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Understanding the Mortality Decline at Older Ages

Improved Life Course or Improved Present Period?


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For over a century, western countries have shown continuing declines in mortality at increasingly older ages. The reasons for these mortality declines are poorly understood. For the Netherlands, this study examines to what extent the mortality decline at old age can be explained by improved life course characteristics of subsequent cohorts (life course factors) and/or by improved medical and longterm care (period factors).

Findings are based on a comparison of a 5-year survival following the 1996 and 2006 cycles of the nationally representative Longitudinal Aging Study Amsterdam for ages 78–87 years. In the pooled sample, the effect of baseline year (2006 vs. 1996) on survival was tested. Cox regression models tested the change in the hazard ratio of baseline year after adding life course and period factors to a basic model including age, gender, and interview mode.

Life course factors showed a more favorable profile in 2006 than in 1996: higher levels of education of participants and their fathers and fewer years of smoking. Period factors showed lower rates of long-term care institutionalization and a rise in prevalence for lung disease, heart disease, diabetes, cancer, and cognitive decline. At the same time, severe disability remained stable. Crude 5-year mortality after 2006 was 16% lower than after 1996 (p = .021). The life course factors—education and smoking history— explained 39.2% of the improvement in survival. The period factors—heart disease, diabetes, cancer, and cognitive decline—however, showed suppressor effects, implying that adding them to the basic model increased the survival difference by 44.6%.

These findings are compatible with both more favorable life course characteristics and better disease-specific survival, with the latter suggesting better medical care. From these two, improved disease-specific survival showed a stronger influence on the mortality decline.

Document Type: Research Article

Publication date: February 1, 2013

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