exam two // chapter seven

wars

wars

Demographers often use the ________ as an accepted operational definition of the human life span. As of 2016, the longest known and verified life span is 122 years and 164 days, lived by the Frenchwoman Jeanne Louise Calment_

"maximum recorded age at death"

Stillbirth rate

Stillbirth rate

These were caused by

"a lack of life choices under the former Communist regimes, [as well as by] unemployment, relative deprivation, and inability to cope with the economic challenges of post-Communist times."

It is superficial to treat death as a single unitary force....In reality death is brought about by one or a combination of a great variety of causes, or diseases, and the understanding of mortality requires an understanding of the trends in each of the major causes of death"

(Bogue, 1969).

•Males at age 70: Hispanics have an expectancy value of 15.4 years, NH-whites, 14.2 years, and NH-blacks, 12.8 years. And the same pattern holds for females at age 70: Hispanics live the longest, then NH-whites, and last, NH-blacks. •Among females at age 80, NH-blacks and NH-whites have the same value, 9.6 years, but the racial cross-over is beginning to occur for females. The cross-over has not yet occurred among males at age 80

. Hispanics still live the longest, then NH-whites, and then, NH-blacks, the same patterns observed in most of the life table

The HIV-AIDS epidemic has resulted in several African countries actually showing increases in past years in their levels of mortality. In Botswana, "life expectancy has fallen from 64 years in 1985-1990 to 47 years in 2005-2010

.. In Southern Africa as a whole, where most of the worst affected countries are, life expectancy has fallen from 61 to 52 years over the last 20 years"

As late as 1800, infant mortality rates were 200 or more per 1,000 births, even in countries of the developed world. As late as the 1870s, the IMR in European countries varied from

100 in Norway to nearly 300 in southern Germany.

HIV/AIDS (Acquired immune deficiency syndrome) has been ravaging the world for more than thirty-five years. It could soon be responsible for more deaths that the combined

100 million toll of the Black Death and Spanish flu epidemics

It was first noticed in the United States in 1981, initially among gay men. Hemophiliac cases of AIDS were first reported in 1982. The human immunodeficiency virus (HIV) causing AIDS was isolated in

1983 at the Pasteur Institute in Paris.

•The MMR for the world for 2015 was estimated to be 216 per 100,000 live births and was the highest in sub-Saharan Africa. •Sierra Leone was the country with the highest in the world in 2015, an MMR of 1,360 maternal deaths per 100,000 births. •An additional eighteen counties, all in sub-Saharan Africa, had very high MMRs, including the Central African Republic (MMR of 881), Chad (856), Nigeria (814), and South Sudan (789). The lowest MMRs are

2 maternal deaths per 100,000 live births in Estonia, 3 in Greece and Singapore, and 4 in Belarus, Italy, Sweden and Austria. The MMR for the United States is 21

ASDRs are high in the initial year of life, then drop precipitously. They begin increasing again at around age

40 or so (although in societies highly affected by HIV/AIDS, they tend to increase more so at the younger adult ages

In Swaziland, the rate was 143 deaths to children under age 5, per 1,000 live births, but without the presence of HIV/AIDS, the rate would have been 73. In Lesotho, it was shown that 123 children under age 5 die for every 1,000 births, but without the presence of HIV/AIDS, this rate would have been

71

Plausible sizes of the military and civilian death toll would be around

8.5 million in World War I and 40 million in World War II

•the three leading (external) causes for persons aged 1-24 years old, accounting for 64 percent of all deaths in this age group.

Accidents, homicide, and suicide• These three external causes of death are also among the top five for decedents aged 25-44 (43 % of all deaths).

Age Specific Death Rate

Age Specific Death Rate

Outside of sub-Saharan Africa, no other country has an HIV prevalence rate higher than the 3 percent rate of the

Bahamas or the 2 percent rate of Haiti

Hispanic Paradox

Hispanic Paradox

Infant Mortality

Infant Mortality

The major proponent on the other side, _______________, •has observed that every time a maximum life expectancy number is published, it is soon surpassed.

James Vaupel

Maternal mortality ratio

Maternal mortality ratio

Measurement of Mortality

Measurement of Mortality

Mortality Reversals

Mortality Reversals

Mortality Trends and Causes of Death in Developed and Developing Countries

Mortality Trends and Causes of Death in Developed and Developing Countries

Mortality and Longevity in the United States

Mortality and Longevity in the United States

•In 2013, the post neonatal mortality rate (PMR) for the world was 18, with a low value of 2 in the countries of the developed world. •Deaths in the post neonatal period, as well as in the first few years of life, are often due mainly to exogenous causes, such as infectious disease, accidents, and injury. In countries experiencing declining death rates, their PMRs tend to decline much more rapidly than their

NMRs

Neonatal mortality rate and postneonatal mortality rate

Neonatal mortality rate and postneonatal mortality rate

Perinatal mortality rate

Perinatal mortality rate

Race and Ethnic Differences

Race and Ethnic Differences

Socioeconomic differentials in mortality

Socioeconomic differentials in mortality

•If heart disease were eliminated as a cause of death in the United States, life expectancy at birth would increase only by a few years. If cancer were eliminated, life expectancy would increase by only three years. This is because of a phenomenon known in demography as the

Taeuber paradox

The Future Course of Mortality

The Future Course of Mortality

A recent epidemic was the Spanish flu epidemic. It spread throughout Europe in 1918 and then to the rest of the world. Epidemiologists have estimated that the epidemic resulted in the deaths of around 50 million people; others place the toll even higher

The Spanish flu may well have infected almost 1 billion people, or nearly half of the population of the world at that time

A man might have a wife and one or two steady girlfriends, all at the same time. A woman might simultaneously have a husband and a couple of boyfriends.

This pattern adds significantly to the risk of contracting the virus.

