The Impact of the 2009/2010 European Debt Crisis on Mortality Trends

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1 The Impact of the 2009/2010 European Debt Crisis on Mortality Trends Mary Hall University College Dublin Shane Prendergast Irish Life Colin Murphy - Deloitte 05 November 2015 Mortality Trends Working Party John Flanagan Mary Hall Aine Houlihan Colin Murphy Shane Prendergast 05 November

2 Agenda Overview of European Economic Crisis Mary Hall Trends by All Causes of Death Shane Prendergast Trends by Cause of Death Colin Murphy Conclusion Colin Murphy 05 November Research Review Extensive but conflicting research on impact of economy on mortality Theory: Economic Boom: increase in certain causes of death mainly heart disease and accidents Recession: increase in suicides Support Theory: Valkonen et al.(2000), Rhum (2003 and 2007), Gerdthan et al.(2006) Granados(2008), Miller et al. (2009) Do Not Support Theory: Khang et al. (2005), Murphy et al. (2006). Gordon et al. (2015). 05 November

3 European Financial Crisis : Global Financial Crisis 2008: Lehman brothers collapse 2008: Icelandic banking collapse 2010: Irish Bailout 2011: Portugal Bailout : EU support for Italian and Spanish Economies : Ongoing Greek Debt Crisis 05 November Irish Economic Crisis Mid 1990s 2007: Celtic Tiger 2007: Collapse of housing bubble 2008: Recession : Banking Crisis Sept Banking Guarantee Nov 2010 EU/IMF bailout 2013 Exit EU/IMF bailout programme 2014 Irish GDP growth rate of 4.8% 05 November

4 Grouping of Countries for Analysis A = Euro Countries most affected by crisis: Greece, Ireland, Italy, Portugal, Spain B = Euro Countries less affected for comparison: France, Germany, Netherlands C = Non Euro Countries for comparison: Sweden, United Kingdom 05 November Group A Real GDP Growth Rate Source Eurostat 05 November

5 Group B Real GDP Growth Rate Source Eurostat 05 November Group C Real GDP Growth Rate Source Eurostat 05 November

6 Group A Unemployment Rate Source Eurostat 05 November Group B Unemployment Rate Source Eurostat 05 November

7 Group C Unemployment Rate Source Eurostat 05 November Pic 5 Trends by All Causes of Death 05 November

8 Health Care Spending Heath care spending has been falling in those countries most hit by the economic recession. The largest falls have been in Greece, Ireland, Portugal, Italy & Spain. Source: Health at a Glance Europe 2014 (joint publication of the OECD and the European Commission) Overall Mortality Rates Still Falling Source: Eurostat, combined standard death rates per 1,000 of population ages 0 to November

9 Mortality League Table Lowest combined mortality rates in Spain Lowest male rate in Sweden and female rate in Spain Highest Mortality rates in Germany Highest male rate in Portugal and female rate in the UK Source: Eurostat, average years combined standard death rates per 1,000 of population ages 0 to 84 Largest gender differential in Portugal Mortality League Table Young / Old Differentials Italy has lowest mortality rates for under 65 s, while France has the highest mortality rates for under 65 s Spain has lowest mortality rates for over 65 s, while Germany has the highest mortality rates for over 65 s Source: Eurostat, average years combined standard death rates per 1,000 of population Largest differential between young and old in France 9

10 Mortality Differentials - Gender Gap In general the mortality gap between males and females is closing in most countries The exceptions are Portugal & Greece where gender gap has widened over the analysis period Progression female age standardised mortality rate divided by male age standardised mortality rate between ages 0 84 along with % change over the entire period The largest differentials are in France and Portugal while the smallest differentials are in the UK Netherlands & Sweden Group A 2 Year Mortality Improvement Rates 6.0% 4.0% Improvement Rates Combined All Ages Combined mortality improvement rates have slowed by roughly 1% in Ireland, Italy & Greece 2.0% 0.0% Ireland Greece Italy Portugal Spain Improvement rates have remained steady in Portugal & Spain throughout the analysis period The lowest rates are in Greece with the more recent improvements being below 1% Source: Eurostat ages 0 to 84 10

