Popular Science Monthly/Volume 26/February 1885/Sick-Rates and Death-Rates
By CL. T. CAMPBELL, M. D.
THE operations of benefit societies ought to provide a fruitful field for investigation by the student of vital statistics. These organizations, embracing a very large membership, deal practically with the accidents of sickness and of death, and can be made to supply valuable data. In Great Britain this has been done, and can be done, with comparative ease. The laws of that country take direct cognizance of benefit societies, and require from them statistical reports of their work, which are tabulated and published by authority. The latest available report of the British Registrar of friendly societies mentions no fewer than 15,379 branches of different organizations of this kind; of which number 12,300, embracing a membership of 4,672,175, had sent the required returns. The experience of so large a number of persons should certainly be of value. And we find that it has been utilized to a considerable extent, for from these returns tables of the expectation of sickness and death have been prepared by a number of English statisticians, including Ratcliffe, Finlaison, and others.
On this continent information concerning the operations of these societies can be obtained only from such reports as they publish themselves. They are not under Government supervision; and their statistics are not available for purposes of comparison without considerable labor on the part of the inquirer.
As a contribution to this subject, I propose giving the experience of the oldest, and, I believe, the largest, benefit society in North America, that of the Odd-Fellows, which has been in operation sixty-four years, and has a membership of about half a million. Though the society has branches in South America, Australia, Germany, and other places, yet the statistics I shall give will be confined to the membership in the United States and Canada—two countries whose circumstances of race, climate, and social customs are similar.
The membership of the Society of Odd-Fellows is confined to healthy white males, of the age of twenty-one and upward. When I say "healthy," I mean approximately so. In some localities a medical certificate of good health is required from every candidate for membership; and in all cases prima facie evidence of sound physical condition is a necessary prerequisite for admission. While, therefore, the society may not consist of lives as carefully selected as the policy-holders of an insurance company, yet they constitute a fair average of the healthy male adults of the Caucasian race. And any possible inferiority to life-insurance subjects in the matter of physical health will be more than balanced by the advantages resulting from the comparatively high standard of morals necessary to membership in a benevolent and moral organization.
The death-rate of this society for the last nine years has been as follows:
The average rate for the period embraced in this table appears from these figures to be less than one in 100 (.0097). But the returns come from a very large section of country, with varying conditions, geographical and social, which may materially affect the mortality in special localities. It will be advisable, therefore, to individualize more closely. For convenience, we will classify the several States and Provinces into five groups. We will let the Eastern group embrace Connecticut, Delaware, Massachusetts, Maine, Maritime Provinces of Canada, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont; the Northern—Dakota, Manitoba, Michigan, Minnesota, Montana, Ontario, Quebec, Wisconsin, and Wyoming; the Central—Colorado, Illinois, Indiana, Iowa, Kansas, Kentucky, Missouri, Nebraska, Ohio, and West Virginia; the Southern—Alabama, Arkansas, Florida, Georgia, Louisiana, Maryland, Mississippi, New Mexico, North Carolina, South Carolina, Tennessee, Texas, and Virginia; the Western—Arizona, British Columbia, California, Nevada, Oregon, and Washington. This is a somewhat arbitrary division, but it will serve the purpose.
Taking the statistics of 1881, we find the membership, deaths, and rate per 100 in these several groups to have been as follows:
The apparent conclusion from this table would be that, while in the Eastern, Central, and Western sections the rate did not range very far from the general average, in the Northern it was very much below, and in the Southern very much above. Is this variation characteristic of the localities, or is it due to some special feature of the membership whose experience is tabulated? We find that in the Northern group of States and Provinces the rate is about thirty per cent below the average. But in this section the society is comparatively young; many of its branches have only been in existence a few years; and the membership is composed largely of men in the prime of life, or of those who have but recently passed some test of physical soundness. This might account for the lower rate of mortality. In the Southern section, while there are quite a few old branches, yet in many parts they are as young as in the North—the society having, like all others, suffered by the civil war, and having begun anew during the last fifteen years. We might reasonably expect, therefore, that the rate in the South, though above the average reported, is yet below the actual rate of the locality.
