1. THE DECLINE OF MORTALITY IN THE SECOND HALF OF THE 20 TH CENTURY Victor R. Fuchs Henry J. Kaiser Jr. Professor Emeritus Stanford University Department of Health London 8 May 2003

5. Standard Deviation of Log of Age-adjusted Death Rate: All Causes, 1960-1996 0.06 0.07 0.08 0.09 0.1 0.11 0.12 19601965197019751980198519901995 13 countries 12 countries (excluding Japan) 0 standard deviation

6. Percent Per Annum Rate of Change of Age-adjusted Death Rate: Diseases of Circulatory System U.S. vs. U.K. (5 year moving average centered on middle year) percent

7. Annual Consumption of Fluid Cream Products in U.S. 1950-1998, Half Pints Per Person (5 year moving average centered on middle year) Half pints per person

8. Annual Consumption of Eggs in U.S. 1950-1998, Number Per Person (5 year moving average centered on middle year) Eggs per person

9. Pork, Beef, Chicken and Fish Consumption in U.S.: 1950-2000 Boneless, trimmed (edible) weight, pounds per capita per year 0 10 20 30 40 50 60 70 80 90 19501955196019651970197519801985199019952000 Beef Pork Chicken Total fish and shellfish pounds per capita

10. Percent Per Annum Rate of Change of U.S. Age-adjusted Death Rate Lung Cancer & All Maglinant Neoplasms: Men & Women (5 year moving average centered on middle year) -2 0 1 2 3 4 5 6 7 8 19631968197319781983198819931998 Lung Cancer Men Lung Cancer Women Malignant Neoplasms Men Malignant Neoplams Women percent

11. Percent Per Annum Rate of Change of U.S. Age-adjusted Death Rate Heart Disease, Men & Women(r = 0.86) (5 year moving average centered on middle year) -5 -4 -3 -2 0 1 2 1950195519601965197019751980198519901995 Men Women Percent

12. Percent Per Annum Rate of Change of U.S. Age-adjusted Death Rate Stroke, Men & Women (r = 0.98) (5 year moving average centered on middle year) -8 -6 -4 -2 0 2 4 195019551960196519701975 1980 198519901995 Men Women %

13. Percent of Population with Systolic Blood Pressure >=160 & >=180 Ages 25-74 (Age-standardized) 0 2 4 6 8 10 12 14 16 Systolic >=160 Men Systolic >=160 Women Systolic >=180 Men Systolic >=180 Women 1960-19621971-19751976- 1980 1988-1994 Percent

14. Age, Period and Birth Cohort

15. Approximate a Cohort-to-Cohort Change in Age-specific Mortality, England & Wales (percent per annum)

16. Correlation Coefficient (r) Among 13 Countries Across 42 Age-specific Cohort-to-Cohort Changes in Mortality1960-95, Age 35-64

17. OLS Regression Across 42 Age-Specific Cohort-to-Cohort Rates of Change of Mortality (percent per annum) M = k + aC26-30 + bC31-35 + cC36-40 + dC41-45 + eP71-75 + fP76-80 + gP81-85 + hP86-90 + iP91-95 Cohorts in excluded class: 1901-25 and 1946-60 Periods in excluded class: 1961-65 and 1966-70

22. Cohort a of Maximum Rate of Decline b in Age-Specific Mortality For Each Country

23. Period a of Maximum Rate of Decline b in Age-Specific Mortality For Each Country

24. Summary Age-adjusted mortality declined by more than one percent per annum in most “western” countries in the second half of the 20 th century The rate of decline was more rapid for females than males, for the young than for the old, and for circulatory diseases than for other causes The rate of decline was much more rapid for some countries than for others, (not just convergence) and much more rapid during some periods than in other periods

25. Summary (continued) The U.S. had a particularly rapid rate of decline in mortality from circulatory diseases in the 1970s. Of the three principal explanations that have been offered: change in diet, reduction in cigarette smoking, and control of hypertension, aggregate data provides most support for control of hypertension Regression analyses of age-specific cohort-to- cohort rates of decline show considerable variation in the timing of decline across countries. The maximum rate of decline for England & Wales was in 1981-85

26. Summary (continued) The maximum rate of decline for cohorts in 10 countries was highly concentrated for the birth cohort 1936-1940. For England & Wales, the maximum was for the cohort born in 1931-35 An understanding of why the 1936-40 birth cohort (and to a more limited extent the 1931- 1935 cohort) experienced particularly large rates of decline in mortality could contribute to a more comprehensive explanation of mortality trends in the second half of the 20 th century