11 Group A Change in 2 Year Mortality Improvement Rates By Age Band & Gender Source: Eurostat change in annual mortality improvement from average to average Group B 2 Year Mortality Improvement Rates Improvement Rates Combined All Ages 5.0% 4.0% 3.0% 2.0% 1.0% 0.0% Germany France Netherlands The slowdown in improvement rates in the core Eurozone countries has been less significant Mortality improvement rates have decreased by 0.4% pa in both Netherlands & France Source: Eurostat ages 0 to 84 German rates have fallen by roughly 1% which is more akin to the Group A countries 11

12 Group B Change in 2 Year Mortality Improvement Rates By Age Band & Gender Source: Eurostat change in annual mortality improvement from average to average Group C 2 Year Mortality Improvement Rates 4.0% 3.0% 2.0% 1.0% Improvement Rates Combined All Ages 0.0% UK Sweden Mortality improvement rates have picked up slightly in the UK & Sweden over the analysis period Much less volatility in improvement rates for group C countries compared to the other groups Very consistent movement in rates across genders Source: Eurostat ages 0 to 84 12

13 Group C Change in 2 Year Mortality Improvement Rates By Age Band & Gender Source: Eurostat change in annual mortality improvement from average to average Case Study Ireland Change in 2 Year Mortality Improvement Rates Males Slowdown in improvement rates occurring across all age bands and gender splits Females Males ages showing the biggest slowdown in improvement rates For females the biggest slowdown occurring between ages Fall in improvement rates lowest in the age band for males and for females Source: Eurostat change in annual mortality improvement from average to average 13

14 Trends by Cause of Death 05 November 2015 International Classification of Disease 10 th Revision ICD-10 is a medical classification list by the World Health Organisation (WHO), containing codes for differing types of death including suicide, cancer, external causes, etc. Causes of deaths analysed Cancer: C00 C99 Suicide: X60 X84 Circulatory Diseases: I00 I99 External Causes: V01 X59, X85 Y99 Other: All other ICD codes 05 November

15 Irish male average improvement rate by cause of death 6.0% 4.0% 2.0% 0.0% -2.0% -4.0% -6.0% Cancer Suicide Circulatory Disease External Causes Other Average Improvement = SQUARE ROOT ( Average (Crude Rate Year X + Crude Rate Year X-1 ) / Average (Crude Rate Year X-2 + Crude Rate Year X-3 )) 05 November Irish female average improvement rate by cause of death 12.0% 10.0% 8.0% 6.0% 4.0% 2.0% 0.0% -2.0% -4.0% -6.0% Cancer Suicide Circulatory Disease External Causes Other Average Improvement = SQUARE ROOT ( Average (Crude Rate Year X + Crude Rate Year X-1 ) / Average (Crude Rate Year X-2 + Crude Rate Year X-3 )) 05 November

16 Irish male suicide death rate per thousand by age band Linear (25-44) Linear (45-64) Average suicide rate for 25 to 64 years olds is deaths per thousand. Peak Death rates in 2011 for year olds and 2012 for November Male suicide death rate per thousand England & Wales Northern Ireland Scotland Linear (Northern Ireland) 05 November

17 Male suicide death rate per thousand England & Wales Northern Ireland Scotland Linear (England & Wales) Linear (Northern Ireland) Linear (Scotland) 05 November Average female suicide improvement rates 15.0% 10.0% 5.0% 0.0% -5.0% -10.0% -15.0% -20.0% -25.0% England & Wales Northern Ireland Scotland Ireland 05 November

18 What are male suicide rates across Europe? Average < Average < November Irish female cancer death rate per thousand by age band Increase in cancer death rate at age 75+. Decrease in cancer death rates at ages 45 to Linear (45-64) Linear (65-74) Linear (75+) 05 November