In order to obtain the true death-rate of the average adult male population, it is necessary to confine our investigations, if possible, to those branches which have been in existence for at least the life of one generation; and which will, therefore, contain their just proportion of aged persons. For the year 1881 the statistics were collected of 425 branches in different States, which had been in existence for not less than thirty-five years. In these, with a membership of 51,452, there were 655 deaths, or 1·27 per 100.
It is not possible from the returns to give anything like a correct average for each State or province, or even for each of the groups previously defined. In some States the membership of the older lodges is too small to give results that could form the basis of a correct estimate; but, by grouping some of the States in a geographical classification, we may calculate the average of certain sections. Thus the Southern States of Alabama, Arkansas, Georgia, Louisiana, South Carolina, and Tennessee have an average of 2·9 per 100; the Eastern States of Maine, Massachusetts, New Jersey, Rhode Island, and Vermont have an average of 1·1; the Central States of Illinois, Indiana, Michigan, Ohio, and Wisconsin, also 1·1; in the Pacific States the society is not thirty-five years old, so that no statistics are obtainable from that quarter; while from other sections the returns were not in a shape to supply the requisite data. But enough was obtainable to show that on the most favorable estimate in tropical States the death-rate is twice as high as in the temperate zone.
Making due allowance for the failure of any of the subordinate officials to send complete returns of their deaths, it is a fair conclusion from such statistics as are available that the average death-rate of the better class of the adult male population of this continent is for the temperate regions 1·5 in every 100; and for the tropical regions three in every 100.
But it is in the matter of sickness that the vital statistics of the United States and Canada have hitherto been most deficient; and in this connection the operations of a large society making weekly payments to its sick members, and thus keeping some record of the amount of sickness experienced by them, can be made useful.
The returns available here, it must be noted, do not give the full sickness experience. Reports are made only of the number of weeks for which sick-benefits are paid. Usually a person must be a member a certain length of time, from one to six months, before he is entitled to benefits; in some localities no benefits are paid for the first week of sickness; members who are in arrears to the society receive no benefits. So that the actual average of sickness will be somewhat in advance of the figures given.
Taking the entire society in the United States and Canada, we find the following returns for the last seven years:
Submitting these returns to the same system of grouping that we adopted with the mortality returns, we have the following result:
A noticeable feature of this table is that the death-rate and sick-rate bear a close relationship in the several localities. To make it more apparent, we place them in parallel columns:
In order to obtain, however, the average for the general population, we turn to the older branches, with the following results: For 1881, there were 655 branches over thirty-five years old, reporting 83,121 members, with 79,902 weeks' sickness—being an average of ·961 of a week. We find that the Eastern section, with 60,783 members, reports 63,295 weeks' sickness, or an average of 1·041; and the Central reports 15,839 members and 13,211 weeks—an average of ·834. The returns from the Northern and Southern States are insufficient for a fair comparison; but the fact that one State alone, Maryland, with a membership of 10,785, reports 21,259 weeks' sickness, is an evident indication that there is the same proportionate advance in the rate in every locality.
Judging from the experience of this society, it is a reasonable conclusion that the average sickness of the better class of the adult male population of the United States and Canada is one week and a half each year.
But a more important calculation, which can be made from the statistics of benefit societies, is the expectation of sickness for each year of a person's life. This has been computed in England by several actuaries. While they have not agreed entirely in details, for the simple reason that they have taken the experience of different classes of people, yet they have agreed on the general principle that there is a regular increase in the average of yearly sickness with each year of a person's life. The statistics of the Society of Odd-Fellows in America have also been tabulated at different periods during the last thirty years. The first calculations were made in 1854, and were based on the experience of 66,000 persons. The plan adopted for securing the necessary data was to require each subordinate branch to send to the central authorities a return of the number of members at each year of age, of the number sick at each year of age, and of the number of weeks' sickness for each age. This process has been repeated at different periods and in different States. In some States it is done every year.
From the data thus obtained has been compiled a table of the expectation of sickness, which has been published by the authorities of the society as a basis for the use of the membership in the arrangement of their beneficial system. As this table has never, so far as I know, been published outside the society's own journals, I submit it here, with the expectation of life, according to the American tables: