The Decline of Mortality in England and Wales 1861 to 1964: Decomposition by Cause of Death and Component of Mortality

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Abstract
The decline in mortality in England and Wales, between 1861 and 1964 is analysed, using competing-hazard models. These methods provide greater specificity concerning the potential biases due to misdiagnosis, and facilitate the examination of temporal shifts in the age-patterns of mortality. The results provide a number of insights into the historical decline of mortality that were not previously available. First, misclassification of causes of death as ill-defined conditions in historical data is not limited to the diseases of ageing, as has typically been assumed. The degenerative diseases have probably emerged as the most frequently misclassified causes of death only during recent times. Secondly, the unusual age distribution of deaths considered to be characteristic of the influenza epidemic of 1918–19 appeared more than ten years earlier and lasted for more than ten years after the pandemic. This suggests that this age-pattern of deaths was not a characteristic of the Swine influenza virus itself, and that some alternative hypothesis for the shift in age-patterns of death is needed. Thirdly, the analysis of the decline in deaths from tuberculosis indicates that the cohort model of the shifts in age-patterns of this cause of death is inconsistent with the dynamics of this cause of death before 1921. Fourthly, the age-patterns of mortality of influenza, pneumonia and bronchitis, tuberculosis, and one or more of the degenerative diseases are temporally correlated. Thus, the trends in mortality from influenza may have played a predominant role in determining the timing and rate of decline in a number of other causes of death, as well as in determining the age-pattern of the historical decline in mortality. Finally, the analyses of the degenerative diseases as a group indicate that these causes of death have not increased as a result of modern lifestyles, although there is evidence of shifts in deaths among the degenerative diseases. In general, these estimates of the timing, rate and age-pattern of the historical decline in mortality are more consistent with the trends in mortality observed by epidemiologists over the last 20 to 30 years than previous analyses of the historical decline in mortality. This overall finding suggests that the current trends in mortality are much older than is typically supposed.

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