Cause-of-death contributions to declining mortality improvements and life expectancies using cause-specific scenarios

In recent years, improvements in all-cause mortality rates and life expectancies for males and females in England and Wales have slowed down. In this article, cause-specific mortality data for England and Wales from 2001 to 2018 are used to investigate the cause-specific contributions to the slowdown in improvements. Cause-specific death counts in England and Wales are modeled using negative binomial regression, and a breakpoint in the linear temporal trend in log mortality rates is investigated. Cause-specific scenarios are generated, where the post-breakpoint temporal trends for certain causes are reverted to pre-breakpoint rates and the effects of these changes on age-standardized mortality rates and period life expectancies are explored. These scenarios are used to quantify cause-specific contributions to the mortality improvement slowdown. Reductions in improvements at older ages in circulatory system diseases, as well as the worsening of mortality rates due to mental and behavioral illnesses and nervous system diseases, provide the greatest contributions to the reduction of improvements in age-standardized mortality rates and period life expectancies. Future period life expectancies scenarios are also generated, where cause-specific mortality rate trends are assumed to either persist or be reverted. In the majority of scenarios, the reversion of cause-specific mortality trends in a single cause of death results in the worsening of period life expectancies at birth and age 65 for both males and females. This work enhances the understanding of cause-specific contributions to the slowdown in all-cause mortality rate improvements from 2001 to 2018, while also providing insights into causes of death that are drivers of life expectancy improvements. The findings are of benefit to researchers, policymakers, and insurance professionals.