Annual Symposium: Recent Trends in Mortality and Morbidity in Ireland: Wealthier and Healthier: Ireland's Demographic Catch-Up

What the paper says

1. INTRODUCTION In the first half of this paper I summarise the trend in Irish deaths rates over the period 1973-2006. In the second half I discuss some possible explanations of these trends. 2. THE RECENT DECLINE IN IRISH MORTALITY RATES While the long-run trend in Irish death rates has been downwards, since the end of the twentieth century they have been falling more rapidly than in earlier years and than rates in other European countries. (2) Between 1999 and 2005 the Irish age-standardised rate fell by 26 per cent, compared with a fall of only four per cent between 1994 and 1999. (3) Between 1999 and 2004 (still the latest year for which EU-15 data are available) the EU rate fell by nine percent, the Irish by 22 per cent. Figure 1 compares the rates for men and women in Ireland and EU-15 over the period 1994-2004/05. As recently as 1999 the Irish rate exceeded the EU-15 average by 26 per cent (men) and 18 per cent (women). By 2004 the gap had been eliminated for men and considerably reduced for women. In 2005 the Irish male rate fell by a further seven per cent and the female rate by three per cent. Table 1 shows Irish death rates relative to the EU-15 average in 1994, 1999, and 2004 for four disease groups that accounted for over 70 per cent of all deaths in the 1990s. These are malignant neoplasms (C00-C97), (4) ischaemic heart diseases (IHD) (120-125), cerebrovascular diseases (160-169), and diseases of the respiratory system (J00-J99). While there has been no improvement in Ireland's relative position for deaths from malignant neoplasms over the past ten years--the rate for men has been very close to the EU average since the 1990s, but the Irish rate for women has remained some 20 per cent above the EU average--for the other diseases groups there has been a marked improvement. Since 1999 the Irish death rate for diseases of the respiratory system declined by about 12 per cent since 1999 relative to the EU average. For ischaemic heart disease the rate of decline in the differential doubled for men after 1999 and increased slightly for women. In the case of cerebrovascular diseases, the differential with EU-15 widened between 1994 and 1999 for men and women, but fell by 20 per cent for both between 1999 and 2004. The acceleration in the rate of decline of the death rates from IHD, cerebrovascular, and respiratory diseases accounts for most of the catch-up in Irish mortality rates (especially among men) relative to the EU since the turn of the century. (5) Figures 2 through 8 give a longer-term perspective on Irish death rates over the period 1973-2006 and help identify more clearly structural breaks in trends. (6) All show the natural log of the four-quarter moving average of death rates on the Y-axis, so that changes in slope may be equated with changes in trend. (7) Figure 2 shows the death rate for the total population from all causes. There are two clear changes of slope--a flattening out over the decade 1988-98 and a nosedive after 1998. (8) Much the same picture emerges from Figure 3, which shows the death rates for three older age groups. The percentage decline over the whole period was greatest among the 55-64 age group (57%), followed by the 65-74 group (51%), and then the 75+ group (37%). In all three age groups, but most strikingly for the 75+ group, the rate of decrease accelerated in the late 1990s. The death rate for the 75+ age group declined by 25% over the eight years 1998-2006, compared with a decline of only 20% over the previous twenty five years. Figures 4 through 8 look at trends in the principal causes of death. Figure 4 shows that the death rate from respiratory illness fluctuated without a clear trend until the late 1990s and then fell sharply. Figure 5 shows that the rate from IHD fell much more rapidly over the most recent ten years that over the previous quarter of a century, when the rate of decline was not very marked. …