Centre for Demographic Studies

Studies of functional impairments in the U.S. elderly population have tended to rely on prevalence estimates from nationally representative health and institutional surveys. These prevalence estimates generally show higher rates of disability for females than males. Unfortunately, prevalence estimates can be misleading when one attempts to assess the risks of certain types of health event transitions for individuals. This study directly examined the individual transitions both into and out of functionally impaired states using longitudinal data from the 1982 and 1984 National Long Term Care Surveys (NLTCS). The data show that, even at very high levels of impairment, there are significant numbers of community residents who apparently manifest long-term improvement in functioning. The longitudinal data also show that the risks of becoming disabled are roughly the same for males and females. This suggests that sex differences in the national prevalence of disabilities arise from the greater longevity of females at any given level of age and functional impairment.

The U.S. elderly (65+) and oldest-old (85+) populations are growing rapidly which, combined with their high per capita acute and long-term care needs, will increase total U.S. health care needs. Also important in determining needs is how health and function change as mortality declines in the elderly population. Recent increases in adult life expectancy have been due to declines in stroke and heart disease mortality. There is controversy, however, about how those declines relate to the health and function of survivors. We examined changes in the prevalence and incidence of chronic disability using the 1982, 1984, and 1989 National Long Term Care Surveys. The total prevalence of U.S. chronically disabled community-dwelling and institutionalized elderly populations declined from 1984 to 1989, overall, for each of three age strata and after mortality adjustment. These changes varied over level of disability. Factors contributing to these changes, including measurement, are reviewed.

We investigate the causal effect of education on health and the part of it that is attributable to health behaviors by distinguishing between short-run and long-run mediating effects: whereas, in the former, only behaviors in the immediate past are taken into account, in the latter, we consider the entire history of behaviors. We use two identification strategies: instrumental variables based on compulsory schooling reforms and a combined aggregation, differencing, and selection on an observables technique to address the endogeneity of both education and behaviors in the health production function. Using panel data for European countries, we find that education has a protective effect for European men and women aged 50+. We find that the mediating effects of health behaviors-measured by smoking, drinking, exercising, and the body mass index-account in the short run for around a quarter and in the long run for around a third of the entire effect of education on health.

OBJECTIVES: : To elucidate whether well-known predictions of mortality are reduced or even reversed, or whether mortality is a stochastic process in the oldest old. DESIGN: : A multidimensional survey of the Danish 1905 cohort conducted in 1998 with follow-up of vital status after 15 months. SETTING: : Denmark. PARTICIPANTS: : All Danes born in 1905, irrespective of physical and mental status were approached. Two thousand two hundred sixty-two persons of 3,600 participated in this survey. MEASUREMENTS: : Professional interviewers collected data concerning sociodemographic factors, smoking, alcohol consumption, body mass index, physical and cognitive performance, and health during a visit at the participant's residency. Cox regression models were used to evaluate predictors of mortality. RESULTS: : Five hundred seventy-nine (25.7%) of the 2,249 participants eligible for the analysis died during the 15 months follow-up. Multivariate analyses showed that marital status, education, smoking, obesity, consumption of alcohol, and number of self-reported diseases were not associated with mortality. Disability and cognitive impairment were significant risk factors in men and women. In addition poor self-rated health was associated with an increase in mortality in women. CONCLUSION: : In the oldest old, several known predictors of mortality, such as sociodemographic factors, smoking, and obesity, have lost their importance, but a high disability level, poor physical and cognitive performance, and self-rated health (women only), predict mortality, which shows that mortality in the oldest old is not a stochastic process.

In this paper we describe the Subnational Human Development Database. This database contains for the period 1990-2017 for 1625 regions within 161 countries the national and subnational values of the Subnational Human Development Index (SHDI), for the three dimension indices on the basis of which the SHDI is constructed - education, health and standard of living --, and for the four indicators needed to create the dimension indices -- expected years of schooling, mean years of schooling, life expectancy and gross national income per capita. The subnational values of the four indicators were computed using data from statistical offices and from the Area Database of the Global Data Lab, which contains indicators aggregated from household surveys and census datasets. Values for missing years were estimated by interpolation and extrapolation from real data. By normalizing the population-weighted averages of the indicators to their national levels in the UNDP-HDI database, values of the SHDI and its dimension indices were obtained that at national level equal their official versions of the UNDP.

