How common are premature obituaries

Premature mortality and years of life lost in Baden-Württemberg

Heart attacks and breast cancer cost most years of life

Ulrike Winkelmann

Premature mortality affects men more often than women. The main reason for this are gender-specific differences in lifestyle. Of the ten causes of death that cost the highest number of years of life lost in the population of Baden-Württemberg as a result of death under the age of 70, the majority are largely influenced by behavior-related risk factors such as smoking, consumption of alcohol or lack of exercise. In addition, fatal injuries caused by suicide are a significant contributor to premature mortality, especially among the country's male population.

Lifestyles that are detrimental to health, deficits in health care and poor environmental and living conditions are common causes of premature death. The occurrence of such deaths accordingly provides indications of the need for action in prevention and health care. In health reporting, mortality well below median life expectancy is observed through two basic indicators:

  • The indicator »premature mortality« records the number of deaths between the ages of 1 and 69 years per 100,000 of the population of the same age.
  • The “Years of Life Lost” indicator weights the number of early deaths with the number of years of life that would have remained up to the age of 70 and also relates this to the population of the same age.1

The indicator »premature mortality« is prominently used in the German sustainability strategy. Here in the subject area of ​​»health and well-being« the goal is defined that the age-standardized2 The number of premature deaths is to fall to 190 for men and 100 for women by 2030 per 100,000 of the population of the same age.3 In Germany, premature mortality in 2017 was age-standardized at 276 deaths for men and 149 deaths for women per 100,000 of the respective age group. With 232 and 128 premature deaths per 100,000, Baden-Württemberg was significantly lower than the national average.

One weakness of the indicator »premature deaths« is that all deaths between 1 and 69 years of age are recorded equally. For example, no difference is made whether the death of a 15-year-old or a 69-year-old is involved. Since this differentiation is desirable from a health policy point of view, the indicator »years of life lost« due to death under the age of 70 is also used. The death of a 15-year-old is recorded here with 55 years of life lost, the death of a 69-year-old correspondingly with one year of life lost.

In the 2017 reporting year, age-standardized using the “old European population”, the male and female population of Baden-Württemberg lost 3,028 and 1,726 years of life per 100,000 men and women in the corresponding age group. In Germany, the values ​​were, as expected, higher at 3,547 and 1,961 years of age per 100,000 men and women in the age group.

Both the values ​​for Germany and the data for Baden-Württemberg show that men are significantly more frequently affected by premature mortality than women.

A newborn boy in Baden-Württemberg today can hope for an average life expectancy of 79.5 years, a newborn girl even for almost 84 years.4 The average life expectancy of the male population is currently around 4.4 years lower than the life expectancy of women. This corresponds to the excess mortality of the male population.

The differences in life expectancy and mortality between men and women can be traced back to a complex interaction of diverse factors. Above all, social, economic and cultural variables play a role, which are reflected in gender-specific behavior and living conditions.5 These include, for example, smoking behavior, alcohol consumption, diets and willingness to take risks, in which men on average show less health-conscious behavior than women. This coincides with the factors that have already been mentioned as the main influencing variables of premature mortality. In this respect, the higher premature mortality among men can be seen as an essential aspect of the lower life expectancy of men.6

Biological constitutional factors also influence the life expectancy of men and women. As Luy showed in the so-called monastery study, however, these should only lead to a 1 to 2 year longer life expectancy for women.7

On average, died per year from 2015 to 20178 around 13,700 men and 7,700 women aged 1 to under 70 years. This corresponds to 26% of all deaths of men and 14% of all deaths of women from Baden-Württemberg. The premature mortality of men was 294 deaths per 100,000 men in the age group and the premature mortality of women was 171 deaths per 100,000 women in the age group.9

The number of years of life lost due to death under the age of 70 averaged around 172,000 and 94,000 years of life in the male and female population of Baden-Württemberg, respectively. In relation to 100,000 in this age group, this corresponds to 3,700 years of age for men and 2,100 for women.

Diagram 1 shows the ten diseases or injuries for men and women that, as causes of death in the Southwest, claimed the highest number of years of life lost on average between 2015 and 2017. They cover a good third (35% men / 37% women) of the total years of life lost due to death under the age of 70.

