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s.

If the

4
ived and

1ratio'.1as
boration.
Multiple Decrement Processes
inuously
easured

neasure
hat we

4.1 Multiple Decrement Tables for a Real Cohort

4.2 Multiple Decrement Life Tables for Periods
4.3 Some Basic Mathematics of Multiple Decrement Processes
4.4 Associated Single Decrement Tables from Period Data
1
4.5 Cause-specific Decomposition of Differences in Life Expectancies
4.6 Associated Single Decrement Tables from Current Status Data
e time
4.7 Stationary Populations with Multiple Sourcesof Decrement
' f some
as the
arried ln the previous chapter, we defined a single decrement process as one in which individuals
have only one mode of exit from a defined state. A multiple decrement process is one in which
individuals have more than one mode of exit. As we noted , multiple decrement processes are
far more common in demography than are single decrement processes. These situations arise,
for example , in fertility analysis when individuals are viewed as being exposed to the risk
of pregnancy and to discontinuance of use of contraception; in migration, when individuais
are exposed to the risk of moving to different places; in nuptiality, when married persons are
exposed to the risks of divorce and widowhood; and in many other circumstances. And as we
noted earlier, persons in a particular state in a real cohort are always exposed to the risk of death,
in addition to whatever other risks they may have of leaving that state. Multiple decrement
processes are sometimes referred to as situations of "competing risks ."

4.1 Multiple Decrement Tables for a Real Cohort

Conceptually, the construction of a multiple decrement table for a real cohort is no more chal-
lenging than the construction of a single decrement table. It is only necessary to add columns
equivalent to other columns in a single decrement life table but which pertain exclusively to
particular causes of decrement (i.e., to particular modes of exit from the table). The functions
in these columns have a straightforward interpretation :

,A~= numberof decrements from cause i in the age interval x to x +n

q_~ = probability of leaving the table from causei between ages x and x
11 + n for
someone who reached age x

= ,A~/tx
72 MULTIPLEDECREMENTPROCESSES

,i1n'.r= rate of decrement from causei in the age interval x to x +n

= "d~./11Lx
(~-= number of persons reaching age x who will eventually succumb to causei
00

= L11dt
a=x

The lx values in these formulas pertain to the number of cohort members who reach age
x, i.e., who have survived all causes of decrement before age x. Likewise, the 11Lxcolun1n
pertains to ali person-years lived between x and x + n by the cohort members who have
survived ali causes of decrement. Ali of the columns customarily found in a single decre-
ment table are also found in a multiple decrement table, where they refor to "ali causes of
decrement combined." Although we are using age x as the basic dimension of the multiple
decrement table for illustrative purposes, it is representing the more general dimension of
duration since entry into the state.
Note that we have not defined columns for 11L'.r, Tj, 11 at , ore~.. The reason is that et (for Figure
which the other columns are needed as input) does not admit to a straightforward interpretation. Janua
In one sense, it could be "the life expectancy at age x for persons who will succumb to cause
; ." But those who will !ater succumb to i cannot be identified at age x. They will only be
identi fiable at ]ater stages as the competing risks work themselves out. It is pointless to compute Also,
an expectation for unidentifiable people . A similar problem of interpretation arises in regard
toti., the number of persons aged x who will eventually exit from cause i. B ut this is a useful
column beca use it can be used to calculate ((. / lx, the proportion of persons aged x who will
eventually leave the table from causei. One of its major uses, for example, is to calculate the
probability that a marriage will end in a divorce. The base of this proportion is lx, ali persons
surviving to age x, and this number is indeed identifiable by age x. It is when (~ is made the
base of a probability or expectation that conceptual difficulties become intractable .
Added up over ali causes i, the decrements must sum to the total number leaving the defined The r
state: defin
Fil
Janu,
are t
colu
By our formulas for 11m~ and q_(., these
11
must also sum to the equivalent function in the life
table for ali causes combined:
4.2
Con
for 1

fro~
and Buv
dec,
int{
bas
tab
MULTIPLEDECREMENTPROCESSES 73

(M) 27.42
~(D) 1.22
usei
(M) 17.62
(D) 59.60
(D) 0.07
(M) 17.22
reach age (M) 22.47
x column (D) 16.41 (M) =Marriage; (D) = Death
who have (M) 23.47
gle decre- (M) 19.63
causes of 1 1 1 1 1 1 1 1

e multiple o 10 20 30 40 50 60 70 80
, ension of
Age in years - ~

at ei. (for Figure4.1 Life-lines in the single state for a hypothetical cohort of 1O births; date of birth,
pretation. January 1, 1800
to cause
1 only be
compute Also, since
in regard
a useful 00

who will ,~ = L "ctf"

a= x
ulate the
persons

defined
The relation in (4.1) simply says that ali of the survivors to age x in the cohort must Jeave the
defined state from one or another recognized cause of decrement above that age.
Figure 4.1 presents life-lines for a cohort of 10 individuais each of whom was born on
January 1, 1800. The state of interest is being single, i.e., never-married. Exits frorn the state
are to marriage and death, as indicated on the figure. The life Iines are converted into certain
columns of a multiple decrement Iife table in table 4.1.
the life

4.2 Multiple Decrement Life Tables for Periods

Constructing a multiple decrement table for real cohorts involves preparing a basic life table
for all causes of decrernent combined, and then adding the columns that pertain to decrements
frorn the individual causes. T his latter task is simply a matter of recording what has happened.
But very often the analy st wants to draw forth the irnplicatio ns of the intensities of a multiple
decrement process that are recorded during some specific period of time . Almost always, these
intensities will be represented by sets of decrernent rates from various causes, 11 So theMt.
basic problem is one of co nvert ing these observed rates into the probabilities of exiting the
table from various causes.
Table 4.1: Life table in the single statefor a hypothetical cohort of 10 births shown infigure 4.1
Age Number Number Number Number Probability Probability Probability Number Number Person-
remaining dying marrying leaving of dying of of leaving reaching reaching years
zn between between single state between marrying sing le state age x who age x who lived in
single ages x and ages x and between ages x and between between will will single state
state at x + n while x+n ages x and x +n while ages x and ages x and eventually eventually between
agex in single x+n in single x+n x+n die while in marry ages x and
state state single state x+n
X lx ndf nd1: ndx = ndf nqf nq1;1 nqx = nqf zD X
zM
X nLx
+nd1: +nq1;1
o 10 1 o 1 1/10 o 1/10 4 6 9.07
1 9 1 o 1 1/9 o 1/9 3 6 32.22
5 8 o o o o o o 2 6 40.00
10 8 1 3 4 1/8 3/8 4/8 2 6 70.88
20 4 o 3 3 o 3/4 3/4 1 3 23.36
30 1 o o o o o o 1 o 10.00
40 1 o o o o o o 1 o 10.00
50 1 1 o 1 1/1 o 1/1 1 o 9.60
60 o o o

