Cause of Death Mortality: International Trends by Socio ... · Denmark By Affluence 2007 Ischaemic heart diseases 40 50 60 70 80 1e-05 1e-03 1e-01 Age England by Deprivation 2007

,

Cause of Death Mortality: International Trendsby Socio-Economic Group

Andrew J.G. Cairns

Heriot-Watt University, Edinburgh

Director, Actuarial Research Centre, IFoA

Joint work with C. Redondo, D. Blake, K. Dowd, M. Kallestrup-Lamb, C. Rosenskjold

Longevity 14, Amsterdam, September 2018

Andrew J.G. Cairns Cause of Death Mortality 1 / 49

,

Outline

Motivation and long term goals

Data

Comparison of US, Denmark and England

England: deeper dive


,

Purpose of looking at cause of death data

What are the key drivers of all-cause mortality?

How are the key drivers changing over time?Which causes of death have high levels of inequality:

by education;by affluence?

Can we point to specific causes of death as responsible forgrowing inequality?

Leading to: insight into mortality underpinning lifeinsurance and pensions


,

Drivers

Medical advances

Health spending

Public health initiatives

Individual risk factors:

Controllablee.g. smoking, diet, exercise, alcohol, sun, drugs,

hygeine, risky sex, stress, environment...

leading to cohort effectsNot (easily) controllablee.g. genetic, affluence, education,

character/personality traits, ...


,

Socio-economic datasets

Cause of death data for:US (males and females)

by education level: low (≤ high school); high

Denmark (males only):

by education level: low; medium; high(cohorts > 1920 only)by individual affluence: 10 deciles

England (males and females)

by small area income deprivation: 10 decilesby region: 9 areas


,

Cause of Death Groupings

US1.1 Infectious diseases excl. HIV/AIDS US 1.2 HIV/AIDS1 Infectious diseases 2 Cancer: mouth, gullet, stomach3 Cancer: gut, rectum 4.1 Cancer: larynx4.2 Cancer: trachea 4.3 Cancer: lung, bronchus5 Cancer: breast 6.1 Cancer: uterus, cervix6.2 Cancer: ovary 6.3 Cancer: other female genital7.1 Cancer: prostate, testicular 7.2 Cancer: other male genital8 Cancer: skin, bones and certain organs 9 Cancer: lymphatic10 Benign tumours 11 Diseases: blood12 Diabetes 13 Mental illness14.1 Diseases of nervous system excl. Alzh. 14.2 Alzheimers15 Blood pressure + rheumatic fever 16 Ischaemic heart diseases17 Other heart diseases 18 Diseases: cerebrovascular19 Diseases: circulatory 20 Diseases: lungs, breathing21 Diseases: digestive (excl. alcohol: 27) 22 Diseases: urine, kidney,...23 Diseases: skin, bone, tissue 24(DU) Senility without mental illness25 Road/other accidents 26 Other causes27 Alcohol → liver disease 28 Suicide29 Accidental Poisonings

Detail ⇒ able to separate causes with and without significant risk factors or inequality


,

Data – Other Details

US (Cristian Redondo – Session: MortalityModelling 5)

Deaths subdivided into 30 CoD groupsSingle ages 40-89 and born between 1914 and 1970Single years 1989-2015

Denmark (Carsten Rosenskjold)29 CoD groupsAge groups 31-35, 36-40, ..., 91-95Five-year blocks 1985-89, 1990-94, 1995-99, 2000-2004, 2005-2009

England34 CoD groupsAge groups 20-24, 25-29, ..., 85-89Single years 2001-2016


,

Denmark – Affluence – Top 10 CoD

Males; Ages 71-75; Years 2005-2009

Rank Least Affluent Most Affluent1 Ischaemic heart Skin & organ cancer2 Respiratory Ischaemic heart3 Lung cancer etc. Prostate cancer4 Skin & organ cancer Respiratory5 Other Lung cancer etc.6 Cerebrovascular Cerebrovascular7 Other heart Other8 Diabetes Gut cancer9 Gut cancer Other heart

10 Prostate cancer Alzheimers etc.

Prostate: almost no inequality.Causes of death with significant controllable risk factors

feature much more heavily amongst the least affluent.