In Table 7.1 (see the file of tables and figures), at every age, except one, the United States has lower ASDRs than

Venezuela

There are many statistical software programs available that demographers use to execute the statistical calculations for standardizing mortality rates for age composition. The example in the P&S textbook used the direct standardization program in the Stata Statistical Software Program (StataCorp, 2015) to standardize

Venezuela's death rate by assigning to Venezuela the age composition of the United States

Over 72 percent of all deaths in the U.S. in 2007 occurred to persons of age

age 65 and older, and almost 30 percent of all the deaths occurred to person of age 85 and older

CDRs must be interpreted with special caution. When CDRs are compared among countries, differences are sometimes due to differences in

age composition

it measures the number of deaths to persons in a specific age group per 1,000 persons in that

age group

Because death varies so considerably with age, demographers use _____________ as a more precise way to measure mortality.

age-specific death rates (ASDRs

The age curve of mortality forms

an inverted U curve, when the age-specific death rates are plotted

•The AIDS epidemic has halted or reversed many of the gains in life expectancy in many sub-Saharan African countries. In sub-Saharan Africa, "one-third of children who are born infected with HIV (transmitted through their mothers) die before their first birthday, and about 60 percent die

by age 5

The risk of death varies by

by age, sex, race/ethnicity, socioeconomic status, and many other characteristics

Among 45-64 year-old decedents, only one external cause, accidents, is among the five main causes for middle-aged decedents. Most of their deaths are due to chronic conditions, namely

cancer, heart disease, chronic lower respiratory diseases, and chronic liver disease (61 % of deaths to persons in this age group.

chapter seven

chapter seven: mortality

In the nineteenth century, Britain was subjected to four cholera epidemics. In 1854, the mystery of the transmission of cholera was solved by "an ingenious physician named John Snow [whose discovery also] helped eliminate

cholera from Britain and eventually from the Western world"

•Among the oldest group of decedents, those aged 65+, heart disease, cancer, chronic lower respiratory diseases, stroke, and Alzheimer's disease are the five main causes of their death (accounting for 66% of all deaths). Males are less likely to die of AD than females at all ages, and that the gap increases among the oldest-old. Women live longer than men and thus are more likely to die of

chronic and degenerative diseases such as AD.

The greater gains occurred at the younger ages, because society can now pretty much control the infectious diseases that in the past resulted in deaths of infants and young children. We still don't have control of the

chronic diseases that kill older persons.

Demographers use the concept of life expectancy much more frequently than the

concept of the life span.

Later, Sharpe and Lotka (1911) proved mathematically that if a population that is closed to migration experiences constant schedules of age-specific fertility and mortality rates, it will develop a

constant age distribution and will grow at a constant rate, irrespective of its initial age distribution

Famines has been considered as a cause of death. Populations in preindustrial times had much less

control over their food supply than we do today.

The ASDR (or nMx) is not

crude

The CDR is referred to as

crude

Crude death rate

crude death rate

If an epidemic strikes several countries or continents, it is known as a pandemic. Pandemics are much more disruptive

demographically, economically, and socially than are epidemics

•The WHO estimates an estimated 2.6 million stillbirths in the world in 2009. •In 2009, the worldwide SBR was 18.9 stillbirths per 1,000 live births plus still births. SBRs ranged from lows of 2 in Finland and Singapore to highs of 47 in Pakistan, 42 in Nigeria, 36 in Bangladesh, and 34 in Djibouti. Most stillbirths occur in the countries of the

developing world. The major causes are (preventable) complications during the birthing process, maternal infections, and maternal disorders, especially diabetes and hypertension

epidemic diseases

epidemic diseases

Famines

famines

•A fetus may die prior to the onset of labor, that is, in utero, because of pregnancy complications or various maternal diseases. Or a fetus may be alive at the onset of labor but die during the process and, thus, emerge from its mother in a dead state. The formula for the stillbirth rate (SBR), sometimes referred to as the

fetal death rate

•The Central African Republic had the highest IMR in the world in 2013: 116 infant deaths per 1,000 live births. The Democratic Republic of the Congo has an IMR of 109; the next highest IMRs are in Chad, Angola, Guinea-Bissau and Sierra Leone. In 2013, five more countries had IMRs of 80 or higher (i.e., Burundi, Mozambique, Somalia, Equatorial Guinea, and Lesotho). Although great success in lowering infant mortality has been achieved in the last century, these benefits

have not been fully realized by the countries just mentioned

For example, the United States in 2006 had a CDR of 8, while Venezuela had a CDR of 4. This does not necessarily mean that young people and middle-age people and old people in the United States all die at

higher rates than they do in Venezuela

In other countries, a female born in the year of 2013 in Japan had a life expectancy of 86 years; and a female born in Singapore, Spain, Switzerland or France had a life expectancy of about 85 years. These life expectancies of 86 and 85 are the

highest in the world

CDRs also should not be used to compare the death experiences of the same population at different points in time, particularly

if the population's age structure has changed over time.

Epidemics were important to the development of modern demography, especially in the tracking of deaths in a population. For instance, the Spanish flu epidemic resulted in

in the establishment of the Growth Surveillance System by the League of Nations.

The more frail blacks die before they are age 80 or 90, and this produces a more robust group of blacks, who has survived the previous 70-80 or so years, and hence live longer than the

majority.

ASDRs, and not CDRs, should be used to compare the

mortality experiences of countries with known differences in age composition.

•In the early 1900s, infant mortality in China was likely around 300, and it did not decline to around 200 until the founding of the People's Republic in 1949. High IMRs led to the cultural practice in China and Korea and in many other Asian societies of not giving a

newborn baby a name until it had lived for several months and showed signs of continued viability.

He mapped the wells and the incidence of cholera for various areas of London, a map that some refer to today as

one of the most famous documents in the history of science"

The Irish potato famine of 1846-1851, known in Ireland as the Great Famine, killed around a million people, although some estimates place the number as high as 1.5 million. This is a huge number of deaths when

one recalls that the total population of Ireland in the early 1840s was just over 8 million

Thus, it would be incorrect to compare the CDR of the United States, say, in 1960, when it was 9.5/1,000, with the CDR of the United States, say, in 2014, when it was 8.2/1,000, and conclude that the mortality experience in the United States

only changed slightly in the 50+ period.

The last major famine in Europe was the Finnish famine of 1868. Also, as many as 19 million persons likely

perished in India between 1891 and 1910 as a result of famines.

