different countries. Meslé and Vallin (2006) compared patterns of cause of death for women in the United States, the Netherlands, France, and Japan to better understand the recent divergent trends in female old-age mortality in those countries. To identify the main causes of death responsible for the differences in female life expectancy at older ages, the authors compared the period 1968-1984 against the period 1984–2000 and decomposed the change in life expectancy at age 65 into age- and cause-specific mortality changes. They found that most of the divergence derived from the fact that the declines in mortality due to heart disease and cerebrovascular disease in the United States and the Netherlands were partially offset by increases in several other causes of death in those countries, while Japan and France managed to achieve lower mortality from a variety of causes at increasingly older ages (Meslé and Vallin, 2006).

In a specially commissioned background paper for this report, Glei, Meslé, and Vallin updated and extended this line of work (see Glei et al., 2010). Instead of considering trends in 4 countries, the authors extended their analysis to 10 countries, paying particular attention to the 3 countries identified earlier as underachieving over this period (the United States, Denmark, and the Netherlands) and to the highest achiever, Japan. The authors also extended their analysis to include both men and women and updated their investigation of age- and cause-specific mortality contributions to changes in life expectancy using data up to 2004.

Trends in Causes of Death for the United States, Denmark, the Netherlands, and Japan

Figures 2-1 and 2-2 display trends in age-standardized mortality among men and women aged 50 and above for the United States, Denmark, the Netherlands, and Japan (Glei et al., 2010). To circumvent coding problems, the authors grouped the causes of death into nine clusters.

In the United States, heart disease is the number one cause of death, responsible for more than 600,000 deaths annually (Xu et al., 2010).1 While the age-standardized mortality rate for both men and women aged 50 and above has declined significantly since 1980 (see Figures 2-1 and 2-2), heart disease remains the number one killer and the major cause of the current

1

In 2007, the leading 15 causes of death in the United States were (1) heart disease; (2) malignant neoplasms (cancer); (3) cerebrovascular disease (stroke); (4) chronic lower respiratory diseases; (5) accidents (unintentional injuries); (6) Alzheimer’s disease; (7) diabetes mellitus (diabetes); (8) influenza and pneumonia; (9) nephritis, nephritic syndrome, and nephrosis (kidney disease); (10) septicemia; (11) intentional self-harm (suicide); (12) chronic liver disease and cirrhosis; (13) essential hypertension and hypertensive renal disease (hypertension); (14) Parkinson’s disease; and (15) assault (homicide) (Xu et al., 2010). Note that AIDS has not been one of the 15 leading causes of death in the United States since 1997, although it continues to be one of the five leading causes of death in specific subpopulations.



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