Reexamining the Dominance of Birth Cohort Effects on Mortality.

The association between birth cohort and subsequent mortality has been of interest especially following publication of studies around 1930 of cohorts born up to the latter part of the nineteenth century, particularly for England and Wales. Updated results are presented for this population, together with those for two other cohorts, twentieth-century Japanese and British populations born about 1930, which have been identified as having particularly clear-cut birth cohort patterns, and which are used to underpin incorporation of cohort effects in both British official and actuarial mortality forecasts. Graphical methods used to identify cohort patterns are discussed. A number of limitations and difficulties are identified that mean that the conclusions about the predominance of cohort effects are less robust than often assumed. It is argued that alternative explanations should be considered and that the concentration on birth cohorts with particularly advantaged patterns may distort research priorities.

Paul Everett Meehl: the cumulative record.

In this brief biographical sketch of Paul Meehl, the authors examine the "cumulative record" of his scholarship and mentorship. This record sheds light on why Meehl is widely regarded as one of the most influential clinical psychologists of the 20th century, as well as on Meehl's remarkable intellectual life. Time has proven that Meehl's writings are exceptional in their quality, influence, breadth, and depth. In addition, Meehl's cumulative record raises important questions regarding the reinforcement contingencies in major research-oriented psychology departments.

The ethical implications of Paul Meehl's work on comparing clinical versus actuarial prediction methods.

Paul E. Meehl's work comparing statistical versus actuarial prediction-and the large body of research that followed by others on the same topic-was mainly theoretical and empirical. Meehl also suggested that this work led to a "practical" conclusion, which was quite strong. The author argues that, in addition, it leads to an ethical conclusion, equally strong. Whether the scientific findings are combined with an overarching ethical principle that the best predictions possible should be made for clients, or whether these findings are framed as delineating what can be done for clients-and that clinicians ought not to attempt to do what they cannot-the conclusion is the same. Whenever statistical prediction rules (SPR's) are available for making a relevant prediction, they should be used in preference to intuition. Any modification of these rules should be systematic and subject to the same type of evaluation originally used to assess the SPR's themselves. It is even possible to develop near-optimal rules in new situations. Providing service that assumes that clinicians "can do better" simply based on self-confidence or plausibility in the absence of evidence that they can actually do so is simply unethical.

[Order of mortality, duration of life and annuities in Johann Peter Süssmilch's Göttliche Ordnung]. / Un pasteur actuaire? Ordre de la mortalité, durée de la vie et rentes viagères dans L'Ordre divin de Johann Peter Süssmilch/Pastor and actuary.

The government of Providence builds the order which pastor Süssmilch sees in the demographic events and especially the order of mortality. God governs the length of human life and assigns to each person a just balance between fear of death and expectation of life. This authorizes Süssmilch to clarify the notions of probable life and life expectancy with the design to treat of their main application in the field of political arithmetic, that is the computations of Government loans under the form of annuities on lives. So he treats of an important question which concerns the history of actuarial calculation as well as the history of probability, of statistics and demography. We cannot forget also the political and philosophical points of view which the pastor underlines vividly: what sort of contract joins the creature and his God? This study of the contingent but optimal regularities which Providence makes in the world builds an important contribution to the physico-theological current.

Abdominal obesity and mortality risk among men in nineteenth-century North America.

The health consequences of an adverse body-fat distribution (e.g., android, upper-body, visceral) have only recently concerned the medical community. Ninety years ago, however, actuarial study demonstrated the relationship of body-fat distribution to the mortality experience of insured, North American men. Thirty-four insurance companies pooled their data on males issued life policies between 1870 and 1899. Special classes of risk were defined by weight for height at baseline or by the observation that abdominal girth exceeded the girth of the expanded chest (abdominal obesity). The mortality experience of each risk class was compared to an age-stratified, actuarial table of the period. We present new analyses of these historical data relating specifically to the mortality impact of abdominal obesity. Among 163,567 overweight men, the prevalence of abdominal obesity increased with age and with degree of overweight. Among moderately overweight men, those with abdominal obesity experienced 133% of the expected mortality rate compared to 112% of the expected mortality for those who were not abdominally obese. Severely overweight men with abdominal obesity experienced 152% of the expected mortality compared to 135% of the expected mortality for severely overweight men who were not abdominally obese. We believe this nineteenth-century, acturial study of waist and chest girths was the first demonstration that body-fat distribution can influence longevity. These early actuarial findings, taken with more recent reports, establish that abdominal enlargement, but not necessarily an 'upper-body' fat distribution, constitutes a major health hazard. Future research must establish which abdominal-obesity index best predicts disease outcomes.

Examples of early mortality follow-up studies.

Numerous mortality studies may be found in publications of the life insurance industry dating back about a century. Examples presented include mortality in asthma history (1903), overweight (1844-1905), and hypertension (1907-11). The favorable effect of underwriting selection on mortality was recognized early, and standard insurance mortality tables in North America have always distinguished between select and ultimate mortality rates. The mortality ratio has been the traditional measure of excess mortality in insurance follow-up studies. Similar mortality studies in the medical literature before 1920 are extremely difficult for investigators to locate. One important exception with regard to methodology and completeness of comparative mortality and survival results was a 20-year follow-up of pulmonary tuberculosis patients after discharge that was reported in 1908.

Early studies of tuberculosis.

Cohort studies have been of great importance in the establishment of what is known about the epidemiology of tuberculosis. The individuals who conducted these studies provided useful models for the application of life table, person-time, and cohort analyses to the study of diseases. These tuberculosis workers not only have shown that follow-up of large cohorts can be virtually complete, but, even more importantly for future cohort studies, they have also shown how cohort investigations can be done at minimal expense.

Actuarial contributions to life table analysis.

The correct principles for the construction of life tables and more particularly select life tables were developed by actuaries in England in the first half of the 19th century. Actuaries explored the phenomenon of selection not only between the insured and annuitants but also in the general population, distinguishing among initial temporary selection, antiselection, and class selection. The conclusion was reached early that no such thing as an unselected population exists. Group life insurance experience among the actively employed has been shown to provide a more appropriate standard of expected mortality than general population death rates in studies of medical impairments and occupational hazards at ages under 65 years. Mortality rates derived from the Cancer Prevention Study can serve as a useful standard of expected mortality when the objective is determination of excess mortality compared with ostensibly healthy persons at ages 65 years and older.