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Johan Mackenbach
Benjamin Gompertz
(1779‐1865)
From age 20, human
mortality rate
doubles every 8 years
Rate of increase by
age: species‐specific,
constant over time
Gompertz (1825)
Gompertz‐
Makeham (1860)
Heligman‐Pollard
(1980)
Heligman‐
Pollard: three
components
Exponential
increase is
senescence
Immutable
despite all
progress?
Recent trends in life expectancy – no sign of
slowing down
Intermezzo: stagnation and renewed increase
of life expectancy in the Netherlands
Does Gompertz’ law still hold – before and
beyond the age of 80?
Life expectancy at birth
90
males (0.32 -> 0.16)
80 females (0.35 -> 0.09)
70
60
50
40
30
20
1840 1860 1880 1900 1920 1940 1960 1980 2000 2020
Van Poppel e.a., 2010
Maddison 2001
“Female life
expectancy in the
record‐holding
country has risen
for 160 years at a
steady pace of
almost 3 months
per year” (Oeppen
& Vaupel 2002)
Vallin and Meslé 2009
Van der Lucht & Polder 2010
USA, Denmark, Netherlands share similar
histories of stagnation
Partly due to causes of death related to
smoking
But: recent upturn in Denmark since 1995, in
Netherlands since 2002
Glei et al., 2009
Glei et al., 2009
Females
Heart Diseases
Other circulatory
Lung cancer
Non-Lung cancers
Respiratory diseases
Mental/Nervous System
All other causes
-1 0 1 2 3
Contribution to gain in e50 (in years)
DNK NLD USA 10-Country Mean
Males
Heart Diseases
Other circulatory
Lung cancer
Non-Lung cancers
Respiratory diseases
Mental/Nervous System
All other causes
-1 0 1 2 3
Contribution to gain in e50 (in years)
DNK NLD USA 10-Country Mean Glei et al. 2010
Per Capita Consumption of Manufactured Cigarettes
12
Australia
Austria
Belgium
10
Canada
Denmark
Manufactured Cigarette Consumption
Finland
(number per adult per day)
8 France
Germany
Greece
6 Italy
Japan
Netherlands
4 New Zealand
Norway
Spain
Sweden
2
Switzerland
United Kingdom
United States
0
1935- 1940- 1945- 1950- 1955- 1960- 1965- 1970- 1975- 1980- 1985- 1990- 1995- 2000- 2005-
1939 1944 1949 1954 1959 1964 1969 1974 1979 1984 1989 1994 1999 2004 2006
Years
NAS panel 2010
First noted by Statistics Netherlands:
declining absolute number of deaths
Then attributed to climatic factors (mild
winters, cool summers)
Most determinants of mortality did not show
favorable change
Only exception is health care (use and
expenditure, particularly for elderly)
Mortality rate, all causes, 2002=100
160
140
120
65-69
70-74
75-79
100 80-84
85-89
90-94
95+
80
60
40
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Mackenbach et al. 2010
Life expectancy gains at age 65 per period and cause of death, females
infectious and parasitic
neoplasms
endocrine, nutrit., metabolic
mental and behavioural
nervous system
circulatory system
2002-2008
1995-2002
respiratory system
digestive system
genitourinary system
symptoms, signs, ill-defined
external causes
all other causes
-0,2 0 0,2 0,4 0,6 0,8 1
years gained at age 65
Mackenbach et al. 2010
1995‐2001 2001‐2007
Betablocker use +9.2 +12.5
Statin use +13.6 +23.8
Hospital admission +5.2 +23.6
All surgical procedures +3.2 +5.9
Cardiac catheterizations +0.2 +0.4
PTCA ‐‐ +0.5
Coronary bypass ‐0.05 +0.03
Mackenbach et al. 2010
Growth in real terms: 4.1% in 1970s, 2.2% in
1980s, 2.2% in 1990s, 5.6% in 2000s
Cost containment measures (supply,
budgets) in 1980s and 1990s
Growing discontents led to sudden relaxation
of budgetary restraints in 2001
Government plan “Zorg verzekerd” induced
cost explosion in 2001/2/3
Mackenbach et al. 2010
DOES GOMPERTZ’ LAW STILL HOLD ‐
BEFORE AND BEYOND THE AGE OF 80?
Source: Statistics Netherlands. Mackenbach &
Looman, in prep.
BEFORE AGE 80: MORTALITY
INCREASE AT LEAST AS STEEP
BEFORE AGE 80: MORTALITY
INCREASE AT LEAST AS STEEP
Men Women
Doubling 95% CI Doubling 95% CI
time (“c”, yr) time (“c”, yr)
1950 7.14 7.02‐7.26 6.79 6.63‐6.96
1960 7.07 6.95‐7.19 6.71 6.55‐6.87
1970 6.97 6.86‐7.08 6.96 6.79‐7.13
1980 6.70 6.59‐6.81 7.08 6.90‐7.25
1990 6.50 6.40‐6.60 7.24 7.06‐7.43
2000 6.61 6.51‐6.72 7.56 7.36‐7.76
2009 6.52 6.55‐6.76 7.60 7.40‐7.81
Gompertz’ model fitted to Netherlands’ mortality data between ages 40 and 80. Data
source: Statistics Netherlands. Mackenbach & Looman, in prep.
RELIABILITY THEORY OF AGEING
Exponential increase of mortality with age is
elegantly explained by Reliability Theory of Aging
(Gavrilov & Gavrilova 1991)
Aging results from gradual failure of the essential
components of complex systems, with initial
redundancy of irreplaceable elements in each
component
Apparent “aging rate” (i.e., mortality doubling
period) depends on presence of initial flaws and on
level of redundancy
Thatcher et al. 1998
Dark blue: Gompertz
Red: Observed
Light blue: Logistic
Green: Quadratic Vaupel et al. 1998
POSSIBLE EXPLANATIONS FOR
MORTALITY “DECELERATION”
Fundamental aspects of aging, e.g. Reliability
Theory of Aging: redundancy in number of
irreplaceable elements vanishes with age, and
failure rate of last element then determines
mortality
Selection effects in heterogeneous populations: at
advanced ages: only those with lower starting
mortality levels and/or lower rates of aging will still
be alive
Age trajectory of
mortality in
heterogeneous
population (red)
can be different
from that in its
subpopulations
(blue).
Vaupel 2010
Despite lower mortality among adults
and elderly, and mortality deceleration
among the very old, survival to age 120
will remain exceptional
Extrapolation of logistic models fitted
on mortality for ages 80‐110 suggests
that mortality risk (q) at age 120 = 0.5 ‐
0.65
Although the “iron laws of mortality”
still apply, there have been enormous
increases in average longevity
Aging still seems inevitable, but shifts
in mortality to higher ages suggest that
it can be postponed
Postponement of senescence is very
good news, particularly if it also leads
to postponement of disability
