Evolution of mortality worldwide in the age class 75-84 y

Evolution of mortality
worldwide in the age class
75-84 y
H. Kesteloot
Dept. of Epidemiology, K.U.Leuven
HK2004

Mortality rates (/100.000/yr) mean of 3 last available years mostly from the
years 1997-1999. Age-adjusted 75-84 years.
MEN Country All-causes TCV Total cancer AC-TCV-TCA
HK2004
1 Japan 6181 1996 1941 2244
2 France 6497 2260 1955 2282
3 Australia 6688 2940 1886 1863
4 Switzerland 6916 3016 1840 2060
5 USA 6997 3086 1755 2157
6 Canada 7087 2960 1927 2201
7 Italy 7149 3136 2019 1994
8 Spain 7157 2602 1957 2599
9 Sweden 7166 3725 1721 1721
10 Greece 7198 3721 1758 1719
11 Austria 7208 4036 1842 1329
12 New Zealand 7286 3459 1902 1925
13 Norway 7890 3817 1991 2083
14 Germany 7897 4008 1994 1895
15 Luxembourg 8027 3531 2260 2235
16 England & Wales 8067 3580 2051 2437
17 Finland 8248 4038 1809 2402
18 Netherlands 8352 3262 2367 2723
19 Belgium 8482 3306 2427 2749
20 N. Ireland 8559 3963 2034 2562
21 Denmark 8600 3611 2193 2796
22 Argentina 8782 4116 1675 2991
23 Scotland 8883 4072 2297 2515
24 Portugal 9080 3896 1805 3378
25 Lithuania 9172 5706 1947 1520
26 Chili 9486 3456 1957 4073
27 China (rural) 9648 3939 1142 4567
28 China (urban) 9660 4465 1821 3374
29 Poland 9835 5570 1900 2365
30 Ireland 9950 4597 2215 3138
31 Latvia 9999 6542 1825 1633
32 Estonia 10078 6511 1947 1620
33 Hungary 10732 6249 2489 1995
34 Ukraine 11238 8296 1154 1788
35 Russian Fed. 11574 7916 1561 2097

Mortality rates (/100.000/yr) mean of 3 last available years mostly from the years
1997-1999. Age-adjusted 75-84 years.
WOMEN Country All-causes TCV Total Cancer AC-TCV-TCA
HK2004
1 Japan 3233 1279 821 1134
2 France 3554 1341 841 1372
3 Switzerland 3981 1841 887 1252
4 Australia 4110 1961 961 1188
5 Spain 4210 1917 796 1497
6 Canada 4241 1823 1058 1360
7 Sweden 4276 2194 948 1134
8 Italy 4365 2189 958 1217
9 Luxembourg 4559 2217 1039 1302
10 Norway 4566 2243 980 1343
11 New Zealand 4573 2189 1126 1258
12 USA 4630 2099 1035 1496
13 Austria 4640 2803 1016 821
14 Netherlands 4689 1934 1052 1703
15 Belgium 4795 2191 1034 1570
16 Finland 4942 2498 927 1517
17 Germany 4965 2722 1089 1154
18 England & Wales 5185 2356 1144 1685
19 Denmark 5316 2168 1263 1884
20 Argentina 5396 2760 896 1741
21 N. Ireland 5508 2696 1145 1667
22 Greece 5514 3389 850 1275
23 Portugal 5709 2921 835 1954
24 Scotland 5897 2729 1398 1771
25 Chili 6167 2424 1180 2563
26 Lithuania 6190 4624 888 678
27 Ireland 6261 3082 1234 1945
28 China (rural) 6525 2769 608 3148
29 Estonia 6664 4853 907 903
30 Poland 6693 4188 956 1550
31 China (urban) 6801 3395 929 2477
32 Latvia 6834 4910 915 1009
33 Hungary 7332 4772 1316 1244
34 Russian Fed. 8128 6190 741 1197
35 Ukraine 8278 6794 522 962

Ln Mortality rate vs Age (mean of 3 LAY (1997-99))
Age range 35-84 y
Gompertz – Men
Country Intercept Age (y) ML R²
Japan 1.192 0.095 109.0 0.9993
Australia 1.118 0.096 108.1 0.9925
Spain 1.908 0.087 110.7 0.9932
Canada 1.355 0.094 107.7 0.9969
USA 2.215 0.083 111.4 0.9984
Finland 2.016 0.087 108.6 0.9973
England & Wales 0.924 0.102 104.1 0.9993
Denmark 1.581 0.094 105.5 0.9982
Hungary 3.478 0.073 109.2 0.9943
Russian Fed. 4.291 0.064 112.7 0.9996
R²: determination coefficient; ML: extrapolated maximum life expectancy
HK2004