,

Denmark: Cause of Death Data 2005-2009

40 50 60 70 80

1e−

051e

−04

1e−

031e

−02

1e−

01

Year

Dea

th R

ate

(log

scal

e)

Denmark By EducationIschaemic heart diseases

40 50 60 70 801e

−05

1e−

041e

−03

1e−

021e

−01

Year

Dea

th R

ate

(log

scal

e)

Denmark By AffluenceIschaemic heart diseases

Wide gap Affluence: wider gap Gap narrows with age


,

Denmark: Cause of Death Data, Age Group 66-70

1985 1995 2005 2015

5e−

042e

−03

5e−

032e

−02

Year

Dea

th R

ate

(log

scal

e)

Denmark by EducationIschaemic heart diseases

1985 1995 2005 20155e

−04

2e−

035e

−03

2e−

02

Year

Dea

th R

ate

(log

scal

e)

Denmark by AffluenceIschaemic heart diseases

Gap widens over time


,

Impact of Controllable Risk Factors

Risk factors (controllable and not controllable)⇒Impact on cause of death rates

Some risk factors ⇒ big impact on some causese.g. smoking −→ lung cancere.g. several risk factors −→ ischaemic heartdisease⇒ significant inequality gaps

Other causes of death:no known (significant) controllable risk factorse.g. prostate cancer


,


40 50 60 70 80

1e−

051e

−04

1e−

031e

−02

1e−

01

Year

Dea

th R

ate

(log

scal

e)

Denmark By EducationCancer: prostate, testicular

40 50 60 70 801e

−05

1e−

041e

−03

1e−

021e

−01

Year

Dea

th R

ate

(log

scal

e)

Denmark By AffluenceCancer: prostate, testicular

Education: no differences Affluence: small differences


,

Multi-Country: Year 2007, Ischaemic Heart Disease

40 50 60 70 80

1e−

051e

−03

1e−

01

Dea

th R

ate

(log

scal

e)US By Education 2007

Ischaemic heart diseases

LowHigh

40 50 60 70 80

1e−

051e

−03

1e−

01

Denmark By Education 2007Ischaemic heart diseases

LowMediumHigh

40 50 60 70 80

1e−

051e

−03

1e−

01

Age

Dea

th R

ate

(log

scal

e)

Denmark By Affluence 2007Ischaemic heart diseases

40 50 60 70 80

1e−

051e

−03

1e−

01

Age

England by Deprivation 2007Ischaemic heart diseases

US: wider than Denmark England similar to Denmark but higher


,

Multi-Country: Age 68, Ischaemic Heart Disease

1985 1990 1995 2000 2005 2010 2015

5e−

042e

−03

1e−

02

US by Education, Age 68Ischaemic heart diseases

Dea

th R

ate

(log

scal

e)

LowHigh

1985 1990 1995 2000 2005 2010 2015

5e−

042e

−03

1e−

02

Denmark by Education, Age 68Ischaemic heart diseases

LowMediumHigh

1985 1990 1995 2000 2005 2010 2015

5e−

042e

−03

1e−

02

Denmark by Affluence, Age 68Ischaemic heart diseases

Dea

th R

ate

(log

scal

e)

Year1985 1990 1995 2000 2005 2010 2015

5e−

042e

−03

1e−

02

England by Deprivation, Age 68Ischaemic heart diseases

Year

Significant improvements, but not throughout


,

Multi-Country: Age 68, Prostate Cancer

1985 1990 1995 2000 2005 2010 2015

5e−

042e

−03

1e−

02

US by Education, Age 68Cancer: prostate, testicular

Dea

th R

ate

(log

scal

e)

LowHigh

1985 1990 1995 2000 2005 2010 2015

5e−

042e

−03

1e−

02

Denmark by Education, Age 68Cancer: prostate, testicular

LowMediumHigh

1985 1990 1995 2000 2005 2010 2015

5e−

042e

−03

1e−

02

Denmark by Affluence, Age 68Cancer: prostate, testicular

Dea

th R

ate

(log

scal

e)

Year1985 1990 1995 2000 2005 2010 2015

5e−

042e

−03

1e−

02

England by Deprivation, Age 68Cancer: prostate

Year

No controllable risk factors; US improvements; DK vs US genetic factors?


,

Multi-Country: Age 68, Lung Cancer

1985 1990 1995 2000 2005 2010 2015

5e−

042e

−03

1e−

02

US by Education, Age 68Cancer: lung, larynx, ..

Dea

th R

ate

(log

scal

e)

LowHigh

1985 1990 1995 2000 2005 2010 2015

5e−

042e

−03

1e−

02

Denmark by Education, Age 68Cancer: lung, larynx, ..

