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Diversification in causes of death in low-mortality countries: emerging patterns and implications
  1. Marie-Pier Bergeron-Boucher1,
  2. José Manuel Aburto1,2,3,
  3. Alyson van Raalte3
  1. 1Interdisciplinary Centre on Population Dynamics, Syddansk Universitet, Odense, Denmark
  2. 2Department of Sociology and Leverhulme Centre for Demographic Science, University of Oxford, Oxford, Oxfordshire, UK
  3. 3Max-Planck-Institute for Demographic Research, Rostock, Mecklenburg-Vorpommern, Germany
  1. Correspondence to Dr Marie-Pier Bergeron-Boucher; mpbergeron{at}


Introduction An important role of public health organisations is to monitor indicators of variation, so as to disclose underlying inequality in health improvement. In industrialised societies, more individuals than ever are reaching older ages and have become more homogeneous in their age at death. This has led to a decrease in lifespan variation, with substantial implications for the reduction of health inequalities. We focus on a new form of variation to shed further light on our understanding of population health and ageing: variation in causes of death.

Methods Data from the WHO Mortality Database and the Human Mortality Database are used to estimate cause-of-death distributions and life tables in 15 low-mortality countries. Cause-of-death variation, using 19 groups of causes, is quantified using entropy measures and analysed from 1994 to 2017.

Results The last two decades have seen increasing diversity in causes of death in low-mortality countries. There have been important reductions in the share of deaths from diseases of the circulatory system, while the share of a range of other causes, such as diseases of the genitourinary system, mental and behavioural disorders, and diseases of the nervous system, has been increasing, leading to a more complex cause-of-death distribution.

Conclusions The diversification in causes of death witnessed in recent decades is most likely a result of the increase in life expectancy, together with better diagnoses and awareness of certain diseases. Such emerging patterns bring additional challenges to healthcare systems, such as the need to research, monitor and treat a wider range of diseases. It also raises new questions concerning the distribution of health resources.

  • medical demography
  • mathematical modelling
  • public health

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  • Handling editor Sanni Yaya

  • Twitter @jm_aburto, @AlysonVanRaalte

  • Contributors M-PB-B and JMA have contributed to the design of the study. All three authors contributed to the interpretation of the results; and the drafting, revision and approval of the manuscript. M-PB-B conceptualised the study, did the analysis and produced the results. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

  • Funding The first author received funding from the SCOR Corporate Foundation for Science. The second author acknowledges support from the Newton International Fellowship from the British Academy. The third author is funded by a starting grant from the European Research Council (grant # 716323). SCOR, the British Academy, and the European Research Council played no role in this study.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available in a public, open access repository. The data are publicly available in the WHO Mortality Database and Human Mortality Database. R code to reproduce the results can be shared upon request to the corresponding author.

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