< s:,,::, ... ? ~ ~ z "'

;:3
o. cr lo--'\
o::t' cr s 5- '-<
13'O8(1)...,.s:,,(l)X.....,i:,,.- (1) o 5- ;l i'j;" n ..., ::t' ;l "-
PJ::,o.-.~o z + ~ ~ ~
-. pj ;:r'
.t-< ~ 3 ~ '"O
;:, \
- ~ ,.... !:i 1J
S 3 nrD e 8 ~(D 3 :e ::, -;:s o
(1)...,
e: ;,-o; - ('t) (D
9".
8.
t:l
- _+ g :e 5-
00
;:s - (1) g. oo
<
(D _ 00 g l""'I" C/'.l
..,.
~
(1)
t:j")
'. 0
,,.. H
!:l >-t
(1)
""'t (")
(D
(1) " --
==ti"'l""'I"
~ e:;.
~ oo
- ...._\......_
_ ~ - ~ -~
- o.
-:.._rn__
MULTIPLEDECREMENTPROCESSES 75
ln order to make this conversion, refer back to the relation between rates of decrement and
probabilities of decrement for a cobort:

and

Note tbat, justas in the basic life table of chapter 3, the numerators of ,,in~. and 11q{ are the
same whereas the denominators of the former is II L x and of the latter, lx , So we can use the
relation between lx and II Lx derived in chapter 3 to devel_opa conversion formula. Substituting
(li Li
,
+ (n. - 11ax)11dx)/ n for lx in the expression for 11q~ gives :

(4.2)

This formula for 11q_\. is very similar to formula (3.1) for 11qx. The denominators are identical;
the only difference between the formulas is that (4.2) has ,,in~ in the numerator where (3.1)
has 11mx, The values of nx and 11mx in the denominator of (4.2) are not specific to causei but
are the values pertaining to all causes of decrement combined.
It is common to write the rate of decrement from causes other than i in the age interval x to
x +nas 11m; i. So 11mx = ,,m~ + ,,m;i. Inserting this relation in formula (4.2) gives:

i
n 11,nX
,,q,
i
= . . (4.3)
1 + (n. - nax)(llm'.r + 11111;')
Now the competing nature of the multiple decrements comes into full view. Holding constant
11
m~,the higher is ,,m_-;;in (4.3), the lower will be 11q{. ln other words, given a certain death
rate from cancer in the age interval 65-9, for example, the proportion of 65-year-olds who die
from cancer between ages 65 and 70 will be lower the higher are death rates from other causes.
The reason for this dependence is that, when 11111 ; ; is higher, more of the potential victims of
cancer will be carried off by other causes in the age interval. Because of this dependence, 11q_ \.
is commonly referred to as a "dependent probability."
Does this dependence mean that when the death rate from other causes declines the death
rate from cancer must rise? Not at all. This common confusion results from a mistaken view
that the rates of decrement are necessarily dependent on one another, that "people must die
of something, after all." But nothing requires that the rate of cancer death per person-year of
exposure be increased when other causes decline. What is clear is that the number of person-
years of exposure to the risk of cancer deaths will increase when other causes decline, so
that the number of cancer deaths will increase. Given the sarne number starting out an age
interval Ux), the number of deaths from cancer , and hence the probability of cancer death, will
be increased in the interval. The necessary relationship that governs the multiple decrement
process relates not to the rates but to the probabilities; ali persons starting life must die of
something, and if the probability of exiting from one cause declines, the probability of exiting
from some other cause(s) must increase.
76
Formula (4.2) for 11q_
MULTIPLEDECREMENTPROCESSES

(. will provide a straightforward way of_c?nverting 11 to 11q_tand

thereby completing the multiple decrement life table. However, 1t 1s unnecessanly tedious 1
.
implement. Note that, by dividing 11q_~- by 11qx, we get:
i i
o
m;r ---
BOX4.1
i
/lqX 11Glx 11,nx
-=- -
/lqX

So:
2. ,,di= 11

3, lXi=~ "'
a

Exampl
Once we have computed the life table for ali causes combined , we can simply take the 11qx
series from that table and apportion it to various causes of decrement according to their relative
rates of decrement, since the probabilities are in the same ratio as the rates, or the recorde<! Agex
decrements, themselves .
So the steps for constructing a period multi pie decrement life table are the following:
a) Compute a life table for ali causes of decrement combined. The basic ingredient in this o
1
table is
5
LO
15
20
the rate of decrement from ali causes combined in the age interval x to x + n . The usual 25
procedure consists of assuming for each cause that 11 M(. = 11m~, (which also implies 30
35
11Mx = 11111.x ), where II MI is the observed decrement rate from cause i between ages x
40
and x + n in the population. This must be converted to 11qx, as described in chapter 3.
45
b) Compute the probability of exit from causei in the age interval x to x +nas:
50
55
60
65
70
Note that if we have accepted 11
MI ,,1n~, then the relationship becomes: 75
80
85
Ali
where IIDi. is the observed number of decrements from cause i between ages x and x +n
Proport
in the population and II Dx is the observed number of decrements from ali causes combined
deat
in the interval. Propor
c) Compute the number of decrements from causei in the age interval x to x + n as :
Data so

d) Compute the number of persons aged x* who will eventually Jeave the table from
Box
cause i as:
1991,
CX)
of inte
t~. = I: ndi
x= x*
. and al
(21,2
MULTIPLEDECREMENTPROCESSES 77
r--
i
nqx and
edious to
- BOX4.1 Multpl e Decrement Lif e Table
. ,,D,(
1. li q:.