LowMediumHigh

1985 1990 1995 2000 2005 2010 2015

5e−

042e

−03

1e−

02

Denmark by Affluence, Age 68Cancer: lung, larynx, ..

Dea

th R

ate

(log

scal

e)

Year1985 1990 1995 2000 2005 2010 2015

5e−

042e

−03

1e−

02

England by Deprivation, Age 68Cancer: lungs, bronchus

Year

Significant inequality; improvements might be driven by smoking

prevalenceAndrew J.G. Cairns Cause of Death Mortality 16 / 49

,

Variation in Reporting Practice: e.g. Mental Illness

40 50 60 70 80

1e−

051e

−03

1e−

01

Dea

th R

ate

(log

scal


Mental illness

LowHigh

40 50 60 70 80

1e−

051e

−03

1e−

01

Denmark By Education 2007Mental illness

LowMediumHigh

40 50 60 70 80

1e−

051e

−03

1e−

01

Age

Dea

th R

ate

(log

scal

e)

Denmark By Affluence 2007Mental illness

40 50 60 70 80

1e−

051e

−03

1e−

01

Age

England by Deprivation 2007Mental illnesses

Alcohol & drug abuse; mental disorders; −→ vascular dementia


,

Deaths of Despair: A Growing Problem? 2002/07/12

40 50 60 70 80

1e−

051e

−03

1e−

01

Dea

th R

ate

(log

scal

e)US By Education 2002Accidental Poisonings

LowHigh

40 50 60 70 80

1e−

051e

−03

1e−

01

Denmark By Education 2002Accidental Poisonings

LowMediumHigh

40 50 60 70 80

1e−

051e

−03

1e−

01

Age

Dea

th R

ate

(log

scal

e)

Denmark By Affluence 2002Accidental Poisonings

40 50 60 70 80

1e−

051e

−03

1e−

01

Age

England by Deprivation 2002Accidental poisonings

US, Denmark: significant


,


40 50 60 70 80

1e−

051e

−03

1e−

01

Dea

th R

ate

(log

scal


LowHigh

40 50 60 70 80

1e−

051e

−03

1e−

01


LowMediumHigh

40 50 60 70 80

1e−

051e

−03

1e−

01

Age

Dea

th R

ate

(log

scal

e)


40 50 60 70 80

1e−

051e

−03

1e−

01

Age



,


40 50 60 70 80

1e−

051e

−03

1e−

01

Dea

th R

ate

(log

scal


LowHigh

40 50 60 70 80

1e−

051e

−03

1e−

01


LowMediumHigh

40 50 60 70 80

1e−

051e

−03

1e−

01

Age

Dea

th R

ate

(log

scal

e)


40 50 60 70 80

1e−

051e

−03

1e−

01

Age


Growth: England > US > DK US: evidence of a cohort effect


,


40 50 60 70 80

1e−

051e

−03

1e−

01

Dea

th R

ate

(log

scal


Alcohol −> liver

LowHigh

40 50 60 70 80

1e−

051e

−03

1e−

01

Denmark By Education 2002Alcohol −> liver

LowMediumHigh

40 50 60 70 80

1e−

051e

−03

1e−

01

Age

Dea

th R

ate

(log

scal

e)

Denmark By Affluence 2002Alcohol −> liver

40 50 60 70 80

1e−

051e

−03

1e−

01

Age

England by Deprivation 2002Alcohol related liver disease

Affluence a much bigger driver


,


40 50 60 70 80

1e−

051e

−03

1e−

01

Dea

th R

ate

(log

scal


Alcohol −> liver

LowHigh

40 50 60 70 80

1e−

051e

−03

1e−

01


LowMediumHigh

40 50 60 70 80

1e−

051e

−03

1e−

01

Age

Dea

th R

ate

(log

scal

e)


40 50 60 70 80

1e−

051e

−03

1e−

01

Age



,


40 50 60 70 80

1e−

051e

−03

1e−

01

Dea

th R

ate

(log

scal


Alcohol −> liver

LowHigh

40 50 60 70 80

1e−

051e

−03

1e−

01


LowMediumHigh

40 50 60 70 80

1e−

051e

−03

1e−

01

Age

Dea

th R

ate

(log

scal

e)


40 50 60 70 80

1e−

051e

−03

1e−

01

Age


US: possible cohort effect


,

US Males Age 63: Stagnation

1990 1995 2000 2005 2010 2015

0.01

00.

015

0.02

00.

