Stagnation in mortality decline among elders in the Netherlands.

PURPOSE This study assesses whether the stagnation of old-age (80+) mortality decline observed in The Netherlands in the 1980s continued in the 1990s and determines which factors contributed to this stagnation. Emphasis is on the role of smoking. DESIGN AND METHODS Poisson regression analysis with linear splines was applied to total and cause-specific mortality data by age, year of death (1950-1999), and sex. An age-period-cohort analysis was carried out to determine whether the trends followed period or cohort patterns. ICD revisions were bridged by use of a concordance table. RESULTS A sudden reversal in old-age mortality decline occurred around 1980, leading to a stagnation of the decline and even increases in mortality thereafter. Smoking-related cancers, chronic obstructive pulmonary disease, and diseases specifically related to old age contributed to this stagnation. Trends in smoking-related cancers and chronic obstructive pulmonary disease showed a cohort pattern--especially for men. When these smoking-related diseases were excluded, the trends in old-age mortality in The Netherlands showed an increasing stagnation for both sexes. IMPLICATIONS Smoking behavior can only partly explain the stagnation of mortality. Other factors such as increased frailty and changes in medical and social services for elderly people probably played a more decisive role in the recent stagnation.