By the late 1980s and into the 1990s, HIV/AIDS had been identified in every region of the world. HIV is spread

person to person via contact with body fluids

Prevailing causes of death

prevailing causes of death

Some research has found limited support for the salmon bias and the healthy migrant effects. But other analyses find little support for these effects, esp. that involving the

salmon bias

In the tenth revision of the ICD (adapted in 1992), the causes of death are classified under twenty-two major headings, and they are listed as follows:

see chart on slide 25

•The countries of Asia, Latin America and the Caribbean, Northern America, and Oceania have been experiencing increases in life expectancy at a steady pace, but the countries of Europe for the most part have experienced a slowdown beginning in the late 1960s through the late 1980s. This occurred because of

severe reductions in life expectancy in countries of Eastern Europe, particularly in the Russian Federation and the Ukraine. The remaining regions of Europe have had increasing life expectancies which are currently equal to or higher than that of Northern American

However, death comes later to Latinos; and if you are a Latina (Latino female) and live in the United States, you will likely have the longest average longevity (length of life) about 83.8 years. An African American male, on the other hand, has the

shortest longevity about 71.4 years, on average.

Vaupel and his colleagues, esp. James Carey, have noted that death rates in human and many nonhuman populations do not continue to increase with increasing age, but that there is a

slowing or deceleration of mortality at the oldest ages.

One of Europe's worst epidemics, the Black Death, resulting in the death of around one-third of the continent's population. The estimated number of deaths caused by the Black Death ranges from a low of 25 million up to a high of 60 to 75 million. This is an astounding value given

that all of Europe in the 14th century likely numbered around 80 to 90 million inhabitants.

The median age

the age that divides a population into equally younger and older groups

The WHO defines a maternal death as

the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration or site of pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes

The life table

the life table

The second reason, "population heterogeneity in frailty," refers to the fact that socioeconomically disadvantaged groups, such as blacks in the United States, will suffer higher death rates throughout most of their lives, compared to

the majority population

A similar statement may be made with regard to race composition, where the majority race usually has lower mortality rates than

the minority group.

•In high-mortality populations, the age-specific death rate in the first year of life is not reached again in the society until at age 70 or later. The infant mortality rate (IMR) is

the most common measure of infant death. It is the number of deaths in a year to persons under age 1 per 1,000 babies born in the year

The crude death rate (CDR), is

the number of deaths in a population in a given year per 1,000 members of the entire population. It is expressed as deaths in the year CDR=-------------------------x 1000 population at midyear

The maternal mortality ratio (MMR) is

the number of deaths in a year to women dying as a result of complications of pregnancy, childbirth, and the puerperium (that is, the condition of the woman immediately following childbirth, usually ending when ovulation begins again), per 100,000 births occurring in the year.

Because famines have almost always taken place in rural and in poor populations,

the precise nature of their toll is not easy to measure

The measurement of mortality dates back to John Graunt (1620-1674) and his analyses of the "Bills of Mortality." Mortality refers to

the relative frequency of death in a population.

Death does not occur at the same rate for every person; some die sooner than others. Mortality and its effects are best discussed from

the vantage point of the society. On average, death comes earlier to males than to females, and earlier to members of most racial minority groups than to members of the majority.

By comparison, a baby girl born in 2013 in Lesotho (in Southern Africa) could expect

to live on average for about 45 years from the time when she was born, and a baby girl born in Sierra Leone (in Western Africa), about 46 years.

Isolated areas with food shortages were unable to import surplus food from other areas, because

transportation technology and roadways were underdeveloped.

In London, Snow (the Father of Epidemiology) showed that certain wells were yielding contaminated water, and that people drinking

water from these sources were mainly the ones who were dying.

We have no control over when or where we were born, but

we have a lot of control and influence over whether, when, and where we ourselves produce children

When comparing values of life expectancy at birth across countries, especially developing countries, therefore,

we should not think of e0 as, strictly speaking, a modal age at death.

•According to UNICEF, "around two-thirds of all neonatal deaths occurred in just ten countries, with India accounting for more than a quarter and Nigeria for about a tenth." The main but not only causes of neonatal deaths are endogenous conditions,

•"such as congenital malformations, chromosomal abnormalities, and complications of delivery, as well as...low birthweight" (Pebley, 2003).

CDRs for the countries of the world in 2014 ranged from a low of

•1 in the United Arab Emirates (UAE) and Qatar to a high of 21 in Lesotho.

The United Nations reported in 2012 that HIV prevalence is estimated to be 2 percent or higher among the population of age

•15-49 in the 39 most highly affected countries of the world (36 of them are in Africa).

•A boy born in 1900 could expect to live to the age of 46 and a girl to 48. By 2010, a boy infant could anticipate living for 76 years (30 years of gain) and a girl infant for 81 years (33 years of gain). A 60-year-old male in 1901 could expect to live for 14 more years and a female of the same age for 15 more years. By 2010, a 60-year-old male could anticipate

•22 more years of life (7 years of gain) and a 60-year-old female 24 more years (9 years of gain).

Scholars now tend to define war in terms of the number of deaths that have occurred. Wilkinson (1980) developed a register of wars since 1820 that includes

•315 engagements where the number of deaths exceeded 300.

•In Lesotho, where one-fourth of adults were estimated to be living with HIV/AIDS in 2005, life expectancy was nearly 60 years in 1990-1995," but has dropped to 44 for the year of 2013. Lesotho's life expectancy should have been approaching

•69 years in this decade if the HIV/AIDS epidemic had not hit the country. Instead, Lesotho's life expectancy will be considerably lower. The epidemic has taken a devastating toll !!

•Life expectancy for males in 2000 in Russia was 59 years, below its value of 60 in the mid-1950s. Meanwhile, other Western countries have increased their life expectancy in the decades of the last century. Life expectancy at birth (both sexes) in the United States increased from around

•70 years in 1960 to 79 in 2013.

•Also, declining mortality has the direct effect of increasing rates of population growth and age structure, unless fertility rates fall as well. •Declining mortality has numerous social and economic implications leading to considerable speculation about the future levels of mortality or life expectancy. In 2013, the developed world as a whole had a life expectancy at birth of

•79 years (75 years for males, 82 for females). Japan's life expectancy of 83 years (80 for males, 86 for females) was the highest in the world, followed closely by Australia, Spain, Sweden, and Singapore, all at 82 years.

•Life expectancy in the U.S. increased dramatically from 46 for males and 48 for females in 1900 to 76 for males and 81 for females in 2013. During the 1900s, the increased recognition of the germ theory of disease led to interventions for the control of infectious disease

•Also, the increased prevention and control of the chronic diseases (esp. heart disease and stroke affecting adults) led to improvements in life expectancy.

