Other countries would die for our falling mortality rate

 

I was taken aback by a headline in last Tuesday's Irish Times Health Supplement: "Irish death rate higher than average" because at that moment I was preparing to write an article about the dramatic decline in our death rate that has taken place in the first six years of this decade, writes Garret FitzGerald

Reading the text of this story I soon discovered the explanation for this apparent conflict.

The Health Supplement piece was about a study carried out by the Society of Actuaries for the purpose of estimating survival rates for life insurance purposes, and studies of this kind have to be based on long-term trends in mortality, in this case the trend over a 25-year period from 1980 to 2004.

And for 20 of those 25 years our death rate was well above the EU average.

However, because of the long-term actuarial function of this study, it did not include any breakdown in death rates in sub-periods of that quarter of a century.

Such a breakdown would have shown a sudden change in the mortality pattern after 1999.

By contrast, what I - an honorary member of the Society of Actuaries as it happens - was about to write about, prompted by a communication from someone who shares my interest in statistics, was the extraordinary decline in our death rate that has taken place during those six years from 1999 to 2005.

Back in 1999 our age-standardised death rate was the highest in western Europe. Only seven eastern European states had a worse record than ours.

However by 2005 only four western European states had as good a record as Ireland - Italy, Sweden, France and Spain.

There is no evident relationship between our economic growth in the 1990s and this more recent improvement in our death rate.Yet in the mortality stakes, just like economic growth, we have once again caught up with our neighbours in record time.

Of course, death rates are falling almost everywhere. Yet in most countries this improvement is at a rate of 2 per cent to 3 per cent a year. And in a substantial minority of European countries the decline is 1 per cent a year.

In our case, however, the recent rate of improvement has been almost 5 per cent a year.

This represents a three- to four-fold acceleration of the annual decline in mortality that we had been experiencing prior to 2000.

I find it surprising that such a remarkable phenomenon, although known to health experts, has attracted no public attention.

I have analysed this process by looking at causes of death.

There have been reductions in the rate of mortality under almost all headings yet for some causes of death the mortality rate has been falling slowly - by 1 per cent a year or less.

That is true of lung, breast and prostate cancer, and for digestive and genito-urinary causes. The latter has the slowest improvement rate of all, perhaps because of the rapid rise in sexually-transmitted diseases.

The fastest decline in mortality rates is to be found in respect of all forms of circulatory and respiratory diseases and also cancer of the colon. In all these cases the death rate has been falling by between 5 per cent and 7 per cent a year.

The higher figure is the remarkable rate at which deaths from heart attacks has been declining. The virtual halving of such deaths within six years has been a remarkable phenomenon.

Research is taking place into this sudden and sharp change in our mortality pattern.

One such study is suggesting that 60 per cent of the improvement may be due to lifestyle factors rather than actual healthcare improvements, although some believe the lifestyle factor may be even more pronounced than this.

"Lifestyle" relates to such factors as better eating habits and a reduction in smoking. Some experts believe, however, that this improvement may also reflect the delayed effects of better care for children many decades back.

What remains to be explained is why this improvement in mortality rates has come so suddenly, and has been so rapid.

I have been told that, important though this new trend may be in its own right, it may have less impact than one might expect on expectation of life. There has, however, also been a recent improvement in this, affecting men more than women. This has slightly bridged the substantial gap between male and female survival figures. But that is a matter that I shall leave to actuaries, whose comment on the long-term significance of these recent data would be interesting to hear.