Ln Mortality rate vs Age (mean of 3 LAY (1997-99))
Age range 35-84 y
Gompertz – Women
Country Intercept Age (y) ML R²
Japan 0.565 0.093 117.8 0.9914
Australia 0.512 0.097 113.2 0.9952
Spain 0.517 0.096 114.6 0.9816
Canada 0.703 0.096 112.7 0.9992
USA 1.344 0.089 114.0 0.9990
Finland 0.631 0.097 112.1 0.9872
England & Wales 0.532 0.100 109.1 0.9991
Denmark 1.072 0.094 110.0 0.9991
Hungary 1.847 0.088 110.3 0.9939
Russian Fed. 1.966 0.088 108.8 0.9968
R²: determination coefficient; ML: extrapolated maximum life expectancy
HK2004

Mortality rates per 100,000/yr, age-adjusted 75-84 yr, mean of 3 latest
available years (1997-99); MEN
Country AC TCV IHD CVA TCA RES
Japan 6181 1996 499 952 1941 2244
Australia 6688 2940 1726 625 1886 1863
USA 6997 3086 1661 478 1755 2157
Canada 7087 2960 1737 544 1927 2201
Spain 7157 2602 928 761 1957 2599
England & Wales 8067 3580 2097 775 2051 2437
Finland 8248 4038 2590 886 1809 2402
Denmark 8600 3611 1877 800 2193 2796
Hungary 10732 6249 2716 1759 2489 1995
Russian Fed. 11574 7916 3819 3076 1561 2097
AC: all causes; TCA: total cancer; RES: AC-TCV-TCA
HK2004

Mortality rates per 100,000/yr, age-adjusted 75-84 yr, mean of 3 latest
available years (1997-99); WOMEN
Country AC TCV IHD CVA TCA RES
Japan 3233 1279 305 596 821 1134
Australia 4110 1961 998 535 961 1188
Spain 4210 1917 503 635 796 1497
Canada 4241 1823 961 421 1058 1360
USA 4630 2099 986 421 1035 1496
Finland 4942 2498 1425 700 927 1517
England & Wales 5185 2356 1152 690 1144 1685
Denmark 5316 2168 986 604 1263 1884
Hungary 7332 4772 1916 1384 1316 1244
Russian Fed. 8128 6190 2676 2700 741 1197
AC: all causes; TCA: total cancer; RES: AC-TCV-TCA
HK2004

Ln Mortality rate vs Age, Age² (mean of 3 LAY (1997-99))
Age range 35-84 y
2 nd degree polynomial – Men
Country Intercept Age (y) Age² R²
Japan 1.510 0.083 0.935x10 -4 * 0.9994
Australia 2.919 0.032* 0.531x10 -3 0.9973
Spain 3.701 0.023 0.528x10 -3 0.9991
Canada 2.327 0.060 0.287x10 -3 0.9984
USA 2.903 0.059 0.203x10 -3 0.9993
Finland 3.135 0.048 0.330x10 -3 0.9996
England & Wales 1.271 0.089 0.102x10 -3 * 0.9994
Denmark 2.080 0.076 0.147x10 -3 * 0.9986
Hungary 2.592 0.105 -0.261x10 -3 * 0.9963
Russian Fed. 4.147 0.069 -0.424x10 -4 * 0.9996
R²: determination coefficient;
*: not significant at the p < 0.05 level
HK2004

Ln Mortality rate vs Age, Age² (mean of 3 LAY (1997-99))
Age range 35-84 y
2 nd degree polynomial – Women
Country Intercept Age (y) Age² R²
Japan 2.469 0.025* 0.561x10 -3 0.9972
Australia 2.280 0.035 0.521x10 -3 0.9998
Spain 3.999 -0.027 0.103x10 -2 0.9996
Canada 1.287 0.075 0.172x10 -3 0.9997
USA 1.913 0.069 0.168x10 -3 0.9996
Finland 3.083 0.010* 0.723x10 -3 0.9960
England & Wales 1.292 0.074 0.224x10 -3 0.9999
Denmark 0.792 0.105 -0.824x10 -4 * 0.9993
Hungary 3.140 0.042 0.381x10 -3 0.9969
Russian Fed. 3.238 0.043 0.375x10 -3 0.9997
R²: determination coefficient;
*: not significant at the p < 0.05 level
HK2004

