Jessica Y. Ho

The changing contribution of smoking to educational differences in life expectancy: indirect estimates for Finnish men and women from 1971 to 2010

Background We estimated the contribution of smoking to educational differences in mortality and life expectancy between 1971 and 2010 in Finland. Methods Eight prospective datasets with baseline in 1970, 1975, 1980, 1985, 1990, 1995, 2000 and 2005 and each linked to a 5-year mortality follow-up were used. We calculated life expectancy at age 50 years with and without smoking-attributable mortality by education and gender. Estimates of smoking-attributable mortality were based on an indirect method that used lung cancer mortality as a proxy for the impact of smoking on mortality from all other causes. Results Smoking-attributable deaths constituted about 27% of all male deaths above age 50 years in the early 1970s and 17% in the period 2006–2010; these figures were 1% and 4% among women, respectively. The life expectancy differential between men with basic versus high education increased from 3.4 to 4.7 years between 1971–1975 and 2006–2010. In the absence of smoking, these differences would have been 1.5 and 3.4 years, 1.9 years (55%) and 1.3 years (29%) less than those observed. Among women, educational differentials in life expectancy between the most and least educated increased from 2.5 to 3.0 years. This widening was nearly entirely accounted for by the increasing impact of smoking. Among women the contribution of smoking to educational differences had increased from being negligible in 1971–1975 to 16% in 2006–2010. Conclusions Among men, the increase in educational differences in mortality in the past decades was driven by factors other than smoking. However, smoking continues to have a major influence on educational differences in mortality among men and its contribution is increasing among women.

Mortality Under Age 50 Accounts For Much Of The Fact That US Life Expectancy Lags That Of Other High-Income Countries

Life expectancy at birth in the United States is among the lowest of all high-income countries. Most recent studies have concentrated on older ages, finding that Americans have a lower life expectancy at age fifty and experience higher levels of disease and disability than do their counterparts in other industrialized nations. Using cross-national mortality data to identify the key age groups and causes of death responsible for these shortfalls, I found that mortality differences below age fifty account for two-thirds of the gap in life expectancy at birth between American males and their counterparts in sixteen comparison countries. Among females, the figure is two-fifths. The major causes of death responsible for the below-fifty trends are unintentional injuries, including drug overdose--a fact that constitutes the most striking finding from this study; noncommunicable diseases; perinatal conditions, such as pregnancy complications and birth trauma; and homicide. In all, this study highlights the importance of focusing on younger ages and on policies both to prevent the major causes of death below age fifty and to reduce social inequalities.

Adult Mortality Five Years after a Natural Disaster

Exposure to extreme events has been hypothesized to affect subsequent mortality because of mortality selection and scarring effects of the event itself. We examine survival at and in the five years after the 2004 Indian Ocean earthquake and tsunami for a population-representative sample of residents of Aceh, Indonesia who were differentially exposed to the disaster. For this population, the dynamics of selection and scarring are a complex function of the degree of tsunami impact in the community, the nature of individual exposures, age at exposure, and gender. Among individuals from tsunami-affected communities we find evidence for positive mortality selection among older individuals, with stronger effects for males than for females, and that this selection dominates any scarring impact of stressful exposures that elevate mortality. Among individuals from other communities, where mortality selection does not play a role, there is evidence of scarring with property loss associated with elevated mortality risks in the five years after the disaster among adults age 50 or older at the time of the disaster.

Contribution of smoking-attributable mortality to life-expectancy differences by marital status among Finnish men and women, 1971-2010

BACKGROUND Smoking is known to vary by marital status, but little is known about its contribution to marital status differences in longevity. We examined the changing contribution of smoking to mortality differences between married and never married, divorced or widowed Finnish men and women aged 50 years and above in 1971–2010. DATA AND METHODS The data sets cover all persons permanently living in Finland in the census years 1970, 1975 through 2000 and 2005 with a five-year mortality follow-up. Smoking-attributable mortality was estimated using an indirect method that uses lung cancer mortality as an indicator for the impact of smoking on mortality from all other causes. RESULTS Life expectancy differences between the married and the other marital status groups increased rapidly over the 40-year study period because of the particularly rapid decline in mortality among married individuals. In 1971–1975 37–48% of life expectancy differences between married and divorced or widowed men were attributable to smoking, and this contribution declined to 11–18% by 2006–2010. Among women, in 1971–1975 up to 16% of life expectancy differences by marital status were due to smoking, and the contribution of smoking increased over time to 10–29% in 2006–2010. CONCLUSIONS In recent decades smoking has left large but decreasing imprints on marital status differences in longevity between married and previously married men, and small but increasing imprints on these differences among women. Over time the contribution of other factors, such as increasing material disadvantage or alcohol use, may have increased.

O5-2.2 The changing contribution of smoking to educational differences in mortality: estimates for finnish men and women from 1971 to 2005

Introduction Major socioeconomic differences in mortality are observed in high income countries. While smoking remains one of the major single causes of mortality, its contribution to levels and trends in socioeconomic differences in mortality remain unclear. We present estimates of the contribution of smoking to educational differences in mortality between 1971 and 2005. Methods Census records linked with death records for all Finns aged 50+ were studied. Smoking attributable mortality is estimated with an indirect method developed by Preston et al that uses lung cancer mortality as a proxy for the impact of smoking on mortality from all other causes. Results In the early 1970s smoking attributable deaths constituted about 27% of all male deaths above age 50 and 17% in the 2000s; 1% and 4% among women respectively. At age 50 life-expectancy differentials between men with basic vs high education increased from 3.4 to 4.4 years. In the absence of smoking these differences would have been 1.5 and 3.1 years, 60% and 25% less than those observed. Half of the increase in life-expectancy among men with basic education was attributable to smoking. Among women the contribution of smoking to educational differentials in mortality was negligible in the 1970s but increased to about 10% in the early 2000s. Conclusion Smoking continues to have a major influence on educational differences in mortality among men and its contribution is increasing among women. Anti-smoking efforts can achieve gains in longevity among men and reverse the trend of increasing smoking attributable mortality among women.