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Gains in life expectancy after elimination of major causes of death: revised estimates taking into account the effect of competing causes.
Open accessAbstract
BACKGROUND: It is generally acknowledged that conventional estimates of the potential number of life years to be gained by elimination of causes of death are too generous. This is because these estimates fail to take into account the fact that those who are saved from the cause are likely to have one or more other conditions ("competing" causes of death), which may increase their risks of dying. It is unknown to what extent this introduces bias in comparisons of life years to be gained between underlying causes of death. The purpose of the study was to assess this bias. DATA AND METHODS: A sample of 5975 death certificates from the Netherlands, 1990, was coded for the presence of diseases that, according to a set of explicit rules, could be regarded as potential causes of death "competing" with the underlying cause. Logistic regression analysis was used to quantify age and sex adjusted differences between four main underlying causes of death (neoplasms, cardiovascular diseases, respiratory diseases, all other diseases) in prevalence of the six most frequent competing causes of death (neoplasms, ischaemic heart disease, cerebrovascular disease, other cardiovascular diseases, chronic obstructive lung disease, all other diseases). These prevalence differences were then used to revise conventional calculations of gains in life expectancy, by taking them to indicate differences in risk of dying from these competing causes after the underlying cause has been eliminated. RESULTS: The prevalence of competing causes of death is relatively low among persons dying from neoplasms as the underlying cause, about average among persons dying from cardiovascular diseases, and relatively high among persons dying from respiratory diseases. Taking this into account results in substantial decreases of potential life years to be gained by elimination of cardiovascular diseases and respiratory diseases, relative to the number of years to be gained by elimination of neoplasms. Specifically, while according to the conventional calculations the gain in life expectancy by elimination of cardiovascular diseases exceeds that for neoplasms by more than one year, in the revised calculations the number of life years to be gained is approximately equal. CONCLUSIONS: Despite its limitations, mainly relating to reliance on death certificate data, this study suggests that conventional estimates of differences between underlying causes of death in life years to be gained by elimination are seriously biased by ignoring the effects of competing causes. Specifically, the relative impacts of eliminating cardiovascular diseases and respiratory diseases, as compared with eliminating neoplasms, seem to be overestimated. The implications are discussed.
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Written from the paper’s full text.
TL;DR
Conventional cause-elimination life-table estimates overstate gains from eliminating cardiovascular and respiratory diseases relative to neoplasms because they ignore competing causes. Using 1990 Netherlands death-certificate data, revised estimates made cardiovascular disease and neoplasms nearly equally important in life years gained.
Key findings
- In a sample of 5,975 death certificates, 2,762 competing causes were identified, corresponding to 46.2 competing causes per 100 deaths; prevalence of ischaemic heart disease, cerebrovascular disease, and other cardiovascular disease varied strongly by underlying cause and was usually lowest among deaths from neoplasms.
- Conventional estimates of life years gained by elimination were: neoplasms 3.83 years for men and 3.38 for women; cardiovascular diseases 4.93 for men and 4.52 for women; respiratory diseases 0.82 for men and 0.57 for women; other diseases 2.51 for men and 2.76 for women.
- Revised estimates accounting for competing causes were: cardiovascular diseases 4.02 years for men and 3.37 for women; respiratory diseases 0.41 for men and 0.28 for women; other diseases 1.91 for men and 1.92 for women; neoplasms remained the reference at 3.83 for men and 3.38 for women.
- The conventional advantage of cardiovascular diseases over neoplasms fell from more than one year, or approximately 30%, to 5% among men and 0% among women; sensitivity analyses with convergence or contributing causes modified the estimates but the overall conclusion held.
Methods
- A sample of 5,975 death certificates from deaths in the Netherlands in 1990 was stratified by four broad underlying cause groups—neoplasms (30% of sample), cardiovascular diseases (30%), respiratory diseases (20%), and other diseases (20%)—and by five-year age group weighted by life years lost; ill-defined and external causes were excluded.
- Competing causes were coded if they were apparently independent of the underlying cause, chronic, and had the potential to become a new underlying cause; age- and sex-adjusted odds ratios were estimated by logistic regression with neoplasms as the reference category.
- Cause-elimination life-table calculations used Chiang’s formula; revised calculations used prevalence odds ratios as a proxy for mortality risk ratios, with sensitivity analyses for convergence of excess mortality and for contributing causes.