Brazilian discussions of race between 1880 and 1940 were partly a use of European scientific theory to rationalise the native system of colour discrimination. When scientific orthodoxy turned against ‘race’ between 1920 and 1945, much of the intellectual racism of Brazil also dispersed. Quite rightly, most intellectual histories of race in Brazil stress a disjuncture around 1930. However, from the 1870s onward, and most clearly after abolition, there was also a medical-psychiatric strand to ‘race’ that can be unravelled from the rest of the skein. Part of racial thinking in Brazil reflected the general medicalisation of social thought that began when early-nineteenth-century physicians called for hygienic reforms within upper-class families to protect children from hereditary or environmental contaminations. The Spencerian and Comtean positivist social science that became fashionable in Brazil after 1870 also contributed to medicalisation. It saw society as an organism, and compared the role of the social scientist to the role of the physician: to examine symptoms of disease and propose therapies. From the 1880s through the 1920s, the national ailment that the medicalised social thought of Brazil most often diagnosed, an ailment that connected individual health to national well-being, was degeneration.

In a context of global-scale inequalities and increased middle-class transnational mobility, this paper explores how the arrival of Western European and North American migrants in Barcelona drives a process of gentrification that coexists and overlaps with the development of tourism in the city. Research has focused increasingly on the role of visitors and Airbnb in driving gentrification. However, our aim is to add another layer to the complexity of neighbourhood change in tourist cities by considering the role of migrants from advanced economies as gentrifiers in these neighbourhoods. We combined socio-demographic analysis with in-depth interviews and, from this, we found that: (1) lifestyle opportunities, rather than work, explain why transnational migrants are attracted to Barcelona, resulting in privileged consumers of housing that then displace long-term residents; (2) migrants have become spatially concentrated in tourist enclaves and interact predominantly with other transnational mobile populations; (3) the result is that centrally located neighbourhoods are appropriated by foreigners – both visitors and migrants – who are better positioned in the unequal division of labour, causing locals to feel increasingly excluded from the place. We illustrate that tourism and transnational gentrification spatially coexist and, accordingly, we provide an analysis that integrates both processes to understand how neighbourhood change occurs in areas impacted by tourism. By doing so, the paper offers a fresh reading of how gentrification takes place in a Southern European destination and, furthermore, it provides new insights into the conceptualisation of tourism and lifestyle migration as drivers of gentrification.

BACKGROUND: Climate change driven by human activities has increased annual temperatures in Spain by around 1°C since 1980. However, little is known regarding the extent to which the association between temperature and mortality has changed among the most susceptible population groups as a result of the rapidly warming climate. We aimed to assess trends in temperature-related cardiovascular disease mortality in Spain by sex and age, and we investigated the association between climate warming and changes in the risk of mortality. METHODS: We did a country-wide time-series analysis of 48 provinces in mainland Spain and the Balearic Islands between Jan 1, 1980, and Dec 31, 2016. We extracted daily cardiovascular disease mortality data disaggregated by sex, age, and province from the Spanish National Institute of Statistics database. We also extracted daily mean temperatures from the European Climate Assessment and Dataset project. We applied a quasi-Poisson regression model for each province, controlling for seasonal and long-term trends, to estimate the temporal changes in the province-specific temperature-mortality associations with distributed lag non-linear models. We did a multivariate random-effects meta-analysis to derive the best linear unbiased prediction of the temperature-mortality association and the minimum mortality temperature in each province. Heat-attributable and cold-attributable fractions of death were computed by separating the contributions from days with temperatures warmer and colder than the minimum mortality temperature, respectively. FINDINGS: Between 1980 and 2016, 4 576 600 cardiovascular deaths were recorded. For warm temperatures, the increase in relative risk (RR) of death from cardiovascular diseases was higher for women than men and higher for older individuals (aged ≥90 years) than younger individuals (aged 60-74 years), whereas for cold temperatures, RRs were higher for men than women, with no clear pattern by age group. The heat-attributable fraction of cardiovascular deaths was higher for women in all age groups, and the cold-attributable fraction was larger in men. The heat-attributable fraction increased with age for both sexes, whereas the cold-attributable fraction increased with age for men and decreased for women. Overall minimum mortality temperature increased from 19·5°C between 1980 and 1994 to 20·2°C between 2002 and 2016, which is similar in magnitude to, and occurred in parallel with, the observed mean increase of 0·77°C that occurred in Spain between these two time periods. In general, between 1980 and 2016, the risk and attributable fraction of cardiovascular deaths due to warm and cold temperatures decreased for men and women across all age groups. For all the age groups combined, between 1980-94 and 2002-16, the heat-attributable fraction decreased by -42·06% (95% empirical CI -44·39 to -41·06) for men and -36·64% (-36·70 to -36·04) for women, whereas the cold-attributable fraction was reduced by -30·23% (-30·34 to -30·05) for men and -44·87% (-46·77 to -42·94) for women. INTERPRETATION: In Spain, the observed warming of the climate has occurred in parallel with substantial adaptation to both high and low temperatures. The reduction in the RR and the attributable fraction associated with heat would be compatible with an adaptive response specifically addressing the negative consequences of climate change. Nevertheless, the simultaneous reduction in the RR and attributable fraction of cold temperatures also highlights the importance of more general factors such as socioeconomic development, increased life expectancy and quality, and improved health-care services in the country. FUNDING: None.

