significant disparities were also observed in the mortality rates of various subgroups of women by geographic regions of Canada. DATA GAPS AND RECOMMENDATIONS: These results indicate that women do not appear to have a large biological survival advantage but, rather, are at lower risk of preventable deaths. They also provide additional information needed for the development of policies aimed at reducing disparities in life and health expectancies in Canada and other developed countries.     

Mortality in 272 European regions, 2002–2004. An update

This paper presents a comprehensive update of life expectancy and mortality in 2002–2004 in the modern European Union (EU-27) and EFTA countries. We focus on causes of death at younger ages (0–64 year). EUROSTAT delivered updated population numbers and mortality data by sex, age and cause of death for 272 NUTS-2 regions. We compared mortality by life tables, cause decomposition life tables and age standardized rates. Gini coefficients estimated inequity of death rates over the regions. Life expectancy at birth in the EU-27 was 75.1 years (men) and 81.3 years (women). The difference between the 10th and 90th percentile of 272 regions was 8.0 (men) and 5.6 years (women). Men lived 6.1 years shorter in the new member states (NMS, new members since 2004) than in the EU-15 (members before 2004), women 3.9 years. 60% (men) and 33% (women) of the differences in life expectancy between EU 15 and NMS were explained by mortality under age 65. The main causes explaining differences in life expectancy were ischemic and other heart disease, stroke, alcohol related mortality, lung cancer and injuries. The fraction of ill defined causes of death was large and very variable between countries. Mortality differences in the EU-27 are dominated by smoking, alcohol, diseases related to diet and a sedentary lifestyle, unsafe roads and differences in health care performance. Closing the health gap is feasible and ought to be a major target of the European Union, but monitoring will need better registration of causes of death.     

Changing mortality patterns in East and West Germany and Poland. II: short-term trends during transition and in the 1990s

OBJECTIVES: To examine trends in life expectancy at birth and age and cause specific patterns of mortality in the former German Democratic Republic (GDR) and Poland during political transition and throughout the 1990s in both parts of Germany and in Poland. METHODS: Decomposition of life expectancy by age and cause of death. Changes in life expectancy during transition by cause of death were examined using data for 1988/89 and 1990/91 for the former GDR and Poland; examination of life expectancy changes after transition were based on 1992-97 data for Germany and 1991-96 data for Poland. RESULTS: In both the former GDR and Poland male life expectancy at birth declined by almost one year during transition, mainly attributable to rising death rates from external causes and circulatory diseases. Female life expectancy in Poland deteriorated by 0.3 years, largely attributable to increasing circulatory mortality among the old, while in East German female rising death rates in children and young adults were nearly outbalanced by declining circulatory mortality among those over 70. Between 1991/92 and 1996/97, male life expectancy at birth increased by 2.4 years in the former GDR, 1.2 years in old Federal Republic, and 2.0 years in Poland (women: 2.3, 0.9, and 1.2 years). In East Germany and Poland, the overall improvement was largely attributable to falling mortality among men aged 40-64, while those over 65 contributed the largest proportion to life expectancy gains in women. The change in deaths among men aged 15-39 accounted for 0.4 of a year to life expectancy at birth in East Germany and Poland, attributable largely to greater decreases from external causes. Among those over 40, absolute contributions to changing life expectancy were greater in the former GDR than in the other two entities in both sexes, largely attributable to circulatory diseases. A persisting East-west life expectancy gap in Germany of 2.1 years in men in 1997 was largely attributable to external causes, diseases of the digestive system and circulatory diseases. Higher death rates from circulatory diseases among the elderly largely explain the female life expectancy gap of approximately one year. CONCLUSIONS: This study provides further insights into the health effects of political transition. Post-transition improvements in life expectancy and mortality have been much steeper in East Germany compared with Poland. Changes in dietary pattern and, in Germany, medical care may have been important factors in shaping post-transition mortality trends.     

Changing trends of diseases in Eastern Europe: closing the gap

One of the greatest challenges in Europe at the beginning of the 21st Century is the wide east-west health gap. In 2008, the difference in life expectancy between men in some Western European countries and Russia was 20 years. Whilst trends for life expectancy at birth have improved in many areas around the world, those for Russia, as well as those for some other former Soviet Union countries, have fluctuated greatly and have not shown signs of growth since the middle of the 20th Century. This problem is most acute in Russia and former Soviet Union countries, but is also far from being solved in the states that have made significant progress since 1990 and joined the European Union in the 21st Century. One of the priorities of the Polish presidency of the European Union, which began in July 2011, is the call for a European solidarity for health that could help to close the health gap dividing Europe.     