•The countries with the lowest IMRs in the world in 2013 were Iceland (1.8 infant deaths per 1,000 live births), Finland (1.8), and Japan (1.9). IMRs of 2 and 3 are about as low as they will ever be attained. The IMR in the United States in 2013 was 5.4

•Although this is certainly low compared to the IMRs in many other countries, it is higher than the average IMR of 5/1,000 for the developed world.

•racial mortality cross-over.

•Blacks have the lowest life expectancy at birth, e0, compared to Hispanics and whites. For most of the years of their lives, blacks have higher death rates than Hispanics and whites. Nevertheless, black death rates become lower than those for whites by later life, and in some cases, are lower than those for Hispanics. This is what is known in demography as the

International comparisons of cause-of-death data are difficult because of differences in terminology, method of certification, diagnostic techniques, and quality.

•But some generalizations are possible about the general structure of the causes of death.

•Since the 1890s, many of the larger U.S. cities initiated "public works sanitation projects (such as piped water, sewer systems, filtration and chlorination of water) and public health administration" (Haines, 2007). The death rates, as a result of these efforts, dropped and rural-urban differences in mortality disappeared

•But white-black differences remained, as they do to this day.

There are two principal migration effects

•First is the healthy migrant effect, which states that the longevity advantage is due to the facts that many Mexican Americans in the United States were born elsewhere, and that migration is known to be selective of persons in better physical and mental health. •Second is the return migrant effect, also known as the salmon bias, which states that Mexican Americans in poor physical health often return to Mexico at old ages to live out the rest of their lives and, thus, that their deaths are not counted in the U.S. statistics.

•The IMR of the world in 2013 was 38 infant deaths per 1,000 live births. Infant mortality in the contemporary world varies considerably from country to country. In general, the more modernized the country, the lower its

•IMR. This means that in the world in 2013, on average, about one baby died before reaching the age of 1 year for every twenty-six born. The IMR was 5 in the more developed countries and 42 in the less developed countries.

•Crude death rates (CDRs) during the colonial period were likely moderate, ranging from 20 deaths per 1,000 per population to just under 40. Also, life expectancy did not exceed age 40, and was much lower in many places. •In New Hampshire and Massachusetts, life expectancy was about 35, and had increased to around 40 by 1850.

•In 1850, life expectancy at birth for whites averaged just over 39 years and for blacks only 23 years. Infant mortality was very high. •Since the 1850s, some of the U.S. mortality decline has resulted in part from improvements in public health and sanitation (especially better water supplies and sewage disposal), as well as improvements in diet, clothing, and shelter.

•In 1900, a white female infant could expect to live 51 years, compared to 35 years for a black female infant (a 16-year disadvantage). A white male infant had a life expectancy in 1900 of 48 years, compared to 33 years for a newborn black male (a 15-year disadvantage).

•In 2010, Whites still had a longevity advantage over blacks, but the racial advantage has narrowed. The LE advantage for white females over black females fell to 3 years, and to 5 years for white males over black males.

A major reason for the racial differential is the socioeconomic consequences of lifelong poverty. Other factors are low birth weight and low levels of childhood nutrition. Factors operating in midlife include the lack of access to health insurance, "the strain of physically demanding work, and exposure to a broad range of toxins, both behavioral (e.g., smoking) and environmental (e.g., workplace exposures)"

•In addition, the unfortunate experiences of racial discrimination not only have serious and adverse psychological and physiological effects, but also, in a most important way, limit the potential quantity and quality of health care available.

•Third are various cultural effects including the better dietary practices of Latinos compared to other U.S. residents and the stronger family obligations and relationships among Latinos compared to non-Latinos. •Figure 7.7 in our P&S textbook shows data on life expectancy at birth for the U.S. for the years of 2006 through 2011 for Hispanic males and females, non-Hispanic (NH) white males and females, and NH black males and females.

•In every year, 2006 through 2011, Hispanic females have higher life expectancy than any of the other race/ethnic sex groups, with a life expectancy at birth, e0, in 2011 of 83.7 years. Non-Hispanic white females are next with an e0 value of 81.1. And next are Hispanic males with a value of e0 in 2011 of 78.9. NH black females are next with an e0 of 77.8, and next are NH white males at 76.4, and last are NH black males with an e0 of 71.6.

Often, the number of civilian deaths exceeds the number of military deaths

•It is likely that during World War II in Russia, 60 percent of the deaths were civilian.

•Of particular interest in any analysis of majority-minority group differences in mortality is the very consistent finding that Hispanics in the United States, particularly Mexican Americans, have death rates of about the same magnitude as, and sometimes lower than, Anglos (i.e., non-Hispanic whites).

•Mexican Americans and African Americans "are more likely to be unemployed, poor, and without a high school degree and...have [also] experienced a long history of discrimination" (Rogers, Hummer, and Nam, 2000).

At age 90, NH-black males and NH-black females show a life expectancy advantage over NH-white males and females. And at age 100, NH-black males and NH-black females now have the higher life expectancy values compared to

•NH-white males and females and to Hispanic males and females.

•People do not all die of the same major causes, and these are largely due to the socioeconomic levels of the countries. •The WHO has produced an illustrative example that makes this point very clear. Consider a hypothetical population of 1,000 persons to represent all the women, men, and children of the world who died in 2008.

•Of these 1,000 decedents, 159 come from rich countries, 677 from middle-income countries, and 163 from poor countries. For each group of countries, the distributions of deaths according to the top ten causes are neither identical nor are they ranked the same in the three groups of countries.

Is it likely that mortality rates will continue to fall, resulting in even higher levels of life expectancy than those attained by these countries? There are two positions:

•One argues for a limit, and the other argues against it.

The impact of mortality varies significantly according to social and demographic characteristics.

•People in higher social classes live longer than those in the lower classes. Richer people live longer than poorer people. Married people live longer than single, separated, or divorced people.

What is causing the mortality reversals in Eastern Europe?

•Possible factors include the "lack of preventative health programs and inadequate quality of medical services; smoking and alcohol abuse; [and] general neglect of individual health."

•But Mexican Americans compared to Anglos are not at all disadvantaged with regard to life expectancy and other measures of longevity -- in fact, they are advantaged, but African Americans are disadvantaged.