In the male population, the cause of death "myocardial infarction" (acute myocardial infarction) cost the most life time with around 239 years per 100,000 of the age group. Equally high was the loss of years of life from the cause of death, breast cancer (a malignant neoplasm of the mammary gland), which took the greatest toll on the country's female population.

Lung cancer (malignant growth of the bronchi and lungs) was the second highest killer of life for both men and women across the country. Lung cancer caused 222 years of life lost per 100,000 of the age group in men and 154 per 100,000 of the age group in women.

For all of the premature deaths - statements about individual cases are naturally not part of the statistics - the importance of behavior-related factors can be seen. In addition to genetic or constitutional factors, behavior-related risk factors play a role in most of the causes of death shown in Figure 1:

  • Smoking, the single most significant health risk and leading cause of premature mortality in developed countries, is the single most important risk factor for heart attack, chronic ischemic heart disease and lung cancer. Smoking tobacco is also a risk factor for pancreatic cancer and colon cancer.10
  • The causes of death listed in Figure 1, »mental and behavioral disorders due to alcohol (F10) and alcoholic liver disease (K70)«, are 100% caused by alcohol. In addition, excessive alcohol consumption increases the risk of liver cirrhosis, colon and breast cancer.11
  • Excessive obesity and the wrong diet, especially fatty ones, are the main risk factors for the cardiovascular diseases listed here, but they also influence the risk of pancreatic cancer and colon cancer.12
  • Sedentary lifestyle significantly increases the risk of developing breast cancer and is a predisposing factor for cardiovascular disease and colon cancer.13

The causes of death shown with the highest number of years of life lost in the male population (Figure 1) also include three types of injuries: asphyxiation, traumatic brain injury (intracranial injury to the brain) and unspecified multiple injury. These injuries can be the result of various external causes. In the case of suffocation, 90% of the years of life lost were due to the external cause "suicide". More than 80% of the years of life lost due to the cause of death due to traumatic brain injury were due to accidents.

In the case of multiple injuries, almost two thirds of the years lost were due to accidents and one third to suicides.

As already mentioned, women die far less often than men from external causes. Accordingly, among the ten causes of death with the highest number of years of life lost in the female population of Baden-Württemberg, only the type of injury "suffocation" is found. 88% of this was due to suicides.

The full scope of premature mortality from external causes is revealed when it is considered by cause group regardless of the type of injury caused. In the annual mean 2015 to 2017, 22% of the years of life lost in the male population and 12% of the years of life lost in the female population were due to external causes.

This corresponded to 810 years of life lost per 100,000 of the age group for men and 241 years of life lost per 100,000 of the age group for women.

Almost half of the years of life lost due to external causes were accounted for by suicide in both men and women (Figure 2). In the male population, this corresponded to a loss of around 355 years of life per 100,000 of the age group. This means that the loss of life due to suicide was even higher than that due to a heart attack. In the female population, suicides caused a loss of 116 years of life per 100,000 of the age group. This was only slightly less than the number of years of life lost to lung cancer.

From a statistical point of view, the number of years of life lost due to a certain cause of death is determined firstly by the number of deaths under the age of 70 and secondly by the mean age at which these deaths occur (Figure 3). There are differences between the causes of death here. The lowest mean age at death was found in the deaths from external causes listed in Figure 1. It was in both the male and female populations under 50 years of age, i.e. each death accounted for an average of 20 years of life lost. In the case of cardiovascular diseases, the mean age at death is around 60 years, which means that an average of 10 years of life was lost for each death.

In the 20 years of the study period, the premature mortality of the Baden-Württemberg population fell significantly. For the male population in the country, the decline in age-standardized fell14 premature mortality and the years of life lost as a result, at 35% and 37% respectively, are more pronounced than for the female population. The premature mortality of women fell by only 25%, the number of years of life lost by 28%.

As a result, the difference between premature mortality and the years of life lost in the male and female population in Baden-Württemberg decreased. Using the example of premature mortality: In 1998, the age-standardized premature mortality of men with 355 deaths per 100,000 of the age group was more than twice as high as that of women with 170 deaths per 100,000 of the age group. In 2017, this difference had narrowed 1.8 times: the premature mortality rate for men was 232 deaths per 100,000 in the age group compared with 128 deaths per 100,000 in the female population.

