MORTALITY TRENDS
• Trends in national mortality rates •
This website
Information about causes of death
'All we possess is the present, and the present endlessly dissolves into the past.'
—Michael Frayn, Copenhagen (1998)
'Anyone can stop a man's life, but no one his death; a thousand doors open on to it.'
—Seneca The Younger (4 BC - AD 65), Phoenissae
'…a prerequisite for knowing anything is understanding why it is as it is—in other words, grasping its primary cause.'
—Aristotle, Physics (about 330 BC) [transl. Robin Waterfield, 1996]
'Plenty is the condition that will let us distinguish, for the first time, between avoidable and unavoidable suffering.'
—Francis Spufford, Red Plenty (2010)
'Civilisation advances by extending the number of operations which we can perform without thinking about them.'
—Alfred North Whitehead, Introduction to Mathematics (1911)
'People who are disadvantaged in one regard tend to be disadvantaged in other regards, since the forces that structure life chances and
experience tend to ensure some folk get the worst of all things.'
—George Davey Smith and Shah Ebrahim, British Medical Journal (2002)
'If the misery of our poor be caused not by the laws of nature, but by our institutions, great is our sin.'
—Charles Darwin, quoted by Richard Lewontin, in It Ain't Necessarily So (2000)
'A decent provision for the poor is the true test of civilization.'
—Samuel Johnson, quoted by James Boswell in Life of Samuel Johnson (1791)
'The worst government is often the most moral. One composed of cynics is often very tolerant and humane.
But when fanatics are on top there is no limit to oppression.'
—HL Mencken, Minority Report (1956)
'…pause for serious thought is not a habit of governments.'
'Confronted by menace, or what is perceived as menace, governments will usually attempt to smash it, rarely to examine it, understand it, define it.'
'…to recognize error, to cut losses, to alter course, is the most repugnant option in government.'
'Policy founded on error multiplies, never retreats.'
'The knots of folly draw tighter.'
—Barbara Tuchman, The March of Folly (1984)
'…[The] politicians' logic: something must be done; here is something; therefore we must do it.'
—Antony Jay & Jonathan
Lynn, Yes Prime Minister (1986)
'The diversity of our opinions does not arise because some men are more rational than others but only
because we direct our thoughts along different ways, and do not consider the same things.'
—René Descartes, Philosophical Writings (1958)
'This is the heart of modern journalism, the rapid repackaging of largely unchecked second-hand material, much of it designed to service the political or
commercial interests of those who provide it.'
'The ethic of honesty has been overwhelmed by the mass production of ignorance.'
—Nick Davies, Flat Earth News (2008)
'Language is the main instrument of man's refusal to accept the world as it is.'
—George Steiner, After Babel (1975)
'"Change" is scientific, "progress" is ethical; change is indubitable, whereas progress is a matter of controversy.'
—Bertrand Russell, Unpopular Essays (1950)
'Towery city and branchy between towers;
Cuckoo-echoing, bell-swarmed, lark-charmed, rook-racked, river-rounded.'
—Gerard Manley Hopkins, Duns Scotus's Oxford (1879)
'…her [Oxford's] autumnal mists, her grey springtime, and the rare glory of her summer days…'
—Evelyn Waugh, Brideshead Revisited (1945)
'…the ancient and noble city of Oxford is, of all the towns of England, the likeliest progenitor of unlikely events and persons.'
—Edmund Crispin, The Moving Toyshop (1946)
'At times in my first year I used to feel that when I boarded the train at Paddington for Oxford, I was setting out not for a city set in the countryside of
southern England but for another planet, moored somewhere above Didcot.'
—Geoffrey Cox , Eye Witness (1999)
'That former period is not an age that is passed away, and powerless, but is living, present and prevailing in all its vigour.'
'…the halls of Oxford are founded for eternity…'
—Frederick von Raumer, Being a Series of Letters Written to Friends in Germany (1836)
[transl. Sarah Austin]
How this website came about
This website began on 8 May 2008 as a collection of graphs showing trends in mortality rates for a couple of countries, compiled—as a pastime—by
New Zealand-born Oxford-based
epidemiologist, Gary Whitlock.
Initially called MORtrends (www.mortrends.org), it became Mortality Trends (www.mortality-trends.org)
on 6 March 2010, and by the end of that year, the main, Choose a graph, page encompassed full sets of graphs for 40 countries.
The website was comprehensively updated and revamped on 5 May 2012. At present, the site contains just over 18,200 unique graphs.
By coincidence, Gary Whitlock experienced a series of health crises during much the same period as the site was being developed. He had a melanoma removed from his left leg on 21 February 2008, and a carcinoma removed from his left parotid gland (a salivary gland on the side of the neck and face) on 18 August 2010. His general health began to collapse in February 2012, and metastases were discovered in his lungs on 21 March 2012. After several investigations, including two different types of lung biopsy, the origin of the metastases at last became clear: it was the parotid, and the prognosis was grim. His wish was, however, that this website continue for at least a few years after his death, in much the same form as he left it. A personal farewell to family and friends.
