Interpreting changes in life expectancy during temporary mortality shocks.

BACKGROUND: Life expectancy is a pure measure of the mortality conditions faced by a population, unaffected by that population's age structure. The numerical value of life expectancy also has an intuitive interpretation, conditional on some assumptions, as the expected age at death of an average newborn. This intuitive interpretation gives life expectancy a broad appeal. Changes in life expectancy are also routinely used to assess mortality trends. Interpreting these changes is not straightforward as the assumptions underpinning the intuitive interpretation of life expectancy are no longer valid. This is particularly problematic during mortality 'shocks,' such as during wars or pandemics, when mortality changes may be sudden, temporary, and contrary to secular trends. OBJECTIVE: This study aims to provide an alternative perspective on what changes in life expectancy measure that remains applicable during mortality shocks. CONCLUSIONS: Returning to two different models that the period life table may represent, I show that a difference in life expectancy is typically interpreted from the synthetic cohort model as the difference in mean longevity between different birth cohorts. However, it can also be interpreted from the stationary population model as a measure of premature mortality in a death cohort. The latter, less common interpretation makes more sense for temporary declines in life expectancy induced by mortality shocks. The absolute change in life expectancy is then an age-standardized value of the average lifespan reduction for people dying during the mortality shock. CONTRIBUTION: To clarify what a decline in life expectancy measures during mortality shocks is important, especially as demographers often assess the mortality impact of those shocks using this metric, which gets widely reported beyond demographers' inner circle.

Physical intimate partner violence in India: how much does childhood socialisation matter?

While a large number of studies assumed gendered socialisation leads to partner abuse, little evidence exists for India. We bridge this crucial gap by exploring the pathways between childhood socialisation and intimate partner violence, using data 'Youth in India: Situation and Need Study (2006-2007)' for 5573 young married men (15-29 years). Nearly 17 per cent of men inflicted physical IPV in the past 12 months. Seventy-seven per cent recognized the experience of gender discrimination in their family and reported exposure to violence in two ways-one-third witnessed fathers abusing their mothers and 48 per cent were beaten by their parents. Adverse childhood experiences were associated with IPV perpetration. The structural equation model indicated significant pathways between IPV and childhood socialisation in the forms of experienced violence and gender discrimination. Findings underscore the importance of a violence-free, gender-neutral family environment for young generations and call for a comprehensive policy to ameliorate the impacts of IPV.

The Covid-19 pandemic and the expansion of the mortality gap between the United States and its European peers.

The mortality gap between the United States and other high-income nations substantially expanded during the first two decades of the 21st century. International comparisons of Covid-19 mortality suggest this gap might have grown during the Covid-19 pandemic. Applying population-weighted average mortality rates of the five largest West European countries to the US population reveals that this mortality gap increased the number of US deaths by 34.8% in 2021, causing 892,491 "excess deaths" that year. Controlling for population size, the annual number of excess deaths has nearly doubled between 2019 and 2021 (+84.9%). Diverging trends in Covid-19 mortality contributed to this increase in excess deaths, especially towards the end of 2021 as US vaccination rates plateaued at lower levels than in European countries. In 2021, the number of excess deaths involving Covid-19 in the United States reached 223,266 deaths, representing 25.0% of all excess deaths that year. However, 45.5% of the population-standardized increase in excess deaths between 2019 and 2021 is due to other causes of deaths. While the contribution of Covid-19 to excess mortality might be transient, divergent trends in mortality from other causes persistently separates the United States from West European countries. Excess mortality is particularly high between ages 15 and 64. In 2021, nearly half of all US deaths in this age range are excess deaths (48.0%).

Preventing, but Not Caring for, Adolescent Pregnancies? Disparities in the Quality of Reproductive Health Care in Sub-Saharan Africa.

