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Neste artigo, são estimados os diferenciais educacionais de mortalidade de adultos residentes em São Paulo. É realizada uma análise comparativa de estimativas a partir de dados do Censo 2010 e do Sistema de Informação de Mortalidade (SIM) – Datasus e de três formas distintas de mensuração da escolaridade: registrada no SIM; declarada no Censo para o responsável pelo domicílio; e imputada estatisticamente no Censo para indivíduos que morreram. Para as imputações da escolaridade, utilizou-se o método de Dempester (1977), que propõe o uso do algoritmo esperança-maximização (algoritmo E-M) para lidar com dados faltantes. Foram considerados três níveis de escolaridade (baixo, médio e alto) e estimadas as taxas de mortalidade com base em modelos Poisson. Os resultados indicam que a obtenção de escolaridade pode reduzir em até 77% as taxas de mortalidade entre 25 e 59 anos de idade. Além disso, em um país em que a população tem baixa escolaridade, obter ensino médio representa um ganho significativo do ponto de vista da sobrevivência adulta (cerca de 50%). Encontraram-se padrões de mortalidade por escolaridade semelhantes para as estimativas obtidas com dados registrados no SIM e aqueles imputados no Censo 2010. Além disso, a análise sugere que estimativas assumindo a escolaridade do responsável pelo domicílio resultam em diferenciais de mortalidade atípicos, provavelmente distorcidos pela transição de educação no Brasil. Espera-se que o modelo de imputação proposto aqui possa ser utilizado em futuras análises dos dados de mortalidade a partir do Censo 2010.

EnglishAbstract The paper examines the implications of Covid-19 pandemic for the city of Belo Horizonte (BH), during the first 80 days of the disease. We use a descriptive-analytical approach to estimate the growth of Covid-19 cases over time, the excess of deaths, the virus’ rate of transmissibility, and the consequent burden on the municipal the health system, measured by the rate of occupancy of public hospital beds. Also, we identify the main containment policies adopted by local authorities, and the implications of reopening measures and the following reduction of social distancing. Our findings reveal that a well-managed Unified Health System (SUS) is paramount to effectively tackle the pandemic and its consequences for the population. The reopening process has imposed new challenges that will require close monitoring by the authorities and by the society. portuguesResumo Este artigo examina o contexto e as implicacoes da pandemia por Covid-19 na cidade de Belo Horizonte (BH) nos primeiros 80 dias da doenca. Utilizamos um recorte analitico descritivo para mensurar a evolucao dos casos, o excesso de obitos, a taxa de transmissibilidade do virus e a pressao da doenca sobre o sistema de saude de BH e regiao, atraves da taxa de ocupacao hospitalar nos leitos publicos. Alem disso, identificamos as principais politicas de contencao adotadas pelas autoridades locais, bem como as implicacoes da reducao do distanciamento social. Nossos resultados demonstram que o Sistema Unico de Saude (SUS), bem gerido, e fundamental para o enfrentamento da pandemia e a mitigacao de suas consequencias para a populacao. O processo de flexibilizacao que se inicia tem imposto novos desafios que requererao monitoramento atento das autoridades e da sociedade.

Age is a key variable for sciences and public planning. The demographic consequences of not measuring age correctly are manifold, including errors in mortality rates and population estimates, particularly at older ages. It also affects public programs because target populations depend on reliable population age distributions. In Brazil, the start of the vaccination campaign against COVID-19 marked the collection of new administrative data. Every citizen must be registered and need to show an identity document to get vaccinated. The requirement of proof-of-age documentation provides a unique opportunity for measuring the elderly population using a different database. This article examines the reliability of age distributions of men and women 80 years and older. We calculate various demographic indicators using data from the vaccination registration system and compare them to those from the target population estimates of the National Vaccination Plan, censuses, and population projections for Brazil and countries with high-quality population data. We show that requiring proof-of-age, such as in the vaccination records, increases data quality, mainly through the reduction of age heaping and age exaggeration. However, I.D. cards cannot fully solve wrong birth dates that result from weak historical registration systems. Thus, one should be careful when using estimates of the old age population living in some of the Brazilian regions, particularly the North, Northeast, and Center-West. Also, our analysis reveals a mismatch between the projected population by age, sex, and region, which guided the vaccination plan, and the number of vaccinated at ages 80 and older. The methodology developed to adjust the mortality rates used in the demographic projections is probably the main factor behind the disparities found.

Brazil has been heavily affected by coronavirus disease 2019 (COVID-19). In this study, we used data on reported total deaths in 2020 and in January–April 2021 to measure and compare the death toll across states. We estimate a decline in 2020 life expectancy at birth (e0) of 1.3 years, a mortality level not seen since 2014. The reduction in life expectancy at age 65 (e65) in 2020 was 0.9 years, setting Brazil back to 2012 levels. The decline was larger for males, widening by 9.1% the female–male gap in e0. Among states, Amazonas lost 60.4% of the improvements in e0 since 2000. In the first 4 months of 2021, COVID-19 deaths represented 107% of the total 2020 figures. Assuming that death rates would have been equal to 2019 all-cause rates in the absence of COVID-19, COVID-19 deaths in 2021 have already reduced e0 in 2021 by 1.8 years, which is slightly larger than the reduction estimated for 2020 under similar assumptions. New estimates of life expectancy at birth and at age 65 years in Brazil reveal substantial declines as a result of COVID-19, bringing mortality back to levels observed 20 or more years ago.

Objectives To examine the association between education and mortality by age and gender in Chile. Methods We drew data from 10,147 adults aged 40 years and over from the Chilean Social Protection Survey linked to the national death records. We specify five Cox regression models to estimate the main and interaction effects for education levels, age, sex, and mortality. Results The hazard ratios reduce with increasing education. Secondary and tertiary education levels are associated, respectively, with 34% and 41% lower hazard rates than 0–4 years of schooling. Also, the educational gradient in mortality is significantly weaker at older ages, and it does not differ by gender. Discussion Our findings endorse the negative association of formal education with adult mortality, uncovering Chile’s structural problems despite the economic improvements underway. It also corroborates the importance of novel longitudinal data for mortality analyses in Latin America.