Limitations
- Stated: the study relied on death certificate data, which are not a perfect source for underlying or competing causes; death certificates were not designed to elicit competing causes, WHO guidelines discourage their notification, and completion is frequently suboptimal.
- Stated: the revised calculations assume that increased death rates among those with a competing cause remain increased for the rest of life; the authors consider this unlikely and use a sensitivity analysis assuming a 10% reduction of excess mortality per additional year of life after being saved, implying a 65% reduction over 10 years.
- Stated and evident: co-occurrence may represent a contributing rather than competing cause, and the maximum-effect assumption for contributing causes almost certainly overestimates the importance of cardiovascular diseases; because prevalence among the dead cannot be compared with the total population, only relative differences between underlying causes can be adjusted, not absolute estimates.
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Claims the paper makes
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- Findingnone given
According to conventional calculations, gains in life expectancy after elimination of cardiovascular diseases exceed those of neoplasms by more than one year, or approximately 30%.
“According to the conventional calculations, gains in life expectancy after elimination of cardiovascular diseases exceed those of neoplasms by more than one year, or approximately 30%.”
Quote in the paperSubstantial claim - Findingreasoning
Respiratory diseases and other diseases fall even farther behind neoplasms in revised calculations than in conventional calculations.
“Respiratory diseases and other diseases fall even farther behind neoplasms than in the conventional calculations.”
Quote in the paperSubstantial claim- The authors state this as an assumption: The mortality quotients n Q x for the general population also apply to those saved from dying from cause A.
- The authors state this as an assumption: The prevalence odds ratios for C obtained in the regression analyses can be used as a proxy of the mortality risk ratios for C.
- The authors state this as an assumption: The case fatality of C does not differ between patients dying (saved) from A and those dying (saved) from B.
- Findingown data
The conventional calculation method suggests that elimination of neoplasms as an underlying cause would result in 3.83 life years gained among men and 3.38 life years gained among women.
“The conventional calculation method suggests that elimination of neoplasms as an underlying cause would result in 3.83 life years to be gained among men, and 3.38 life years to be gained among women.”
Quote in the paperNot a substantial claim - Findingown data
There is no clear variation between underlying causes of death in the prevalence of either neoplasms or chronic obstructive lung disease as competing causes of death.
“There is no clear variation between underlying causes of death in the prevalence of either neoplasms or chronic obstructive lung disease as competing causes of death.”
Quote in the paperNot a substantial claim - Findingown data
The prevalence of ischaemic heart disease, cerebrovascular disease, and other cardiovascular diseases as competing causes differs strongly by underlying cause of death.
“The prevalence of ischaemic heart disease, cerebrovascular disease, and other cardiovascular diseases, however, diVers strongly by underlying cause.”
Quote in the paperSubstantial claim
- Findingreasoning
According to revised calculations taking into account competing causes of death, the advantage for cardiovascular diseases over neoplasms dwindles to 5% among men and 0% among women.
“According to the revised calculations, taking into account competing causes of death, the advantage for cardiovascular diseases dwindles to 5% among men and 0% among women”
Quote in the paperSubstantial claim- The authors state this as an assumption: The mortality quotients n Q x for the general population also apply to those saved from dying from cause A.
- The authors state this as an assumption: The prevalence odds ratios for C obtained in the regression analyses can be used as a proxy of the mortality risk ratios for C.
- The authors state this as an assumption: The case fatality of C does not differ between patients dying (saved) from A and those dying (saved) from B.
- Findingreasoning
After adjustment for competing causes, elimination of cardiovascular diseases results in a gain in life expectancy very close to the estimate for neoplasms, both among men and among women.
“Elimination of cardiovascular diseases now results in a gain in life expectancy, which, both among men and among women, is very close to the estimate for neoplasms.”
Quote in the paperSubstantial claim- The authors state this as an assumption: The mortality quotients n Q x for the general population also apply to those saved from dying from cause A.
- The authors state this as an assumption: The prevalence odds ratios for C obtained in the regression analyses can be used as a proxy of the mortality risk ratios for C.
- The authors state this as an assumption: The case fatality of C does not differ between patients dying (saved) from A and those dying (saved) from B.
- Findingown data
The age and sex adjusted prevalence of some competing causes differed substantially by underlying cause group.