025

US low educationUS high education

Males, Age 63, All Cause Mortality

Year

Dea

th R

ate

(log

scal

e)?


,

US Drivers of Change 1991-2013, Males Age 63

Low education absolute changes in mortality

1e−05 2e−05 5e−05 1e−04 2e−04 5e−04 1e−03 2e−03 5e−03

−0.

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−0.

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0.00

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CoD Death Rate in 1989−1993 (log scale)

Abs

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CoD

Dea

th R

ate

1991

−20

13US Males Aged 63, Low Education, Changes in CoD Death Rates

Three big gains, many small “losers”Andrew J.G. Cairns Cause of Death Mortality 25 / 49

,

US Drivers of Change 1991-2013, Males Age 63

High education absolute changes in mortality

1e−05 2e−05 5e−05 1e−04 2e−04 5e−04 1e−03 2e−03 5e−03

−0.

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CoD Death Rate in 1989−1993 (log scale)

Abs

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CoD

Dea

th R

ate

1991

−20

13US Males Aged 63, High Education, Changes in CoD Death Rates

Small “losers” −→ small gainsAndrew J.G. Cairns Cause of Death Mortality 26 / 49

,

England: Income Deprivation versus Region

North EastNorth WestYorkshire & HumberEast MidlandsWest MidlandsEast of EnglandLondonSouth EastSouth West

Not in dataset:Scotland, Wales,Northern Ireland


,

England: Males (40-89) ASMR and ADSMR Inequality

2000 2005 2010 2015

0.01

50.

020

0.02

50.

030

12345678910

ASMR for age range 40−89

Year

AS

MR

(lo

g sc

ale)

Age Standardised Mortality RatesMales By Income for All Causes

2000 2005 2010 2015

0.01

50.

020

0.02

50.

030

North EastNorth WestYorkshire and The HumberEast MidlandsWest MidlandsEast of EnglandLondonSouth EastSouth West


Year

AS

MR

(lo

g sc

ale)

Age Standardised Mortality RatesMales By Region for All Causes

2000 2005 2010 2015

0.01

50.

020

0.02

50.

030 ADSMR for age range 40−89

London

Year

AD

SM

R (

log

scal

e)

Age & DeprivationStandardised Mortality Rates

Males By Region for All Causes

ADSMR adjusts for different income deprivation mix by regionClear “London Effect”.

Greater improvements in healthcare??Greater improvements in GDP??


,

England: Females (40-89) ASMR and ADSMR Inequality

2000 2005 2010 2015

0.00

80.

010

0.01

20.

014

0.01

60.

020

12345678910


Year

AS

MR

(lo

g sc

ale)

Age Standardised Mortality RatesFemales By Income for All Causes

2000 2005 2010 2015

0.00

80.

010

0.01

20.

014

0.01

60.

020



Year

AS

MR

(lo

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Age Standardised Mortality RatesFemales By Region for All Causes

2000 2005 2010 2015

0.00

80.

010

0.01

20.

014

0.01

60.

020

ADSMR for age range 40−89

London

Year

AD

SM

R (

log

scal

e)

Age & DeprivationStandardised Mortality Rates

Females By Region for All Causes


,

Cause of Death Inequaility: Income vs Region

1 2 5 10

1.0

1.5

2.0

2.5

3.0

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Inequality Between Income Groups

Ineq

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etw

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Reg

ions

Comparison of Inequality Between Income Groupsand Between Regions (Standardised)

Ischaemic heart diseasesRespiratory diseases

Cancer: skin, bones, internal organs

Cancer: lungs, bronchusCerebrovascular diseases

Cancer: prostate

Alzheimers

Respiratory diseasesIschaemic heart diseasesCerebrovascular diseases


Cancer: lungs, bronchus

Cancer: breastCancer: uterus, cervix

Cancer: ovary

Alzheimers

●

●

●●

MalesFemalesMajor Cause of DeathMinor Cause of Death

Inequality =ASMR(worst) / ASMR(best)

Inequality=A(D)SMR(worst)/A(D)SMR(best)Region: best=London; worst=N.W.Income Deprivation: best=10; worst=1


,


1 2 5 10

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1.5

2.0

2.5

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Ineq

ualit

y B

etw

een

Reg

ions





Cancer: prostate

Alzheimers





Cancer: ovary

Alzheimers

●

●

●●



London: not always the best for individual causes of death.