Women live longer but can expect to spend more years in poorer health compared to men. In the context of population aging and declining gender ratios at older ages, there are increasing concerns about how this disadvantage in female health will affect well-being and sustainability, particularly in developing regions that are rapidly aging. Our study compares differences in health expectancies at older ages for men and women in order to assess gender disparities in health.We use data from the Survey on Health, Well-Being, and Aging in Latin America and the Caribbean to decompose the gender gap into total and age-specific mortality and disability effects in seven cities in the region. Our results show that at older ages, higher disability rates among women reduced the gender gap in healthy life expectancy by offsetting women’s mortality advantage. In addition, we find that women’s mortality advantage decreased almost systematically with age, which reduced the contribution of the mortality effect to the gender gap at older ages. Although the gender gap in health followed a similar pattern across the region, its decomposition into mortality and disability effects reveals that there was substantial variation among cities. Thus, across the region, the implications of the gender gap in health for well-being vary, and the policies aimed at reducing this gap should also differ.

Brazil has the second-largest number of COVID-19 deaths worldwide. We use data on reported deaths to measure and compare the death toll across states from a demographic perspective. We estimate a decline in 2020 life expectancy at birth of 1.94 years, resulting in a mortality level not seen since 2013. The reduction in life expectancy at age 65 was 1.58 years, setting Brazil back to 2009 levels. The decline was larger for males, widening by 2.3% and 5.4% the female-male gap in life expectancy at birth and at age 65, respectively. Among states, Amazonas lost 59.6% of the improvements in life expectancy at birth since 2000. With 2021 COVID-19 deaths at about 43% of the total 2020 figures (as of mid-March) the demographic effect is likely to be even higher this year.

An insightful paper by Dowd et al. (1) highlights the importance of demography for analyzing coronavirus disease 2019 (COVID-19)–related mortality. The authors underscore the role of population age structure and intergenerational contacts for understanding differences in cross-country fatality and estimate the potential impact of the pandemic on different populations, acknowledging the need for additional information on the prevalence of comorbidities. We aim to interpret the proposed scenarios considering the widely different prevalence of chronic conditions by age in three of the countries discussed in the original paper. We argue that the burden of chronic diseases has the potential to offset the possible benefits of younger populations with different epidemiological characteristics. Age is fundamental to understanding differences in mortality risks. Indeed, age is a marker of the … [↵][1]1To whom correspondence may be addressed. Email: nepomuceno{at}demogr.mpg.de or acosta{at}demogr.mpg.de. [1]: #xref-corresp-1-1

La composicion de los hogares en el Brasil ha experimentado cambios profundos en el ultimo medio siglo, lo que ha repercutido en las formas de corresidencia de las personas. Sin embargo, existen pocos estudios sobre los cambios que se producen en los patrones de corresidencia a lo largo de la vida, y todavia menos trabajos en los que se analizan los factores demograficos asociados a dichos cambios. En el presente trabajo se utilizan datos censales para estimar y comparar los patrones de corresidencia con diferentes tipos de familiares en funcion de la edad en el Brasil, en 1960 y 2010. A continuacion, se cuantifica la fraccion de esperanza de vida total y el tiempo medio en anos que se vive en corresidencia con cada tipo de familiar. Por otra parte, mediante un procedimiento de estandarizacion, se aislan los efectos de las mejoras de supervivencia de la persona de referencia sobre la duracion de la corresidencia. De los resultados se desprende que el numero de anos vividos en corresidencia con todos los tipos de familiares aumento entre 1960 y 2010. Sin embargo, excepto en el caso de la corresidencia con madres y abuelas, los cambios en la proporcion de personas en corresidencia segun la edad contribuyeron a reducir la duracion de la corresidencia. Este aumento de la duracion de la corresidencia no habria ocurrido si no fuera por las mejoras en la supervivencia, gracias a las cuales las personas de referencia pudieron disfrutar de mas anos para vivir en corresidencia.

Resumo Quando a fecundidade declina, não é somente o número de filhos que se torna menor, mas também o número de irmãos. Para determinar as mudanças ocorridas sobre a disponibilidade de irmãos no Brasil, o presente estudo emprega um método que se destina a estimar o número esperado de irmãos nascidos vivos e sobreviventes, por meio de modelos matemáticos que utilizam apenas taxas de fecundidade e de mortalidade. Os resultados indicam que, no início da transição demográfica brasileira, a média de irmãos nascidos vivos se estabelece em patamares elevados e sofre um forte declínio durante o processo, motivado principalmente pela queda da fecundidade. Observa-se, ainda, que a média de irmãos sobreviventes nas idades mais avançadas tende a ser muito semelhante para coortes mais velhas e mais novas, mas o número de irmãos sobreviventes durante a infância dessas coortes tende a diferenciar-se fortemente. Isso ocorre porque, por um lado, o efeito da elevada mortalidade, principalmente a infantil, reduz a média de irmãos gerados pela alta fecundidade para as coortes mais velhas e, por outro, a queda da fecundidade diminui o número de irmãos nascidos vivos das coortes mais novas, ao mesmo tempo que a redução da mortalidade garante sua quase constância no ciclo de vida. Como conclusão, indica-se que: o número médio de irmãos nascidos vivos tende a se estabelecer em baixos níveis nos próximos anos; o número médio de irmãos sobreviventes tende a ser cada vez mais próximo da média do número de irmãos nascidos vivos; e, apesar dos baixos níveis de fecundidade corrente, não se pode falar em uma tendência de extinção dos irmãos e, por consequência, primos, tios, etc. Abstract When fertility declines, it is not only the number of children that becomes smaller, but the number of siblings as well. To determine changes in the number of siblings over time in Brazil, this study uses a method that is designed to estimate, through mathematical models which use only fertility and mortality rates, the availability of surviving siblings in different cohorts. The results indicate that, at the beginning of the demographic transition, the mean number of the born alive siblings is established at high levels and suffers a sharp decline during the transition, mainly due to falling fertility. They also show that the mean number of the surviving siblings at older ages tends to be very similar for older and younger cohorts. However, the mean number of surviving siblings during the childhood of these cohorts tends to differ greatly. This is due to high mortality, especially infant mortality, on the one hand and, on the other, from fertility decline which reduces the number of live births in more recent cohorts while the reduction of mortality increases their chances of survival. The study's conclusion points out the following trends: the mean number of surviving siblings will tend to settle at lower levels in coming years and the mean number of surviving siblings tends to be increasingly closer to the mean number born alive. Despite current low levels of fertility, it would be incorrect to speak of the extinction of siblings and, consequently, of cousins, uncles, etc. Resumen La reducción de la fecundidad reduce no sólo solamente el número de niños, pero también el número de hermanos. Para evaluar los cambios en la disponibilidad de hermanos en Brasil, se utilizó un método que estima el número esperado de hermanos nacidos vivos y sobrevivientes por medio de modelos matemáticos que utilizan solamente las tasas de fecundidad y mortalidad. Nuestros resultados indican que, en el comienzo de la transición demográfica, el promedio de hermanos nacidos vivos se establece en niveles altos y sufre una fuerte caída durante la transición, debido principalmente a la caída de la fecundidad. Los resultados muestran que el promedio de hermanos sobrevivientes a edades más avanzadas tiende a ser muy similar para las cohortes de más edad y las más jóvenes. Sin embargo, el número medio de hermanos sobrevivientes durante la infancia de estas cohortes tiende a variar mucho. Esto ocurre por dos razones. Por un lado, la mortalidad elevada, principalmente la infantil, reduce el número medio de hermanos para las cohortes más viejas. Por otro, el descenso de la fecundidad disminuye el número de nascidos vivos en las cohortes más nuevas, mientras la reducción de la mortalidad aumenta sus posibilidades de sobrevivencia. En conclusión, las siguientes tendencias son señaladas: el número promedio de hermanos nacidos vivos tiende a establecerse en niveles bajos en los próximos años, el número medio de hermanos sobrevivientes tiende a ser más cerca de la media de nacidos vivos, y a pesar de la reducción de la fecundidad, no hay evidencia de una posible extinción de los hermanos y, en consecuencia, de primos, tíos, etc.

