Frailty at death: An examination of multiple causes of death in four low mortality countries in 2017.

BACKGROUND: The increasing prevalence of frailty in aging populations represents a major social and public health challenge which warrants a better understanding of the contribution of frailty to the morbid process. OBJECTIVE: To examine frailty-related mortality as reported on the death certificate in France, Italy, Spain and the United States in 2017. METHODS: We identify frailty at death for the population aged 50 years and over in France, Italy, Spain and the United States. We estimate the proportions of deaths by sex, age group and country with specific frailty-related ICD-codes on the death certificate 1) as the underlying cause of death (UC), 2) elsewhere in Part I (sequence of diseases or conditions or events leading directly to death), and 3) anywhere in Part II (conditions that do not belong in Part I but whose presence contributed to death). RESULTS: The age-standardized proportion of deaths with frailty at ages 50 and over is highest in Italy (25.0%), then in France (24.1%) and Spain (17.3%), and lowest in the United States (14.0%). Cross-country differences are smaller when frailty-related codes are either the underlying cause of the death or reported in Part II. Frailty-related mortality increases with age and is higher among females than males. Dementia is the most frequently reported frailty-related code. CONCLUSIONS: Notable cross-country differences were found in the prevalence and the type of frailty-related symptoms at death even after adjusting for differential age distributions.

Multi-morbidity and frailty at death: A new classification of death records for an ageing world.

Mortality statistics based on underlying cause of death are challenged by increased life expectancy and the growing share of population reaching ages associated with frequent multi-morbidity (with death likely resulting from interactions between multiple diseases). We provide a novel way of analysing causes of death: accounting for all causes mentioned on death certificates and summarizing this information along two dimensions emblematic of ageing populations-multi-morbidity and frailty. We implement this classification for all deaths at ages 50+ in Italy in 2014. Multi-morbid processes represent the majority of deaths, rising from 43 per cent at ages 50-54 to 63 per cent at ages 85-89. Multi-morbidity at death is more frequent among males, although age patterns are identical for both sexes. About one in four deaths involves frailty symptoms, rising to 45 per cent at ages 95+. Mortality rates involving frailty are very similar for both sexes. Supplementary material is available for this article at: https://doi.org/10.1080/00324728.2020.1820558.

The death toll of French former prisoners.

Several studies have documented that ex-prisoners are at higher risk of death than the general population but only one study, concerning one single prison, has examined the French case. This study relies on a nationally representative sample of all inmates released from French prisons between June and December 2002. A linkage between two administrative databases makes it possible to study mortality within 5 years after release. The magnitude of ex-prisoners' excess mortality is similar to that observed in other studies. The standardized mortality ratio is 3.6 (95% CI 3.1-4.1). Excess mortality after release is especially high between the ages of 30 and 50. Inmates incarcerated for at least 5 years have lower risks of dying (OR 0.4, 95% CI 0.2-0.9). We also find that adjusted sentences are protective (OR 0.6, 95% CI 0.3-0.9).

Obesity-related mortality in France, Italy, and the United States: a comparison using multiple cause-of-death analysis.

OBJECTIVES: We investigate the reporting of obesity on death certificates in three countries (France, Italy, and the United States) with different levels of prevalence, and we examine which causes are frequently associated with obesity. METHODS: We use cause-of-death data for all deaths at ages 50-89 in 2010-2011. Since obesity may not be the underlying cause (UC) of death, we compute age- and sex-standardized death rates considering all mentions of obesity (multiple causes or MC). We use cluster analyses to identify patterns of cause-of-death combinations. RESULTS: Obesity is selected as UC in no more than 20% of the deaths with a mention of obesity. Mortality levels, whether measured from the UC or the MC, are weakly related to levels of prevalence. Patterns of cause-of-death combinations are similar across the countries. In addition to strong links with cardiovascular diseases and diabetes, we identify several less familiar associations. CONCLUSIONS: Considering all mentions on the deaths certificates reduces the underestimation of obesity-related mortality based on the UC only. It also enables us to describe the various mortality patterns involving obesity.

After the epidemiologic transition: a reassessment of mortality from infectious diseases among over-65s in France and Italy.

OBJECTIVES: To assess more accurately the contribution of infectious diseases (IDs) to mortality at age 65+. METHODS: We use cause-of-death data for France and Italy in 2009. In addition to chapter I of the 10th International Classification of Diseases (ICD-10), our list of IDs includes numerous diseases classified in other chapters. We compute mortality rates considering all death certificate entries (underlying and contributing causes). RESULTS: Mortality rates at age 65+ based on our extended list are more than three times higher than rates based solely on ICD-10 chapter I. IDs are frequently contributing causes of death. In France, the share of deaths at age 65+ involving an ID as underlying cause increases from 2.1 to 7.3 % with the extended list, and to 20.8 % when contributing causes are also considered. For Italy, these percentages are 1.4, 4.2 and 18.7 %, respectively. CONCLUSIONS: Publicly available statistics underestimate the contribution of IDs to the over-65s' mortality. Old age is a risk factor for IDs, and these diseases are more difficult to treat at advanced ages. Health policies should develop targeted actions for that population.

Mortality from Alzheimer's disease, Parkinson's disease, and dementias in France and Italy: a comparison using the multiple cause-of-death approach.

OBJECTIVE: We perform an in-depth analysis of all death certificates collected in France and Italy with an entry of Parkinson's disease (PD), Alzheimer's disease (AD), or another dementia. METHOD: Data are for 2008. We measure how frequently these conditions are the underlying cause of death. We then examine what other causes are reported on the certificates. RESULTS: In both countries, AD is the underlying cause for about 6 in 10 certificates with an AD entry. The proportion is lower for PD and dementia, but higher in France than in Italy. Many contributing causes reflect the circumstances surrounding the end of life in AD, PD, and dementia, often characterized by bed confinement and frailty. DISCUSSION: Our research highlights several consequences of the conditions under study that could be targeted by public health policy. It also speaks to the existence of differences in diagnosis/certification practices that may explain differences in mortality levels.

Why do Italian people rate their health worse than French people do? An exploration of cross-country differentials of self-rated health.

The prevalence of bad self-rated health (SRH) varies considerably across countries. Here we present the results of a cross-national comparative study based on the data of National Health Surveys conducted in France and Italy. According to these data, 11% of the Italian and 6% of the French adult population aged between 45 and 74 rate their health as bad or very bad. This gap may result from differences in population structure regarding the individual characteristics (sociodemographic characteristics, diseases and disabilities, lifestyle, and others) that impact on SRH i.e., a structural effect. It may also be that the link between these characteristics and SRH is "country-specific" i.e., a contextual effect. We use logistic regression models to assess the contribution of both explanations. We find that the structural effect plays a prominent role in the higher prevalence of bad SRH in Italy compared to France.