==,,qx D
li X

. ; I
2. ,,d:.
==llqX ' X
00

3. ,~ ==1=,,dt
a=X

Example:US, females, 1991. Cause i = death from neoplasms,lx = "master" US

the 11qx life table for 1991, females, for ali causescombined
relative
ecorded Agex 11Dx
,,D_( fx ,,qx ,,q_(. ,,d~ ,;.
All deaths Deathsfrom
neop/asms
ng:
o 15,758 63 100,000 0.00783 0.00003 3 21,205
-, t in this
1 3,169 275 99,217 0.00168 0.00015 14 2 1,20 1
5 1,634 268 99,050 0.00092 0.00015 15 2 1,187
10 1,573 217 98,959 0.00090 0.000 12 12 21,172
15 3,955 318 98,870 0.00236 0.00019 19 21,160
20 4,948 467 98,637 0.00262 0.00025 24 2 1, 14 1
e usual 25 6,491 856 98,379 0.00314 0.00041 41 2 1,117
implies 30 9,428 1,924 98,070 0.00425 0.00087 85 21,076
35 12,027 3,532 97,653 0.00584 0.00171 167 20,991
ages x
40 15,543 5,958 97,083 0.00818 0.00314 304 20,823
r 3.
45 19,264 8,434 96,289 0.01330 0.00582 56 1 20,5 19
50 25,384 11,673 95,008 0.02095 0.00963 915 19,958
' 55 37,211 17,078 93,018 0.03371 0.01547 1,439 19,043
60 59,43 1 25,263 89,882 0.05155 0.02191 1,969 17,604
65 88,087 33,534 85,249 0.07669 0.02920 2,489 15,634
70 114,693 36,695 78 ,711 0.11552 0.03696 2,909 13, 145
75 143,554 36,571 69,6 18 0.17427 0.04439 3,091 10,236
80 164,986 30,220 57,486 0.27363 0.05012 2,88 1 7, 146
85 320,578 32,739 41,756 1.00000 0.10212 4,264 4,264
Ali 1,047,714 246,085 21,205
x+n
bined Proportion offemale newborns that will eventually die from neoplasms under the US age-cause-specific
death rates of 1991: 21, 205/100, 000 = 21.2%
Proportion offema les who survive to age 75 that will die from neoplasm s: 10, 236/69, 618 = 14.7%
Data source: National Center for Healt h Statistics, 1996.

from
Box 4.1 presents several co lumn s for a multipl e de creme nt life tabl e for US fema les in
1991, using the lx and 11qx co lumn s for the "master" life tab le in the US in 19 9 1. The sta te
of interest is being alive and decrements from th at sta te are attribut ed to neop la sms (cancer)
and ali other ca us es of deat h. The chance that a newborn would die from neoplasms is 0 .2 12
(21,205 /100 ,000).
78

4.3
MULTIPLEDECREMENTPROCESSES

Some Basic Mathematics of Multiple Decrement Processes

Recall that in chapter 3 we defined the force of mortality as:
--
than r
pertai
0 utco
slipp<
( x ) = lim 11mx
ofde
11---+
cause
We can corre spondingly define the force of decrement from causei as: That
relati
i (x) = lim
11---+
11m'.r for e
raise
The force of decrement from cause i at age x is simp ly the rate at which persons are leaving
this 1
the defined state from causei in the tiny interval of age from x to x + dx. It is an annua lized a set
rate because its units are number of events (i.e., decrements) per person-year of exposure.
sepa
Since, with k causes of decrement, o
l 2 k in te
11,nx + 11,nx + + ,i'nx = 11mx, }( ;
as we take the limit of both side s as n approache s zero we must have exat

where (x) is the "force of decrement from all causes combined ." The force of decrement
functions from various causes are additive and their sum equa ls the force of decrement from
ali causes combined as long as we define the set of decrements to be mutually exclusive and ln a
exhaustive (i.e., we haven't left any out and we haven't counted any decrements twice). io
We asserted in chapter 3 that one of the rnost irnportant relations in dernography is:
x+ n
11/Jx =e - J-' ,(y )d y

ln a multi pie decrernent process we can express (y) as the sum of i (y ) o ver all i, so that:

-
=ex,) J-'+" 1( 1)d Y , e - J-'+"
x 2 ( 1)d
,)> 1
.. ... e- J-'
x +11k(
,y )d >1

or,

11/Jx
* l 11/Jx
= 11Px * 2 11/Jx
* k
where

* pi
li X
= e - f_;r + 11,'( y )dy (4.4)
T
is the probability of rernaining in the defined state during the interval x to x + n if only in
decrement i were operating . t
Equation (4.4) says that the probability of remaining in the defined state between x and
x + n when many causes are operating (i.e. the probability of surviving all decrements) is the fr
product of each of the probabilities of remaining in that state if individual decrements were b
acting alone. The analogy to coin-tossing is obvious. If we define an event as tossing a head,
then the probability that no event will occur in three tosses is the product of the probabilities o
MULTIPLEDECREMENTPROCESSES 79
than 110 head will appear on each of the three tosses: 0.5 0 .5 0 .5. This multiplicative property
ertains only when the outcomes of the three tosses are statistically independent: when one
~utcome does not depend on the others . Clearly, the assumption of independence has also
slipped into our derivation of (4.4) . 1~entered at the point whe_rewe defined members of the set
of decrements to be mutually exclu sive and exhaustlve . That 1s, the proce ss of assignment of a
cause to each particular decrement created a set of wholly separate and "independent" entities.
That these stati stical entities are independent - admit no overlap or combinations or synergistic
relations - does not mean that the underlying processes that they represent are independent.
for example, it is very likely that an increase in the incidence of influenza in a population will
raise death rates from certain cardiovascular diseases as well as from influenza. But whatever
are leaving this synergistic relation among disease processes, the data will always come to the analyst in
annualizect a set of cause-of -death assignments in which influenza and cardiovascular diseases are tidily
posure. separated; equation (4.4) will continue to hold .
Other functions in the life table from ali decrements combined can be sirnilarly expressed
in terms of the various force of decrement functions by substituting , 1(x ) + ,2 (x) + +
/ (x) for ,(x) in the corresponding continuous notation formula (see appendix 3.1). For
1
example:

decrement
eg = f 00

e- l' ,(a) da dx = f
00

e- l'[,1(a)+, 2(a )+ +, k(a)] da dx

ment from
o o
lusive and ln addition, functions from single decrement i can be derived by noting that deaths from cause
ice). i over a small age interval da are l(a),; (a) da. Then:
is:

11
qx
;
=
d~
11

l( x ) =
fx+11
x 1
l(a), (a)da
l(x)
f
x+11
e- J;',( y)d y ,i(a)da

X
, so that:
x+11

f
X
e- f " [,I (y)+, 2(y)+ + ,k(y )] dy
x ,i ( a ) e.a
[

11(, X li f Xx+n e - J" ,(y)dy fl,i ( (/ ) Gl (l

X
i
11/11.
X
nLx j / +n e-f;' ,(y)dy da

f x+n e - J"[,l(y)+11, 2(y)++,k(y)]d y ,i( a ) GC/

X X
l
J;-+11 e- l ," [,l(y)+,2(y)+ ..+, k(y)]d y da

(4.4)
qt
The formula for 11 shows again why the probability of succumbing to causei in a discrete age
if only interval depends upon the value of other decrements; the higher is any other force of decrement,
the lower will be 11 q_~.
x and The formula for ,,1n'.r shows that its value is also "dependent" on the force of decrement
) is the from causes other than i. However, the direction of this dependence is not predictable, since
ts were both numerator and denominator include these terms.
a head, ln a cohort, the age composition of person-years lived in the age interval x to x+n will depend
bilities only on the l (a) function in that interval, i.e. on ,1(a)+, 2 (a) + ...+ ,k (a)for x ::ea ::ex +n.
80 MULTIPLEDECREMENTPROCESSES