Avoidable mortality by neighbourhood income in Canada: 25 years after the establishment of universal health insurance

AIM: To examine neighbourhood income differences in deaths amenable to medical care and public health over a 25-year period after the establishment of universal insurance for doctors and hospital services in Canada. METHODS: Data for census metropolitan areas were obtained from the Canadian Mortality Database and population censuses for the years 1971, 1986, 1991 and 1996. Deaths amenable to medical care, amenable to public health, from ischaemic heart disease and from other causes were considered. Data on deaths were grouped into neighbourhood income quintiles on the basis of the census tract percentage of population below Canada's low-income cut-offs. RESULTS: From 1971 to 1996, differences between the richest and poorest quintiles in age-standardised expected years of life lost amenable to medical care decreased 60% (p<0.001) in men and 78% (p<0.001) in women, those amenable to public health increased 0.7% (p = 0.94) in men and 20% (p = 0.55) in women, those lost from ischaemic heart disease decreased 58% in men and 38% in women, and from other causes decreased 15% in men and 9% in women. Changes in the age-standardised expected years of life lost difference for deaths amenable to medical care were significantly larger than those for deaths amenable to public health or other causes for both men and women (p<0.001). CONCLUSIONS: Reductions in rates of deaths amenable to medical care made the largest contribution to narrowing socioeconomic mortality disparities. Continuing disparities in mortality from causes amenable to public health suggest that public health initiatives have a potentially important, but yet un-realized, role in further reducing mortality disparities in Canada.     

Inequalities in life expectancy by educational level and its decomposition in Barcelona, 2004-2018

ObjectiveTo analyse the gap in life expectancy by educational level in the city of Barcelona from 2004 to 2018 and to decompose this gap by age and causes of death.MethodWe computed abridged life tables at the age of 25 years by sex from 2004 to 2018 using standard methods. Educational level was categorised in two groups (lower secondary or less vs. upper secondary or higher education). The life expectancy gap was further decomposed by age and by causes of death based in Arriaga's method in 5-year age blocks up to the age of ≥ 90 years and broad causes of death using ICD-10 codes.ResultsThe life expectancy gap at 25 years by educational level oscillated without trend at around 3.08 years for men and 1.93 years for women. Decomposition by age showed a favourable significant shift in the contribution to this gap from young to older ages for men, with few changes for women. Decomposition by causes of death showed that the diseases concentrating the largest share of the contribution were neoplasms and respiratory and circulatory disease. There was a significant downward trend in external causes for men and in infectious diseases for both men and women but a significant upward trend for respiratory disease for both sexes.ConclusionsThe stability of the life expectancy gap by educational level during the period analysed resulted from a combination of divergent trends by age and causes of death among high and low educational levels.     

Life expectancy gap between the Francophone majority and Anglophone minority of a Canadian population

Language is an important determinant of health, but analyses of linguistic inequalities in mortality are scant, especially for Canadian linguistic groups with European roots. We evaluated the life expectancy gap between the Francophone majority and Anglophone minority of Québec, Canada, both over time and across major provincial areas. Arriaga’s method was used to estimate the age and cause of death groups contributing to changes in the life expectancy gap at birth between 1989–1993 and 2002–2006, and to evaluate patterns across major provincial areas (metropolitan Montréal, other metropolitan centres, and small cities/rural areas). Life expectancy at birth was greater for Anglophones, but the gap decreased over time by 1.3 years (52% decline) in men and 0.9 years (47% decline) in women, due to relatively sharper reductions in Francophone mortality from several causes, except lung cancer which countered reductions in women. The life expectancy gap in 2002–2006 was widest in other metropolitan centres (men 5.1 years, women 3.2 years), narrowest in small cities/rural areas (men 0.8 years, women 0.7 years), and tobacco-related causes were the main contributors. Only young Anglophones <40 years in small cities/rural areas had mortality higher than Francophones, resulting in a narrower gap in these areas. Differentials in life expectancy favouring Anglophones decreased over time, but varied across areas of Québec. Tobacco-related causes accounted for the majority of the current life expectancy gap.     