Although the risk factors of child mortality in Sub-Saharan Africa have received much attention in the literature, detailed spatially varying relationships among these factors have remained unknown. The assumption is that the determinants exact matching influence across space but there are good reasons to doubt the veracity of this claim. This study examines the spatially varying relationships of determinants of child mortality in Nigeria, using data from Demographic and Health Surveys. We control the duration of exposure to the risks of mortality by computing the mortality index of individual women. Based on this, we used geographically weighted regression to map the varying effects of the risk factors. The results show that there are huge variations, across space, in the contributions of all the variables considered. We established that factors that made consistent contributions, albeit at different scales, include women’s education, household headship, wealth index, and toilet facilities. The observed ...

Background: The impact of extreme conditions on survival has been the focus of mortality studies using military data. However, in countries at peace, the military live in favorable conditions, being positively selected with respect to health. In this type of context, military data may help to improve our understanding of mortality differentials, particularly in countries where defective vital systems are still cumbersome for mortality studies. Methods: We estimate death rates for Brazilian Air Force (BAF) officers through Poisson regression models, compute life expectancies, and compare them with those of average Brazilians and people in low-mortality countries. We also examine causes of death and mortality differentials through a competing risks framework and Fine and Gray regression models. Results: BAF life expectancy is higher than that of the average Brazilian and comparable to Sweden, France, and Japan in 2000. Younger pilots have a higher risk of dying on duty when compared with other officers but experience lower mortality rates from other causes at advanced ages. Conclusions: BAF officers are a population subgroup in Brazil with a life expectancy comparable to the one in advanced societies. There is no association between mortality and place of birth, which indicates that different childhood backgrounds did not affect BAF mortality differentials later in life. Contribution: This paper takes a novel approach focusing on a specific subgroup with lower mortality rates than the general population and good-quality longitudinal information available, a rarity in developing countries. We argue that this approach can be an interesting strategy to study mortality differentials in developing countries.

O objetivo deste trabalho é analisar o envelhecimento populacional brasileiro no período de 1950 a 2100. A metodologia consiste na decomposição da variação da idade média populacional em função de três tendências (Preston; Himes; Eggers, 1989): o envelhecimento natural da população; os efeitos rejuvenescedores dos nascimentos; e os dos óbitos. Os dados utilizados, para a análise de 1950 a 2000, provêm das publicações do CELADE (2007a, 2007b) e, de 2000 a 2100, da projeção calculada pelo CEDEPLAR (2008), cenário BR2. Os resultados são consistentes com a literatura anterior, ao apontarem o papel preponderante da queda de fecundidade no processo de envelhecimento populacional, bem como o papel secundário, mas crescente, exercido pela transição de mortalidade sobre a estrutura etária. No início da transição demográfica, em meados do século passado, quando a população brasileira era jovem e quase estável, o grande volume de nascimentos impedia o aumento da idade média da população. Nas décadas seguintes, a contínua queda da natalidade resultou em um avanço gradativo da idade média da população, que deverá passar de 23,41 anos em 1950 para 51,10 anos em 2100. Aos poucos, a estrutura etária tenderá para um novo cenário de quase estabilidade, sem grandes variações na idade média, graças ao efeito dos óbitos, que substituirão, parcialmente, o papel dos nascimentos no passado, pela exclusão de pessoas com idades superiores à idade média na população. A grande mudança populacional brasileira, marcada pela substituição em larga escala de crianças por idosos, que terá ocorrido em um intervalo de apenas um século, deverá dar lugar a uma população envelhecida, com variações na estrutura etária restritas às idades mais elevadas, a depender do futuro da fecundidade e da longevidade. Esse cenário tem fortes implicações para a sociedade brasileira, uma vez que, se conseguirmos adaptar nossos sistemas econômicos e sociais ao novo padrão demográfico, os ajustes poderão ser menores a partir de 2050.

A análise do conjunto de taxas específicas de crescimento por idade de uma população, proposta por Horiuchi e Preston (1988), é uma maneira alternativa de investigar o processo da mudança da estrutura etária de uma população, bem como de examinar possíveis "marcas" deixadas pela história demográfica de cada coorte. O objetivo deste trabalho é aplicar tal metodologia à população brasileira, discutindo grandes mudanças demográficas a partir da função corrente de crescimento populacional do Brasil, observada nos períodos entre 1970 e 1980, 1980 e 1990, 1990 e 2000, 2000 e 2010. A partir dos padrões da função de taxas específicas de crescimento, simulados por Horiuchi e Preston (1988) para descrever a estrutura das taxas específicas de crescimento para cada regime de mudança demográfica, foram avaliadas possíveis marcas da história demográfica presentes nas atuais coortes brasileiras. Os resultados demonstram que as informações contidas nas taxas específicas de crescimento são bastante elucidativas com relação aos efeitos de variações nos regimes demográficos, sendo de grande utilidade em populações cujas taxas vitais não são confiáveis ou estão indisponíveis.