•Several hypotheses have been offered to account for this so-called Hispanic epidemiological paradox, also referred to as the Latino mortality paradox and the Hispanic paradox. The demographer at UT-Galveston Kyriakos Markides was the first to identify this paradox.

Even today, data on causes of death are far from complete. Some deaths around the world are not even registered or incorrectly diagnosed.

•Sometimes, socially unpopular causes of death, such as suicide, syphilis, and HIV/AIDS, are misrepresented or camouflaged.

By the time the epidemic had run its course in North America, nearly 700,000 had died in the United States and around 50,000 in Canada. Some small villages in Quebec and Labrador were almost wiped out entirely.

•The most common victims of this epidemic were young adults, 20 to 40 years of age.

Nine countries, all in sub-Saharan Africa, are the most affected in the world. In Swaziland, 25 percent of its population aged 15-49 is infected with HIV, followed by Lesotho at 23 percent, Botswana at 22 percent, South Africa at 19 percent, Zimbabwe at 15 percent, Namibia at 14 percent, Mozambique at 11 percent, and Malawi at 10 percent.

•The next eight highest rates, from 7 percent in Uganda to 4 percent in Guinea-Bissau, are also in sub-Saharan African countries.

•In 2006, the PeMR for the United States was 6.5 and had dropped slightly to 6.3 by 2011. In 2000, the PeMR for the world was 47 per 1,000 live births plus stillbirths; it was 10 in the developed world and 50 in the less developed regions

•The rates ranged from highs of 111 in Mauritania, 104 in Liberia, 96 in both Afghanistan and Cote d'Ivoire, and 90 in Sierra Leone, to lows of 4 in the Czech Republic and Singapore and 5 in Italy, Martinique, and Sweden.

•Another analysis demonstrated that Mexican origin birth-giving women have lower odds of having STIs than NH blacks. Other research has shown that neighborhood crime rates, especially murder, were higher for blacks living in segregated neighborhoods, but this relationship did not hold for Hispanics living in segregated neighborhoods

•The return to crime for residentially segregated blacks was much higher than it was for residentially segregated Hispanics, particularly for violent crimes.

•Death is a complex behavior. There are many thousand different ways to die; some causes of death occur more frequently than others. In 2012, there were approximately 56 million deaths in the world. Figure 7.4 (see the P&S text) shows data from the World Health Organization (WHO) for the ten leading causes of death in the world in 2012

•The top cause was heart disease at 7.4 million deaths; stroke was next at 6.7 million deaths; chronic obstructive pulmonary disease (COPD), a lung disease that interferes with normal breathing, accounted for 3.1 million deaths. Ten causes accounted for over half of all deaths in the world in 2012.

•Indeed in Korea, even to this day, a small feast is prepared on the 100th day after a baby is born, in honor of the child's surviving the first few months of life (the most difficult period of time for survival). During the latter part of the 19th century and into the 20th century, most countries in the developed world had decreases in their IMRs

•The transition to lower levels of infant mortality in the Western countries, and to lower child and adult mortality, was due in large part to reductions in infectious and parasitic diseases. •The IMR in the United States was more than 100 in 1915-1916, dropping to 26 by 1960 and to 13 by 1980. In 2013, the IMR was 5 deaths per 1,000 live births.

Most national governments classify causes of deaths according to the International Classification of Diseases (ICD) as developed by the World Health Organization (WHO).

•This classification undergoes periodic revision. Causes of death in the United States have been classified according to ICD-10 since 1999.

An estimated 620,000 men, roughly half from the North and half from the South, died during the four years of fighting between 1861 and 1865.

•This was equivalent to 2 percent of the country's total population (31 million) at that time. This would be around 6.4 million people in terms of the U.S. population in 2015.

Or, in the words of Nathan Keyfitz, "Everyone dies of something sooner or later, so that, when the effects of the eradication of cancer had shaken down, the same number of deaths would occur as before, and the only benefit would be the substitution of heart and other diseases for cancer. A cure for cancer would only have the effect of giving people the opportunity to die of heart disease.

•Thus] all that this particular medical advance would do would be to increase the options: one could choose to die of heart disease rather than cancer."

Why is Venezuela's CDR one-half that of the United States, while all but one of its ASDRs are higher than those of the United States?

•Venezuela has proportionately many more people in the younger age groups than the United States. The opposite holds true regarding people in the middle and older ages, with higher proportions in the United States than in Venezuela. E.g., the population 65-69 is 3.4 percent of the United States versus 1.8 percent of Venezuela.

•Despite the improvements in life expectancy in the 20th century, a sizable racial gap remains.

•Whites had a much higher life expectancy at birth than blacks at the start of the last century.

•According to UNICEF, there were almost 2.8 million neonatal deaths in the world in 2013. This amounts to over 60 percent of the approximately 4.6 million infant deaths that occurred in that year worldwide. •Table 7.5 (in the P&S text) list the neonatal mortality rates for the developed world and the various regions of the developing world for 2013 and for 1990.

•Worldwide in 2013, the NMR was 20 neonatal deaths per 1,000 live births; it was 30 in 2000 and 33 in 1990. •In the developed countries in 2013 it was 3 (in the U.S. it was 4), and 22 in the countries of the developing regions.

On the other hand, degenerative diseases are the major causes of death in the developed world. It is expected that there will be future improvements in the treatment of these diseases in the next decades. However, only

•a breakthrough in the area of the physiological process of aging will bring a substantial increase in the length of time people in the developed world will live.

If one population has an excess of females and another an excess of males, and if the age compositions of the two are similar, the latter population will have

•a higher CDR than the former because of the heavier representation of males.

The life table dates back to John Graunt (1620-1674) and his "Bills of Mortality." The life table starts with

•a population at age 0 (a radix) of 100,000.

This phenomenon of mortality reversals is

•a relatively new occurrence in demography. Dudley Poston notes in the P&S textbook that when he "first began teaching demography to undergraduate students in 1970, any evidence of significant mortality reversals was for the most part unknown."

•More surviving children and adults translate into more potential and hopefully productive workers. •Improved childhood survival weakens and reduces the importance of some of the social, economic, and emotional rationales for high birth rates. Also, there will be an increased efficiency and productivity of the labor force because healthier adults are

•able to work better and longer.