Determinants of and inequalities in self-perceived health in Ukraine

Ukraine is the second most populous of the former Soviet Republics and since transition its economy has fared even more poorly than Russia. Although the impact of the collapse of the former Soviet Union on health in Russia has been investigated, little is known of its impact in other post-Soviet republics. We report a cross-sectional study undertaken in Ukraine in March 2000. A multi-stage random sampling technique was used and 1600 interviews completed (72% response rate) with a representative national sample of Ukrainian adults. We investigated socioeconomic and psychosocial determinants of self-perceived health, which has been shown to be a valid and reliable measure of overall health and predictive of mortality. Odds ratios for less than good physical health were calculated using logistic regression. The self-rated health of Ukrainians was poor, 25% of men and 43% of women rated their health as poor or very poor. This is worse than levels recorded in Russia and considerably worse than levels seen in western Europe. Marked gender, geographical and socioeconomic inequalities in health were recorded. Women are at increased risk of poor self-rated health compared with men (OR 3.58, 2.50-5.14) as are women living in villages compared with those in cities (OR 3.24, 1.30-8.07). Socioeconomic factors including poor material situation (OR 1.64, 1.01-2.67), and psychosocial factors including low control over life (OR 1.89, 1.15-3.11) were identified as independent health determinants. Control over life was found to account for the negative impact of low social position on health. Good family relations protected against poor health. The findings suggest that a decrease in control, arising from an increasingly uncertain political and economic environment, a reduction in material wealth and the stress of change may all have contributed to the decline in life expectancy seen with transition.     

Health expectancy in the Russian Federation: a new perspective on the health divide in Europe

OBJECTIVES: To compare life expectancy and healthy life expectancy in the Russian Federation and in countries of Eastern and Western Europe. METHODS: WHO mortality data and data on self-reported health from the World Values Survey and the Russian Longitudinal Monitoring Survey were used to compare the above three regions. Life expectancy was calculated using Sullivan''s method, with years of life lived divided into healthy and unhealthy. The gap in healthy life expectancy between the Russian Federation and Western Europe was examined by decomposing the difference by gender and age. FINDINGS: The probability of remaining alive and healthy declines faster in the Russian Federation than in Western Europe, with the gap between Eastern Europe and the Russian Federation widening at older ages. In the Russian Federation, this rapid decline is due mainly to the high probability of death or of poor health for men and women, respectively. CONCLUSIONS: There is a large toll of premature male mortality in the Russian Federation but there also appears to be a substantial burden of ill-health among women. As in other countries, the responses of men and women to adversity differ, leading to premature death in men but survival in a poor state of health in women. Epidemiological studies including objective measures of health would help policy-makers to estimate more precisely the scale and nature of this problem. Policy-makers must recognize that health expectancy in the Russian Federation is reduced in both men and women.     

Increasing ethnic differences in mortality in Estonia after the collapse of the Soviet Union

STUDY OBJECTIVE: This study examined the change in ethnic differences in mortality in Estonia 1989-2000. DESIGN: Two unlinked cross sectional census based analyses were compared. Total and cause specific mortality was analysed for ethnic Estonians and Russians. The absolute differences in mortality were evaluated through life expectancy at birth and age standardised mortality rates. Relative differences were assessed by mortality rate ratios with 95% confidence intervals, calculated using Poisson regression. SETTING: Estonia before and after the fall of the Soviet Union. PARTICIPANTS: Individual cause specific death data for 1987-1990 (69549 deaths) and for 1999-2000 (33809 deaths) came from the national mortality database. Population denominators came from the population censuses of 1989 and 2000. MAIN RESULTS: In the period 1989-2000, ethnic differences in life expectancy increased from 0.4 years to 6.1 years among men and from 0.6 years to 3.5 years among women. In 2000, Russians had a higher mortality than Estonians in all age groups and for almost all selected causes of death. The largest differences were found for some alcohol related causes of death especially in 2000. CONCLUSIONS: Political and economic upheaval, increasing poverty, and alcohol consumption can be considered the main underlying causes of the widening ethnic mortality gap.     

Analysis of sex,age and disease factors contributing to prolonged life expectancy at birth,in cases of malignant neoplasms in Japan

BACKGROUND: This study aimed to examine the contribution made by the change in mortality from malignant neoplasms to the life expectancy at birth, observed during the years 1965-1995 in Japan. METHODS: We used data on the population and number of deaths by cause, age and sex in 1965, 1975, 1985 and 1995. The contribution of different ages and causes of death to the change in life expectancy were examined with the method developed by Pollard. RESULTS: We found that, among all causes, the decrease of mortality from stomach cancer led to the greatest improvement in life expectancy for both sexes. On the other hand, negative contributions were seen with cancers of many sites, such as cancer of the intestine, liver and lung for males, and cancer of the intestine, gallbladder, lung and breast for females. Recently, the contributing years of all cancers have been negative because of the increase in mortality from malignant neoplasms. In addition, increase of death from malignant neoplasms in middle-aged and elderly people negatively influenced the life expectancy at birth. CONCLUSIONS: Female cancer influenced the improvement in life expectancy at birth. Cancer for males, however, contributed little to improvement of life expectancy at birth except for a little prolongation of life expectancy at birth during the years 1965-1975. To develop a public health policy, the contributing years to life expectancy at birth can be a useful indication in evaluating the impact of death from various diseases. It is necessary to analyze the contribution made by various causes of death to the changes of life expectancy at birth.     