Cuba es un país que, además de presentar niveles de fecundidad inferiores al nivel de reemplazo, ha registrado un significativo saldo migratorio negativo. Se observa también un intenso flujo migratorio interno cuyo patrón es muy diferente entre las provincias. Debido a la magnitud de estos flujos migratorios, la migración se presenta como un componente demográfico importante en la dinámica poblacional cubana. De esta forma, el objetivo de este trabajo es estimar el efecto de la migración interna e internacional sobre el potencial de crecimiento a largo plazo de Cuba y de sus provincias. Para esto, calculamos medidas de reproducción y de crecimiento poblacional a partir de los métodos demográficos convencionales y de la metodología propuesta por Preston y Wang (2007), que se basa en los métodos de variable r. Considerando el patrón demográfico corriente, en la mayoría de los territorios de Cuba se observa una reducción substantiva en la capacidad de reposición de las generaciones y en tamaño futuro de la población cuando se consideran los efectos de la migración. Cuba é um país que, além de apresentar níveis de fecundidade inferiores ao nível de reposição, tem registrado um saldo migratório líquido negativo significativo. Observa-se também um intenso fluxo migratório interno, cujo padrão é bastante diferente nas diversas províncias do país. Devido à magnitude destes fluxos migratórios, a migração apresenta-se como um componente demográfico importante na dinâmica populacional cubana. Assim, o objetivo deste trabalho é estimar o efeito das migrações interna e internacional sobre o potencial de crescimento de longo prazo de Cuba e de suas províncias. Para tanto, foram calculadas medidas de reprodução e de crescimento populacional a partir dos métodos demográficos convencionais e da metodologia proposta por Preston e Wang (2007), que se baseia nos métodos da variável-r. Levando em conta o padrão demográfico atual, observa-se, na maioria dos territórios de Cuba, uma redução substantiva na capacidade de reposição das gerações e no tamanho futuro da população quando se consideram os efeitos da migração. Cuba has shown very low fertility levels, even below replacement level, in addition to significant negative net migration flows. In the country's interior there is intense population mobility, characterized by different migration patterns from one province to another. In this article the effects of both internal and international migration flows on long-term population growth in Cuba and in its provinces are discussed. We estimate reproduction and population growth measures using conventional demographic methods, together with the methodology developed by Preston and Wang (2007), based on variable-r methods. Given current demographic patterns in the majority of Cuban provinces, and when migration effects are accounted for, our analysis shows significant negative consequences for the future maintenance of the Cuban population.

Os cuidados de longa duração (CLD) se referem aos serviços de acompanhamento prestados, durante longo tempo, àqueles idosos que se tornam dependentes, e, portanto, necessitam do auxílio de outra pessoa para a realização de atividades da vida diária. No Brasil, a família desempenha papel fundamental como provedora de cuidados informais aos idosos dependentes. Entretanto, essa rede de apoio aos idosos tem sido enfraquecida pelas mudanças sociais e demográficas, tais como a redução no tamanho das famílias e o aumento da participação da mulher no mercado de trabalho. Esse contexto de redução na oferta de (potenciais) cuidadores informais se alia ao contínuo crescimento do contingente de idosos no país, o que torna fundamental o aprimoramento das condições de acesso a serviços formais de cuidados no Brasil. Neste artigo, os seguros privados de longa duração, nomeados de seguros de dependência, são analisados como instrumento de financiamento para o risco de dependência. O artigo tem como objetivo descrever, com base na experiência internacional, as características dos mercados de seguros privados, assim como detalhar os tipos de coberturas oferecidas nesses mercados.

The last century in Brazil was witness to profound changes. Female life expectancy at birth increased from 34.6 years in 1910 to 77.26 years in 2010. At the same time, the educational composition of the population has changed dramatically. In the 1940s, only 25 percent of the children aged 5 to 14 years old were enrolled in school. Currently, nearly all children attend school. We examine the extent to which changes in the age-specific distribution of education have contributed to the decline in adult mortality among women in Brazil. Our analysis follows other applications in the literature to measure the mortality reduction that would occur if exposure to specific risk factors were changed at the counterfactual level. The effects are not trivial: between 1960 and 2010, about 38 percent of the increase in life expectancy at age 30 can be attributed to changes in the educational composition of women. An additional 22 percent increase is expected until 2040.

artículo (arbitrado)--Universidad de costa Rica, instituto de Investigaciones en Salud. 2011. Este documento es privado debido a limitaciones de derechos de autor. Despite a myriad of studies examining the relationship between socioeconomic status and health outcomes, few have assessed the extent to which biological markers of chronic disease account for social disparities in health. Studies that have examined this issue have generally been based on surveys in wealthy countries that include a small set of clinicalmarkers of cardiovascular disease. The availability of recent data from nationally representative surveys of older adults in Costa Rica and Taiwan that collected a rich set of biomarkers comparable to those in a recent US survey permits us to explore these associations across diverse populations. Similar regression models were estimated on three data setsethe Social Environment and Biomarkers of Aging Study in Taiwan, the Costa Rican Study on Longevity and Healthy Aging, and the Health and Retirement Study in the USA e in order to assess (1) the strength of the associations between educational attainment and a broad range of biomarkers; and (2) the extent to which these biomarkers account for the relationships between education and two measures of health status (self-rated health, functional limitations) in older populations. The estimates suggest non-systematic and weak associations between education and high risk biomarker values in Taiwan and Costa Rica, in contrast to generally negative and significant associations in the US, especially among women. The results also reveal negligible or modest contributions of the biomarkers to educational disparities in the health outcomes. The findings are generally consistent with previous research suggesting stronger associations between socioeconomic status and health in wealthy countries than in middle-income countries and may reflect higher levels of social stratification in the US. With access to an increasing number of longitudinal biosocial surveys, researchers may be better able to distinguish true variations in the relationship between socioeconomic status and health across different settings from methodological differences. Universidad de Costa Rica UCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias de la Salud::Instituto de Investigaciones en Salud (INISA)

A great deal of research has focused on factors that may contribute to the Hispanic mortality paradox in the United States. In this paper, we examine the role of the salmon bias hypothesis—the selective return of less-healthy Hispanics to their country of birth—on mortality at ages 65 and above. These analyses are based on data drawn from the Master Beneficiary Record and NUMIDENT data files of the Social Security Administration. These data provide the first direct evidence regarding the effect of salmon bias on the Hispanic mortality advantage. Although we confirm the existence of salmon bias, it is of too small a magnitude to be a primary explanation for the lower mortality of Hispanic than non-hispanic (NH)-White primary social security beneficiaries. Longitudinal surveys that follow individuals in and out of the United States are needed to further explore the role of migration in the health and mortality of foreign-born US residents and factors that contribute to the Hispanic mortality paradox.