“The age and sex adjusted prevalence of some of these competing causes diVered substantially by underlying cause group.”
Quote in the paperSubstantial claim - Findingown data
Only five categories of competing causes were found in more than 1% of all deaths: neoplasms, ischaemic heart disease, cerebrovascular disease, other cardiovascular disease, and chronic obstructive lung disease.
“Only five categories of competing causes were found in more than 1% of all deaths (neoplasms, ischaemic heart disease, cerebrovascular disease, other cardiovascular disease, chronic obstructive lung disease) and these were used for further analyses, together with a category of all other diseases.”
Quote in the paperSubstantial claim - Findingreasoning
Taking into account the higher prevalence of competing causes among persons dying from underlying causes other than neoplasms, the numbers of life years gained by elimination of these other causes become smaller.
“If you take into account the higher prevalence of competing causes among persons dying from other underlying causes than neoplasms, the numbers of life years gained by elimination of these other causes become smaller.”
Quote in the paperSubstantial claim- The authors state this as an assumption: The mortality quotients n Q x for the general population also apply to those saved from dying from cause A.
- The authors state this as an assumption: The prevalence odds ratios for C obtained in the regression analyses can be used as a proxy of the mortality risk ratios for C.
- The authors state this as an assumption: The case fatality of C does not differ between patients dying (saved) from A and those dying (saved) from B.
- Study design and conductcitation
The study relied on death certificate data, which is not a perfect source of information on underlying causes, let alone competing causes.
“Firstly, we relied on the contents of death certificates, and this is not a perfect source of information on underlying causes, let alone competing causes.20 21”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [20] Bild DE, Stevenson JM. Frequency of recording of diabetes on US death certificates: analysis of the 1986 national mortality followback survey. J Clin Epidemiol 1992;45:275–81. source
- cites [21] Goldacre MJ. Cause-specific mortality: understanding uncertain tips of the disease iceberg. J Epidemiol Community Health 1993;47:491–6. source
- Interpretationown data
Revised estimates that take into account differences between causes of death in prevalence of competing causes show that neoplasms and cardiovascular diseases have become nearly equally important in the Netherlands in the early 1990s.
“Our revised estimates, which take into account diVerences between causes of death in prevalence of competing causes, show that neoplasms and cardiovascular diseases have become (nearly) equally important in the Netherlands in the early 1990s.”
Quote in the paperSubstantial claim- The authors state this as an assumption: The mortality quotients n Q x for the general population also apply to those saved from dying from cause A.
- The authors state this as an assumption: The prevalence odds ratios for C obtained in the regression analyses can be used as a proxy of the mortality risk ratios for C.
- The authors state this as an assumption: The case fatality of C does not differ between patients dying (saved) from A and those dying (saved) from B.
- Interpretationreasoning
Conventional estimates of differences between underlying causes of death in life years to be gained by elimination are seriously biased by ignoring the effects of competing causes.
“Despite its limitations, mainly relating to reliance on death certificate data, this study suggests that conventional estimates of diVerences between underlying causes of death in life years to be gained by elimination are seriously biased by ignoring the eVects of competing causes.”
Quote in the paperSubstantial claim- The authors state this as an assumption: The mortality quotients n Q x for the general population also apply to those saved from dying from cause A.
- The authors state this as an assumption: The prevalence odds ratios for C obtained in the regression analyses can be used as a proxy of the mortality risk ratios for C.
- The authors state this as an assumption: The case fatality of C does not differ between patients dying (saved) from A and those dying (saved) from B.
- Interpretationreasoning
Competing causes will only reduce the number of life years to be gained if the intervention does not eliminate the competing causes together with the underlying cause.
“However, these competing causes will only reduce the number of life years to be gained, if the intervention does not eliminate the competing causes with the underlying cause.”
Quote in the paperSubstantial claim - Interpretationreasoning
The overestimation of gains in life expectancy after elimination of ischaemic heart disease may differ by underlying cause of death, thereby introducing bias in comparisons between the effects of eliminating different causes of death.
“Moreover, this element of overestimation may diVer by underlying cause of death, thereby introducing bias in the comparison between the eVects of eliminating diVerent causes of death.”
Quote in the paperSubstantial claim - Interpretationown data
Specifically, the relative impacts of eliminating cardiovascular diseases and respiratory diseases, as compared with eliminating neoplasms, are overestimated.