The changing gender differences in life expectancy in Korea 1970-2005

Women live much longer than men in Korea, with remarkable gains in life expectancy at birth for the past decades. The gender differential has steadily increased over time, reaching a peak of more than 8 years in 1980s, and decreased thereafter to 6.7 years in 2005. Studies to investigate the pattern and contributing factors to changes in the life expectancy gender gap have been mostly from Western countries, and there has been no such study in Asian countries, except in Japan. We therefore aimed to examine age- and cause-specific contributions to the changing gender differentials in life expectancy in Korea, in particular the decline of the gap, using a decomposition method. Between 1970 and 1979 when the gender gap in life expectancy widened, faster mortality decline among women in ages 20-44 explained 66% of the total increase in the gender gap, which would be due to substantial improvements in reproductive health among women and excess male mortality in occupational injuries and transport accidents. Although greater survival advantage among elderly women over 70 contributed to further increase in the gender gap, the contributions from younger ages with the ages 15-64 contributing the most (-2 years) resulted in the overall reduction of the gender gap which began in 1992 and continued to 2005. Among causes of death, liver diseases (-0.5 years, 38% of the total decline), transport accidents (-0.4 years, 31%), hypertensive diseases (-0.3 years, 19%), stroke (-0.1 years, 11%), and tuberculosis (-0.1 years) contributed the most to the overall 1.4 years reduction in the gender gap. However, changes in mortality from lung cancer (+0.3 years), suicide (+0.3 years), chronic lower respiratory diseases (+0.2 years), and ischemic heart diseases (+0.1 years) contributed to widening the gap during the same period. In sum, while smoking-related causes of death have contributed most to the narrowing gap in most other industrialized countries, these causes contributed toward increasing the gender gap in Korea. Instead, liver disease, hypertension-related diseases, and transport accidents were major contributing causes of death to the narrowing of gender differentials in life expectancy in Korea.     

The gender gap in primary health care resource utilization in Central Asia

There is a large gender gap in life expectancy in some countries of the former Soviet Union. Life expectancy of males is as much as 13 years less than that of females, and a significant portion of the excess male mortality is caused by cardiovascular disease. Although effective primary health care is necessary to manage cardiovascular disease and reduce acute episodes and mortality, the primary health care system is under-utilized by adult males in the region. This study combines disaggregated utilization data with cost data to analyze patterns of per capita primary care resource consumption in urban and rural regions of Kazakhstan and Uzbekistan. The results show that both in absolute and per capita terms, the principal users of primary health are women of reproductive age and children under five. Based on a combination of utilization and cost of services, women of reproductive age consume approximately 1.5 times the average per capita primary health care resources, while men in the same age group consume approximately one-half of the average. Children under five consume about three to five times the average per capita primary care resources. Based on the results of the study, regional government health purchasers worked together with providers to develop a new per capita payment system with age/sex adjustments and incentives for outreach to bring adult men into the primary care system.     

Diverging socioeconomic inequality in life expectancy of Francophones and Anglophones in Montréal, Québec: tobacco to blame?

Aim

We evaluated the ages and causes of death contributing to life expectancy gaps between economically advantaged and disadvantaged Francophones and Anglophones of Montréal, a Canadian metropolitan centre.

Subject and Methods

We partitioned the life expectancy gap at birth between socioeconomically disadvantaged and advantaged Francophones and Anglophones of Montréal (Québec) into age and cause of death components for two periods (1989–1993, 2002–2006). Changes in the contributions of causes over time were evaluated.

Results

Life expectancy was lower for disadvantaged Francophones and Anglophones by 5 years in men and 1.6 years in women compared with advantaged individuals. Over time, the socioeconomic gap widened for Francophones (men 0.3 years, women 2.8 years), due to smaller reductions in mortality from tobacco-related causes (cardiovascular, cancer, respiratory) in disadvantaged than in advantaged Francophones, especially after age ≥65 years (except lung cancer mortality that increased, particularly in disadvantaged women). The socioeconomic gap narrowed, however, for Anglophones (men 1.0 year, women 0.6 years), due to greater reductions in cardiovascular mortality in disadvantaged than advantaged Anglophones.