Objectives. This study examined socioeconomic differentials in mortality among Hispanics in the United States, focusing on the older ages. We address previous research suggesting that social disparities in health are smaller for Hispanics than for non-Hispanic Whites and examine whether these differentials in survival are related to the mortality advantage that characterizes the older Hispanic population (i.e., the Hispanic paradox). Methods. We used Poisson regression models based on data from the 1989 to 1994 waves of the National Health Interview Survey, with linked mortality through 1997, to estimate death rates for Hispanics and non-Hispanic Whites by age, gender, and socioeconomic status. Results. Deaths rates varied significantly (p < .05) by education and income for Whites and Hispanic subgroups defined by nativity (U.S. born and foreign born) and nationality (Mexican, Puerto Rican, and other Hispanic). However, with the exception of Puerto Ricans, the effects of education were significantly smaller for Hispanics than for Whites. The ethnic differences in mortality patterns by income were not statistically significant. Discussion. The findings reveal that the mortality advantage for Hispanics is concentrated at lower levels of socioeconomic status, with little or no advantage at higher levels. We propose several mechanisms related to immigration and assimilation patterns that may underlie these patterns of mortality.

OBJECTIVE: To analyze whether socioeconomic and health conditions during childhood are associated with mortality during old age. METHODS: Data were extracted from the SABE Study (Saúde, Bem-estar e Envelhecimento – Health, Welfare and Aging), which were performed in 2000 and 2006. The sample consisted of 2004 (1,355 living and 649 dead) older adults. The statistical analysis was performed based on Poisson regression models, taking into account the time variation of risk observed. Older adults’ demographic characteristics and life conditions were evaluated, as were the socioeconomic and lifestyle conditions they acquired during their adult life. RESULTS: Only the area of residence during childhood (rural or urban) remained as a factor associated with mortality at advanced ages. However, this association lost significance when the variables acquired during adulthood were added to the model. CONCLUSIONS: Despite the information regarding the conditions during childhood being limited and perhaps not accurately measure the socioeconomic status and health in the first years of life, the findings of this study suggest that improving the environmental conditions of children and creating opportunities during early adulthood may contribute to greater survival rates for those of more advanced years. RESUMO OBJETIVO: Analisar se as condições socioeconômicas e de saúde na infância estão associadas à mortalidade em idosos. MÉTODOS: Utilizaram-se os dados do Estudo SABE (Saúde, Bem-estar e Envelhecimento) realizado em 2000 e 2006. A amostra foi composta por 2004 idosos, sendo 1.355 idosos sobreviventes e 649 óbitos. Modelos de Regressão de Poisson foram estimados, levando-se em consideração a variação do tempo de risco. Foram avaliadas características demográficas, condições no início da vida do idoso e condições socioeconômicas e de estilo de vida adquiridos na fase adulta. RESULTADOS: Situação de residência (rural ou urbano) quando criança associou-se à mortalidade nas idades avançadas. No entanto, essa variável perdeu significância quando variáveis que representam características adquiridas na fase adulta foram adicionadas ao modelo. CONCLUSÕES: Mesmo que as informações disponíveis sobre condições na infância sejam limitadas e possam não medir com precisão o status socioeconômico e de saúde nos primeiros anos de vida, os achados sugerem que melhorias nas condições ambientais das crianças e a criação de oportunidades no início da vida adulta podem contribuir para maior sobrevivência nas idades mais avançadas.

Whether age is an independent prognostic factor in breast cancer is a matter of debate. This is a retrospective cohort study of 767 breast cancer patients, stages I-III, treated at the Hospital das Clínicas, Minas Gerais Federal University, Belo Horizonte, Minas Gerais State, Brazil, from 2001 to 2008, aiming to study the relationship between age and survival. We included variables related to patients, tumors, and types of treatment. Different sets of Cox models were used for survival analysis. Hazard ratios (HR) and 95%CI were calculated. The relationship between age and breast cancer survival did not change substantially in any of them. In the model that accounted for all variables, women aged 70 and older (HR = 1.51, 95%CI: 1.04-2.18), and 35 or younger (HR = 1.78, 95%CI: 1.05-3.01) had shorter cancer specific survival than patients aged between 36 and 69. In addition, older age, having at least one comorbidity, and being white were associated with a higher risk of dying from other causes. In conclusion, shorter breast cancer survival is expected among the youngest and oldest patients. É discutível se idade é um fator prognóstico independente para câncer de mama. Conduzimos uma coorte retrospectiva de 767 pacientes com câncer de mama, estádios I-III, tratadas no Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil, de 2001 a 2008, para estudar a relação entre idade e sobrevida. Incluímos variáveis relacionadas às pacientes, aos tumores e ao tratamento. Diferentes conjuntos de modelos de Cox foram construídos. As razões de risco (RR) e IC95% foram calculados. A relação entre idade e sobrevida por câncer de mama não foi alterada substancialmente entre os modelos de Cox. No modelo com todas as variáveis explicativas, as mulheres de 70 anos ou mais (RR = 1,51; IC95%: 1,04-2,18) e até 35 anos (RR = 1,78; IC95%: 1,05-3,01) tiveram sobrevida causa-específica mais curta que as de 36-69 anos. Idades a partir de 70 anos, ter ao menos uma comorbidade e ser branca foram associadas a risco maior de óbito por outras causas. Em conclusão, as pacientes mais jovens e as mais idosas parecem ter sobrevida mais curta por câncer de mama. Es discutible si la edad es un factor pronóstico independiente para el cáncer de mama. Se realizó sobre una cohorte retrospectiva de 767 pacientes con cáncer de mama, etapas I-III, atendidas en el Hospital de Clínicas, Universidad Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil, entre 2001 y 2008, para estudiar la relación entre edad y supervivencia. Incluimos variables relacionadas con las pacientes, los tumores y el tratamiento. Se construyeron diferentes conjuntos de modelos de Cox. Se calcularon los cocientes de riesgo (CR) e IC95%. La relación entre edad y supervivencia del cáncer de mama no ha cambiado substancialmente en los modelos. En el modelo con todas las variables, las mujeres de 70 años o más (CR = 1,51; IC95%: 1,04-2,18) y 35 años o menos (CR = 1,78; IC95%: 1,05-3,01) tuvieron menor supervivencia por cáncer de mama que las de 36 a 69 años. Tener edad avanzada, al menos una comorbilidad, y ser de piel blanca se asociaron a un mayor riesgo de morir por otras causas. En conclusión, las mujeres más jóvenes y las mayores parecen tener menor supervivencia de cáncer de mama.

