The Australian mortality decline: cause-specific mortality 1907-1990

Abstract

This review describes the changes in composition of mortality by major attributed cause during the Australian mortality decline this century. The principal categories employed were: infectious diseases, nonrheumatic cardiovascular disease, external causes, cancer, 'other' causes and ill-defined conditions. The data were age-adjusted. Besides registration problems (which also affect allcause mortality) artefacts due to changes in diagnostic designation and coding are evident. The most obvious trends over the period are the decline in infectious disease mortality (half the decline 1907-1990 occurs before 1949), and the epidemic of circulatory disease mortality which appears to commence around 1930, peaks during the 1950s and 1960s, and declines from 1970 to 1990 (to a rate half that at the peak). Mortality for cancer remains static for females after 1907, but increases steadily for males, reaching a plateau in the mid-1980s (owing to trends in lung cancer); trends in cancers of individual sites are diverse. External cause mortality declines after 1970. The decline in total mortality to 1930 is associated with decline in infection and 'other' causes. Stagnation of mortality decline in 1930-1940 and 1946-1970 for males is a consequence of contemporaneous movements in opposite directions of infection mortality (decrease) and circulatory disease and cancer mortality (increase). In females, declines in infections and 'other' causes of death exceed the increase in circulatory disease mortality until 1960, then stability in all major causes of death to 1970. The overall mortality decline since 1970 is a consequence of a reduction in circulatory disease, 'other' cause, external cause and infection mortality, despite the Previous analyses of cause-specific mortality in Australia, such as those of Cumpston, Lancaster and D'Espaignet et al., have treated specific disease categories or have used aggregations of disease groups based on the ICD chapter headings.*3 The problem with the ICD chapter nomenclature is that it is a mixture of an aetiological and a body systems meth'od of classification. This is a particular problem for infectious diseases (chapter I). In this analysis, designated infective and postinfective conditions have been relocated to an expanded infectious disease category, and rheumatic fever and its sequelae have been deducted from the circulatory diseases chapter.The approach taken in this article is to examine changes in major-cause categories of death in Australia, 1907Australia, -1990, in the light of the concept of the epidemiological or health t r a n s i t i~n .~~,~~ The aim of this article is to show how the composition of mortality by attributed cause has changed during the remarkable decline in mortality in the Australian population this century. MethodsCause-specific mortality data were obtained and analysed by single calendar year. Age-standardised rates were calculated to adjust for the effect of age in comparisons. Sex was taken into account by stratification. Proportional mortalit...

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