Academic journal article Population

Mortality in France by Département

Academic journal article Population

Mortality in France by Département

Article excerpt

Knowledge of the level, structure and trends of mortality at a finer scale than that of the country as a whole is necessary both for the scholarly purpose of better understanding the factors behind the variations and inequalities observed, and for reasons of public health, in order to decide where resources are most needed and to determine what type of intervention to apply and to which parts of the territory. This paper is part of a longstanding demographic tradition (Blayo, 1970; Caselli and Egidi, 1986a and 1986b; Daguet, 2005 and 2006; Meslé and Vallin, 1998; Nizard and Prioux, 1975; Noin, 1973; Salem et ah, 2000; Caselli and Vallin, 2002; Ledere et ah, 2010). Its purpose is to describe the variations in mortality between France's départements, their evolution over the last thirty years and their structural characteristics)11 Specifically, the aim is to answer three questions:

* What is the current geography of overall mortality in metropolitan France and how has it changed over the last thirty years?

* Do differences in life expectancy between départements correspond to specific age patterns of mortality?

* What causes of death explain the geographical variations in mortality?

This analysis is based on the annual life tables by sex and département in metropolitan France121 for the period 1976-2008. The tables were constructed and transmitted by the regional, local and urban statistics department (Division des Statistiques régionales, locales et urbaines) of the National Institute for Statistics and Economic Studies (Institut national de la statistique et des études économiques, INSEE))31

To reduce the effect of random annual fluctuations due to small populations in some départements, we worked with three-year life tables using the arithmetic mean for a given indicator over three successive years. For simplicity, the text refers to the middle year of each three-year period. For example, life expectancy at birth in 2007 refers to the arithmetic mean of life expectancy at birth from 2006 to 2008.

I. Little change in the geography of life expectancy over the last thirty years

In 2007, life expectancy at birth in metropolitan France was 77.2 years for men and 84.3 years for women, i.e. 8.1 and 7.0 years more than in 1977. These average figures conceal major geographical variations. In 2007, the difference between the life expectancies of the two départements at the top and bottom of the range (Hauts-de-Seine and Pas-de-Calais) was 6.0 years for men and 3.4 years for women, compared with 5.9 and 4.2 years in 1977 (Appendix Table A.2). Overall, geographical inequalities in mortality seem to have persisted for men, where they are more marked, but to have declined for women. In fact, both fell steadily - until the early 1990s for men and the early 2000s for women - and then increased noticeably for men and very slightly for women (Figure 1). At its narrowest, the gap in life expectancy at birth between the highest and lowest ranked départements was 5.1 years for men (in 1991) and 3.1 years for women (in 2002 and 2003).

Figures 2 and 3 show life expectancy at birth by sex in metropolitan France in 1977 (1976-1978) and 2007 (2006-2008). The départements are divided into five groups along the distribution scale. The middle group is around the mean (plus or minus half a standard deviation) and the other groups are bounded by one or two standard deviations on either side. It should be borne in mind that the range within groups on these maps is much smaller in absolute terms for women than for men, with a gap between the extremes of the top and bottom groups of 2.75 years in 1977 and 2.25 years in 2007 for women, versus 4.45 and 3.50 years for men. All the values are represented on these maps, but because of the small number of deaths in some sparsely populated départements, any relative excess or deficit of mortality seen in these départements may be due to chance and may not reflect the actual state of health of the local population. …

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