Background Few studies focus on "preclinical" warning signs associated with mortality. In this article, we investigate associations between all-cause mortality and two clusters of biological risk factors: (i) standard clinical measures related to cardiovascular disease and metabolic function; and (ii) nonclinical measures pertaining to hypothalamic-pituitary-adrenal axis activity, sympathetic nervous system activity, and inflammatory response. Methods Data come from the 2000 Social Environment and Biomarkers of Aging Study, a national sample of Taiwanese persons aged 54 years or older; 1497 persons were interviewed in their homes, and 1023 participated in a hospital examination. The analysis is based on 927 respondents with complete information. Logistic regression models describe the association between biomarkers and the 3-year probability of dying. Results Although both groups of biomarkers are significantly associated with mortality, the model with neuroendocrine and immune biomarkers has better explanatory and discriminatory power than the one with clinical measures. The association between these nonclinical measures and mortality remains strong after adjustment for the clinical markers, suggesting that the physiological effects of the nonclinical biomarkers are broader than those captured by the cardiovascular and metabolic system measures included here. Conclusions Nonclinical markers are likely to provide warning signs of deteriorating health and function beyond what can be learned from conventional markers. Our findings are consistent with those of recent studies that (i) demonstrate the importance of neuroendocrine and immune system markers for survival, and (ii) indicate that standard clinical variables are less predictive of mortality in older than in younger populations.

THE STUDY of mortality determinants has a long history in social science. Much of the early literature examined factors associated with mortality by estimating life tables for specific classifications of the population. These comparisons yielded insights on the relationship of mortality to age, sex, smoking habits, and socioeconomic variables, but they were less useful in revealing the simultaneous influence of multiple factors or the effect of measures beyond the classic socio-demographic variables in the demographer's toolkit. During the past few decades, the availability of micro-level data-especially from demographic and health interview surveys-and the concomitant use of multivariate models have permitted in-depth studies of the determinants of longevity (Elo and Preston 1996; Hayward and Gorman 2004). The resulting analyses have provided a better understanding of the complex mechanisms that mediate mortality risk. In particular, there is now a substantial literature investigating the salience of various self-reported dimensions of health for adult and old-age mortality (Hurd, McFadden, and

OBJECTIVE To analyze conditional and unconditional healthy life expectancy among older Brazilian women.METHODS This cross-sectional study used the intercensal technique to estimate, in the absence of longitudinal data, healthy life expectancy that is conditional and unconditional on the individual’s current health status. The data used were obtained from the Pesquisa Nacional por Amostra de Domicílios (National Household Sample Survey) of 1998, 2003, and 2008. This sample comprised 11,171; 13,694; and 16,259 women aged 65 years or more, respectively. Complete mortality tables from the Brazilian Institute of Geography and Statistics for the years 2001 and 2006 were also used. The definition of health status was based on the difficulty in performing activities of daily living.RESULTS The remaining lifetime was strongly dependent on the current health status of the older women. Between 1998 and 2003, the amount of time lived with disability for healthy women at age 65 was 9.8%. This percentage increased to 66.2% when the women already presented some disability at age 65. Temporal analysis showed that the active life expectancy of the women at age 65 increased between 1998-2003 (19.3 years) and 2003-2008 (19.4 years). However, life years gained have been mainly focused on the unhealthy state.CONCLUSIONS Analysis of conditional and unconditional life expectancy indicated that live years gained are a result of the decline of mortality in unhealthy states. This pattern suggests that there has been no reduction in morbidity among older women in Brazil between 1998 and 2008. OBJETIVO Analisar a expectativa de vida saudável condicional e não condicional de idosas brasileiras.MÉTODOS Estudo transversal, utilizando a técnica intercensitária, para estimar, na ausência de dados longitudinais, a expectativa de vida saudável não condicional e condicional ao estado de saúde corrente do indivíduo. Os dados utilizados foram obtidos da Pesquisa Nacional por Amostra de Domicílios de 1998, 2003 e 2008, cuja amostra foi composta, respectivamente, por 11.171, 13.694 e 16.259 mulheres com idade igual ou superior a 65 anos. Foram utilizadas, também, tábuas completas de mortalidade do Instituto Brasileiro de Geografia e Estatística, para os anos de 2001 e 2006. A definição dos estados de saúde baseou-se na dificuldade em realizar as atividades de vida diária.RESULTADOS O tempo de vida remanescente apresentou forte dependência com o estado de saúde corrente das idosas. No período 1998-2003, a proporção do tempo a ser vivido com incapacidade por mulheres saudáveis aos 65 anos era de 9,8%. Esse percentual aumentou para 66,2% quando as mulheres aos 65 anos já apresentavam alguma incapacidade. A análise temporal mostrou que a expectativa de vida ativa das mulheres aos 65 anos aumentou entre 1998-2003 (19,3 anos) e 2003-2008 (19,4 anos). No entanto, ganhos de vida se concentraram, sobretudo, no estado não saudável.CONCLUSÕES A análise da expectativa de vida condicional e não condicional indica concentração dos ganhos de vida, provenientes do declínio da mortalidade, em estados não saudáveis. Esse padrão sugere que não houve redução da morbidade entre as idosas brasileiras entre 1998 e 2008.

Background Breast cancer incidence is increasing. The survival rate varies and is longer in high-income countries. In Brazil, lower-income populations rely on the Unified Public Health System (Sistema Único de Saude, SUS) for breast cancer care. The goal of our study is to evaluate the survival of patients with operable breast cancer stages I-III at a Brazilian public hospital that treats mostly patients from the SUS. Methods A cohort study of patients who underwent surgery for breast cancer treatment at the Clinical Hospital of the Federal University of Minas Gerais from 2001 to 2008 was performed, with a population of 897 cases. Information on tumor pathology and staging, as well as patients’ age and type of health coverage (SUS or private system) was collected. A probabilistic record linkage was performed with the database of the Mortality Information System to identify patients who died by December 31th, 2011. The basic cause of death was retrieved, and breast cancer-specific survival rates were estimated with the Kaplan-Meier method. The Cox proportional hazards model was used for univariate and multivariate analysis of factors related to survival. Results A total of 282 deaths occurred during the study’s period, 228 of them due to breast cancer. Five-year breast cancer-specific survival rates were 95.5% for stage I, 85.1% for stage II and 62.1% for stage III disease. Patients from the SUS had higher stages at diagnosis (42% was in stage III, and from the private system only 17.6% was in this stage), and in the univariate but not multivariate analysis, being treated by the SUS was associated with shorter survival (hazard ratio, HR = 2.22, 95% CI 1.24-3.98). In the multivariate analysis, larger tumor size, higher histologic grade, higher number of positive nodes and age older than 70 years were associated with a shorter breast cancer-specific survival. Conclusions Five-year breast cancer survival was comparable to other Brazilian cohorts. Patients treated by the SUS, rather than by the private system, had shorter survival times, mostly due to higher initial stage of the disease.