Slope of ALL-CAUSE mortality per 100,000/yr, age-adjusted 75-84 yr,
1970-(1997-2000); MEN
Country N R² A B T P %Diff/y
Japan 30 0.962 10819 -176.4 -26.57 # -1.63
Australia 30 0.949 11757 -183.7 -22.82 # -1.56
Spain 29 0.930 10669 -143.5 -18.89 # -1.34
Finland 30 0.954 12380 -146.8 -24.01 # -1.19
England&Wales 30 0.965 12182 -143.8 -27.95 # -1.18
USA 29 0.945 9774 -102.2 -21.45 # -1.05
Canada 28 0.962 9493 -91.5 -25.82 # -0.96
Hungary 31 0.607 12897 -64.9 -6.69 # -0.50
Denmark 29 0.421 9586 -27.0 -4.43 *** -0.28
Russian Fed. (80) 19 0.001 11889 -3.2 -0.15 NS -0.03
* p < 0.05; ** p < 0.01; *** p < 0.001; # p < 0.0001; NS: not significant
HK2004

Slope of ALL-CAUSE mortality per 100,000/yr, age-adjusted 75-84 yr,
1970-(1997-2000); WOMEN
Country N R² A B T P % Diff/y
Japan 30 0.975 7838 -175.1 -32.87 # -2.23
Spain 29 0.959 8032 -152.1 -25.22 # -1.89
Australia 30 0.915 7323 -121.8 -17.39 # -1.66
Finland 30 0.904 8748 -142.3 -16.21 # -1.63
Canada 28 0.935 5916 -71.4 -19.26 # -1.21
England & Wales 30 0.961 7518 -89.9 -26.37 # -1.20
USA 29 0.809 6034 -61.6 -10.70 # -1.02
Hungary 31 0.910 9695 -79.2 -17.10 # -0.82
Denmark 29 0.791 6551 -51.6 -10.11 # -0.79
Russian Fed. (80) 19 0.103 7814 18.4 1.40 NS 0.24
* p < 0.05; ** p < 0.01; *** p < 0.001; # p < 0.0001; NS: not significant
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Slope of All-Cause mortality per 100,000/yr, age-adjusted 75-84 years, MEN
Evolution 1970-LAY (1997-2000)
HK2004
Country N R² Intercept Slope T P %Diff/y
Singapore 30 0.878 14349 -267.4 -14.20 # -1.86
Japan 30 0.962 10819 -176.4 -26.57 # -1.63
Australia 30 0.949 11757 -183.7 -22.82 # -1.56
Austria 31 0.960 12757 -186.4 -26.53 # -1.46
Hong Kong 27 0.810 9833 -138.9 -10.31 # -1.41
France 29 0.958 10303 -144.8 -24.68 # -1.41
Spain 29 0.930 10669 -143.5 -18.89 # -1.34
Portugal 30 0.797 13633 -181.8 -10.49 # -1.33
Germany 30 0.940 12617 -156.2 -21.01 # -1.24
Italy 28 0.918 10940 -134.7 -17.11 # -1.23
New Zealand 29 0.893 11484 -139.8 -14.99 # -1.22
Switzerland 28 0.981 10154 -122.6 -36.52 # -1.21
Luxembourg 31 0.802 12706 -153.3 -10.84 # -1.21
Finland 30 0.954 12380 -146.8 -24.01 # -1.19
England & Wales 30 0.965 12182 -143.8 -27.95 # -1.18
Northern Ireland 30 0.877 12804 -146.0 -14.13 # -1.14
Belgium 31 0.941 11984 -133.4 -21.58 # -1.11
USA 29 0.945 9774 -102.2 -21.45 # -1.05
Scotland 31 0.906 13001 -134.3 -16.73 # -1.03
Canada 28 0.962 9493 -91.5 -25.82 # -0.96
Sweden 29 0.898 9888 -91.5 -15.42 # -0.93
Estonia 17 0.649 12089 -100.1 -5.27 # -0.83
China urban 13 0.257 10697 -76.9 -1.95 NS -0.72
China rural 13 0.235 10524 -74.0 -1.84 NS -0.70
Chili 24 0.614 11639 -74.4 -5.92 # -0.64
Ireland 28 0.655 12104 -72.7 -7.02 # -0.60
Norway 29 0.861 9546 -52.1 -12.95 # -0.55
Argentina 20 0.360 10162 -52.0 -3.18 ** -0.51
Hungary 31 0.607 12897 -64.9 -6.69 # -0.50
Greece 29 0.774 8404 -40.2 -9.61 # -0.48
Netherlands 30 0.754 9718 -38.8 -9.26 # -0.40
Poland 30 0.405 11768 -46.5 -4.36 *** -0.40
Latvia 21 0.164 11388 -36.3 -1.93 NS -0.32
Denmark 29 0.421 9586 -27.0 -4.43 *** -0.28
Korea 16 0.029 9888 -27.3 -0.64 NS -0.28
Russian Fed. 19 0.001 11889 -3.2 -0.15 NS -0.03
Lithuania 18 0.001 9328 -2.3 -0.15 NS -0.02
Ukraine 18 0.160 11005 36.2 1.75 NS 0.33
* p