For a populatio11 ata moment intime, the age composition, N(a), depends not only 011those compa
force of decreme11t fu11ctions but also 011the preexisting age composition of the population.
So the mortality rate from decrement i between age x and x + n observed i11the population
11 Mi.,
will be: '

x+11
J:"+
11
N (a) i (a) da
( ) i
fxx+11 Nac,,ci
J c(a)i(a)da (4.5)
X

where c(a) is the proportion of the populatio11 aged a to a + da within the age group x to
x + n. As i11the case of the basic life table, it 11eed11otbe the case that II M_;.
in a population
equal li nlX in a cohort with the same force of decreme11t functions from i a11d.
-i. But, as in
m~
the case of the basic life table, it is common to assume that the life table 11 i11a population
equal 11 Miin the populatio11 (for an exception, see Preston, Keyfitz, and Schoen, 1972).
can11
isim
4.4 Associated Single Decrement Tables from Period Data to ge
Associated with each decrement i in a multiple decreme11t process is a force of decrement de0n
function, i (x). Very ofte11the analyst is interested i11knowing what a life table would look
like if only that cause of decrement were operati11g to diminish a cohort. The life table that *li
results from aski11gthis question is called an associated single decrement life table (ASDT).
The decrement we are i11terested in may equally well be -i (ali decrements other than i). If
a table is constructed based on - i (x), it is sometimes called a "cause-deleted" table, since ln g1
cause i has been arbitrarily deleted from the set of multiple decrements. Such a table would wha
still be considered an associated single decrement table since cause - i can be co11sidered one age~
of two decrements - along with i - in a multiple decrement process. singi
Almost always, the activity of a particular decrement i will be observed as it works itself out diffi
within a multiple decrement process. Normally, we don't observe directly associated single pro<
decrement processes: processes in which one decreme11t alone is operating. The construction dec:
of an associated single decrement table therefore involves a thought experiment in which we nM
ask "what would happen if . . . " ln an associated single decrement table for a period, this witl
feature involves an additional layer of hypothesizing beyond that involved in constructing a 1
hypothetical cohort. (
We denote ali functions of an associated single decrement table with a"*" as a superscript on ana
the left. lt is easy to specify what the functions in an associated single decrement table should 11

be in tenns of i (x). They are the sarne functions defined for the basic life table in chapter hm
3. The formulas of appendix 3.1 can readily be adapted for these functions, by replacing sar
(x) by i(x). Equation (4.4) expresses the formula for i/J'.pthe probability of surviving as
from age x to x + n in an associated single decrement life table where cause i is the only
decrement.
It is not necessary to repeat ali these formulae but it might be useful to review the three an
types of functions encountered so far. Functions involving ali decrements combined are
obtained by computing both survivors and deaths with (x) = 1(x) + ... + k (x). Sim-
ilarly, associated single decrement functions are obtained by computing both survivors and
1
deaths with (x) alone. Functions referring to one of the decrements in a multiple decre-
ment life table have a "mixed" structure since survivors to any age must be computed with TI
the (x) functions whereas deaths from causei must be computed using i (x). For example,
MULTIPLEDECREMENTPROCESSES 81
1ly on those compare:
population.
population,
11d x =l(x) f x +n
e- f,'.',(y)dy,(a)da
X

zi f
x+n
(4.5) ~d.[. =* (x ) e- J:' ,\ y) dy ,i (a) ela
X

group x to
population
. But, as in
,A'.
-=l(x) f x+ n
e - f ;' ,(y)dy /(a)da
X
population
972). Although we can readily define associated single decrement functions in terms of ,i (x ), we
cannot directly observe ,i (x). We can observe ,,in'.r in a cohort (or II M_
/. in a population). But it
is important to note that the value of II M~ we observe when multiple decrements are operating
to generate the observation would not typically be the sarne value we would observe if only
. decrement decrement i were operating. We observe ,,in'.r in a cohort but we need ~m~ for the ASDT:
ould Iook
r table that
1;+11
e - J:',(y) dy ,i (a) da
whereas
e (ASDT). J/+ e - f,'.' ,(y)dy da
11

than i) . If
ble, since In general, the rate of decrernent frorn ,i (x) if i were the only decrement (~m~) differs from
ble would what it would be if i were working in the presence of other decrements (11m'.r). Since at ali
dered one ages ,(a) > ,1 (a), the age-distribution of person-years lived in the interval is older when a
single decrernent is operating than when rnultiple decrernents are operating . This weighting
s itself out differential raises im~ relative to ,,in~ if ,i (x) is rising in the interval. If we use conventional
ted single procedures , we will already have accepted the II M_ t function to estimate 11m'.rin the rnultiple
1struction decrement table . How can we then tum around and say that we want to reproduce that sarne
hich we Mi
11
function in the associated single decrement table to estimate ~m'.r ? But if we don't start
riod, this with 11M.~, where do we begin?
tructing a There are severa! solutions to this dilemma, none of thern completely satisfactory:
(a) Ignore the disparity between ~ m~. anel 11111~. The disparity is produced by a process exactly
script on analogous to the age distributional disturbances that can produce a disparity between 11mx and
Ie should 11Mx even when the force of mortality functions are the sarne in a cohort as in a population. We
1 chapter have generally ignored this Iatter disp arity in producing a basic Iife table, so we might do the
eplacing sarne in moving frorn a multiple decrement table to an ASDT. ln this case we would proceed
urviving as in chapter 3 for the basic life table . The 11mx -+ 11qx conversion would be:
the only

he three
anel
ned are
). Sim-
ors and
e decre-
1
ed with The remaining problern of life table construction is then to adopt a set of values, a prob- ~at
. xample, Iem which could be solved by procedures similar to those outlined in chapter 3. Graduation
82 MULTIPLEDECREMENTPROCESSES

procedures become relatively more attractive since "borrowing"