How to interpret the graphs on this website
Trends in mortality rates can reflect changes in disease occurrence or treatment, in which case they represent something real about a population's health. However, trends can also reflect alterations in how causes of death were defined or coded. These are artefacts, and are of little interest except simply to know that each is there. If on one of these graphs you see a jagged corner, a crooked step, or a fleeting dip, very probably the excursion is an artefact, not something of real significance. Many such artefacts are marked here by dotted lines, but most are not—there are simply too many of them.
'His [Percy Stock's] success owed much to his ability to distinguish the important data and methods, and to avoid the lure of trivia.'
—D.D. Reid on Percy Stocks (pictured right),
statistician and interpreter of national mortality data, British Journal of Preventive & Social Medicine (1975)
A common type of artefact is that caused by changes to how the underlying cause of death is specified when a disease is complicated by another life-threatening condition. For example, acute stroke is often complicated by pneumonia, and this is sometimes a fatal development. For such deaths, the underlying cause might have been coded as stroke in one era, but as pneumonia in another. On this website, mortality rates for specific causes are for what was considered to be the underlying cause at the time the death was recorded.
Not all genuine trends are of major significance to the health of the population in question: some are, but most are not. The key to gauging the public health significance of a trend is to measure the absolute size of any change, referring to the scale on the vertical axis. For example, a fall in the annual mortality rate for a particular disease from 500 to 400 per 100,000 would be an even greater public health gain than a fall for another disease from 10 to 1 per 100,000 (even though it is a fall of just 20% compared with 90%), as out of every 100,000 living it would represent 100 deaths a year averted, in comparison with 9.
Copying graphs
Provided your purpose is non-commercial, you are welcome to copy any of the graphs on this website.
Most of the graphs were produced using data from the World Health Organization (WHO) and the United Nations Population Division ('World Population Prospects: The 2010 Revision'), but apart from providing the relevant data, these two bodies had no role either in the production of the graphs or in their interpretation on this website. For all of these graphs, an appropriate acknowledgement would be:
'From www.mortality-trends.org, using WHO and
UN Population Division data'
For the few graphs based on data from other sources (eg, the Human Mortality Database), an appropriate acknowledgement is shown below the relevant image.
Under no circumstances will permission be granted for any of these graphs, or information related to them, to be used for commercial purposes. This website is provided as a public good.
Information about causes of death
Definitions of the different causes of death are given here.
Technical details
Most of this website's graphs show time trends in mortality rates. For each calendar year, a mortality rate was calculated as the number of deaths divided by the number of people in the relevant population, and then multiplied by 100,000. The relevant population was all those people who would have been counted among the deaths had they died in that year. Thus, the population is only of males if the deaths were male, and only of people aged 60-69 years if the deaths were at this age.
Mortality rates were standardised for age by taking the unweighted mean of the component 5-year rates. For example, the rate for age 60-69 years is the unweighted mean of the rates for 60-64 and 65-69 years. (A slight exception is for age 1-14 years, where age 1-4 receives only four-fifths weighting compared with ages 5-9 and 10-14.) All-cause mortality rates standardised in this way can be used to calculate the probability of death in a particular age band, as follows: P = 1 - e-Y.R/100,000, where Y is the number of years in the age band, R/100,000 is the age-standardised mortality rate expressed as annual deaths per 100,000, and P is the probability that a person at the very start of the age band would die before reaching its end if R were to obtain throughout the whole period. For example, the age-standardised mortality rate for UK men at age 50-59 in 2005 was 593 per 100,000 (actually a smoothed rate—see below—but the principle broadly holds nonetheless), so the probability of a 50-year old man dying before 60 was, at 2005 mortality rates, 6%. The corresponding probability for UK women was (based on a rate of 384 per 100,000) 4%. Half a century earlier the probabilities were, respectively, 13% and 7%. Mortality rates for the first year of life were not age-standardised because this age band is extremely narrow.
The mortality rates were then smoothed before being plotted. The smoothed rate for a particular year is a weighted average of the rate in that year (weight = 3), the preceding year (weight = 2), and the year before that (weight = 1). The smoothed rate for a particular year was not calculated if any of these three components was missing. (This is why, for example, graphs start plotting at 1952 if the first available data were for 1950.)
Questions and answers (FAQ)
Q: How were the graphs made?
A: The graphs were produced by Gary Whitlock using a computer programme he wrote in VB.Net. Jill Boreham made many practical suggestions relating to the methods of analysis, and Richard Peto provided the core idea of focussing on mortality rates that are age- and sex-specific.
'The effects of real enthusiasm and real determination are incalculable. In the realm of the just possible they are sometimes decisive.'
—Michael Frayn, Copenhagen (1998)
Q: How was the website made?
A: Gary Whitlock designed, compiled and maintains the website. Jill Boreham made numerous useful suggestions about content and formatting, and Ben Cairns came up with the idea for a 'Jump' button on the Random graph page.