PURPOSE: There is concern that adolescents experience worse quality of health care than older women. We compare quality of reproductive health services (family planning and antenatal care) for adolescents (<20 years) versus adult women (≥25 years), in four sub-Saharan African countries. METHODS: In total, 2,342 family planning visits and 8,600 antenatal care visits were analyzed from Democratic Republic of the Congo, Malawi, Senegal, and Tanzania. Service Provision Assessment surveys include observation of care and client exit interviews. We compare visit content and care satisfaction for adolescents versus adult women aged ≥25. All models are multilevel, weighted to reflect survey design, and include client, provider, and facility covariates (pooled models also include survey fixed effects). RESULTS: Adolescents receive more overall family planning care activities compared to adult women (2.31 activities in adjusted generalized linear models, standard error [SE] 1.29, p < .1), and 3.76 more discussion activities (e.g., counseling) on average (SE 1.94, p < .1), but significantly fewer discussion activities during antenatal care (-3.10 activities, SE .97, p < .01). However, adolescents' satisfaction with both care types was not significantly different than adult women. These relationships largely persist in country-stratified models, using different model specifications, and when comparing adolescents to women aged ≥20. CONCLUSIONS: Adolescents' family planning visits are similar to, or even slightly more comprehensive than, adult women-but their antenatal visits include fewer recommended care components, with particular gaps for activities requiring provider-client dialog. This suggests opportunities for strengthening communication between providers and young women, and improving care across the reproductive health continuum.

Global and National Declines in Life Expectancy: An End-of-2021 Assessment.

Timely, high-quality mortality data have allowed for assessments of the impact of the novel coronavirus disease 2019 (COVID-19) on life expectancies in upper-middle- and high-income countries. Extant data, though imperfect, suggest that the bulk of the pandemic-induced mortality might have occurred elsewhere. This article reports on changes in life expectancies around the world as far as they can be estimated from the evidence available at the end of 2021. The global life expectancy appears to have declined by 0.92 years between 2019 and 2020 and by another 0.72 years between 2020 and 2021, but the decline seems to have ended during the last quarter of 2021. Uncertainty about its exact size aside, this represents the first decline in global life expectancy since 1950, the first year for which a global estimate is available from the United Nations. Annual declines in life expectancy (from a 12-month period to the next) appear to have exceeded two years at some point before the end of 2021 in at least 50 countries. Since 1950, annual declines of that magnitude had only been observed on rare occasions, such as Cambodia in the 1970s, Rwanda in the 1990s, and possibly some sub-Saharan African nations at the peak of the acquired immunodeficiency syndrome (AIDS) pandemic.

The Mean Unfulfilled Lifespan (MUL): A new indicator of the impact of mortality shocks on the individual lifespan, with application to mortality reversals induced by COVID-19.

Declines in period life expectancy at birth (PLEB) provide seemingly intuitive indicators of the impact of a cause of death on the individual lifespan. Derived under the assumption that future mortality conditions will remain indefinitely those observed during a reference period, however, their intuitive interpretation becomes problematic when period conditions reflect a temporary mortality "shock", resulting from a natural disaster or the diffusion of a new epidemic in the population for instance. Rather than to make assumptions about future mortality, I propose measuring the difference between a period average age at death and the average expected age at death of the same individuals (death cohort): the Mean Unfulfilled Lifespan (MUL). For fine-grained tracking of the mortality impact of an epidemic, I also provide an empirical shortcut to MUL estimation for small areas or short periods. For illustration, quarterly MUL values in 2020 are derived from estimates of COVID-19 deaths that might substantially underestimate overall mortality change in affected populations. These results nonetheless illustrate how MUL tracks the mortality impact of the pandemic in several national and sub-national populations. Using a seven-day rolling window, the empirical shortcut suggests MUL peaked at 6.43 years in Lombardy, 8.91 years in New Jersey, and 6.24 years in Mexico City for instance. Sensitivity analyses are presented, but in the case of COVID-19, the main uncertainty remains the potential gap between reported COVID-19 deaths and actual increases in the number of deaths induced by the pandemic in some of the most affected countries. Using actual number of deaths rather than reported COVID-19 deaths may increase seven-day MUL from 6.24 to 8.96 years in Mexico City and from 2.67 to 5.49 years in Lima for instance. In Guayas (Ecuador), MUL is estimated to have reached 12.7 years for the entire month of April 2020.

Beyond deaths per capita: comparative COVID-19 mortality indicators.