,


1 2 5 10

1.0

1.5

2.0

2.5

3.0

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Ineq

ualit

y B

etw

een

Reg

ions





Cancer: prostate

Alzheimers





Cancer: ovary

Alzheimers

●

●

●●



Causes of death with significant controllable risk factors:Inequality between regions ⇒ (??) significant variation in risk factorsbetween regions


,

Lung Cancer: Males

2000 2005 2010 2015

0.00

100.

0015

0.00

25


England Males ADSMR By RegionCancer: lungs, bronchus

Year

AD

SM

R (

log

scal

e)

2000 2005 2010 2015

0.00

100.

0015

0.00

25

12345678910

England Males ASMR By IncomeCancer: lungs, bronchus

Year

AS

MR

(lo

g sc

ale)

Significant variation between income deciles (⇒ smoking prevalence)Significant variation between regions (after standardisation)×1.5 variation by region; ×2.5 by income decileLondon effect; Northern regions very poor


,

Lung Cancer: Females

2000 2005 2010 2015

0.00

040.

0006

0.00

100.

0014


England Females ADSMR By RegionCancer: lungs, bronchus

Year

AD

SM

R (

log

scal

e)

2000 2005 2010 2015

0.00

040.

0006

0.00

100.

0014

12345678910

England Females ASMR By IncomeCancer: lungs, bronchus

Year

AS

MR

(lo

g sc

ale)

Slight worsening ⇒ smoking prevalence risingSame northern regions do badlyWider regional spreadLondon effect


,

Respiratory Diseases: Males

2000 2005 2010 2015

0.00

10.

002

0.00

30.

004


England Males ADSMR By RegionRespiratory diseases

Year

AD

SM

R (

log

scal

e)

2000 2005 2010 2015

0.00

10.

002

0.00

30.

004

12345678910

England Males ASMR By IncomeRespiratory diseases

Year

AS

MR

(lo

g sc

ale)

Flatter than males: similar pattern to lung cancer males


,

Respiratory Diseases: Females

2000 2005 2010 2015

0.00

100.

0015

0.00

25


England Females ADSMR By RegionRespiratory diseases

Year

AD

SM

R (

log

scal

e)

2000 2005 2010 2015

0.00

100.

0015

0.00

25

12345678910

England Females ASMR By IncomeRespiratory diseases

Year

AS

MR

(lo

g sc

ale)

Similar pattern to lung cancer females


,

Ischaemic Heart Disease: Males

2000 2005 2010 2015

0.00

20.

003

0.00

40.

006

0.00

8


England Males ADSMR By RegionIschaemic heart diseases

Year

AD

SM

R (

log

scal

e)

2000 2005 2010 2015

0.00

20.

003

0.00

40.

006

0.00

8

12345678910

England Males ASMR By IncomeIschaemic heart diseases

Year

AS

MR

(lo

g sc

ale)

Success story: major improvementsDeterioration: widening gap and regional inequalityFemales: similar picture


,

Breast Cancer: An Equality Success Story

2000 2005 2010 2015

2e−

043e

−04

5e−

047e

−04


England Females ADSMR By RegionCancer: breast

Year

AD

SM

R (

log

scal

e)

2000 2005 2010 2015

2e−

043e

−04

5e−

047e

−04

12345678910

England Females ASMR By IncomeCancer: breast

Year

AS

MR

(lo

g sc

ale)

Limited controllable risk factorsSuccess story: no significant inequality


,

Ovarian Cancer: A Regional Lottery?

2000 2005 2010 2015

0.00

010

0.00

015

0.00

025


England Females ADSMR By RegionCancer: ovary

Year

AD

SM

R (

log

scal

e)

2000 2005 2010 2015

0.00

010

0.00

015

0.00

025

12345678910

England Females ASMR By IncomeCancer: ovary

Year

AS

MR

(lo

g sc

ale)

Limited controllable risk factorsLimited income effectSignificant regional effect


,

Diabetes: Males

2000 2005 2010 2015

0.00

010

0.00

015

0.00

025

0.00

040


England Males ADSMR By RegionDiabetes

Year

AD

SM

R (

log

scal

e)

2000 2005 2010 2015

0.00

010

0.00

015

0.00

025

0.00

040

12345678910

England Males ASMR By IncomeDiabetes

Year

AS

MR

(lo

g sc

ale)

Significant inequalityWidening inequality gap by income decilesWorsening mortality after about 2010


,

Alzheimers: Females (no clear risk factors)

2000 2005 2010 2015

1e−

042e

−04

3e−

045e

−04


England Females ADSMR By RegionAlzheimers

Year

AD

SM

R (

log

scal

e)

2000 2005 2010 2015

1e−

042e

−04

3e−

045e

−04

12345678910

England Females ASMR By IncomeAlzheimers

Year

AS

MR

(lo

g sc

ale)

Modest income effect; Strong regional effect ⇒ ?? health migrationDeterioration (2×) ⇒ ??

evidence for non-independence of causes of deathimprovements elsewhere ⇒ ?? more frail survivors in old age


,

Further remarks

US, Denmark: Need to factor in changing levelsof educational attainment

Is it possible to decompose improvements intomedical advances and changes in risk “taking”?