•The mortality declines that have occurred in the United States are consistent with demographic transition theory. •Mortality started dropping gradually in response to changes in the social and economic conditions and the environment that were part of societal modernization. Mortality data for the United States are limited until

•about the middle of the 1800s. Systematic information on U.S. mortality has only been available since 1933.

•In many sub-Saharan African countries, there have been drastic increases in mortality and consequent declines in life expectancy since the mid-1980s. An analysis by Ashford (2006) examined mortality rates in the early years of the 2000-2010 decade for children under age 5 per 1,000 live births for the countries of Lesotho, Namibia, South Africa, Swaziland, and Zimbabwe, along with what the death rates would have been had there been no deaths to children via HIV/AIDS, but the mortality rates for young children are way

•above what they would have been without HIV.

•Maternal deaths in earlier centuries were very common, even in Europe and the United States. Reliable data on maternal mortality were not collected in the Western world until the mid-nineteenth century. The two most important factors leading to maternal deaths are

•age and parity (the number of times a woman has given birth; it also refers to birth order, for example, a second-born child, who would be a second-parity child). •The risks of maternity death (during pregnancy) are higher for very young women and older women than for women in their twenties and thirties. •High-parity women and women with short birth intervals are also at high risk due to chronic disease and malnutrition, poverty, unwanted pregnancies, inadequate prenatal and obstetric care, and lack of access to a hospital.

The demographic consequences of war with regard to mortality are not easy to determine. Some military historians and archeologists define war as

•all kinds of conflicts involving more than two combatants.

In 2013 alone, 1.5 million people died of HIV-related causes. Each year in the world, there are more than 2 million new HIV cases. This means that perhaps by around the year of 2030, there will have been more than 100 million HIV cases worldwide

•almost all of whom will die of HIV-related causes.

In Africa, increases in life expectancy since the late 1980s have been slowing down. This is largely due to the HIV/AIDS epidemic, as well as to other factors such as

•armed conflict, economic stagnation, and resurgent infectious diseases such as tuberculosis and malaria.

•A major advocate for an upper limit to human life expectancy is James Fries, who predicted in 1980 that humans have a maximum potential life expectancy averaging about 85 years. Jay Olshansky and Bruce Carnes support the contention of Fries and have noted that all living organisms are subjected to a

•biological warranty" period, because "there is substantial decline in functioning of all human biological systems by age 80."

Zaba (2003) has written, that "this may occur during sexual intercourse, or as a result of mother-to-child transmission during pregnancy, delivery, or breastfeeding. The virus may also be transferred in

•blood used for transfusions ... [Also] it can be spread by unsterilized hypodermic needles and surgical instruments."

Here is an example showing nicely how the CDR is a sum of the weighted (by population) ASDRs (7.4). Imagine a hypothetical population with a CDR of 40. This population is divided into two

•broad age groups, 0-34 and 35+. Table 7.2 (in our textbook) contains age data for this hypothetical population.

Agricultural output was severely limited by the inefficiency of manual labor, by plagues of rodents and insects, and by plant diseases. Abundant harvests usually

•could not be exploited owing to inadequate food-storage facilities.

With respect to the first reason, Sautter and her colleagues have noted that "age misreporting (i.e., overstatement of age) on death certificates occurs and is more common among blacks; this error can bias mortality estimates downward at the oldest ages. However, some analyses show that ...

•crossovers are postponed to later ages rather than eliminated when data are adjusted for age misreporting."

The hypotheses to account for it may be subsumed into three groups, namely

•data artifacts, migration effects, and cultural effects. •Under data artifacts are possible under-reporting of Hispanic origin identification on death certificates, and the misstatement of age, perhaps overstatement, at the older ages.

named after the demographer Conrad Taeuber, who pointed out that if a cure is found for one degenerative disease, this will provide the opportunity for

•death to occur from another.

In the United States, the Civil War resulted in the largest number of

•deaths to Americans of any war ever experienced by the USA, before or after.

The IMR is the sum of two rates, namely, the neonatal mortality rate (NMR), i.e., deaths to babies of 28 days of age or less per 1,000 live births, and the postneonatal mortality rate (PMR), i.e

•deaths to babies of 29 days to 1 year of age per 1,000 live births.

One of the most destructive famines in the demographic record occurred in China between 1958 and 1961. It is estimated that between 30 and 40 million Chinese died as a

•direct result of the famine, with 12 million of the deaths to persons under the age of ten.

•The WHO reports there were an estimated 313,000 maternal deaths in the entire world in 2015, a sizable reduction from the estimated number of 529,000 reported in 2000. •99 percent of all the maternal deaths in 2015 occurred in the developing region, with the sub-Saharan Africa region alone accounting for 66 percent maternal deaths, followed by the Southern Asia region. Developing regions accounted

•for almost 99 percent of all the maternal deaths in 2015, with the sub-Saharan Africa region alone accounting for 201,000 maternal deaths (66 percent), followed by the Southern Asia region with 66,000 maternal deaths.

The concept of a stable population was actually first set forth by Leonhard Euler (1760), but its current development stems

•from the work of Lotka, who first introduced the concept in a brief note in 1907.

He convinced the local officials to remove the handle from the water well that was yielding much of the contaminated water; they did, and the incidence of cholera dropped precipitously. This was one of the first times that

•geographic information systems (GIS) were used to shape a policy that led to the closing of certain wells.

•Latinos have an advantage over blacks, and in some cases over whites, with respect to higher life expectancy and lower death rates for most of the main causes of death. •Mexican-origin women have a much lower likelihood of contracting sexually transmitted infections compared to black women. •Hispanic men living in segregated neighborhoods have crime rates significantly lower than those of black men living in segregated neighborhoods. The main author of the P&S textbook, Dudley Poston, states that if he were pressed for a reason for the Hispanic advantage

•he would lean toward the cultural effects explanation. He feels that the strong social support networks in the Hispanic community and their demonstrably better health habits should play a key role. But the paradox remains a topic of considerable interest among demographers.

There have been major changes over the historical record in the main causes of death. People used to die mainly of infectious and parasitic diseases, but the major causes of death today in developed countries, like the United States, are

•heart disease, cancer, and stroke. However, these days, the major causes of death are not always the same in countries with high and low levels of life expectancy.