OBJECTIVES: Following well-established practices in demography, this article discusses several measures based on the number of COVID-19 deaths to facilitate comparisons over time and across populations. SETTINGS: National populations in 186 United Nations countries and territories and populations in first-level subnational administrative entities in Brazil, China, Italy, Mexico, Peru, Spain and the USA. PARTICIPANTS: None (death statistics only). PRIMARY AND SECONDARY OUTCOME MEASURES: An unstandardised occurrence/exposure rate comparable to the Crude Death Rate; an indirectly age-and-sex standardised rate that can be derived even when the breakdown of COVID-19 deaths by age and sex required for direct standardisation is unavailable; the reduction in life expectancy at birth corresponding to the 2020 number of COVID-19 deaths. RESULTS: To date, the highest unstandardised rate has been in New York, at its peak exceeding the state 2017 crude death rate. Populations compare differently after standardisation: while parts of Italy, Spain and the USA have the highest unstandardised rates, parts of Mexico and Peru have the highest standardised rates. For several populations with the necessary data by age and sex for direct standardisation, we show that direct and indirect standardisation yield similar results. US life expectancy is estimated to have declined this year by more than a year (-1.26 years), far more than during the worst year of the HIV epidemic, or the worst 3 years of the opioid crisis, and to reach its lowest level since 2008. Substantially larger reductions, exceeding 2 years, are estimated for Panama, Peru, and parts of Italy, Spain, the USA and especially, Mexico. CONCLUSIONS: With lesser demand on data than direct standardisation, indirect standardisation is a valid alternative to adjust international comparisons for differences in population distribution by sex and age-groups. A number of populations have experienced reductions in 2020 life expectancies that are substantial by recent historical standards.

Beyond Deaths per Capita: Comparative CoViD-19 Mortality Indicators.

OBJECTIVES: Following well-established practices in demography, this article discusses several measures based on the number of CoViD-19 deaths to facilitate comparisons over time and across populations. SETTINGS: National populations in 186 UN countries and territories and populations in first-level sub-national administrative entities in Brazil, China, Italy, Mexico, Peru, Spain, and the USA. PARTICIPANTS: None (death statistics only). PRIMARY AND SECONDARY OUTCOME MEASURES: An unstandardized occurrence/exposure rate comparable to the Crude Death Rate; an indirectly age-and-sex standardized rate that can be derived even when the breakdown of CoViD-19 deaths by age and sex required for direct standardization is unavailable; the reduction in life expectancy at birth corresponding to the 2020 number of CoViD-19 deaths. RESULTS: To date, the highest unstandardized rate has been in New York, at its peak exceeding the state 2017 Crude Death Rate. Populations compare differently after standardization: while parts of Italy, Spain and the USA have the highest unstandardized rates, parts of Mexico and Peru have the highest standardized rates. For several populations with the necessary data by age and sex for direct standardization, we show that direct and indirect standardization yield similar results. US life expectancy is estimated to have declined this year by more than a year (-1.26 years), far more than during the worst year of the HIV epidemic, or the worst three years of the opioid crisis, and to reach its lowest level since 2008. Substantially larger reductions, exceeding two years, are estimated for Panama, Peru, and parts of Italy, Spain, the USA, and especially, Mexico. CONCLUSIONS: With lesser demand on data than direct standardization, indirect standardization is a valid alternative to adjust international comparisons for differences in population distribution by sex and age-groups. A number of populations have experienced reductions in 2020 life expectancies that are substantial by recent historical standards.

The Mean Unfulfilled Lifespan (MUL): A new indicator of the impact of mortality shocks on the individual lifespan, with application to global 2020 quarterly mortality from COVID-19.

Declines in period life expectancy at birth (PLEB) provide intuitive indicators of the impact of a cause of death on the individual lifespan. Derived under the assumption that future mortality conditions will remain indefinitely those observed during a reference period, however, the intuitive interpretation of a PLEB becomes problematic when that period conditions reflect a temporary mortality "shock", resulting from a natural disaster or the diffusion of a new epidemic in the population for instance. Rather than to make assumptions about future mortality, I propose measuring the difference between a period average age at death and the average expected age at death of the same individuals (death cohort): the Mean Unfulfilled Lifespan (MUL). For fine-grained tracking of the mortality impact of an epidemic, I also provide an empirical shortcut to MUL estimation for small areas or short periods. For illustration, quarterly MUL values in 2020 are derived from estimates of COVID-19 deaths in 159 national populations and 122 sub-national populations in Italy, Mexico, Spain and the US. The highest quarterly values in national populations are obtained for Ecuador (5.12 years, second quarter) and Peru (4.56 years, third quarter) and, in sub-national populations, for New York (5.52 years), New Jersey (5.56 years, second quarter) and Baja California (5.19 years, fourth quarter). Using a seven-day rolling window, the empirical shortcut suggests the MUL peaked at 9.12 years in Madrid, 9.20 years in New York, and 9.15 years in Baja California, and in Guayas (Ecuador) it even reached 12.6 years for the entire month of April. Based on reported COVID-19 deaths that might substantially underestimate overall mortality change in affected populations, these results nonetheless illustrate how the MUL tracks the mortality impact of the pandemic, or any mortality shock, retaining the intuitive metric of differences in PLEB, without their problematic underlying assumptions.

