Determinants of old-age mortality trends in seven European countries

Fanny Janssen, Erasmus MC, Rotterdam & Population Research Centre, Groningen
Anton Kunst, Erasmus Medical Centre, Rotterdam
Johan P. Mackenbach, Erasmus Medical Center, Rotterdam

This paper presents an overview of old-age mortality trends in seven European countries and the role of smoking, mortality selection, socio-economic developments throughout the lifecourse, and medical end-of-life decisions herein. Poisson regression and correlation analyses were applied to all-cause and cause-specific mortality among the elderly (60+/80+) and to empirical data on determinants in Denmark, England&Wales, Finland, France, The Netherlands, Norway, and Sweden, 1950-1999. We found large heterogeneity in the pace of decline, with stagnation since the 1980s in Denmark, The Netherlands, and among Norwegian men. Both period patterns and cohort patterns were observed. The observed cohort patterns are largely determined by smoking, but not fully. Mortality selection has not been a driving factor. Next to the effect of current economic growth an effect of economic developments during earlier ages of the cohort was found. Cross-national differences in old-age mortality might to some extent be the result of differences in attitudes concerning appropriate medical treatment for the elderly.