Conclusion

Socioeconomic inequalities in life expectancy decreased for Anglophones but increased for Francophones in Montréal due to underlying trends in tobacco-related mortality. Despite strong tobacco control laws in Canada, socioeconomic inequality in tobacco-related mortality is widening for Francophones in Montréal.     

2005--2010年中国城市居民期望寿命性别差异的分析

目的了解2005--2010年中国城市居民期望寿命的性别差异及其受年龄和死因的影响, 并探讨影响期望寿命年龄差异变化的主要因素。方法利用2005--2010年《中国卫生统计年鉴》中城市居民年龄别死亡率及死因等死亡数据, 采用绘制寿命表法、期望寿命性别差异及其年龄分解和死因分解法, 进行城市居民期望寿命性别差异的分析比较。结果自2005年中国城市人群期望寿命开始呈上升趋势, 女性期望寿命始终高于男性; 2007年期望寿命性别差异显著增加(相差5．3岁)并呈现-个尖峰, 其中以60～79岁年龄组男女性别死亡率的差异最为显著, 是导致性别期望寿命差异的主要因素(42%～47%)。2005-2007年期望寿命性别差异增大, 主要为0～1岁婴幼儿和>75岁老年组; 2007-2008年该差异缩小, 仅表现为1-15岁和50～55岁年龄组; 2009--2010年差异增大, 主要为60-70岁年龄组。影响期望寿命性别差异的主要死因为肿瘤(1．638-2.019岁)、循环系统疾病(1.271～1.606岁)、呼吸系统疾病(0．551～0.800岁)。肿瘤中以肺癌对期望寿命的影响最大, 每年有约0．6岁的差异; 而肝癌导致男女性死亡差异不断缩小。损伤和中毒等原因也影响期望寿命的性别差异(10．60% 15.78%)。结论缩小中国城市居民健康的性别差距, 重点应关注男性>/60岁老年人; 肿瘤、循环系统疾病和呼吸系统疾病是导致中国城市人群期望寿命性别差异的主要疾病, 同时不可忽视外伤、自杀等对期望寿命差异的影响。     

Avoidable mortality in Lithuania: 1991-199 compared with 1970-1990

This paper assesses the changes in avoidable mortality in Lithuania in 1991-1999 compared with 1970-1990. Causes of death were disaggregated into causes most amenable to treatment and those amenable to prevention. Trends in age-standardised death rates were calculated. In 1970-1990, avoidable causes of death accounted for 26.3% of all deaths. By 1991-1999 this figure had decreased slightly to 24.6%. At the same time, age-standardised death rates from avoidable causes increased by 8%, from 118.1 per 100000 in 1970-1990 to 127.9 in 1991-1999. Avoidable mortality among men was considerably higher than for women in both periods. There was considerable fluctuation in both treatable and preventable mortality during the 1990s, reflecting diversity in trends in different causes of death. Increases occurred in death rates from tuberculosis, cervical cancer and liver cirrhosis and, immediately after independence, also in hypertensive and cerebrovascular diseases and, among men, lung cancer, followed by subsequent declines. Deaths from chronic rheumatic heart disease, asthma and other respiratory diseases, appendicitis, abdominal hernia, cholelithiasis and maternal mortality consistently declined. In conclusion, avoidable mortality declined as a proportion of total mortality in Lithuania during 1991-1999 compared with 1970-1990. This reflected the combined impact of an initial rise in death rates from treatable and, to a lesser extent, preventable causes, followed by subsequent declines. While this indicates some success in the development of medical care, it emphasises the need for more effective public health policies directed at the major determinants of health.     

Mortality and life expectancy in Denmark and in other European countries: What is happening to middle-aged Danes?