• In the United States and everywhere, mortality varies by age, but causes of death also vary by age. The main causes of death in the United States these days are associated with degenerative and chronic diseases. In the U.S. in 2011, the five top causes of death were

•heart disease, cancer, chronic lower respiratory diseases, stroke, and accidents, accounting for over 60 percent of all deaths.

•Other analyses have found evidence of a racial mortality cross-over in different time periods and in different parts of the world. Why does the cross-over exist? Why do blacks at the oldest ages have higher life expectancies than whites?

•here are two main explanations: age misreporting on death certificates, and "population heterogeneity in frailty" (Sautter et al., 2012).

In 2013 in the world, life expectancy at birth was 69 for males and 73 for females. In more developed countries, it was 75 and 82, and in less developed countries (excluding China), 65 and 69. Japan is the country with the

•highest life expectancy at birth, 80 for males, 86 for females. The lowest life expectancies were in Lesotho (42 for males, 45 for females), and Sierra Leone (45 for males, 46 for females).

•The increases in life expectancy resulting from the elimination of a specific degenerative disease are small mainly because these diseases occur principally in the older ages. The elimination of one degenerative disease will shift the cause of death from one degenerative disease to another (such as heart disease and cancer), resulting

•in a gain in life expectancy of perhaps only one or two years.

Besides the recorded military deaths, there is also the issue of civilian losses that occur as a consequence of war

•including infection by diseases carried by the soldiers, killings associated with plunder, famine following the destruction of farmland, and hardships occurring as a result of economic and social disorganization.

The developing countries have a very young age structure, and the young, more so than the old, have benefited and will continue to benefit from reductions in

•infectious and parasitic diseases.

From each age to the next, the population is decremented according to age-specific mortality probabilities until all members have died. The mortality schedule is

•is fixed and does not change over the life of the population.

•Dudley Poston in the P&S textbook takes a position closer to that of Vaupel and his associates than to that of Olshansky and his associates. Poston holds that at the global level, life expectancy will surely increase in the decades of this century. Whether female life expectancy reaches 100 years by 2060 is not as important as the expectation that it will not stagnate at

•just above 85.

Stillbirths are

•known as miscarriages or fetal deaths. A stillbirth is a fetus not born alive; thus, it is not registered as a death because it was not born.

•According to the UN, the twentieth century was the era characterized by the most rapid decline in mortality in human history. In the early 1950s, life expectancy in the world was only 46 years, but reached 69 years by 2010. The UN has projected that in 2050

•life expectancy for the world will reach 76 years. It will reach 82 years by 2100.

Demographers use two different concepts when referring to mortality:

•life span, which is the numerical "age limit of human life" (Kintner, 2004), and •life expectancy, which is the average expected number of years of life to be lived by a particular population at a given time.

As of the start of the year of 2014, the World Health Organization estimated that 74 million people worldwide had been infected since the virus was first recognized in 1981; of these, 39 million have died, and most of the 35 million living with HIV will

•likely die of HIV-related causes.

Epidemic diseases "break out, reach a peak, and subside; endemic diseases cause a relatively constant amount of illness and death overtime" (Johansson, 2003). Epidemics typically start out on a

•local level and are then diffused to nearby areas.

•The paradox has also been studied with cause of death data. Hispanics, especially those of Mexican origin, have lower death rates compared to NH whites for nine of the 15 leading causes of death. The prevalence of smoking is lower among Hispanics compared to NH whites, which could contribute to

•lower Hispanic mortality.

•Although there are no analyses to date provide a definitive explanation, all these studies point to a Hispanic advantage on several dimensions. This is an unexpected finding given the

•lower levels of socioeconomic status for Hispanics, their higher rates of poverty, and the decades of discrimination directed against them by the majority white population.

Figure 7.3 (see the file of figures and tables) is a map of the world showing the numbers of children and adults in 2013 living with HIV in each

•major region of the world. The confidence intervals are shown in brackets.

•According to data from The World Factbook produced by the U.S. Central Intelligence Agency (2015), fifty-four countries and territories had estimated IMRs in 2014 lower than that of the United States. One reason why the U.S. IMR is higher than the IMRs of other fifty-four other countries is statistical. The United States counts as a live birth an infant showing any sign of life, whereas

•many other countries are not as stringent. •The United States counts all births as live if they show any sign of life, regardless of prematurity or size. This includes what many other countries report as stillbirth.

•Demographic transition theory proposed, and it was widely believed, that once death rates in a country began to fall, they would never change direction and start to increase. Since the early 1980s, however, we have seen more and more evidence of

•mortality reversals, first in some of the countries of Eastern Europe and later in sub-Saharan Africa. Russia and many of the countries of the former Soviet Union experienced mortality reversals in the 1980s and 1990s.

The main cause of the famine stemmed from the ill-conceived and overly ambitious Great Leap Forward program, initiated in 1958 by Mao Zedong and designed to "involve a revolutionary struggle against

•nature to realize the great potential of agriculture by maximizing the advantages of the collective economy" (Aird, 1972).

•Life expectancy in the developed world in 1950 was already high, at 65 years; by 2010 it was 77, and is projected to be 83 years in 2050, and 89 years in 2100. In contrast the 49 least developed countries, 20 of which have been severely impacted by HIV/AIDS, had a life expectancy

•of only 35 years in 1950; LE reached 58 years in 2005-10 and is projected to 70 in 2050, and 77 by 2100.

The result of the standardization exercise is that Venezuela has a directly standardized death rate (SDR) of 11.1. This means that if Venezuela had the age composition

•of the United States, while retaining its own ASDRs, it would have a CDR of 11.1, and not its actual CDR of 4.

•The main reason is that "improved living standards, better health care, and public health programs have greater effects on exogenous causes of death than on endogenous causes" (Pebley, 2003). An exogenous cause of death is

•one due mainly to environmental or external factors, such as infections or accidents. An endogenous cause of death in an infant can occur because of genetic issues or conditions associated with fetal development or the birth process.

There were serious declines in population in much of Europe during the famine years of 1315-1317. In the 1690s

•one-sixth of the population in some Swedish provinces died after severe crop failures.

