title: Equity and length of lifespan are not the same.
abstract: Efforts to understand the dramatic declines in mortality over the past century have focused on life expectancy. However, understanding changes in disparity in age of death is important to understanding mechanisms of mortality improvement and devising policy to promote health equity. We derive a novel decomposition of variance in age of death, a measure of inequality, and apply it to cause-specific contributions to the change in variance among the G7 countries (Canada, France, Germany, Italy, Japan, the United Kingdom, and the United States) from 1950 to 2010. We find that the causes of death that contributed most to declines in the variance are different from those that contributed most to increase in life expectancy; in particular, they affect mortality at younger ages. We also find that, for two leading causes of death [cancers and cardiovascular disease (CVD)], there are no consistent relationships between changes in life expectancy and variance either within countries over time or between countries. These results show that promoting health at younger ages is critical for health equity and that policies to control cancer and CVD may have differing implications for equity.
authors.affiliation: Department of Biology, Stanford University, Palo Alto, CA 94305; School of Medicine, Stanford University, Palo Alto, CA 94305; bensel@gmail.com.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Seligman
authors.affiliation: Department of Statistics, Stanford University, Palo Alto, CA 94305.
authors.forename: Gabi
authors.initials: G
authors.lastname: Greenberg
authors.affiliation: Department of Biology, Stanford University, Palo Alto, CA 94305;
authors.forename: Shripad
authors.initials: S
authors.lastname: Tuljapurkar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D002318:Cardiovascular Diseases / Q000401:mortality*; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D005260:Female; D005602:France; D005858:Germany; D054624:Health Status Disparities; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007558:Italy; D007564:Japan; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D009369:Neoplasms / Q000401:mortality*; D006113:United Kingdom; D014481:United States
keywords: age of death variance; health equity; inequality; life expectancy; mortality