“Specifically, the relative impacts of eliminating cardiovascular diseases and respiratory diseases, as compared with eliminating neoplasms, seem to be overestimated.”
- Also stated in: § Discussion · plain
“Specifically, the relative impacts of eliminating cardiovascular diseases and respiratory diseases, as compared with eliminating neoplasms, are overestimated.”
Quote in the paperSubstantial claim- The authors state this as an assumption: The mortality quotients n Q x for the general population also apply to those saved from dying from cause A.
- The authors state this as an assumption: The prevalence odds ratios for C obtained in the regression analyses can be used as a proxy of the mortality risk ratios for C.
- The authors state this as an assumption: The case fatality of C does not differ between patients dying (saved) from A and those dying (saved) from B.
- Also stated in: § Discussion · plain
- Premisecitation
Multiple cause of death statistics have only rarely been used to adjust conventional cause-elimination calculations.
“In several countries information on other conditions mentioned on the death certificate is made available in the form of multiple cause of death statistics, [13][14][15][16] but these have only rarely been used to adjust conventional causeelimination calculations, 9 17 even though according to an authoritative review this would be one of the most promising applications.11”
Quote in the paperSubstantial claim0 of 3 sources checked- cites [9] Manton KG, Poss SS. EVects of dependency among causes of death for cause elimination life table strategies. Demography 1979;16:313–27. source
- cites [17] Wong O. A competing-risk model based on the life table procedure in epidemiological studies. Int J Epidemiol 1977; 6:153–9. source
- cites [11] Israel RA, Rosenberg HM, Curtin LR. Analytical potential for multiple cause-of-death data. Am J Epidemiol 1986;124: 161–79. source
- Interpretationown data
The revised estimates suggest that neoplasms and cardiovascular diseases are equally important in terms of potential gains in life expectancy.
“suggesting that both underlying cause of death groups are equally important in terms of potential gains in life expectancy.”
Quote in the paperSubstantial claim- The authors state this as an assumption: The mortality quotients n Q x for the general population also apply to those saved from dying from cause A.
- The authors state this as an assumption: The prevalence odds ratios for C obtained in the regression analyses can be used as a proxy of the mortality risk ratios for C.
- The authors state this as an assumption: The case fatality of C does not differ between patients dying (saved) from A and those dying (saved) from B.
- Interpretationreasoning
It is likely that the higher prevalence of competing causes among persons dying from cardiovascular disease than among those dying from neoplasms is a generalised phenomenon beyond the Netherlands.
“Although other countries in Western Europe and North America may be in diVerent phases of epidemiological development, it is likely that the higher prevalence of competing causes among persons dying from cardiovascular disease than among those dying from neoplasms is a generalised phenomenon.”
Quote in the paperSubstantial claim - Interpretationreasoning
Gains in life expectancy after elimination of ischaemic heart disease are likely to be too optimistic.
“Gains in life expectancy after elimination of ischaemic heart disease are therefore likely to be too optimistic.”
Quote in the paperSubstantial claim - Premisecitation
Death certificates contain information not only on underlying causes of death but also on other conditions present at the moment of dying.
“Nevertheless, a data source exists that provides opportunities for studying associations between causes of death: death certificates not only contain information on underlying causes of death, but also on other conditions present at the moment of dying.11 12”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [11] Israel RA, Rosenberg HM, Curtin LR. Analytical potential for multiple cause-of-death data. Am J Epidemiol 1986;124: 161–79. source
- cites [12] PuVer RR. New approaches for epidemiologic studies of mortality statistics. Bull Pan Am Health Organ 1989;23: 365–83.
- Interpretationreasoning
Further increases in life expectancy will be as dependent upon progress in the prevention and treatment of cancer as upon further declines in cardiovascular mortality.
“Sooner than most observers realise, further increases in life expectancy will be as dependent upon progress in the prevention and treatment of cancer, as they are upon further declines in cardiovascular mortality.”
Quote in the paperSubstantial claim - Interpretationreasoning
Because associations between competing and underlying causes depend on common risk factors, the effect of competing causes of death is likely to be smaller with interventions targeted at risk factors than with interventions targeted at more advanced steps in the disease process.
“Because associations between competing and underlying causes depend on common risk factors, the eVect of competing causes of death is likely to be smaller with interventions targeted at risk factors than with interventions targeted at more advanced steps in the disease process, for example, medical treatment of symptomatic disease.”