populations is difficult (practically none are published) and hazardou s.
ii'.r
functions from other
~
simplyl
Procedure (a) risks committing relatively large errors in some circumstances. ln cause- combi
of-death life tables at high ages (say, above 65), mortality is high from many causes and is
rising rapidly with age. The changes in age structure induced through the thought experiment
performed in producing an ASDT can be relatively large if the causes deleted have high
death rates. So fairly substantial changes can be induced in the death rates from remaining
causes. Soma
However, when the causes deleted in the ASDT are relatively minor, this approach shoulct
work quite well because the age structural changes induced by the deletion within 5-year-wide
intervals could not be very large.
(b) A seco nd solution is to make the assumption that the force of decrement function for i
is constant at some value y in the interval x to x + n. By substituting y for the .i (x) function This il
iim'.r m~
in the expressions for .
and 11 we find that and 11 iim'.r m~
are both also equal to y. So in
Howel
,1n'.riim'.r Mi..
this case, 1 = = 11 If the force of mortality function is constant with age in the to the
interval, then the rate of decrement is undisturbed by any age distributional changes induced probl
by deleting a cause. Also, if the force of mortality function is constant in the age interval at this a
11m~., then: mom ,
x+ n ; . all ca
* i = e- JX ,,mx d:\ = e-11,1M.~ of .i
11Px
*tix - *t x+n
i a low
*L i must
li X
11M.~ Th
and the rest of the table can be readily completed. succe
This procedure is logically consistent and simple to apply. When the assumption is tenable, it simil
is the preferred approach. But the assumption is rarely very satisfactory unless the age interval ofde
is small. the s
(c) A third approach is proposed by Chiang ( 1968). Assume that the force of decrement func-
tion from cause i is proportional to the force of decrement function from ali causes combined
in the age interval x to x + n :

i (a) = Ri (a) for x ::: a ::: x + n,

Noi
where Ri is the constant of proportionality for decrement i in the interval. This assumption, of kno
course, means that ; (a)and - i (a) have exactly the same shape between ages x and x + n, A
although their leveis will generally differ. Since, by assumption, iix
r+n . j'+n . fro
*pi _ e -
li X -
J; '(a)da _ e-
-
_; R'(a)da
dyi

then

:,p~= e-R' . j'_;-+" (a)da = [ e- _; (a)da J/?'

J'+"
to c
inte
So in this case, the nPx function in the ASDT bears a simple relation to the II Px function in
the "parent" life table for ali causes combined. It is equal to the 11Px in the parent life table
raised to the power Ri.
MULTIPLEDECREMENTPROCESSES 83
rn other furthermore, by the assumption of proportionality, the value of Ri in the interval will
simply equal the ratio of the observed decrements from cause i to the decrernents for ali causes
, cause- combined:
and is
eriment ,,Dl = D+n
N(a)Ri (a) da = Ri
11
e high 11Dx J/+ N(a)(a) da
,1aining
So making this substitution for Ri gives:
should
r-wide
* i ("I)
11Dx
11Px = 11/Jx
n for i
1 nction This ingenious device solves the 11mx - 11q x conversion problem in producing the ASDT.
. So in However, it does not tel1 us what value of *11m'.rshould be used in the life table or, what amounts
in the to the same thing, what value of ~at should be used . Nor is there any obvious solution to this
duced problem. ln the official US cause-of-death life tables of 1959-61 (NCHS, 1968), which used 1
vai at this approach, the values of ~-~-were set equal for ali i to 11ax in the parent life table. But a ~ 1

moment's thought suggests that , with the sarne shape of the force of mortality functions as for
1
ali causes combined, a life table that reflects the operation of a decrement with higher values
of i (a) in the interval will have a younger age distribution of person-years lived and hence
a Jower value of 11ax. ln fact, by the Chiang assumption, the 11ax value in the parent life table
must fall short of the~-~ values for ali i.
The most satisfactory approach to estimating ~-~
is probably to graduate the ~q-~ function in 1
successive intervals and infer the value of ~-~
from the general conformation of this schedule,
le, it similar to an approach suggested for ali causes (section 3.2.2). If we assume that the distribution
erva! of deaths frorn cause i follows a quadratic function over the age interval x - 5 to x + 10, then
the simple graduation formula for data tabulated in 5-year age or duration interval s is :
unc- 5 . . 5
245 x - 5 + 2.S*d + -*d'
1
1 ined --*d' 5 x 245 x+5
(4.6)
* di
5 X

No iteration is required in this case because the ~di

function is directly calculable without
, of knowing ;a~.
n, An approach that is adaptable to interval s of irregular length is to approximate the value of
iax by interpolation between two extreme situations. The first one is when there are no deaths
from cause i in that age interval. The average number of years lived in the interval by those
dying from cause i, ~-~, is then undetermined, but clearly the number of years lived in the
interval by those alive at the beginning of the interval must be n. The other extreme situation
is when all deaths in the age interval are from causei. Then, the average number of years lived
in the interval by those alive at the beginning of the interval must be the sarne in the ASDT
and in the parent life table . Since Ri represents the proportion of deaths in the age interval due
to cause i, the two extreme situations correspond to Ri = O and Ri = 1 respectively. ln the
intermediate cases, we can interpolate between these extremes:
in
le ~Lt
-.-= n- Ri ( n--- 11Lx) (4.7)
*[1 (x) l(x)
84 MULTIPLEDECREMENTPROCESSES

ln both the ASDT and the parent life table the following relationship must hold:

11Lx
-- = n 11Px + 11Gx ,1qx
l(x)

(4.8)
*
li

This equation can also be derived through a Taylor expansion. *

Which of the general approaches to constructing an ASDT should be used in any particular
application obviously depends upon the nature ofthe data and tenability of assumptions. Elandt-
Johnson and Johnson (1980) have compared several of these approaches and concluded that
results are not very sensitive to the procedure used, as should have been anticipated on the
basis of the discussion in chapter 3. If the interval n is short, approach (b) is best since it
is completely consistent and fully developed. If one is constructing cause-deleted tables in
which relatively small causes of decrement are deleted, then approach (c) is best because the
assumption of proportionality rnust be very good (the decrements that remain are a very high A
proportion of total decrements to which they are assurned proportional). ln other situations,
convenience may dictate the approach selected.
Box 4.2 presents an associated single decrernent table for causes of deaths other than neo-
plasms. lt is based upon the data for US females in 1991 that were presented in box 4.1. The
table is constructed by Chiang's method (approach c), with the ~a;i values developed by
graduation (equation 4.6) for x = 10 to 75, and using equation (4.8) for x = O, 1, 5, and 80.
For the last age group, we use here the assumption that ~m~ = 11m~, in which case ~a 8j is
simply e R - i. ln chapter 7, we will investigate how to obtain a better estirnate of ~a;;-d.
85/
The table shows that, in absence of neoplasms, life expectancy at birth would have been 82.46
years, a gain of 3.54 years relative to the life table with all causes present.