Slope of All-Cause mortality per 100,000/yr, age-adjusted 75-84 years, WOMEN
Evolution 1970-LAY (1997-2000)
HK2004
Country N R² Intercept Slope T P %Diff/y
Japan 30 0.975 7838 -175.1 -32.87 # -2.23
Spain 29 0.959 8032 -152.1 -25.22 # -1.89
Switzerland 28 0.962 7094 -130.5 -25.74 # -1.84
France 29 0.981 6529 -117.4 -36.96 # -1.80
Luxembourg 31 0.936 9136 -164.1 -20.62 # -1.80
Portugal 30 0.895 10366 -182.2 -15.49 # -1.76
Italy 28 0.975 7999 -140.1 -32.12 # -1.75
Belgium 31 0.980 8433 -143.2 -37.27 # -1.69
Austria 31 0.990 8988 -151.2 -53.10 # -1.68
Australia 30 0.915 7323 -121.8 -17.39 # -1.66
Finland 30 0.904 8748 -142.3 -16.21 # -1.63
Germany 30 0.990 8999 -144.8 -52.90 # -1.61
Singapore 30 0.920 8877 -133.0 -17.90 # -1.50
China urban 13 0.780 8024 -114.8 -6.25 # -1.43
Sweden 29 0.981 6789 -96.0 -37.50 # -1.41
Argentina 20 0.787 7747 -108.1 -8.15 # -1.39
New Zealand 29 0.936 7331 -101.8 -19.80 # -1.39
Northern Ireland 30 0.929 8636 -119.2 -19.21 # -1.38
Ireland 28 0.936 9096 -115.0 -19.44 # -1.26
Norway 29 0.955 6801 -85.5 -24.07 # -1.26
Netherlands 30 0.845 6710 -84.3 -12.34 # -1.26
Hong Kong 27 0.789 6059 -75.3 -9.68 # -1.24
Chili 24 0.711 8857 -107.9 -7.36 # -1.21
Canada 28 0.935 5916 -71.4 -19.26 # -1.21
England & Wales 30 0.961 7518 -89.9 -26.37 # -1.20
China rural 13 0.704 7346 -82.9 -5.11 *** -1.13
Estonia 17 0.790 8435 -94.5 7.52 # -1.12
USA 29 0.809 6034 -61.6 -10.70 # -1.02
Scotland 31 0.939 8122 -80.5 -21.04 # -0.99
Greece 29 0.883 7258 -61.8 -14.28 # -0.85
Hungary 31 0.910 9695 -79.2 -17.10 # -0.82
Denmark 29 0.791 6551 -51.6 -10.11 # -0.79
Latvia 21 0.625 7997 -53.8 -5.63 # -0.67
Poland 30 0.759 8396 -52.9 -9.38 # -0.63
Lithuania 18 0.297 6659 -23.4 -2.60 * -0.35
Russian Fed. 19 0.103 7814 18.4 1.40 NS 0.24
Ukraine 18 0.368 7673 47.9 3.05 ** 0.62
Korea 16 0.208 5426 49.3 1.92 NS 0.91
* p