Covid-19 Will Reduce US Life Expectancy at Birth by More Than One Year in 2020.

On December 3rd, 2020, the cumulative number of U.S. Covid-19 deaths tallied by Johns Hopkins University (JHU) online dashboard reached 275,000, surpassing the number at which life table calculations show Covid-19 mortality will lower the U.S. life expectancy at birth (LEB) for 2020 by one full year. Such an impact on the U.S. LEB is unprecedented since the end of World War II. With additional deaths by the year end, the reduction in 2020 LEB induced by Covid-19 deaths will inexorably exceed one year. Factoring the expected continuation of secular gains against other causes of mortality, the U.S. LEB should still drop by more than a full year between 2019 and 2020. By comparison, the opioid-overdose crisis led to a decline in U.S. LEB averaging .1 year annually, from 78.9 years in 2014 to 78.6 years in 2017. At its peak, the HIV epidemic reduced the U.S. LEB by .3 year in a single year, from 75.8 years in 1992 to 75.5 years in 1993. As of now, the US LEB is expected to fall back to the level it first reached in 2010. In other words, the impact of Covid-19 on U.S. mortality can be expected to cancel a decade of gains against all other causes of mortality combined.

Household Structure and Child Education in Cambodia.

We analyze the effects of household structure on education in Cambodia. Consistent evidence documents that residence with both biological parents benefits children's education in Western countries. Elsewhere, the issue is gaining more attention with the growing number of "left-behind children" due to adult migration and, possibly, changes in family behavior, but the extant record is both thinner and more contrasted. Controlling for the presence of grandparents and some household characteristics, we find children residing with both biological parents are more likely to be enrolled in school, in the appropriate grade for their age, and literate than those living with only one parent. The effect sizes appear comparable to those in most Western countries, but the effects shrink or even disappear when grandparents are present. The results for children not residing with either parent are mixed, suggesting negative effects for some children might be blurred by positive selection for some others.

One-Parent Families in Contemporary Cambodia.

Non-marital births and divorce remain rare in Cambodia. Due to dramatic levels of adult mortality reached during the late 1970s, growing up with a single parent is not. Using nationally representative, cross-sectional data, we estimate that about 12% of children under age 18 co-reside with only one of their biological parents. Using longitudinal data representative of the Mekong River Valley, we find this proportion to be declining. Nearly half of these children live in nuclear families (single parent with or without a step-parent), even though they live in multigenerational families more frequently than children who live with both their parents, especially, when young and not living with their mother. Last, we consider differences in socioeconomic conditions and child educational outcomes by number of co-residing parents.

The boundaries of genocide: Quantifying the uncertainty of the death toll during the Pol Pot regime in Cambodia (1975-79).

The range of estimates of excess deaths under Pol Pot's rule of Cambodia (1975-79) is too wide to be useful: they range from under 1 to over 3 million, with the more plausible estimates still varying from 1 to 2 million. By stochastically reconstructing population dynamics in Cambodia from extant historical and demographic data, we produced interpretable distributions of the death toll and other demographic indicators. The resulting 95 per cent simulation interval (1.2-2.8 million excess deaths) demonstrates substantial uncertainty over the exact scale of mortality, yet it still excludes nearly half of the previous death-toll estimates. The 1.5-2.25 million interval contains 69 per cent of the simulations for the actual number of excess deaths, more than the wider (1-2 million) range of previous plausible estimates. The median value of 1.9 million excess deaths represents 21 per cent of the population at risk. Supplementary material for this article is available at: http://dx.doi.org/10.1080/00324728.2015.1045546.

It Takes a Village (Perhaps a Nation): Families, States, and Educational Achievement.

Research in the United States has shown that children growing up in 2-parent households do better in school than children from single-parent households. We used the Trends in International Mathematics and Science Study (TIMSS) data to test whether this finding applied to other countries as well (N = 100,307). We found that it did, but that the educational gap was greater in the United States than in the other 13 countries considered. Results from 2-level hierarchical linear models demonstrated that international differences in the educational gap were associated with several indicators of national policy and demographic contexts. No single policy appeared to have a large effect, but several policy combinations were associated with substantially reduced educational gaps between children from different family structures.

The international child poverty gap: does demography matter?