Although men tended to receive more education than women in the past, the gender gap in education has reversed in recent decades in most Western and many non-Western countries. We review the literature about the implications for union formation, assortative mating, the division of paid and unpaid work, and union stability in Western countries. The bulk of the evidence points to a narrowing of gender differences in mate preferences and declining aversion to female status-dominant relationships. Couples in which wives have more education than their husbands now outnumber those in which husbands have more. Although such marriages were more unstable in the past, existing studies indicate that this is no longer true. In addition, recent studies show less evidence of gender display in housework when wives have higher status than their husbands. Despite these shifts, other research documents the continuing influence of the breadwinner-homemaker model of marriage.

Newly released census microdata reveal the nearly worldwide and substantial decline in educational hypergamy (women marrying men with higher educational attainment) across 56 countries from the 1970s to the 2000s. We examine the extent to which the observed decrease in hypergamy is connected to the worldwide rise in female educational attainment. Our results show that educational hypergamy is an enduring form of gender inequality in union formation across the countries examined but that it has been decreasing over the last few decades and in some countries has reversed in recent years. Overall, we find a strong association between hypergamy and gender differences in educational attainment. Societies in which the female educational advantage is greater tend to have lower levels of educational hypergamy. There is a tendency toward a joint increase in women's educational levels and a decrease in educational hypergamy. This article underlines the influence of women's educational opportunities on the increase in gender symmetry in assortative mating, which leads us to predict the end of educational hypergamy.

Unique data from a 1998 healthy longevity baseline survey provide demographic, socio‐economic, and health characteristics of the oldest old, aged 80–105, in China. This subpopu‐lation is growing rapidly and is likely to need extensive social and health services. A large majority of Chinese oldest old live with their children and rely mainly on children for financial support and care. Most Chinese oldest old had no or very little education. Ability to function independently in daily living declines rapidly and self‐rated health declines moderately across the oldest old ages. As compared to their urban counterparts, the rural oldest old have far less pension support, are significantly less educated, and are more likely to be widowed and to rely on children for support. Apart from higher rates of survival, the female oldest old in China are far more disadvantaged than the male oldest old.

The article describes the rise of unmarried cohabitation in Latin American countries during the last 30 years of the twentieth century, both at the national and regional levels. It documents that this major increase occurred in regions with and without traditional forms of cohabitation alike. In addition, the striking degree of catching up of cohabitation among the better-educated population segments is illustrated. The connections between these trends and economic (periods of high inflation) and cultural (reduction of stigmas in ethical domains) factors are discussed. The conclusion is that the periods of inflation and hyperinflation may have been general catalysts, but no clear indications of correlation were found between such economic factors and the rise in cohabitation. The shift toward more tolerance for hitherto stigmatized forms of conduct (e.g., homosexuality, euthanasia, abortion, singleparent household) is in line with the rise of cohabitation in regions of Argentina, Chile, and Brazil where cohabitation used to be uncommon. Further rises in cohabitation during the first decade of the twenty-first century are expected in a number of countries (e.g., mexico) despite conditions of much lower inflation.