E.g. Can we link smoking prevalence to e.g.lung cancer mortality?

What are the causes of the London Effect?


,

Summary

Affluence or income deprivation is better than educationfor all CoD if you have the data

Impact of affluence/education/region varies with CoD

Significant levels of inequality for most of the big CoD’s

CoD absolute levels vary between countries: localpractice(?)

But degree of inequality by CoD is consistent from countryto country

Second order differences between countries may be due tohealthcare systemsEngland:

Regional differences in addition to income effectsConsistent patterns by CoD connected to controllablerisk factors


,

Thank You!

Questions?

E: [email protected] W:

www.macs.hw.ac.uk/∼andrewc/ARCresources


,

The Actuarial Research Centre (ARC)A gateway to global actuarial research

The Actuarial Research Centre (ARC) is the Institute and Faculty ofActuaries’ (IFoA) network of actuarial researchers around the world.The ARC seeks to deliver cutting-edge research programmes that addresssome of the significant, global challenges in actuarial science, through apartnership of the actuarial profession, the academic community andpractitioners.The ’Modelling, Measurement and Management of Longevity andMorbidity Risk’ research programme is being funded by the ARC, theSoA and the CIA.

www.actuaries.org.uk/arc


www.actuaries.org.uk/arc

,

England: Income Deprivation versus Region

Produced by ONS GeographyGIS & Mapping Unit

Contains Ordnance Survey data © Crown copyright and database right 2012

EastMidlands

East ofEngland

London

NorthEast

NorthWest

South East

South West

WestMidlands

Yorkshire andThe Humber

EastMidlands

East ofEngland

London

NorthEast

NorthWest

South East

South West

WestMidlands

Yorkshire andThe Humber

NorthernIreland

Scotland

Wales

NorthernIreland

Scotland

Wales

Please visit the ONS Geography web pages for thelatest information:

Government Offices for the Regions closed at the endof March 2011. The former Government Office Regions(England) are now referred to as 'regions' for statisticalpurposes. Scotland, Northern Ireland and Wales arenot regions, but are often used as equivalents for thepurpose of representing statistics that cover the wholeof the UK.

Boundaries shown in England are effective as follows:Regions at 31st December 2011 (see note below).

Regions

Key

www.ons.gov.uk/ons/guide-method/geography/ons-geography/index.html

Orkney Islands Shetland Islands

United Kingdom: Regions, 2011


,


Many causes of death have known risk factors ordriverse.g. smoking, diet, healthy lifestyle etc.⇒ clear socio-economic differences

Biggest differences at ages < 60

Affluence ⇒ stronger predictor than education(sometimes very much stronger)

Other diseases do not have strong differences:


,

Denmark Males: Statistical Significance

Which CoD’s are significantly affected bysocio-economic status?

H0: Affluence groups all have the same CoDdeath rate mi(c , t, x) = mj(c , t, x) ∀i 6= jversus

H1: Affluence groups do not all have the sameCoD death rates


,

Denmark Males: Statistical Significance

For each cause of death (29), and age group (13)

Rank the death rates for the 10 groups i = 1, . . . , 10

For each year group, tR(i , t) = rank of m(i , t) out of m(1, t), . . . ,m(10, t)Rank 1: highest death rateRank 10: lowest death rate

Data (i ,R(i , t))

Test statistic, S = cor(i ,R(i , t)

)Under H0 the ranks are a random permutation of 1, . . . , 10

Under H0, S is approximately N(0, σ2) where σ = 0.149.

One-sided test: Reject H0 if S > σΦ−1(α)

Large S ⇒ low affluence ∼ high CoD mortality


Documents

Cause of Death Mortality: International Trends by Socio ... · Denmark By Affluence 2007 Ischaemic heart diseases 40 50 60 70 80 1e-05 1e-03 1e-01 Age England by Deprivation 2007