Q: Why show mortality trends just for particular ages?
A: Mortality trends that are not for particular ages generally conceal important differences between trends at different ages.
Q: Why show mortality trends for these particular ages?
A: The age groups correspond reasonably to what may be considered the main phases of life, and each group tends to have its own, distinctive, mortality pattern. For example, the most common causes of death in 'middle age' (on this website taken to mean the age range 35-69 years) remain largely the same throughout middle age, but are quite different from those in early adulthood (15-34 years). On the Choose a graph and Random graph pages, however, no information is given for deaths after age 79 years because information about cause of death becomes less reliable at advanced ages.
'Questions remain—in what sense is anything separable? What is it that is separable?—but it is the job of first philosophy to answer them.'
—Aristotle, Physics (about 330 BC) [transl. Robin Waterfield, 1996]
Q: Why not give mortality trends for males and females combined?
A: As with age, mortality trends often differ so much between males and females that merging these distinct groups conceals more than it reveals.
Q: Why do the sidebars compare rates for 1955, 1975 and 2000?
A: The choice is entirely arbitrary.
Q: Why show full sets of graphs for just 56 causes of death?
A: The main sets of graphs have been restricted to causes of death that are (or were) at least moderately common, and for which time-series data generally extend back several decades. The usual constraining factor is how mortality data were coded and aggregated in the ICD-7, -8 or -9 eras.
'Changing knowledge and subsequent change in nomenclature lead to irreconcilable discontinuities in the quantification of
mortality from various diseases over an extended period of time.'
—PD Sorlie and EB Gold, American Journal of Public Health (1987)
Q: Why show full sets of graphs for just 40 of the world's approximately 200 countries?
A: These 40 countries and territories have provided WHO with mortality data that can be adapted to standard ICD and WHO formats, are of at least moderately high quality (see article by Mathers et al. in the Bulletin of the World Health Organization, 2005; 83: 171-7), and extend back several decades. In the absence of any of these criteria, the main type of graph on this website would frequently be uninformative or misleading. As of 2012, few (if any) other countries met all three of these criteria.
'There is no national science, just as there is no national multiplication table; what is national is no longer science.'
—Anton Chekhov, Notebooks 1894-1902
Q: Why do the main graphs not allow comparisons of two or more countries at the same time?
A: Having this degree of flexibility, while at the same time ensuring high quality control for every potential graph, was—with the available resources—technically infeasible. Some inter-country comparisons are, however, given on the Special graph page.
Q: Why do graphed lines start in the early 1950s for some countries but not for others?
A: The mortality data shared by national authorities with the World Health Organization begin in various years. (Poland's data start in 1959, but the data for 1959-65 were considered too unreliable to be graphed here.)
Q: How can the sidebar report that there were no deaths from a particular cause in a particular year (eg, 2010), yet give a rate per 100,000 that was not 0?
A: The reported number of deaths is for the specified year only (say, 2010), whereas the rate is a weighted average across that (2010) and the preceding two (2009 and 2008) years. So, if there were deaths in one or both of the earlier years, the average rate would not be 0.
Q: Some sidebars say 'percent of all male deaths' or 'percent of all female deaths'. What is meant by this?
A: The percentage of all deaths (ie, at any age) for the particular sex in that year.
Q: Why were the mortality rates for Singapore calculated using population data from WHO instead of UNDP?
A: The population and mortality data from WHO both exclude Singapore's large number of temporary migrant workers, whereas the population data from UNDP include this group.
Q: How does the Random option work?
A:
It randomly selects a graph from among the thousands of different graphs that can be called up
on the Choose a graph page. However, it does not select graphs for categories of residual or ill-defined causes
(eg, 'other vascular diseases', 'other respiratory diseases', 'ill-defined cause'), or graphs with especially few deaths in the particular age group.
Q: Why do quotes sometimes appear in the left sidebar?
A:
These occasional 'treats' (Easter eggs) are brief pieces of text that might be considered apt to the disease, age group or country in question.
Quotes posted in memory of particular individuals appear every time that the relevant combination of factors is selected;
other quotes appear only once every few such times, on a random basis.
Contact
Enquiries and suggestions can be emailed to: info@mortality-trends.org
Useful links
@mortrends: the Twitter account for Mortality Trends
World Health Organization (WHO): a major source of data for Mortality Trends
United Nations Population Division: a major source of data for Mortality Trends
Human Mortality Database: an additional source of data for Mortality Trends
Clinical Trial Service Unit (CTSU): a medical research unit at Oxford University
Deaths from Smoking: the toll of tobacco deaths in different countries
National Obesity Observatory for England: useful information on obesity
Understanding Uncertainty: making sense of chance, risk and probability
Gapminder: animated graphs making a wide range of international comparisons
Paul McGale's astronomy images: a repository of interesting night-sky pictures
Astronomy Picture of the Day: a new astronomy image is posted each day
'The heaventree of stars hung with humid nightblue fruit.'—James Joyce, Ulysses (1922)