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.

More than 50 mio. deaths-corresponding to almost 45% of all deaths-can be attributed to diseases of the circulatory system. The ROMI plot for mortality due to these causes is depicted in Fig. 7.1. Heart diseases ( Fig. 7.2), e.g., myocardial infarction, and cerebrovascular diseases ( 95% of all deaths from circulatory diseases. We can draw at least two conclusions from those figures: • Circulatory diseases can not be the reason why (female) life expectancy in the United States barely increased during the last two decades of the twentieth century. We see major annual declines (three percent and more) in mortality due to these causes. • The pattern found for mortality from heart diseases and cerebrovascular diseases as well as from the composite picture of all circulatory diseases resembles the pattern we found in Chap. 6 for rates of mortality improvement from all causes in many countries such as Spain, Japan, or Italy. At that time we were only able to speculate that the "cardiovascular revolution" was the primary reason for the observed pattern. While Figs. 7.1, 7.2, and 7.3 are no definite proof, we can feel more certain about our suggestions.
So if circulatory diseases were the main reason for life expectancy gains in many European countries during the 1980s and 1990s, why did life expectancy in the United States not increase in a similar manner since mortality from heart diseases, stroke and similar causes also declined remarkably in the US?
If circulatory diseases can be excluded, we turned our attention to malignant neoplasms ("cancers"). They are responsible for more than one in five deaths. Among the various cancer sites, we decided to look at three major sub-categories: colorectal, breast and lung cancer (Figs. 7.5,7.6,7.7,and 7.8) in addition to mortality from all cancers (Fig. 7.4).
Deaths from any kind of cancer for women ( Fig. 7.4) show a mixed pattern: Below age 50 we can detect a continuous trend of improving survival conditions throughout most of our observation period. Lower mortality from cancer extends also to higher and higher ages after the mid-1980s (Fig. 7.4). Those survival improvements that show some characteristics of a cohort effect could be influenced by declining mortality from colorectal cancers as suggested by Fig. 7.5. Also breast cancer (Fig. 7.6) displays steady improvements albeit starting only in the 1990s. The main cause for the poor development of female life expectancy during the late twentieth century is probably lung cancer. Among the authors of this book, Fig. 7.7 on page 77 is the strongest cohort effect they have encountered when analyzing rates of mortality improvement by cause of death. Also men ( Fig. 7.8, p. 78) feature such a strong cohort effect. The pattern for males is located further left on the Lexis map, i.e., earlier in calendar time, supporting the idea of the "'cigarette diffusion' explanation [. . . ] that convergence in male and female smoking is the byproduct of a female lag in the process of cigarette adoption, diffusion, and abatement" (e.g., Pampel 2001, p. 388). Furthermore, our figures on lung cancer, in conjunction with the detrimental effects shown in Fig. 7.9 for respiratory diseases, are in line with Wang and Preston (2009, p. 398) who argue that "[b]ecause of changes in smoking behavior that have already occurred or that can be reliably projected, American mortality is likely to fall more rapidly than is commonly anticipated." Open Access This chapter is licensed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made.
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