Este trabalho tem como objetivo analisar, para a população com 60 anos e mais, residente no Município de São Paulo, Brasil, a associação entre mortalidade e estado marital. Para atingir o objetivo proposto, foram utilizados os dados do Estudo SABE: Saúde, Bem-estar e Envelhecimento (SABE), realizado nos anos 2000 e 2006, e modelos de Regressão de Poisson foram estimados, levando-se, em consideração, a variação do tempo de risco de morte. No geral, os resultados indicam que, entre os idosos paulistanos do sexo masculino, a taxa de mortalidade dos solteiros é 61% maior que a taxa de mortalidade observada para os casados. Por sua vez, a separação/divórcio ou a viuvez parece elevar a chance de morte das mulheres idosas analisadas. No geral, idosas separadas e viúvas apresentaram taxas de mortalidade 82% e 35% maiores que a observada para as casadas. Espera-se que este trabalho possa contribuir para um melhor entendimento dos fatores associados à sobrevivência dos idosos, além de subsidiar políticas de saúde voltadas para esse contingente populacional. This study aimed to analyze the association between mortality and marital status in the elderly population (60 years and older) in São Paulo, Brazil. The authors used data from the SABE Study (Health, Well-Being, and Aging) from 2000 and 2006. Statistical analysis used Poisson regression, considering variation in time of mortality risk. The mortality rate among single elderly males was 61% higher than among married men. Separation or divorce and widowhood increased the odds of death in elderly women (separated/divorced women and widows showed mortality rates 82% and 35% higher, respectively, than married women). It is hoped that the current study will improve our understanding of factors associated with survival in the elderly, in addition to supporting health policies for this population group. Este trabajo tiene como objetivo analizar la asociación entre el estado civil y la mortalidad, entre la población de 60 años o más que vive en São Paulo, Brasil. Para alcanzar ese objetivo, se utilizaron los datos del Estudio SABE (Salud, Bienestar y Envejecimiento), realizado en 2000 y 2006, y los modelos de regresión de Poisson se estimaron teniendo en cuenta la variación tiempo en el riesgo de muerte. En general, los resultados indican que, entre los ancianos de sexo masculino en São Paulo, la tasa de mortalidad de solteros es un 61% más alta que la tasa de mortalidad observada para los casados. A su vez, la separación/divorcio o viudez parece aumentar el riesgo de muerte de las mujeres ancianas. En general, las ancianas separadas y viudas presentaron tasas de mortalidad un 82% y un 35% mayores que la observada para las casadas. Se espera que este trabajo contribuya a una mejor comprensión de los factores asociados con la supervivencia de los ancianos, además de apoyar las políticas de salud dirigidas a este contingente de población.

Our chances of reaching 100 years of age are significantly higher than those of our ancestors who lived until the eighteenth century. Over the past two centuries, advances in public health, income gains, and the continuous technological development have enabled longevity to reach historically unprecedented levels. This article critically surveys the large and growing literature on factors that may have contributed to reducing mortality levels in the world. We are particularly interested on issues that currently have been the focus of demographers: the levels and patterns of mortality at advanced ages, the proliferation of centenarians, and the demographic and socioeconomic consequences of longevity gains. Whenever possible, we discuss the specific case of Brazil.

Over the last decades, Cuba has shown very low fertility levels in addition to significant negative migration flows. Moreover, within the country, there is intensive population mobility, characterized by different migration patterns across Cuba´s provinces. In this article, we look at the effect of both internal and international migration flows on long term population growth in Cuba and in its provinces. For that, we estimate reproduction and population growth measures using conventional demographic methods and the methodology proposed by Preston and Wang (2007), which is based on variable-r methods. Given the current demographic patterns, our analysis reveals important negative consequences for the size of the Cuban population in the future when migration effects are accounted for.

O objetivo deste trabalho é analisar, de forma sistemática, os níveis e padrões do diferencial de mortalidade entre os sexos no município de São Paulo, ao longo de 85 anos, de 1920 a 2005. São utilizados três indicadores na análise: o hiato na esperança de vida ao nascer; a razão de sexo entre taxas específicas de mortalidade por idade; e a contribuição de diferentes idades no hiato na esperança de vida ao nascer, com base no método de decomposição da diferença entre esperanças de vida ao nascer proposto pela ONU (1982). De maneira geral, as tendências de período observadas no município de São Paulo são semelhantes àquelas verificadas em países desenvolvidos, com algumas especificidades. Quanto à tendência de longo prazo do nível do diferencial na mortalidade por sexo, observa-se uma defasagem temporal de 30 a 50 anos. O início do processo de transição do padrão etário da mortalidade diferencial entre homens e mulheres foi tardio, mas, recentemente, as mudanças foram semelhantes às dos países desenvolvidos. Além disso, a análise da contribuição das diferentes idades para o hiato na esperança de vida ao nascer por sexo indica que a redução do diferencial observada no último quinquênio foi explicada, principalmente, pela diminuição da mortalidade masculina nas idades jovens. Entretanto, a redução no risco de morrer entre adultos e idosos também contribuiu com uma parcela significativa (cerca de 30%) do decréscimo do diferencial de mortalidade por sexo no período. Neste sentido, os resultados aqui apresentados sugerem que o comportamento futuro dos diferenciais de mortalidade por sexo dependerá, em maior medida, da heterogeneidade no risco de morrer em idades avançadas. The aim of this study is to systematically analyze levels and patterns of sex differential in mortality rates in the city of São Paulo for a period of 85 years (1920-2005). Three indicators are used: the hiatus in life expectancy at birth; ratio between sexes among specific mortality rates by age; contribution of different ages in the hiatus in life expectancy at birth, based on the method of decomposing difference of life expectancy at birth proposed by the UN (1982). Generally, period trends observed in the city of São Paulo are similar to those found in developed countries, with some specificities. There is a temporal gap of 30 to 50 years in the long-term trend in the sex differential in mortality rate. The onset of the transition from age group to sex diferential was late, but it has become similar to developed countries more recently. Moreover, the analysis of different age contribution to the life expectancy at birth hiatus indicates that the decrease in the differential of the last five years is explained mainly by the decrease in male mortality at young ages. The decrease in death risk among adults and the elderly has also contributed to a significant percentage (about 30%) of the decrease in sex differential in mortality rates in this period. Thus, the results here shown suggest that the future behavior of sex differential in mortality rates will depend greatly on the heterogeneity of the death risk in advanced ages. El objetivo de este trabajo es analizar, de forma sistemática, los niveles y patrones diferenciales de mortalidad entre sexos en el municipio de São Paulo, a lo largo de 85 años, de 1920 a 2005. Se utilizan tres indicadores en el análisis: el intervalo en la esperanza de vida al nacer; la razón de sexo entre tasas específicas de mortalidad por edad; y la contribución de las diferentes edades al intervalo en la esperanza de vida al nacer, en base al método de descomposición de la diferencia entre esperanzas de vida al nacer, propuesto por la ONU (1982). De manera general, las tendencias del período observadas en el municipio de São Paulo son semejantes a aquellas verificadas en países desarrollados, con algunas especificidades. En cuanto a la tendencia a largo plazo del nivel de diferencial en la mortalidad por sexo, se observa un desfase temporal de 30 a 50 años. El inicio del proceso de transición del patrón de edad de la mortalidad diferencial entre hombres y mujeres fue tardío, sin embargo, recientemente, los cambios han sido semejantes a los de los países desarrollados. Asimismo, el análisis de la contribución de las diferentes edades al intervalo en la esperanza de vida al nacer por sexo indica que la reducción del diferencial observada en el último quinquenio fue explicada, principalmente, por la disminución de la mortalidad masculina en las edades jóvenes. No obstante, la reducción en el riesgo de morir entre adultos y ancianos también contribuyó a una proporción significativa (cerca de un 30%) del decremento del diferencial de mortalidad por sexo en el período. En este sentido, los resultados aquí presentados sugieren que el comportamiento futuro de los diferenciales de mortalidad por sexo dependerá, en mayor medida, de la heterogeneidad en el riesgo de morir en edades avanzadas.