Slope of TCV mortality per 100,000/yr, age-adjusted 75-84 yr,
1970-(1997-2000); MEN
Country N R² A B T P % Diff/y
Japan 30 0.981 5950 -151.1 -38.32 # -2.54
Australia 30 0.969 7311 -161.3 -29.41 # -2.21
Spain 29 0.979 5676 -118.3 -35.59 # -2.08
USA 29 0.977 6233 -122.3 -33.82 # -1.96
Canada 28 0.983 5742 -112.0 -38.65 # -1.95
England & Wales 30 0.988 6524 -102.5 -47.69 # -1.57
Finland 30 0.969 7225 -108.9 -29.62 # -1.51
Denmark 29 0.916 5822 -71.2 -17.14 # -1.22
Hungary 31 0.839 7994 -55.8 -12.28 # -0.70
Russian Fed. (80) 19 0.164 8516 -29.5 -1.83 NS -0.35
* p < 0.05; ** p < 0.01; *** p < 0.001; # p < 0.0001; NS: not significant
HK2004

Slope of TCV mortality per 100,000/yr, age-adjusted 75-84 yr,
1970-(1997-2000); WOMEN
Country N R² A B T P % Diff/y
Japan 30 0.984 4554 -123.0 -40.12 # -2.70
Australia 30 0.960 5252 -123.2 -26.04 # -2.35
Spain 29 0.986 4794 -108.8 -44.11 # -2.27
Canada 28 0.983 3941 -86.9 -39.02 # -2.21
USA 28 0.949 4288 -89.1 -22.53 # -2.08
Finland 30 0.956 5780 -116.9 -24.80 # -2.02
England & Wales 30 0.988 4665 -84.5 -48.55 # -1.81
Denmark 29 0.959 4103 -69.4 -25.06 # -1.69
Hungary 31 0.939 6702 -65.3 -21.09 # -0.97
Russian Fed. (80) 19 0.130 6456 -17.2 -1.60 NS -0.27
* p < 0.05; ** p < 0.01; *** p < 0.001; # p < 0.0001; NS: not significant
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Slope of IHD mortality per 100,000/yr, age-adjusted 75-84 yr,
1970-(1997-2000); MEN
Country N R² A B T P % Diff/y
USA 29 0.962 4080 -96.6 -26.24 # -2.37
Canada 28 0.983 3611 -74.7 -39.07 # -2.07
Australia 30 0.971 4047 -82.0 -30.74 # -2.03
Denmark 29 0.893 3951 -65.7 -15.02 # -1.66
Japan 30 0.844 792 -11.7 -12.31 # -1.48
Russian Fed. (80) 19 0.671 4717 -55.2 -5.89 *** -1.17
England & Wales 30 0.838 3346 -36.6 -12.02 # -1.09
Finland 30 0.539 3460 -21.1 -5.72 # -0.61
Hungary 31 0.071 2736 -5.5 -1.48 NS -0.20
Spain 29 0.009 940 -0.7 -0.50 NS -0.08
* p < 0.05; ** p < 0.01; *** p < 0.001; # p < 0.0001; NS: not significant
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Slope of IHD mortality per 100,000/yr, age-adjusted 75-84 yr,
1970-(1997-2000); WOMEN
Country N R² A B T P % Diff/y
USA 29 0.938 2631 -67.6 -20.27 # -2.57
Canada 28 0.986 2266 -52.8 -42.12 # -2.33
Denmark 29 0.969 2448 -50.8 -29.01 # -2.07
Australia 30 0.960 2421 -49.5 -25.87 # -2.04
Japan 30 0.854 554 -9.5 -12.81 # -1.71
Russian Fed. (80) 19 0.745 3410 -47.5 -7.04 # -1.39
England & Wales 30 0.898 1945 -24.2 -15.68 # -1.25
Finland 30 0.695 2136 -18.4 -7.99 # -0.86
Spain 29 0.324 619 -4.1 -3.60 ** -0.67
Hungary 31 0.210 2029 -10.8 -2.77 ** -0.53
* p < 0.05; ** p < 0.01; *** p < 0.001; # p < 0.0001; NS: not significant
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Slope of CVA mortality per 100,000/yr, age-adjusted 75-84 yr,
1970-(1997-2000); MEN
Country N R² A B T P % Diff/y
Japan 30 0.930 3579 -109.7 -19.34 # -3.06
USA 29 0.901 1247 -33.1 -15.71 # -2.66
Australia 30 0.942 1851 -47.5 -21.37 # -2.56
Spain 29 0.945 2223 -54.2 -21.53 # -2.44
