Magdalena M. Muszyńska

The Old-Age Healthy Dependency Ratio in Europe

The aim of this study is to answer the question of whether improvements in the health of the elderly in European countries could compensate for population ageing on the supply side of the labour market. We propose a state-of-health-specific (additive) decomposition of the old-age dependency ratio into an old-age healthy dependency ratio and an old-age unhealthy dependency ratio in order to participate in a discussion of the significance of changes in population health to compensate for the ageing of the labour force. Applying the proposed indicators to the Eurostat’s population projection for the years 2010–2050, and assuming there will be equal improvements in life expectancy and healthy life expectancy at birth, we discuss various scenarios concerning future of the European labour force. While improvements in population health are anticipated during the years 2010–2050, the growth in the number of elderly people in Europe may be expected to lead to a rise in both healthy and unhealthy dependency ratios. The healthy dependency ratio is, however, projected to make up the greater part of the old-age dependency ratio. In the European countries in 2006, the value of the old-age dependency ratio was 25. But in the year 2050, with a positive migration balance over the years 2010–2050, there would be 18 elderly people in poor health plus 34 in good health per 100 people in the current working age range of 15–64. In the scenarios developed in this study, we demonstrate that improvements in health and progress in preventing disability will not, by themselves, compensate for the ageing of the workforce. However, coupled with a positive migration balance, at the level and with the age structure assumed in the Eurostat’s population projections, these developments could ease the effect of population ageing on the supply side of the European labour market.

Europe, the Oldest-Old Continent

Focusing particularly on the European countries in which Jan Hoem has lived his life, we provide an overview of aging and mortality developments in Europe over the last decades. According to the United Nations, Europe is already the oldest continent in the World and will retain its rank for the foreseeable future. It has mainly been reduced mortality rather than low fertility or selective migration that has contributed to this development. If current death rates persist, more than 91 % of Swedish newborn girls can expect to reach age 65. Of those, 75 % will be able to celebrate their 80th birthday. Improved survival chances among the elderly have been essential for the continued increase in life expectancy during recent decades. The number of healthy life-years has continued to grow as well, coinciding with reduced inequalities in age at death. Whereas, these developments are welcome from an individual’s perspective, they put pressure on social security systems in Europe. We conclude by suggesting that the redistribution of work commitments throughout the life course might alleviate some of these challenges for the welfare states.

Alcohol taxation and premature mortality in Europe

www.thelancet.com Vol 385 March 28, 2015 1181 5 Popova LA. The results of the modern demographic policy in Russia. Int J Reg Devel 2014; 1: 26–38. 6 Zaridze D, Lewington S, Boroda A, et al. Alcohol and mortality in Russia: prospective observational study of 151 000 adults. Lancet 2014; 383: 1465–73. slowed and Lithuania’s mortality in men worsened. In 2008, alcohol prices were increased again in Poland and the rate of decreasing premature mortality returned to the same levels before 2002 (unpublished). The Russian Government announced that it would reduce the price of vodka by 16% in February, 2015. Similar to Poland, this decision follows a period of rapid improvements to health. After 50 years of stagnation, the health indicators of the Russian population, especially of young and middle-aged men, have been improving since 2005. As with Lithuania, Poland, and Finland, the decision to lower alcohol prices will probably contribute to halting this health transformation in Russia, especially because vodka consumption continues to be a key contributor to its high rates of premature mortality. Lithuania, Poland, and Finland increased alcohol taxes a few years after reducing them. We fi nd it diffi cult to understand why Russia would be willing to repeat the same mistakes as its neighbouring countries rather than learning from them.

Surface Plots for Cancer Survival

While previous chapters focused only on the event of death, this chapter investigates the dynamics over age and time for the duration between being diagnosed with a specific cancer and death. We use five year survival as our indicator of survival in general, disease-specific survival and relative survival for selected cancer sites such as breast cancer, colorectal cancer, lung cancer or pancreatic cancer. The major impact of the stage of the tumor at the time of diagnosis for survival is illustrated using stage 1 and stage 4 of colorectal cancer as an example.

Surface Plots of Rates of Mortality Improvement for Selected Causes of Death in the United States

This chapter shows that ROMI plots, as presented in the previous chapter, can not only be employed for mortality from all-causes but also for cause-specific mortality. They allow us to demonstrate that the slow increase in life expectancy among women in the United States during the 1980s and 1990s can not be attributed to heart diseases or stroke. Instead, mortality from respiratory diseases and from lung cancer, the latter featuring a pronounced cohort effect, suppressed faster gains in life expectancy.

Data and Software

This chapter describes the major data sets used in this monograph: The Human Mortality Database, data from the National Center for Health Statistics of the United States for the analysis of causes of death, and the individual-level, longitudinal data of the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute of the United States. The latter is used to illustrate the dynamics of cancer survival.

Surface Plots of Smoothed Mortality Data

The surface maps of the previous chapter showed that random fluctuations can be quite large. The present chapter on smoothing mortality data explains how we smoothed the observed mortality with P-splines. We illustrate our smoothing results with the same set of countries as in the previous chapter for unsmoothed data.

The Lexis Diagram

The second chapter specifies how a Lexis diagram is constructed and shows that cohorts are depicted on the 45∘ line. It briefly discusses the so-called identification problem of standard methods of age-, period-, and cohort analysis and explains how those effects look like in the Lexis diagram. The chapter concludes with a brief history of the depiction of population dynamics in three dimensions.

Surface Plots of Observed Death Rates

The chapter on observed death rates illustrates why demographic rates need to be adjusted by the number of person years lived and shows surface maps of such “raw” death rates for a few selected national populations. One can easily see that random fluctuations can turn out be problematic for smaller populations as they may lead to misinterpretations.

Surface Plots of Rates of Mortality Improvement

Surface maps of unsmoothed and smoothed mortality data have been used widely before. In this chapter, we present surface plots of rates of mortality improvement (“ROMI”), which are the derivative of age-specific mortality with respect to time. They have been introduced rather recently. By showing a large set of surface maps for countries from the Human Mortality Database, we argue that those ROMI plots are better able to detect period and cohort effects than standard mortality surface maps.