Background: The trend in life expectancy in Denmark has beenless favourable than in other European countries for severalyears. The aim of this study was to compare mortality in Denmarkwith that in selected European countries, focusing on age groupsand causes of death for which the Danish trends are particularlyunfavourable. Methods: Comparisons were made for the period1952–1993 between Denmark and Norway, the former FederalRepublic of Germany, The Netherlands, the UK, France, Italyand former Czechoslovakia of age-specific mortality rates andchanges in life expectancy specific for each age group and causeof death. Results: At the end of the period only the formerCzechoslovakia had a lower life expectancy than Denmark; thedifference in life expectancy between Denmark and the othersix countries varied between 5 and 48 months. Almost all ofthe difference was due to a higher mortality rate in the 35–74years age group. All heart diseases and ‘symptoms andill-defined conditions’ were responsible for a large proportionof the Danish high mortality, the decrease in mortality fromthis group of diseases being moderate in comparison with theother countries. Lung cancer contributed to a loss of 1–6months more of life expectancy for Danish women than in theother countries. In comparison with Norway, The Netherlandsand the UK, Danish men lost 2 more months' life expectancy dueto liver cirrhosis and Danish women lost 1 month more. Conclusions:A considerable proportion of the extra deaths in Denmark couldbe prevented.     

Change in life expectancy in connection with three large groups of causes of death in Medellín, Colombia, between 1989-1991 and 1994-1996]

OBJECTIVES: To examine changes in life expectancy in Medellin, Colombia, between 1989-1991 y 1994-1996, in connection with four large groups of causes of death commonly employed in studies on the burden of disease: group 1, communicable diseases, perinatal and maternal health problems, and nutritional deficits; group 2, non-communicable diseases; group 3, wounds; group 4, ill-defined causes. The latter were excluded from the analysis because of their ambiguity. METHODS: The calculations were made according to the method described by J. H. Pollard in 1986, with the aid of Microsoft Excel, by using the recommended formulas. The computations were double checked with EPIDAT (version 3.0, unofficial). RESULTS: Between 1989-1991 y 1994-1996, a total gain of 1.93 years in life expectancy was seen in Medellin, with a rise from 62.13 to 64.06 years. The gain was greater in men than in women (2.42 vs. 1.09 years, respectively). The increase noted among females was greatest in the extreme age groups (girls 1 to 4 and women over 54 years of age); in men, it was highest in the middle years (between the ages of 25 and 44). In both sexes, the greatest percentage loss in life expectancy was seen in persons 15 to 19 years of age (23% in men and 4% in women, roughly). In the group comprising communicable diseases, perinatal and maternal health problems, and nutritional deficits, a loss in life expectancy was seen in men (0.04 years), whereas in the group of non-communicable diseases there was a gain in life expectancy in both sexes (0.60 years among men and 0.55 years among women). The greater gain in life expectancy among men was linked to a reduction in mortality from wounds (1.98 years). CONCLUSIONS: If one compares the results obtained in Medellin at the end of the study period with life expectancy at birth in Colombia in 1995, which was 70 years, it is obvious that life expectancy in Medellin is still lagging behind, even though it has risen progressively over the years. This is in keeping with the epidemiological transition the city has experienced, which has been linked with a rise in mortality from degenerative and cardiovascular diseases, chronic respiratory ailments, and diabetes, as well as from diseases resulting from human activity. Nevertheless, this epidemiological transition has been slow in Medellin when compared to Colombia as a whole due to high rates of death from infectious and parasitic diseases, which are more characteristic of the transition in its earlier stages. Despite the fact that mortality from wounds has decreased in Medellin, particularly among young males, it may be worthwhile to reassess the effectiveness of interventions undertaken in recent years to promote peaceful coexistence and tolerance in the community.     

Political conditions and life expectancy in Europe, 1900–2008

The rise of life expectancy in Europe has been a very uneven process, both in time and space. This paper aims to identify instances in which major political conditions are likely to have influenced the rise of life expectancy, focusing on formation and dissolution of states and supranational blocs and on differences between political regimes (democratic vs. authoritarian non-communist and communist rule). Data on life expectancy, cause-specific mortality and political conditions were compiled from existing data sources. Possible relations between political conditions and life expectancy were studied by direct comparisons of changes in life expectancy in countries with different political conditions but similar starting levels of life expectancy. We found that formation and dissolution of states often went together with convergence and divergence of life expectancy, respectively, and that otherwise similar countries that did or did not become part of the Soviet bloc had distinctly different life expectancy trajectories. Democratically governed states had higher life expectancies than authoritarian states throughout the 20th century. The gap narrowed between 1920 and 1960 due to rapid catching up of infectious disease control in both non-communist and communist authoritarian states. It widened again after 1960 due to earlier and more rapid progress in democratic states against cardiovascular disease, breast cancer, motor vehicle accidents and other causes of death that have become amenable to intervention. We conclude that the history of life expectancy in Europe contains many instances in which political conditions are likely to have had a temporary or more lasting impact on population health. This suggests that there is scope for further in-depth studies of the impact of specific political determinants on the development of population health in Europe.