4.5 Cause-specific Decomposition of Differences in Life Expectancies

ln section 3.1 O,we presented a rnethod for estimating the contribution of age-specific mortality
differences to differences between two life expectancies. This method can be easily extended
to estimate the contribution of differences in cause-specific death rates by assuming that the
distribution of deaths by cause is constant within each age group in each population. Under this
assumption, the contribution of differences in all-cause mortality in a specific age group can be
distributed proportionately to the difference in cause-specific mortality in the corresponding
age group (Arriaga, 1989). The specific contribution of differences in mortality rates from
causei between ages x and x + n , 11L\~ , can be estimated with the following equation:

Ai - A ,i'n~(2) - nmi(l)
11'-"x-11'-"x'
' nlnx (2) - 11mx (1)

= nllx. 11 R~(2) 11mx(2) - 11R~(l) nmx(l)

(4.9)
nlnx(2) - nmx(l)
BoX 4.2 Associated Single Decrement Lif e Table for Causes of Death other than
Neoplasms (via approac h e)

Dx-11D .\.
R- i = 11

11Dx
lx, 11px , 11ctx, e~= functions in the master life table
(4.8)
* - i -- [11P.,-l -i
,,Px
1- i _ 1-i . * p-i
x+n - x n x
cular
* 1-i . calculated from equation (4.8) for x = O, 1, 5, 80
andt- x
from equation (4.6) for x = 10 to 75
that
the . e
* -i -* - 1 _ __2.
ce it ,x,a85 - eg5 - R- i
es in
Example: US, females, 1991; causei = neoplasms
e the
high R- i * - i r; i * *ex- i
ions,
Agex lx 11/Jx 11Clx e~ 11/Jx 11 x-i
o 0.99600 100,000 0.99217 0.152 78.92 0.99220 100,000 0.152 82.46
neo- l 0.91322 99,217 0.99832 1.605 78.54 0.99846 99,220 1.605 82.10
5 0.83599 99,050 0.99908 2.275 74.67 0.99923 99,068 2.275 78.23
The
10 0.86205 98,959 0.99910 2.843 69.74 0.99922 98,992 2.875 73.29
d by
15 0.91960 98,870 0.99764 2.657 64.80 0.99783 98,915 2.653 68.34
80. 20 0.9056 2 98,637 0.99738 2.547 59.95 0.99763 98,700 2.548 63.48
25 0.86813 98,379 0.99686 2.550 55.10 0.99727 98,467 2.577 58.63
' 30 0.79593 98,070 0.99575 2.616 50.26 0.99661 98,198 2.585 53.78
35 0.7063 3 97,653 0.99416 2.677 45.46 0.99587 97,866 2.582 48.96
40 0.61668 97,083 0.99182 2.685 40.72 0.99495 97,462 2.637 44. 15
45 0.56219 96,289 0.98670 2.681 36.03 0.99250 96,969 2.672 39.36
50 0.54014 95,008 0.97905 2.655 31.48 0.98863 96,242 2.695 34.64
55 0.54105 93,0 18 0.96629 2.647 27.10 0.98162 95,148 2.703 30.00
60 0.5749 2 89,882 0.94845 2.646 22.95 0.97003 93,399 2.695 25.5 1
lity 65 0.61931 85,249 0.92331 2.63 1 19.05 0.95 178 90,600 2.696 21.22
ded 70 0.68006 78,711 0.88448 2.628 15.42 0.91991 86,23 1 2.686 17.16
the 75 0.74525 69 ,618 0.82573 2.618 12.09 0.86701 79,325 2.676 13.42
this 80 0.81683 57,486 0.72637 2.570 9.08 0.770 17 68,776 2.637 10.07
be 85 0.89788 41,756 0.00000 6.539 6.54 0.00000 52,969 7.283 7.28
ing
om Probability of surviving to age 85 for all causes combined: 0.42
Probability of surviv ing to age 85 in the absence of neoplasms: 0.53
Life expectancy at birth for all cause combined: 78.92 years.
Life expectancy at birth in the absence of neopla sms: 82.46 years.
Datasource: National Center for Hea lth Statistics, 1996 .

. .9)
86
where

11R~. (j) = proportion

MULTIPLEDECREMENTPROCESSES

of deaths from causei in age group x to x + n (,,D.~/11Dx) in population

j (or at time j), and
--
eox 4.3
11/').x = contribution of ali-cause mortality differences in age group x to x + n to differences
in life expectancies, as expressed in equation (3.11)
R',._()),,
li .
lt can be easily shown that

11 = :::
/').x 11/').'.r, and eg(2)-eg(l) = L11/'),_x
= LL11/').~. 11 D.x ==(
X X

The age- and cause-specitic contribution to differences in life expectancies can thus be pre. A -
nx-11
sented in a two-by-two table where the elementary contributions add up to the total difference in
life expectancies. Box 4 .3 presents an application of the age and cause decomposition method
to analyzing the difference in male life expectancies at birth between China and lndia in 1990.
It shows that about 68 percent of the 8.2 additional years of life expectancy at birth in China Age x
is attributable to lower rates of communicable diseases below age 5 in this country. However,
0
the total difference in e is reduced by about one year dueto lower rates of noncommunicable
diseases in India in 1990. o o.
5 o
4.6 Associated Single Decrement Tables from Current Status Data
15 o
30 o
We noted in chapter 3 that a restricted associated single decrement process can be directly 45 o
observed when cohorts are asked about their event histories. Since the members of the cohort 60
70
'
who respond in the survey have clearly had a force of mortality function of zero , we need
not view them as subject to a multi pie decrement process. Therefore , it is possible to proceed Sum
directly to the construction of an ASDT for the proce ss under investigation. The only restriction 111this
on the kind of functions that can be displayed will result from limitations in the data. For Cause l
example, a question might be asked on "what was your marital status tive years ago," rather Cause 2
than the more complex set of questions needed to construct a complete marital history. From Cause 3
the 5-year question, it will be possible to estimate; P.r:1 , the probability that a person who was Total I
aged x tive years earlier (i.e . who is aged x + 5 at the time of survey) will have remained single
to the time of the survey. But no information will be available on ;a:-1. It should be reiterated Datas
that tables constructed from such data will pertain only to the surviving members of the cohort Mortal
who did not emigrate. Their force of decrement function may differ from that of the original Univer
members of the cohort.
Such applications require retrospective que stions. John Hajnal (1953) was apparently the
first to recognize that certain ASDT's could also be constructed from current status data.
wher
ln particular, he proposed that an associated single decrement table for first marriages be
force
constructed from data on the current marital status of the population, without any resort to
devei
retrospective questions. ln our example, the proportion never-married at age x, which can be
cum
obtained by question on current status in a survey, is closely related to the lx column of the
birth cohort's ASDT. Under the assumption that there is no differential mortality or migration
by first-marriage status, the lx column of the cohort 's ASDT (with a radix of one) will exactly
equal the proportion single at age x.
To see this more formally, let us assume the population to be closed to migration. Then the
force of decrement from ali causes combined for the single population at age x will be:
s(x) = D s(x ) + M (x), whe
MULTIPLEDECREMENTPROCESSES
87