Canada 28 0.940 1197 -28.4 -20.17 # -2.37
England & Wales 30 0.976 1710 -33.4 -33.57 # -1.95
Finland 30 0.871 1740 -29.5 -13.73 # -1.70
Denmark 29 0.832 1154 -13.2 -11.57 # -1.14
Hungary 31 0.427 2294 -16.2 -4.65 # -0.71
Russian Fed. (80) 19 0.148 2960 8.8 1.72 NS 0.30
* p < 0.05; ** p < 0.01; *** p < 0.001; # p < 0.0001; NS: not significant
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Slope of CVA mortality per 100,000/yr, age-adjusted 75-84 yr,
1970-(1997-2000); WOMEN
Country N R² A B T P % Diff/y
Japan 30 0.951 2692 -84.6 -23.43 # -3.14
Australia 30 0.939 1765 -48.5 -20.83 # -2.75
USA 29 0.884 1047 -27.7 -14.37 # -2.65
Spain 29 0.942 2018 -50.8 -20.90 # -2.52
Canada 28 0.939 1002 -25.2 -19.96 # -2.52
England & Wales 30 0.982 1541 -31.3 -39.50 # -2.03
Finland 30 0.857 1639 -32.9 -12.93 # -2.01
Denmark 29 0.815 989 -15.1 -10.92 # -1.53
Hungary 31 0.622 2069 -20.5 -6.90 # -0.99
Russian Fed. (80) 19 0.401 2443 13.2 3.37 ** 0.54
* p < 0.05; ** p < 0.01; *** p < 0.001; # p < 0.0001; NS: not significant
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Slope of TOTAL CANCER mortality per 100,000/yr, age-adjusted
75-84 yr, 1970-(1997-2000); MEN
Country N R² A B T P % Diff/y
Finland 30 0.455 2197 -10.4 -4.84 # -0.47
England & Wales 30 0.032 2170 2.2 0.96 NS 0.10
Australia 30 0.229 1876 4.2 2.88 ** 0.22
Canada 28 0.568 1814 8.2 5.84 # 0.45
USA 29 0.557 1654 8.2 5.83 # 0.50
Hungary 31 0.647 2138 12.3 7.29 # 0.58
Russian Fed. (80) 19 0.477 1448 11.8 3.94 ** 0.81
Denmark 29 0.533 1920 15.9 5.55 # 0.83
Japan 30 0.918 1450 19.2 17.73 # 1.33
Spain 29 0.957 1468 19.7 24.40 # 1.34
* p < 0.05; ** p < 0.01; *** p < 0.001; # p < 0.0001; NS: not significant
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Slope of TOTAL CANCER mortality per 100,000/yr, age-adjusted
75-84 yr, 1970-(1997-2000); WOMEN
Country N R² A B T P % Diff/y
Finland 30 0.815 1115 -6.7 -11.10 # -0.60
Spain 29 0.383 847 -1.8 -4.09 *** -0.22
Japan 30 0.037 828 0.5 1.04 NS 0.06
Denmark 29 0.202 1214 1.8 2.62 * 0.15
Hungary 31 0.198 1252 2.0 2.67 * 0.16
Australia 30 0.307 916 2.1 3.52 ** 0.23
Canada 28 0.621 950 3.9 6.53 # 0.41
England & Wales 30 0.787 1015 6.0 10.19 # 0.59
Russian Fed. (80) 19 0.697 663 6.1 6.25 # 0.92
USA 29 0.922 831 7.8 17.85 # 0.94
* p < 0.05; ** p < 0.01; *** p < 0.001; # p < 0.0001; NS: not significant
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Relationship between mortality and age (1)
• Age is the dominant force in determining the increase of
mortality rates with age worldwide.
• The relationship between ln mortality rates and age can be
expressed by simple regression equations [Gompertz equations
(r²>0.99)] or second-degree polynomial equations (r² > 0.99).
• The fit of the equations is equally good in both sexes and is
independent of the differences in causes of mortality between
populations.
• Changes in mortality rates (both decreases and increases) at the
population level concern the whole population in the age range 35-
84 y.
HK2004

