Key Drivers of Long-Term Rates of Mortality Improvements in the United States: Period, Cohort, and Cause of Death Analysis, 1959–2016

The main objective of this article is to identify significant mortality drivers in the U.S. population that have a high likelihood of being linked to the historical improvement or deterioration of mortality over the 1959 to 2016 period. To achieve this objective, we integrate cause of death modeling with epidemiological evidence to explain the underlying drivers. In particular, we analyze cause of death data for six broad groups of causes including circulatory diseases, neoplasms, respiratory diseases, digestive system diseases, external causes, and other causes. We also identify and analyze some key causes that serve as markers of trends in behavioral risk factors that could drive mortality change. These risk factors are AIDS and tuberculosis, alcohol abuse, dementia and Alzheimer’s disease, diabetes and obesity, drug dependency, homicide, hypertensive disease, self-harm, and smoking. We analyze these different groupings of causes of death using life expectancy decomposition techniques and formal age–period–cohort decomposition of both mortality rates and mortality improvement rates. We find that the story of mortality evolution in the United States in the second half of the 20th century, which continued into the first decade of the 21st century, has been mainly a story of mortality improvements from circulatory diseases. Nevertheless, despite the clear dominance of circulatory diseases as a leading cause of death and as the main contributor to mortality improvements between 1959 and 2016, the decline in mortality has been more complex. The trajectories of other major causes have ebbed and flowed, and the patterns of behavioral risk factors that contribute to overall mortality change have seen changes between generations.