Quote in the paperSubstantial claim - Premisereasoning
Because of common risk factors, many persons dying from ischaemic heart disease are at a higher than average risk of dying from various other causes such as lung cancer, cerebrovascular disease, and chronic obstructive lung disease.
“This assumption is far from realistic: because of common risk factors many persons dying from ischaemic heart disease will be at a higher than average risk of dying from various other causes, such as lung cancer (smoking), cerebrovascular disease (hypertension, arteriosclerosis), and chronic obstructive lung disease (smoking).”
Quote in the paperSubstantial claim - Premisenone given
A lack of empirical data on associations between causes of death has until now prevented a solution from being developed for the problem of competing causes in cause-elimination life tables.
“Although this problem of”
Quote in the paperSubstantial claim0 of 5 sources checked- cites [6] Chiang CL. Competing risks in mortality analysis. Annu Rev Publ Health 1991;12:281–307. source
- cites [7] Cornfield J. The estimation of the probability of developing a disease in the presence of competing risks. Am J Public Health 1957;47:601–7. source
- cites [8] Prentice RL, Kalbfleisch JD, Peterson AV, et al. The analysis of failure times in the presence of competing risks. Biometrics 1978;34:541–54. source
- cites [9] Manton KG, Poss SS. EVects of dependency among causes of death for cause elimination life table strategies. Demography 1979;16:313–27. source
- cites [10] Manton K, Stallard E. Recent trends in mortality analyses. New York: Academic Press, 1986.
- Interpretationreasoning
The number of life years to be gained by intervention is likely to be reduced because of the presence of competing causes of death.
“The number of life years to be gained by intervention is likely to be reduced because of the presence of competing causes of death.”
Quote in the paperSubstantial claim- The authors state this as an assumption: The mortality quotients n Q x for the general population also apply to those saved from dying from cause A.
- The authors state this as an assumption: The prevalence odds ratios for C obtained in the regression analyses can be used as a proxy of the mortality risk ratios for C.
- The authors state this as an assumption: The case fatality of C does not differ between patients dying (saved) from A and those dying (saved) from B.
- The quote only partly states this claim. 2
- It may state two separate claims as one. 2
- Probably not a substantial claim. 1
The quote only partly states this claim.
Findingown dataElimination of cardiovascular diseases results in a larger gain in life expectancy than elimination of neoplasms: 4.93 years among men and 4.52 years among women under conventional calculation.
“Elimination of cardiovascular diseases results in a larger gain in life expectancy: 4.93 years among men and 4.52 years among women.”
Quote in the paperSubstantial claimIt may state two separate claims as one.
Findingown dataIn the sample of 5975 death certificates, 2762 competing causes were identified, corresponding to 46.2 competing causes per 100 deaths.
“In the sample of 5975 death certificates, 2762 competing causes were identified.This corresponds to 46.2 competing causes per 100 deaths.”
Quote in the paperNot a substantial claimThe quote only partly states this claim.
Findingown dataElimination of respiratory diseases and other diseases results in smaller gains in life expectancy than elimination of neoplasms under conventional calculation.
“Elimination of respiratory diseases and other diseases results in smaller gains in life expectancy.”
Quote in the paperNot a substantial claimIt may state two separate claims as one.
Findingown dataThere is substantial variation in the prevalence of all other diseases as a competing cause by underlying cause of death; the two most frequent competing causes in this category are diabetes mellitus and senile dementia.
“There is also substantial variation in prevalence of all other diseases-a heterogeneous category within which the two most frequent competing causes are diabetes mellitus and senile dementia.”
Quote in the paperNot a substantial claimProbably not a substantial claim.
PremisecitationConventional cause-elimination life table calculations rest on the assumption that those saved from dying because of the eliminated cause have risks of dying from non-eliminated causes equal to the average risks of dying from these causes in the total population.
“The main assumption on which cause-elimination life table calculations rest is, that those who are saved from dying because of the eliminated cause (for example, ischaemic heart disease) have risks of dying from non-eliminated causes that are equal to the average risks of dying from these causes as observed in the total population.”
Quote in the paperSubstantial claim0 of 4 sources checked- cites [1] Chiang CL. Life table and mortality analysis. Geneva: World Health Organization, 1978.