This study critically reviews the Gender Inequality Index (GII), the new gender-related index proposed by the United Nations Development Programme (UNDP) in the 2010 Human Development Report, arguing that its particular construction limits its usefulness and appropriateness as a global gender inequality index. In particular, the functional form of the index is excessively and unnecessarily confusing. Moreover, the inclusion of indicators that compare the relative performance of women vis-à-vis men, together with absolute women-specific indicators, obscures even more the interpretation of an already complicated index and penalizes the performance of low-income countries. In order to overcome some of the identified limitations, this contribution defines a new composite index of gender inequality that incorporates the GII variables but uses a much simpler functional form. The results suggest that great caution should be exercised when interpreting and using the values of the GII.

OBJECTIVES: To describe the functional capacity and self-rated health of a large cohort of nonagenarians. DESIGN: A cross-sectional survey of all Danes born in 1905 (92-93 years of age), carried out August to October 1998. SETTING: Participants' homes. PARTICIPANTS: Two thousand two hundred and sixty-two nonagenarians, corresponding to a participation rate of 63% (of these, 20% participated by proxy). MEASUREMENTS: Activities of daily living (ADLs) and self-rated health were assessed by interview. Five items from Katz's ADLs (bathing, dressing, transfer, toileting, and eating) were used to construct a three-level five-item ADL scale (not disabled (no disabilities), moderately disabled (1-2 disabilities), severely disabled (3-5 disabilities)). From responses to a more extensive list of questions on ADLs (26 items), we identified scales of strength and agility by means of factor analysis. Furthermore, a 26-item ADL scale was made. Physical performance tests (chair stand, timed walk, lifting a 2.7 kg box, maximum grip-strength, and flexibility tests) were performed among nonproxy responders. RESULTS: According to the five-item ADL scale, 50% of the men and 41% of the women were categorized as not disabled, while 19% and 22%, respectively, were categorized as severely disabled. The five-item ADL scale correlated highly with the 26-item ADL scale (r = 0.83). The ADL scales showed moderate-to-good correlation with each other (r = 0.74-0.83), and with the physical performance tests (r = 0.31-0.58). Only 3.7% of the women and 6.3% of the men walked (normal pace) with a speed of at least 1 meter per second, which is the minimum walking speed required to cross signaled intersections in Denmark. A total of 56% considered their health to be excellent or good. Of the participants, 74% were always or almost always satisfied with their lives, even though only 45% reported that they "felt well enough to do what they wanted." The analyses showed that no single ADL item seemed to be of particular importance for how the participants rated their health. CONCLUSION: The Danish 1905 cohort survey is the largest and the only nationwide survey of a whole birth-cohort of nonagenarians. A total of 2,262 fairly nonselected nonagenarians participated. The level of both self-reported disability and functional limitations measured by physical performance tests among nonagenarians was high. Despite their lower mortality, women were more disabled than men and did not perform as well as men in the physical performance tests. Nevertheless, the majority of the participants considered their health to be good and were satisfied with their lives.

OBJECTIVES: To investigate the influence that demographic determinants, socioeconomic determinants, chronic diseases, and functional capacity have on self-rated health among elderly persons (60 years and older) living in the city of São Paulo, São Paulo, Brazil, and to investigate the existence of differences between men and women in terms of their self-rated health. METHODS: The study was carried out using data collected in the city of São Paulo as part of a project called Health, Well-being, and Aging in Latin America and the Caribbean (the "SABE project"). We analyzed data on 2,135 elderly individuals (58.6% women; mean age, 69.4 years; median age, 68.0 years). The dependent variable was self-rated health (good or poor). The following independent variables were considered: (1) demographic ones (age, sex, marital status, and living arrangements (whether the elderly person lived alone or with others)), (2) socioeconomic ones (schooling and income), (3) the number of chronic diseases (hypertension, arthritis or rheumatism, cardiovascular disease, diabetes, asthma, bronchitis or emphysema, embolism or stroke, and cancer), and (4) functional capacity. To estimate the association between self-rated health and the independent variables and to study gender differences, a multiple binary logistic regression analysis was performed. RESULTS: The presence of chronic diseases in association with gender was the strongest determinant of self-rated health among the elderly in São Paulo. Among men with four or more chronic diseases, they were 10.53 times as likely to characterize their health as poor; among women with four or more chronic diseases, the ratio was 8.31. Functional capacity, schooling, and income were also strongly associated with self-rated health, and the influence of age was significant. The elderly women were more likely to report good self-rated health than were men when the women or men either had no chronic diseases or had two or more. CONCLUSIONS: Our results indicate the need for simultaneous, comprehensive actions in the health sector, social services, and the economic sector to address the main determinants of self-rated health in order to promote well-being and quality of life among the elderly.