According to the Luxembourg Income Study data, the U.S. child poverty rate is the second highest among 15 high-income nations. The present work reveals that 55% of all American children living in a household headed by a single female with no other adult present live in poverty-the highest rate for any of the five living arrangements in the 15 countries examined in this study. While previous analyses have focused on market forces and governmental redistribution across households, we question the contribution of demographic factors that place children in family structures with different poverty risks relative to other factors such as differential market opportunities and governmental benefits for adults caring for children in various living arrangements. Applying a classic demographic decomposition technique to the overall poverty gap, we find that the distributional effect of demographic behavior contributes little to the U.S. poverty gap with other nations (and none with respect to the United Kingdom). Overall differences in labor markets and welfare schemes best explain the U.S. child poverty gap, although for some countries, the gap is accentuated by the gradient of governmental transfers, and for most countries, by the gradient of market earnings across living arrangements.

DIVERSITY AND CHANGE IN CAMBODIAN HOUSEHOLDS, 1998-2006.

Extant ethnographic studies suggest that the nuclear family has been the predominant living arrangement in Cambodia, and the country's rapid socioeconomic transformation since the early 1990s may have accentuated that dominance. To examine these claims, we analyse here household structure in Cambodia between 1998 and 2006, based on data from the 1998 Census, two nationally-representative surveys (2000 and 2005), and a continuing demographic surveillance system (from 2000 on). Our analysis confirms the large prevalence of nuclear families, but not an unequivocal trend toward their increasing prevalence. First, nuclear families are less prevalent in urban than in rural areas, and nationwide, they appear to have receded slightly between 2000 and 2005. We find that increases in the prevalence of extended households correspond to periods of faster economic growth, and interpret these contrasted trends as signs of tensions during this transitional period in Cambodia. While the nuclear family may still be the cultural norm, a high degree of pragmatism is also evident in the acceptance of other living arrangements, albeit temporary, as required by economic opportunities and housing shortage in urban areas.

The Phoenix population: demographic crisis and rebound in Cambodia.

The study of mortality crises provides an unusual and valuable perspective on the relationship between mortality and fertility changes, a relationship that has puzzled demographers for decades. In this article, we combine nationally representative survey and demographic-surveillance system data to study fertility trends around the time of the Khmer Rouge (KR) regime, under which 25% of the Cambodian population died. We present the first quantitative evidence to date that attests to a one-third decline of fertility during this regime, followed by a substantial "baby boom" after the fall of the KR. Further analyses reveal that the fertility rebound was produced not only by a two-year marriage bubble but also by a surge in marital fertility that remained for nearly a decade above its precrisis level. Our results illustrate the potential influence of mortality on fertility, which may be more difficult to identify for more gradual mortality declines. To the extent that until recently, Cambodian fertility appears to fit natural fertility patterns, our findings also reinforce recent qualifications about the meaning of this core paradigm of demographic analysis.

Do marriages forget their past? Marital stability in post-Khmer Rouge Cambodia.

This paper assesses the impact of three main destabilizing factors on marital stability in Cambodia: the radical reformation of marriage under the Khmers Rouges (KR); the imbalanced gender ratio among marriageable adults resulting from gendered mortality during the KR regime; and, after decades of isolation from the West, a period of rapid social change. Although there is evidence of declining marital stability in the most recent period, marriages contracted under the KR appear as stable as adjacent marriage cohorts. Thesefindings suggest that the conditions under which spouses were initially paired matter less for marital stability than does their contemporaneous environment.

A crossover in Mexican and Mexican-American fertility rates: Evidence and explanations for an emerging paradox.

Against a backdrop of two new developments in the fertility behavior of the Mexican-Origin population in the U.S., the present discussion will update contemporary Mexican-Origin fertility patterns and address several theoretical weaknesses in the current approach to immigrant group fertility. Data come from six national surveys (three from Mexico and three from the U.S.) that cover a twenty-five year period (1975- 2000). The findings demonstrate dramatic decreases in the fertility rates in Mexico at the same time that continuous increases have been documented in the fertility rates of native-born Mexican-Americans in the U.S. at younger ages. These changes necessitate a reexamination of the idea that Mexican pronatalist values are responsible for the high fertility rates found within the Mexican-Origin population in the U.S. Instead, they point to the increasing relevance of framing the fertility behavior of the Mexican-Origin population within a racial stratification perspective that stresses the influence of U.S. social context on fertility behavior. As a step in this direction, the analysis examines fertility patterns within the Mexican-Origin population in the U.S., giving special attention to the role of nativity/generational status in contributing to within group differences.