This is plausible insofar as the life expectancy of men has risen faster than the life expectancy of women during this period. Accordingly, the life expectancy of women at birth according to the 1999/2001 life table was 5.6 years higher than the life expectancy of the newly born boys, and only 4.4 years according to the 2015/17 life table. It can be assumed that this reduction is due to an approximation of lifestyles. The participation of women in the labor force has risen sharply in recent years, and their tobacco and alcohol consumption has increased, at least temporarily.15

Declines in mortality were observed for both sexes in all age groups during the study period (Figure 4). However, the relative decreases in mortality in the male population were greater than in the female population in all age groups. The differences between the sexes in the age groups 55 and over are particularly striking. Here, the mortality rate for men fell by 26% to 30%, for women only by 15% to 16%.

Deaths from (malignant) neoplasms were characteristic of the different development in the age groups 55 and over. In the group of 55 to under 70-year-old men, the mortality rate from malignant neoplasms fell between 1998/2000 and 2015/17, depending on the age group, from 26% to 34%. In women of the same age, mortality from cancer as a cause of death only decreased by 5% to 19%.

The development of premature mortality from cardiovascular diseases, including myocardial infarction and chronic ischemic heart disease, did not show any gender-specific differences. Here the mortality declines in both 55 and under 70-year-old men and women ranged from 40% to 50%.

In Baden-Württemberg, premature mortality and the number of years of life lost were relatively low in the period 2015/17. The men who died prematurely reached an average age of 57.4 years. The women who died prematurely had an average age of 57.8 years. This means that each death accounted for an average of 12.6 and 12.2 years of life lost.16 For those affected, premature mortality is associated with a considerable loss of (joint) lifetime. Depending on the cause of death (e.g. suicide, traffic accident), premature deaths can also be associated with great burdens for the bereaved. The health policy goal of further reducing premature mortality is all the more justified because many of the diseases that cause the greatest number of years of death as causes of death are influenced by behavioral risk factors.

1 The definition of deaths between the ages of 1 and 69 is based on a convention (see Health in Germany, 2006, Section 1.3.5). There are also other age limits, for example up to the age of 65.

2 In age standardization, the age-specific mortality rates are related to a hypothetical standard population. Here the so-called »old European population« was used as the standard population. Age standardization allows premature mortality to be compared unaffected by differences in age structure, for example between regions or over time.

3 Federal Statistical Office (2018) (Ed.): Sustainable Development in Germany, Indicator Report, Indicator 3.1.

4 According to 2015/17 mortality table.

5 Robert Koch Institute (2011) (Ed.): Mortality, causes of death and regional differences. Federal health reporting. Issue 52. RKI, Berlin, p. 15.

6 The mortality of men is also higher than the mortality of women in the age groups 70 and over. However, the differences become smaller with increasing age.

7 Luy, Marc (2002): Why women live longer: Findings from a comparison of the monastery population and the general population, in: Materials for Population Science, 106. Wiesbaden: Federal Institute for Population Research (BIB) p. 111 ff.

8 The average of the most recent 3 reporting years 2015 to 2017 is considered in order to keep the effects of random fluctuations as small as possible.

9 The age-standardized values ​​of premature mortality and the years of life lost allow a correct interregional and intertemporal comparison, but are less clear for describing the current situation in Baden-Württemberg. Therefore, non-standardized values ​​are used in the following sections.

10 Mons, Ute (2011): Mortality attributable to tobacco in Germany and in the German federal states - calculations with data from the microcensus and the cause of death statistics, health care; 73, pp. 238–246 as well as KORA heart attack register https://www.helmholtz-muenchen.de/herzschlag-info/risikofaktoren/uebersicht/index.html (accessed: July 16, 2019).

11 Source: Robert Koch Institute (2015) (Ed.): Health in Germany. Federal health reporting. Jointly supported by RKI and Destatis. RKI, Berlin, p. 223.

12 Health in Germany 2015 loc. Cit., P. 202.

13 German Cancer Research Center (DKFZ) 2011: Identified avoidable risk factors for breast cancer. Press release No. 4 from January 18, 2011 and Gesundheit in Deutschland 2015 loc. Cit., P. 190.

14 In this section, age-standardized values ​​are required in order to eliminate possible age structure effects of demographic change.

15 Brachat-Schwarz, Werner: "Why do women live the longest in the Breisgau-Hochschwarzwald district?", In: "Statistical monthly magazine Baden-Württemberg 8/2016", p. 16.

16 Before the age of 70.