BACKGROUND: Europe has emerged as a major climate change hotspot, both in terms of an increase in seasonal averages and climate extremes. Projections of temperature-attributable mortality, however, have not been comprehensively reported for an extensive part of the continent. Therefore, we aim to estimate the future effect of climate change on temperature-attributable mortality across Europe. METHODS: We did a time series analysis study. We derived temperature-mortality associations by collecting daily temperature and all-cause mortality records of both urban and rural areas for the observational period between 1998 and 2012 from 147 regions in 16 European countries. We estimated the location-specific temperature-mortality relationships by using standard time series quasi-Poisson regression in conjunction with a distributed lag non-linear model. These associations were used to transform the daily temperature simulations from the climate models in the historical period (1971-2005) and scenario period (2006-2099) into projections of temperature-attributable mortality. We combined the resulting risk functions with daily time series of future temperatures simulated by four climate models (ie, GFDL-ESM2M, HadGEM2-ES, IPSL-CM5A-LR, and MIROC5) under three greenhouse gas emission scenarios (ie, Representative Concentration Pathway [RCP]2.6, RCP6.0, and RCP8.5), providing projections of future mortality attributable fraction due to moderate and extreme cold and heat temperatures. FINDINGS: Overall, 7·17% (95% CI 5·81-8·50) of deaths registered in the observational period were attributed to non-optimal temperatures, cold being more harmful than heat by a factor of ten (6·51% [95% CI 5·14-7·80] vs 0·65% [0·40-0·89]), and with large regional differences across countries-eg, ranging from 4·85% (95% CI 3·75-6·00) in Germany to 9·87% (8·53-11·19) in Italy. The projection of temperature anomalies by RCP scenario depicts a progressive increase in temperatures, more exacerbated in the high-emission scenario RCP8.5 (4·54°C by 2070-2099) than in RCP6.0 (2·89°C) and RCP2.6 (1·67°C). This increase in temperatures was transformed into attributable fraction. Projections consistently indicated that the increase in heat attributable fraction will start to exceed the reduction of cold attributable fraction in the second half of the 21st century, especially in the Mediterranean and in the higher emission scenarios. The comparison between scenarios highlighted the important role of mitigation, given that the total attributable fraction will only remain stable in RCP2.6, whereas the total attributable fraction will rapidly start to increase in RCP6.0 by the end of the century and in RCP8.5 already by the middle of the century. INTERPRETATION: The increase in heat attributable fraction will start to exceed the reduction of cold attributable fraction in the second half of the 21st century. This finding highlights the importance of implementing mitigation policies. These measures would be especially beneficial in the Mediterranean, where the high vulnerability to heat will lead to an imbalance between the decreasing cold and increasing heat-attributable mortality. FUNDING: None.

Though the general trend in the United States has been toward increasing life expectancy both at birth and at age 65, the temporal rate of change in life expectancy since 1900 has been variable and often restricted to specific population groups. There have been periods during which the age- and gender-specific risks of particular causes of death have either increased or decreased. These periods partly reflect the persistent effects of population health factors on specific birth cohorts. It is important to understand the ebbs and flows of cause-specific mortality rates because general life expectancy trends are the product of interactions of multiple dynamic period and cohort factors. Consequently, we first review factors potentially affecting cohort health back to 1880 and explore how that history might affect the current and future cohort mortality risks of major chronic diseases. We then examine how those factors affect the age-specific linkage of disability and mortality in three sets of birth cohorts assessed using the 1982, 1984, and 1989 National Long Term Care Surveys and Medicare mortality data collected from 1982 to 1991. We find large changes in both mortality and disability in those cohorts, providing insights into what changes might have occurred and into what future changes might be expected.