- cites [6] Chiang CL. Competing risks in mortality analysis. Annu Rev Publ Health 1991;12:281–307. source
- cites [7] Cornfield J. The estimation of the probability of developing a disease in the presence of competing risks. Am J Public Health 1957;47:601–7. source
- cites [8] Prentice RL, Kalbfleisch JD, Peterson AV, et al. The analysis of failure times in the presence of competing risks. Biometrics 1978;34:541–54. source
The authors state this as an assumption.
The mortality quotients n Q x for the general population also apply to those saved from dying from cause A.
“The crucial assumption in the standard cause elimination life table is that the mortality quotients n Q x for the general population also apply to those saved from dying from cause A.”
The authors state this as an assumption.
The prevalence odds ratios for C obtained in the regression analyses can be used as a proxy of the mortality risk ratios for C.
“The main assumption underlying this approach is, that the prevalence odds ratios for C as obtained in the regression analyses (see above) can be used as a proxy of the mortality risk ratios for C.”
The authors state this as an assumption.
The case fatality of C does not differ between patients dying (saved) from A and those dying (saved) from B.
“This is likely to be valid, as long as the case fatality of C will not diVer between patients dying (saved) from A and those dying (saved) from B.”
The authors state this as an assumption.
The increased death rate among those with a competing cause present at the time they are saved from dying from a specific underlying cause of death remains increased during the rest of their lives.
“Secondly, an important assumption on which our (revised) calculations are based, is that the increased death rate among those with a competing cause present at the time they are saved from dying from a specific underlying cause of death, remains increased during the rest of their lives.”
The authors state this as an assumption.
Imperfections in death certificate data are not different between underlying causes of death.
“Still, we see no reason to assume that these imperfections are diVerent between underlying causes of death and therefore, data on other conditions mentioned on the death certificate can at least be used to assess the bias present in comparisons between underlying causes of death of life years to be gained by elimination.”
The authors state this as an assumption.
Competing causes that are part of the same broad group will be eliminated with the underlying cause.
“In the case of elimination of such a broad group, only competing causes that are in another broad group will be assumed to remain; competing causes that are part of the same broad group will be eliminated with the underlying cause.”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Key point reverses which group has more competing causes
MajorThe key point says competing causes are more prevalent among people dying from neoplasms than among those dying from cardiovascular diseases. The discussion states the opposite, a comparison central to the paper's conclusion.
“Among persons dying from neoplasms, the prevalence of diseases that could act as competing causes of death, is higher than among persons dying from cardiovascular diseases.”
“it is likely that the higher prevalence of competing causes among persons dying from cardiovascular disease than among those dying from neoplasms is a generalised phenomenon.”
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Metadata
- Authors
- Mackenbach, J. P., Kunst, A. E., Lautenbach, H., Oei, Y. B., & Bijlsma, F.
- Affiliations
- Erasmus University Rotterdam (NL)
- ORCID
- Kunst, A E
- Venue
- Journal of Epidemiology and Community Health
- Publisher
- BMJ
- Published
- 1999-01
- Volume
- 53
- Issue
- 1
- Pages
- 32-37
- ISSN
- 0141-7681 (ISSN-L)
- 0143-005X
- 1470-2738
- PMC
- PMC1756767
- OpenAlex
- W2025959073
- Cited by
- 43
- References
- 26
- Citations by year
- 2026: 3 · 2025: 1 · 2023: 1 · 2021: 2 · 2020: 2 · 2018: 4 · 2017: 2 · 2015: 1 · 2014: 4 · 2012: 1
- FWCI
- 4.99
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Epidemiology & Community Health (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- RePub (Erasmus University Rotterdam) (submittedVersion, other-oa)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
- Topics
- Social Sciences › Demography › Insurance, Mortality, Demography, Risk Management
- Health Sciences › Medicine › Epidemiology › Healthcare Systems and Public Health
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Keywords
- life expectancy, competing risk of death, underlying cause of death, neoplasms, cardiovascular disease, respiratory diseases, death certificate coding, ischemic heart disease, cerebrovascular disease, chronic obstructive pulmonary disease
- MeSH terms
- Adolescent, Adult, Age Factors, Aged, Aged, 80 and over, Cause of Death, Child, Child, Preschool, Female, Humans, Infant, Infant, Newborn, Life Expectancy, Male, Middle Aged, Netherlands, Sex Factors, Prevalence, Logistic Models
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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