Fifty years trends in middle age mortality in 12 Western European countries

Stein Emil Vollset, University of Bergen and Norwegian Institute of Public Health

The comparison of mortality and causes of death among several countries over time may aid in the identification of underlying causal factors. From the WHO mortality data base we computed all-cause and cause-specific risks of middle age death (40-70 years of age) by using multiple decrement life tables for 12 Western European countries (Finland, Norway, Sweden, Denmark, U.K., Ireland, Netherlands, Germany, Switzerland, France, Italy, and Spain). Between 1952 and 2001, middle age risk of death declined 19 to 48% in men and 29 to 65% in women. Between 1952 and 1970 the risk of middle age death increased in men in several countries. From 1970 to 2001 there was a steady reduction in middle age mortality in men in all 12 countries and for women in all countries except Denmark where the decline was delayed for about 15 years. For risk of middle age death from any cause in men and from circulatory disease in both men and women mortality levels were converging among countries with less variation in 2001 compared to 1952. This contrasted with cancer mortality where no convergence was seen. In 2001, the lowest middle age death risks were found in Sweden, Switzerland, Norway, Italy, and Netherlands (20-23%) for men and in Spain, Switzerland, Italy, France and Finland (10-12%) for women. The highest risks were observed in Denmark and Finland (both 26%) for men, and in Denmark and UK for women (18 and 15%, respectively). An improvement in rank position of middle age death risk between 1952 and 2001 of 5 or more was observed for men in the UK and for women in Ireland, Italy, Finland and Spain. Similar declines in the rank position were observed for men in Denmark, and for women in Denmark, Netherlands and Norway. These time trends in mortality and causes of death may provide clues to the potential for mortality and morbidity prevention.