Dystopian fiction, stories envisioning dire human futures, originated with the novels of H. G. Wells and others a century ago. “Demodystopias” are a subgenre of dystopias where the imagined futures derive from demographic change, taken perhaps to an extreme: the population explosion, aging and depopulation, mass migration, global epidemics, and the eugenic possibilities of new reproductive technologies. This essay traces the genealogy of demodystopias over the twentieth and early twenty‐first centuries. Their themes reflect the demographic issues of the day: fear of overpopulation in the “population bomb” era; later, threatened societal senescence or swamping by immigrants under ultra‐low fertility; new reproductive regimes under genetic engineering; and the geopolitics of demographic change. As with other dystopias, demodystopias seek to identify present‐day negative tendencies that might lead to a future theatrum diabolorum —and to pin responsibility for such an outcome on ourselves. Authors discussed include Margaret Atwood, Anthony Burgess, Günter Grass, Michel Houellebecq, José Saramago, Lionel Shriver, and Kurt Vonnegut.

BACKGROUND: Investments in the survival of older children and adolescents (aged 5-19 years) bring triple dividends for now, their future, and the next generation. However, 1·5 million deaths occurred in this age group globally in 2019, nearly all from preventable causes. To better focus the attention of the global community on improving survival of children and adolescents and to guide effective policy and programmes, sound and timely cause of death data are crucial, but often scarce. METHODS: In this systematic analysis, we provide updated time-series for 2000-19 of national, regional, and global cause of death estimates for 5-19-year-olds with age-sex disaggregation. We estimated separately for countries with high versus low mortality, by data availability, and for four age-sex groups (5-9-year-olds [both sexes], 10-14-year-olds [both sexes], 15-19-year-old females, and 15-19-year-old males). Only studies reporting at least two causes of death were included in our analysis. We obtained empirical cause of death data through systematic review, known investigator tracing, and acquisition of known national and subnational cause of death studies. We adapted the Bayesian Least Absolute Shrinkage and Selection Operator approach to address data scarcity, enhance covariate selection, produce more robust estimates, offer increased flexibility, allow country random effects, propagate coherent uncertainty, and improve model stability. We harmonised all-cause mortality estimates with the UN Inter-agency Group for Child Mortality Estimation and systematically integrated single cause estimates as needed from WHO and UNAIDS. FINDINGS: In 2019, the global leading specific causes of death were road traffic injuries (115 843 [95% uncertainty interval 110 672-125 054] deaths; 7·8% [7·5-8·1]); neoplasms (95 401 [90 744-104 812]; 6·4% [6·1-6·8]); malaria (81 516 [72 150-94 477]; 5·5% [4·9-6·2]); drowning (77 460 [72 474-85 952]; 5·2% [4·9-5·5]); and diarrhoea (72 679 [66 599-82 002], 4·9% [4·5-5·3]). The leading causes varied substantially across regions. The contribution of communicable, maternal, perinatal, and nutritional conditions declined with age, whereas the number of deaths associated with injuries increased. The leading causes of death were diarrhoea (51 630 [47 206-56 235] deaths; 10·0% [9·5-10·5]) in 5-9-year-olds; malaria (31 587 [23 940-43 116]; 8·6% [6·6-10·4]) in 10-14-year-olds; self-harm (32 646 [29 530-36 416]; 13·4% [12·6-14·3]) in 15-19-year-old females; and road traffic injuries (48 757 [45 692-52 625]; 13·9% [13·3-14·3]) in 15-19-year-old males. Widespread declines in cause-specific mortality were estimated across age-sex groups and geographies in 2000-19, with few exceptions like collective violence. INTERPRETATION: Child and adolescent survival needs focused attention. To translate the vision into actions, more investments in the health information infrastructure for cause of death and in the related life-saving interventions are needed. FUNDING: Bill & Melinda Gates Foundation and WHO.

<b>Jeroen Spijker</b> and <b>John MacInnes</b> argue that current measures of population ageing are misleading and that the numbers of dependent older people in the UK and other countries have actually been falling in recent years