population eox4.3 Age and Cause Decomposition of Difference in Life Expectancies at Birth

ifferences ,,mxO), ,,rnx(2) = ali-cause mortality rate between ages x and x + n at time l and time 2
(or in population 1 and 2)
,,Ri (l) , ,,Ri. (2) = proportion
\'" .\
of deaths from cause i between ages x and x + n at time L and time 2
(or in population 1 and 2)

11
D.x = contribution of ali-cause mortality differences in age group x to x + n to differences in eg
(from equation 3.11)

s be pre- . 11 R(.(2) 11111,r(2)

- 11 Ri.(1) umx(l)
etence in n
1:;.'
'
. = ,,D..i:. 1111lx
(2) - 11Jnx
(])

1 methocl
Example: lndia and China, males, 1990*
in 1990.
n China Agex bulia China
owever,
micable
,,R_; ,,R~ 11/11.x ,,R). "R -~ IIR.~

o 0.0267 0.882 0.073 0.046 0.0084 0.677 0.174 0.149 5.6 5.5 0.1 -O.O
5 0.0025 0.504 0.188 0.309 0.0009 0.174 0.337 0.488 0.8 0.6 0.1 0.2
15 0.0021 0.382 0.223 0.394 0.0015 0.068 0.380 0.552 0.3 0.4 -0.1 - O.O
30 0.0043 0.429 0.315 0.257 0.0028 0.101 0.573 0.326 0.6 0.6 - 0.1 O.l
tlirectly 45 0.0139 0.304 0.592 0.104 0.0102 0.095 0.796 0.109 0.8 0.7 O.O 0.1
cohort 60 0.0388 0.248 0.722 0.030 0.0342 0.070 0.879 0.051 0.3 0.5 - 0.J -O.O
e neecl 70 0.0929 0.247 0.728 0.025 0.1003 0.084 0.877 0.039 - 0.3 0.7 - 0.9 - 0.1
roceecl Sum 8.2 9.0 -LO 0.2
riction
*ln this example:
a. For Cause 1 = Communicable diseases , maternal , perinatal and nutritional conditions;
rather Cause 2 = Noncommunicable diseases;
From Cause 3 = Injuries.
o was 70 3
ingle Total Difference = e0(China) 0
- e (India) = 66.5 - 58.3 = 8.2 years= L L ,,!).,.
.r= i = I
rateei
Data source: Murray , C. J. and A. D. Lopez, 1996. The Global Burden of Disease: A Comprehensive Assess111e11/ of
ohort Mortality a11dDisability from Diseases, l11.j11ries
, a11dRisk Factors i111990 a11dProjected to 2020. Bo ston , Harvard
ginal University, School of Public Health.

the
tiata.
where ,Ds (x) is the force of mortality at age x for the single population and ,M (x) is the
\s be
t to force of first marriage (defined of course only for the never-married population). By relations
be clevelopecl above, the number of single persons in a cohort at age x, S(x ), will be found by
the cumulating the forces of decrement:
ion
tly
S(x) = S(O). xPo = S(O) . e- f' 1-L
'(a) da

he = S(O). e- f 0'[1-L' (a)+fLM(a)]da

where S(O) is the number who were single in the cohort at birth.
88 MULTIPLEDECREMENTPROCESSES

The total population aged x in the cohort, N(x), can be similarly derived as: The p
succe
' /JT
N(x) = N(O)e - , (a)da each a

where ,DT (a) is the force of mortality functio11 for the total populatio11 at age a. Now form
the ratio of the si11gleto the total populatio11 at age x :

S(O). e - f' [,D" (a)+,M(a)]da This

S(x ) excep
N(x) N(O) . e - f' ,DT(a)da propo
= e- f' [,M(a)+(,Ds( a ) - ,DT(a))]da
(4.10)

since S(O) = N(O). This expression i11cludes a term in [,Ds(a) - ,DT(a) ], the difference He tt
between the force of mortality functio11s for the single a11dtotal populatio11s. If we assume that age
this differe11ce is zero at all ages - there is 110differe11tial mortality by marital status - then:

S(x) _ -J('O ,M(a)da _ * M

-- -e - x Po (4.11)
N(x)
Tho
si11g
where ; pf/ is the probability of remai11i11gin the si11gle state between ages O and x in the
mea
cohort's ASDT, based 011the force of first marriage alone. So we see a very simple co1111ection
Box
between an observed proportion si11glefor a cohort at age x, S(x)/N( x ), a11dthe ASDT for IT
that cohort.
who
If the assumptio11 of 110differential mortality by marital status is wro11g,then S(x) / N (x) is
assu
biased as a11estimator of the cohort's ; pf/. Suppose that the death rate for the si11glepopulation
or n
exceeds that of the total populatio11 at some or all ages. The11S(x) / N (x) will be biased as an
SM
estimate of; pf/ by the factor:
onl)
i1111
A
exa
Am
usi1
The proportion si11gleat x will underestimate the probability of remaini11g single in the cohort pro
ASDT because single perso11s have higher mortality; a smaller fractio11 of them will have
survived to report their marital status in the survey . Nevertheless, S(x)/ N(x) is a11unbiased
estimate of; pf/ for the cohort members who survived.
A single-round survey asking about curre11tmarital status thus yields 011epiece of information av
about the ASDT for each cohort i11terviewed. But suppose we can assume that the force of
nuptiality has been constant over time. Then each cohort would trace out the same history as 4.
every other cohort and features of that history could be i11ferredby comparisons across cohorts.
This is the logic ofHajnal's procedure . ln
Hajnal's method is typically applied in 5-year age i11tervals. Define the proportio11 si11gle th
(i.e., never married) at ages x to x+5 as: m
a
as
m
MULTIPLE DECREMENTPROCESSES 89
The person-years lived in the single state below age 50 could then be estimated by adding up
successive values of 5Dx and multiplying by 5, the number of years the cohort will spend in
each age interval:
45
fonn pyS (0, 50) =5 L 5Dx
x=0,5
This value could serve as an estimate of the mean age at marriage for the hypothetical cohort
except that not ali members of the cohort will have married by age 50. Hajnal estimates the
proportion who will not marry by age 50 as:

4.10) l
D(50) = 2 (5CT45 + 5CT50)
rence He then calculates the mean age at marriage over the base of those who do in fact marry by
e that age 50:
en:
"45
SMAM = 5 ~x=o, 5 5 Dx - 50 D (50)
- .11) 1 - D(50)
Those not marrying are excluded from the denominator and their person-years lived in the
single state below age 50 are excluded from the numerator. SMAM is called "the singulate
the
mean age at marriage, " because it refers only to marriage occurring to the single population .
tion
Box 4.4 illustrates the computation of SMAM for Turkish males in 1990.
for
The value of SMAM is the mean age at first marriage for a cohort of women (or men)
who marry by age 50. Its computation from current-status data in a single census or survey
) is
assumes that first marriage rates have been constant over time and that differences in mortality
tion
or migration rates by marital status are negligible . If rates have been changing , the value of
an
SMAM is a hodge-podge of rates in the recent and distant past. Nevertheless, because it requires
only a census tabulation of marital status by age, it is the only rneasure of marriage age available
in many historie populations .
Although we have illustrated the concept of deriving ASDTs from current-status data with
examples drawn from first marriage , the procedure can be applied to a wide range of processes.
Among these are the process of becoming a mother, of moving from place of birth, of ever
using contraception, of becoming sterilized, entering school, entering the work force, and other
processes. The proportion of a cohort who have remained in a state is clearly a product of its
cumulative rates of leaving the state, as shown in equations (4.10) and (4. l 1). Current-status
data are notas informative about the timing of events as vital statistics or retrospective survey
data. But they can be informative if interpreted correctly, and sometimes they are the only data
available.

4.7 Stationary Populations with Multiple Sourcesof Decrement

ln section 7 of chapter 3, we introduced one of the two most basic models in demography ,
e the stationary population model. Recall that a stationary population would result from the
maintenance of three conditions: a constant flow of births per unit of time; a constant set of
age-specific mortality rates; and zero net migration rates at ali ages. Let us now extend the
assumption about mortality rates to include constancy of age-specific risks from each of the
multiple sources of decrement. Since we have already shown that a stationary population with
90 MULTIPLEDECREMENTPROCESSES

ln other
---...;;:;,
die fro!11e
Box 4.4 Associated Single Decrement Tab/es from Current-status Data: Calculation
number of
of Singulate Mean Age at Marriage
rhe annual
die of cau
sN.r = Total population aged x to x +n -,
causei
sSx = Nurnber of single persons aged x to x + 11 These r
= -sSx = smg
proport10n 1e at ages x to x + n. 1. Thep
sNx divon
The 1
IT(50) = sIT4s+2 snso 2.
coulc
5 I;;~o sITx - 50 IT(50)
3. The 1
SMAM= 1 - IT(50)
life \
ofbi
Example: Turkey,males, 1990
4. The
Agex sN.r sSx 5 nx wou
call<
o 3,052,255 3,052,255 l.000 to s1
5 3,541,409 3,541,409 l.000
5. The
10 3,560 ,900 3,560 ,900 l.000
equ
15 3,[65,061 3,030,203 0.957
20 2,581,153 l,853 ,222 0.718 t9e
25 2,435 ,765 629,077 0.258 at b
30 2,096 ,899 180,767 0.086 6. Th
35 1,784 ,121 77,134 0.043 in
40 1,418,784 43 ,412 0.031 Th
45 l ,l l l,113 28,627 0.026 the
50 980,115 22,527 0.023 is
po
45
I: snx = 5.119
x=O
n (50) = .026t-023 = .0245
5 5.119 - 50 .0245
SMAM = - -- - - - - = 25.0 years
l - .0245

Dara sou.rce:Turkey. Basbakanlik Devletl statistik En stitusu. Statistical YearbookofTurk ey , 1995. [Turkiye istatistik
yilligi, 1995.] Ankara, Turkey, Ba sbakanlik Devlet Istatistik Enstitu su, 1996.

lo annual births would have II Lx persons at each age (where each function pertains to the same
life table), it must also be the case that each year it would have II Lx ,,1n'.r= ,A~deaths from
cause i at age x to x + n. Thus, the sum of annual deaths from cause i over all ages must be
equal to Zb,the number of persons in an annual cohort of births who will eventually succumb
to causei.
MULTIPLEDECREMENTPROCESSES
91
ln other words , in a stationary population the probability that a newborn will eventuall
die from cause i is equa l to the annual number ~f deaths from cause i divided by the annu:i
lculation number of birth s (or of deaths f1:0m ~li causes, srnc~ ~he annual number of births must equal
the annual number of deaths). L1kew1se, the probab1hty that someone aged x will eventually
die of cause i is equal to the proportion of annual deaths at ages x+ that are attributable to
causei.
These relations have wide applicability in populations that can be assumed to be stationary:
!. The probability that a marriage will end in divorce could be estimated by the ratio of annua l
divorces to annual marriages.
2 . The probability that someone entering graduate school will eventually receive a Ph.D.
could be found by dividing the annua l number of Ph .D .s by the number of entrants to
3. The probability that a newborn will be diagnosed with cancer at some point in his or her
life will be equal to the number of annual cancer diagnoses divided by the annual m1111ber
of births.
4. The probability that someone with newly diagnosed cancer will eventually die from cancer
would equal the ratio of cancer deaths to cancer diagnoses. This probability is typically
called a "case-fatality ratio" in epidemiology and its value is often estimated by resorting
to stationary population assumptions.
5. The expected number of years spent with morbidity from a newly-diagnosed disease would
equal the nurnber of persons suffering from the disease at a moment in time divided by
the annual number of new diagnoses of that disease . This is equivalent to life expectancy
at birth being equa l to population size divided by the annual number of births.
6. The "incidence" of a disease can be defined as the ratio of new cases ofthe diseasediagnosed
in a particular period divided by the person-years lived in the population during that period .
The "prevalence" of a disease can be defined as the proportion of the population having
the disease at a moment in time. If the number having the disease at a moment in time
is H and the annual number of new diagnoses of the disease is l H , then in a stationary
population

H 1H H
To [H'
To
prev alence incidence expected duration of the disease

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