•Many countries in the developed world have socialized medical plans that provide universal health care to the entire population, and many of these countries have lower IMRs than the United States. In the United States and in most countries of the developed world, around two-thirds of infant deaths occur in the first month after birth and are due in large part to "health problems of the infant or the pregnancy, such as

•preterm delivery or birth defects" (Federal Interagency Forum on Child and Family Statistics, 2007). •Deaths to infants during the first month of life are frequently analyzed separately from those that occur after the first month but during the first year of life.

•In the developing world, there will certainly be increases in life expectancy or further declines in mortality. •Many of the developing countries still have high rates of infant mortality and general mortality, including maternal mortality. Infectious diseases remain a dominant cause of death in many of these countries. Modern medical and public health techniques will surely bring about further

•reductions in mortality from these causes.

The perinatal mortality rate (PeMR

•refers to pregnancies not resulting in live births (they were fetal deaths) or they resulted in live births of infants who lived for only seven days or less. As a result, the PeMR is a measure of what demographers refer to as "pregnancy wastage" because it reflects the number of wasted pregnancies.

•In Austria and Germany, fetal weight must be at least 500 grams (1 pound) to count as a live birth; in other parts of Europe, such as Switzerland, the fetus must be at least 30 centimeters (12 inches) long. In Belgium and France, births at less than 26 weeks of pregnancy are registered as lifeless. And some countries do not

•reliably register babies who die within the first 24 hours of birth.

An epidemic is a major increase or upswing of an infectious disease in an area that results in a large number of deaths, followed then by a decline. Many infections and contagious diseases have become epidemic, including

•scarlet fever, chicken pox, measles, influenza, and cholera.

Four very large countries with HIV prevalence rates below one percent, namely, Brazil, China, India, and the United States

•should also be considered in this discussion because of their large absolute number of persons currently living with HIV.

The Great Plague that hit London in the 1660s had continuing outbreaks for several decades thereafter, but its toll was lower than that of the Black Death. It was once believed to have been a bubonic plague, but many now hold that it was a disease

•similar to a viral fever. The "Bills of Mortality" analyzed by John Graunt were produced during the era of the Great Plague.

Alfred Lotka (1880-1949) is the person most responsible for the development of modern demography. Lotka used life tables in the development of his

•stable population theory.

•Black infant mortality is the highest of the major race/ethnic groups; Hispanics and Anglos (i.e., NH-whites) have IMRs that are very similar, just over 5 in 2010. Black infant mortality declined from under 14 infant deaths per 1,000 live births in 2000 to just over 11 in 2010. But black infant mortality in 2010 is

•still twice as high as infant mortality for Hispanics and NH-whites.

•On average, the higher the socioeconomic status (in terms of income, occupation, or education), the lower the mortality in the U.S. and in most other countries. In Differential Mortality in the United States, Evelyn Kitagawa and Philip Hauser (1973) showed that income and education have

•strong negative relationships with mortality, particularly for persons in the 25-64 age group. Their analyses were the first reporting the relationship between socioeconomic status and mortality; it is a very important book.

In Living and Dying in the USA, Richard Rogers, Robert Hummer, and Charles Nam (2000) revealed that among U.S. residents aged 18+, the force of mortality is

•stronger for the poor, the less educated, the unemployed and the uninsured rather than for the rich, the highly educated, and the insured....[Mortality is higher] for those who rarely attend religious services...than for those who frequently attend....[And mortality is higher] for those who smoke, drink heavily, and are inactive [compared to those] who have never smoked, who drink moderately, and exercise regularly." This is an extremely influential and important book.

Of the 35 million now living with HIV, 25 million reside in sub-Saharan Africa. Moreover, 70 percent of the global total of new HIV infections occur in

•sub-Saharan Africa.

•This ends up producing in the surviving elderly black population "a more robust group of disadvantaged individuals." As their age increases, the likelihood of dying is now "weighted toward the robust members of the disadvantaged subgroup who now exhibit lower mortality than the advantaged subgroup (i.e., the whites), who experience an acceleration of mortality at older ages." In a sense this is a

•survival of the fittest" argument.

We also have the influence in deciding the timing and characteristics of our own death (for most of the time), but also

•the deaths of some others (in some cases).

This is a paradox because

•the orderings do not follow what we would assume to be the negative effect of socioeconomic disadvantage and discrimination on life expectancy. •Socioeconomically disadvantaged groups, e.g., blacks and Hispanics, should not live as long as socioeconomically advantaged groups for the socioeconomic reasons I just addressed, as well as for the effects of poverty and discrimination.

One reason for the very high levels of HIV infection in sub-Saharan Africa is partner concurrency

•the practice of men and women having more than one partner concurrently, that is, simultaneously.

The basic life table consists of seven columns, including the probability of dying between age x and age x + n (nqx), the number of survivors at each age x (lx), and life expectancy at each age (ex). In Box 7.2 (in the P&S textbook),

•there is a life table for the U.S. population for the year 2010. See the lengthy discussions there of the life table.

The U.S. IMR dropped from 11 deaths per 1,000 births in the 1980s to

•to 9 in the 1990s to 7 in 2000 to 6 in 2010.

Mortality data from war are best documented for activities in the

•twentieth century compared to previous eras.

We need to be aware of the fact, however, that when considering life expectancy at birth, e0, infant mortality plays a

•very important role. When e0 is low, as in Lesotho or in Sierra Leone, for example, a major reason is their very high infant mortality rate.

Death is our last and final demographic life event. An obituary is announced in a local newspaper when we die. The obituary might include

•when and where we were born, our surviving family members, and perhaps something about our main occupation while we were alive, our education, and other items of interest.

•However, statistical adjustments do not move the U.S. IMR entirely to the low levels of Japan and Sweden. Another reason of an infant's surviving death is mother's socioeconomic status. The leading cause of infant mortality in developed countries such as the United States is congenital malformations

•which can be prevented with good nutritional intake and prenatal vitamins. •However, poor mothers, especially those in poverty, often lack the socioeconomic resources needed to obtain these benefits. They also may be forced to forego full prenatal care, which could result in maternal complications at birth, another prime cause of infant mortality.

Epidemics are also underway in Central Asia and in Eastern Europe. There is an enormous potential for a massive HIV/AIDS epidemic in China owing to the 30 to 40 million excess boys already born in China

•who will not be able to find Chinese brides; these bachelors will likely live in the big cities and be dependent on sex workers.