Social and economic inequalities in health and mortality are widely observed around the world. Individuals with lower socioeconomic status – usually defined by education, income and occupational status – have lower chances of survival and higher morbidity rates than individuals with higher socioeconomic status (Goldman, 2001). This association extends across all the distribution of socioeconomic variables, also within the highest social groups, defining what researchers call social “gradient” in health (Adler et al., 1994). This association has been studied for both sexes, but the relationship among women remains unclear. Also, it is a question rarely studied in developing countries, mostly due to a lack of reliable information. That is the case of Brazil, were although social and income inequality has been very high and persistent over time, with a long tradition of studies in this field (Barros, Foguel e Ulyssea 2007), we know very little about health and mortality disparities. Some previous works suggest a great gap in mortality by income in Brazil (Wood & Carvalho, 1988). However, all the efforts to investigate mortality inequality in Brazil run into the lack of information, especially in adult ages. This article combines information about the mother’s survival and education of respondents from a nationally representative household survey collected in Brazil in 1996 (Pesquisa de Padrões de Vida - PPV), to examine how mortality among adult women varied by level of education during the last decades. This study contributes to the discussion on the adult’s mortality differentials in developing countries with defective data.

This chapter describes how differences in health status at retirement can influence the decision to purchase a life annuity. It extends previous research on annuitization decisions by incorporating the effect of health differentials via differences in survival throughout the latter portion of life. It then shows how precautionary savings motivated by uncertain out-of-pocket medical expenses influence annuitization decisions. Results show that annuities become less attractive to people facing uncertain medical expenses. While full annuitization would still be optimal if annuity markets were truly complete and both life- and health-contingent, lacking this, annuity equivalent wealth values are much lower for those in poor health, as compared to persons in good health.

Objectives. We assessed whether the few findings to date suggesting weak relationships between education and health-related variables among Hispanics are indicative of a more widespread pattern. Methods. We used logistic regression models to examine education differentials (i.e., education gradients) in health behaviors and outcomes among White and Mexican-origin adults, adolescents, and infants. We gathered information from 3 data sets: the Los Angeles Family and Neighborhood Survey, the Fragile Families and Child Wellbeing Study, and the National Health Interview Survey. Results. In contrast with patterns for Whites, education was weakly associated or not associated with numerous health-related variables among the US Mexican-origin population. Among adults, Mexican immigrants were especially likely to have weaker education gradients than Whites. Conclusions. The weak relationships between education and health observed among individuals of Mexican origin may have been the result of several complex mechanisms: social gradients in health in Mexico that differ from those in the United States, selective immigration according to health and socioeconomic status, and particular patterns of integration of Mexican immigrants into US society.

We investigate whether a multi-system measure of physiological dysregulation based on 16 biological measures is associated with deterioration in physical and mental health over a 3-year period. The data come from a national survey of persons 54 and older in Taiwan that collected standard clinical markers related to cardiovascular and metabolic function and "non-clinical" measures pertaining to the immune, neuroendocrine and sympathetic nervous systems. The dysregulation score counts the number of biomarkers for which values are in the lowest or highest decile. Statistical models examine whether dysregulation predicts four health outcomes (survival, physical functioning, cognitive functioning and depressive symptoms), in the presence of extensive controls for baseline health. The estimates reveal significant associations between dysregulation and health for each outcome, although there is variability across outcomes. The associations are often attenuated in the presence of health controls, underscoring the importance of longitudinal analysis. This study extends previous research on the health consequences of physiological dysregulation by considering a broader range of outcomes and biomarkers in a non-Western population-based sample. Our analysis suggests that such dysregulation provides early warning signs of a broad range of comorbidities.

This paper describes how differences in health status at retirement can influence the decision to purchase a life annuity. We extend previous research on annuitization decisions by incorporating the effect of health differentials via differences in survival throughout the latter portion of life. Next, we consider how precautionary savings motivated by uncertain out-of-pocket medical expenses influence annuitization decisions. Our results show that annuities become less attractive to people facing uncertain medical expenses. While full annuitization would still be optimal if annuity markets were truly complete and both life- and health-contingent, lacking this, annuity equivalent wealth values are much lower for those in poor health, as compared to persons in good health.

We used vital records and census data and Medicare and NUMIDENT records to estimate age-and sex-specific death rates for elderly non-Hispanic whites and Hispanics, including five Hispanic subgroups: persons born in Cuba, Mexico, Puerto Rico, other foreign countries, and the United States. We found that corrections for data errors in vital and census records lead to substantial changes in death rates for Hispanics and that conventionally constructed Hispanic death rates are lower than rates based on Medicare-NUMIDENT records. Both sources revealed a Hispanic mortality advantage relative to non-Hispanic whites that holds for most Hispanic subgroups. We also present a new methodology for inferring Hispanic origin from a combination of surname, given name, and county of residence.