19 How are people dying? 05 November An Irish Perspective Proportionate Male deaths by age band % 90% 18% 19% 22% 80% 45% 8% 2% 34% 70% 60% 32% 30% 33% 2% 50% 40% 28% 14% 5% 1% 38% 30% 20% 10% 0% 3% 21% 0% 39% 42% 18% 26% 15% 7% Male <25 Male Male Male Male 75+ Cancer Suicide Circulatory Disease External Causes Other 05 November

20 Average Male proportionate deaths by age band Ages Ages Ages Ages % 90% 18% 19% 26% 25% 33% 29% 25% 22% 24% 26% 24% 37% 34% 36% 34% 80% 36% 8% 2% 1% 4% 6% 2% 2% 70% 5% 32% 23% 2% 2% 2% 2% 60% 30% 33% 24% 34% 31% 29% 34% 33% 50% 23% 30% 14% 14% 38% 5% 1% 37% 38% 37% 40% 2% 0% 4% 0% 1% 17% 15% 3% 30% 21% 24% 0% 0% 0% 0% 20% 12% 39% 42% 15% 37% 34% 36% 40% 39% 40% 10% 15% 15% 10% 13% 26% 25% 26% 25% 0% Cancer Suicide Circulatory Disease External Causes Other 05 November An Irish Perspective Proportionate Female deaths by age band % 90% 80% 70% 60% 50% 40% 67% 24% 20% 5% 16% 16% 11% 2% 10% 26% 2% 24% 0% 38% 2% 41% 30% 20% 10% 0% 14% 56% 48% 3% 40% 0% 7% 19% 9% Female <25 Female Female Female Female 75+ Cancer Suicide Circulatory Disease External Causes Other 05 November

21 Average Female proportionate deaths by age band 100% Ages Ages Ages Ages % 80% 70% 60% 50% 40% 30% 24% 30% 35% 38% 16% 11% 11% 11% 12% 13% 13% 10% 12% 5% 13% 9% 24% 26% 30% 27% 26% 28% 29% 29% 38% 43% 40% 42% 16% 3% 3% 3% 2% 1% 1% 2% 18% 11% 19% 18% 24% 2% 27% 28% 27% 2% 2% 2% 1% 1% 2% 0% 10% 0% 0% 0% 41% 38% 39% 38% 20% 40% 36% 29% 34% 52% 47% 50% 48% 40% 43% 41% 42% 0% 0% 0% 0% 10% 19% 18% 19% 17% 0% Cancer Suicide Circulatory Disease External Causes Other 05 November Male over 65 cancer rates across Europe Average Average November

22 Female over 65 cancer rates across Europe Average Average November Conclusion 05 November

23 There is a link between economic fluctuations and mortality Mortality improvement rates have slowed down most significantly in group A countries Slow down most significant for ages Less significant at ages 75+ Male suicide rates have increased post the financial crises in Ireland and the UK particularly at ages November References 05 November

24 References Gerdtham et al. (2006) Deaths rise in good economic times: Evidence from the OECD. NBER Working Paper No National Bureau of Economic Research, Cambridge, MA. Gordon et al. (2015). Recession, Poverty and Health, Economic Determinants of Mortality in the US. https://cdn1.sph.harvard.edu/wpcontent/uploads/sites/203/2015/03/recessions-and-mortality pdf Granados. (2008). Macroeconomic fluctuations and mortality in postwar Japan. Demography Miller et al. (2009). Why are recessions good for your health. American Economic Review. 99(2): Murphy et al. (2006). The widening gap in mortality by educational level in the Russain Federation American Journal of Public Health. 96: November References (Cont.) Khang et at. (2005). Impact of economic crisis on cause-specific mortality in South Korea. International Journal of Epidemiology. 34: Rhum (2003). Good times make you sick. Journal of Health Economics, 22(4) Rhum (2007). A healthy economy can break your heart. Demography. 44: Valkonen et al.(2000). Changes in socio-economic inequalities in mortality during an economic boom and recession among middle-aged men and women in Finland. European Journal of Public Health, 10, November

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