Relationship between mortality and age (2)
• A highly significant correlation exists between the intercept and
the slope of the Gompertz equations. This points to the existence of
a crossing-over age. Populations with low mortality rates have
higher rates above that age.
• In polynomial regression the age² term is always positive, with
one exception for men in Eastern Europe.
• In countries with a high mortality rate the Gompertz equations
are characterized by a high intercept and a low slope. In a given
country the intercept is always higher and the slope lower in men
compared to women.
• Strong evidence points to the existence of a maximum lifespan
for the human population (rectangularisation of human mortality).
HK2004

Causes for the decline in mortality in the age class 75-84 years.
1. The decline is strongly related to the decline in the age class
35-74 y.
2. The causes in the age class 75-84 y are thus essentially similar
to the causes of the changes in the whole population.
3. The population aged 75-84 y is a healthy selection of the
original population.
4. The older age classes are more conservative and less inclined
to change their lifestyle.
5. The age class 75-84 y has rarely been the object of special
medical attention.
6. Differences in mortality between the social classes decrease
at higher ages.
HK2004

7. Many factors influence mortality rates at the population level:
-genetics
- medical care
- smoking
- nutrition
- pollution
-stress
- obesity
- physical activity
- social class a.o.
8. A healthier nutrition (less salt, less saturated fat, more fruit and
vegetables ...) is the most plausible explanation for the
decrease in mortality rates at older ages.
HK2004

Ethische en socio-economische
aspecten van de
gezondheidszorg bij ouderen
H. Kesteloot
Dept. Epidemiologie, K.U.Leuven
HK2004

De socio-economische realiteit:
In de wereld (6.2 * 10 9 personen) zijn ongeveer
800 * 10 6 personen ondervoed en
sterven 24.000 p/d door honger.
Een miljard mensen hebben een inkomen van
minder dan 1.5 Euro per dag.
HK2004

Kernprobleem
Er is geld te kort.
Dit verplicht te kiezen.
Kiezen is verliezen.
HK2004

Verantwoording voor de beperking van
uitgaven voor gezondheidszorg
bejaarden.
Deze uitgaven zijn zeer belangrijk
2-3 10 9 € per jaar,
En bijzonder weinig efficient
HK2004

Solidariteit
- Wat is belangrijker: solidariteit van de
jongeren met de ouderen (pensioenen) of
solidariteit van de ouderen (groter vermogen)
met de jongeren?
- Houdt de solidariteit op aan de landsgrenzen?
HK2004

De uitgaven voor de gezondheidszorg bij ouderen
ziin inefficient. Ze kunnen de
levensverwachting nauwelijks beïnvloeden.
Er bestaat bij de mens een genetisch bepaalde
maximumleeftijd berekend op ± 107 j. Hoe
hoger de levensduur, hoe sneller de toename
van de mortaliteit met de leeftijd boven de 80 j.
(rectangularisatie van de mortaliteitscurve –
compressie van de mortaliteit)
HK2004

Ethische problematiek:
Kunnen inefficiënte uitgaven voor
gezondheidszorg verantwoord worden gezien
de grote noden op andere, sociaal relevante,
domeinen?
Dit geldt in het bijzonder voor door de Sociale
Zekerheid vergoede uitgaven.
HK2004

Competitieve doelen voor economisch en sociaal
verantwoorde uitgaven
- Geneeskundige kosten voor bejaarden (>85 j), inclusief
dementen
- Uitgaven voor onderwijs (permanente vorming)
- Uitgaven voor wetenschappelijk onderzoek
- Uitgaven voor technologisch innovatieve industriën
- Uitgaven voor kinderopvang
- Uitgaven voor kinderbijslag (stimuleren van geboorten)
- Uitgaven voor sociale woningbouw
- Uitgaven voor kultuur
- Uitgaven voor inburgering van migranten
- Uitgaven voor ontwikkelingshulp e.a.
Criterium: kosten/baten analyse
HK2004

Aanvullen van Zilverfonds.
Belasting op vermogen na overlijden:
< 70 j 0 %
70-74 j 2 %
75-79 j 4 %
80-84 j 6 %
≥85 j 8 %
Verantwoording: verschil in pensioenontvangsten bij
gelijke arbeidsduur
0 j 20 j arbeidsduur 60 j
70 j
85 j
HK2004
∆ 15 j = ± 225.000 €

HK2004