Paper detail

Age-aggregation bias in mortality trends

In a recent article in PNAS, Case and Deaton show a figure illustrating "a marked increase in the all-cause mortality of middle-aged white non-Hispanic men and women in the United States between 1999 and 2013." The authors state that their numbers "are not age-adjusted within the 10-y 45-54 age group." They calculated the mortality rate each year by dividing the total number of deaths for the age group by the population of the age group. We suspected an aggregation bias. After adjusting for changes in age composition, we find there is no longer a steady increase in mortality rates for this age group. Instead there is an increasing trend from 1999-2005 and a constant trend thereafter. Moreover, stratifying age-adjusted mortality rates by sex shows a marked increase only for women and not men, contrary to the article's headline. We stress that this does not change a key finding of the Case and Deaton paper: the comparison of non-Hispanic U.S. middle-aged whites to other countries and other ethnic groups. These comparisons hold up after our age adjustment. While we do not believe that age-adjustment invalidates comparisons between countries, it does affect claims concerning the absolute increase in mortality among U.S. middle-aged white non-Hispanics. Breaking down the trends in this group by region of the country shows other interesting patterns: since 1999 there has been an increase in death rates among women in the south. In contrast, death rates for both sexes have been declining in the northeast, the region where mortality rates were lowest to begin with. These graphs demonstrate the value of this sort of data exploration, and we are grateful to Case and Deaton for focusing attention on these mortality trends.