Popular Science Monthly/Volume 86/April 1915/American Economic and Social Problems Arising Out of the War
|AMERICAN ECONOMIC AND SOCIAL PROBLEMS ARISING OUT OF THE WAR|
|THE TREND OF AMERICAN VITALITY|
By LOUIS I. DUBLIN, Ph.D.
STATISTICIAN, METROPOLITAN LIFE INSURANCE COMPANY, NEW YORK
THE trend of American vitality could best be determined by comparing a series of life tables for the last three or four decades. These would tell us whether the expectation of life at each age had increased or decreased during this period; but, unfortunately, no such tables are at hand. We are only now beginning to realize the value of such statistical devices for measuring our vital resources. The Federal Bureau of the Census is for the first time engaged in preparing comprehensive life tables. These will, we hope, give us fundamental data on American life expectancy in the registration area. For the country as a whole, nothing worthy of consideration will be available until our vital statistics have been much improved and the registration area extended to include all the states.
Our analysis will, therefore, be at best inadequate and incomplete. We have, in the first place, a few life tables for some cities and states which tend to show the trend of vitality in these places. The New York City tables for the period 1909 to 1911, for example, indicate that the probable span of life for children under five has been extended by about ten years since the earlier tables for the period 1879 to 1881 were prepared. The improvement in life expectancy continues until about age 35. From this age onward the expectation becomes reduced. In Massachusetts, the reduction in the expectation of life has occurred at an even earlier age. Life tables for a few other states show similar conditions, the only variation being in the age at which the change sets in. In spite of the unsatisfactory data from which most of these tables were derived, we may infer that the expectation of life at the higher ages has been lessened over a wide area of the country during the last three decades.
This conclusion is confirmed in a measure by a survey of the mortality rates at the several age periods of adult life in the registration states for the years 1900 and 1911, respectively. In order to make our comparison valid, we have been careful to consider only the states which comprised the registration area in 1900. You will note (Table I.) that all age groups up to and including 35 to 44 for males, and 45 to 54 for females show decreases in the rates for 1911 as against those for 1900. From this age period onward, however, the rates for 1911 are higher than for the earlier date. It is evident that at all ages the mortality is much more favorable for females than for males; but in both sexes the forces that have been at work to reduce mortality in early life have not continued in effectiveness. After the period of middle life, an apparent deterioration has occurred.
What then are the factors in this change? From the records of the Bureau of the Census for the registration area it would appear that the causes of death which predominate at the advanced ages, namely, cancer, diabetes, apoplexy, organic heart disease, diseases of the arteries, cirrhosis of the liver and Bright's disease have increased in their incidence during the last ten years. This is shown in the accompanying Table II. It is significant that, together, these seven causes account for more than one half of the deaths after the age of forty.
Death-Rates per 1,000 Population
(Registration States as constituted in 1900)
|Age||1900||1911||Per Cent. Increase
|1900||1911||Per Cent. Increase|
|Under 5||54.2||39.8||- 26.57||45.8||33.3||- 27.29|
|5-9||4.7||3.4||- 27.66||4.6||3.1||- 32.61|
|10-14||2.9||2.4||- 17.24||3.1||2.1||- 32.26|
|15-19||4.9||3.7||- 24.49||4.8||3.3||- 31.25|
|20-24||7.0||5.3||- 24.29||6.7||4.7||- 29.85|
|25-34||8.3||6.7||- 19.28||8.2||6.0||- 26.83|
|35-44||10.8||10.4||- 3.70||9.8||8.3||- 15.31|
|45-54||15.8||16.1||+ 1.90||14.2||12.9||- 9.15|
|55-64||28.9||30.9||+ 6.92||25.8||26.0||+ 0.78|
|65-74||28.9||30.9||+ 6.92||25.8||26.0||+ 0.78|
|75 and over||146.1||147.4||+ 0.89||139.5||139.5||- 15.22|
|All ages||17.6||15.8||- 10.23||16.5||14.0||- 15.15|
(Registration States as constituted in 1900)
|Cause of Death||1900||1910||Per Cent. Increase|
|1. Cancer (all forms)||63.5||82.9||30.6|
|3. Cerebral hemorrhage and apoplexy||72.5||86.1||18.8|
|4. Organic diseases of the heart||116.0||161.6||39.3|
|5. Diseases of arteries||5.2||25.8||396.2|
|6. Cirrhosis of liver||12.6||14.4||14.3|
|7. Bright's disease||81.0||95.7||18.1|
It has, therefore, been assumed quite generally that the deterioration observed after age 40 is due to the increase in the incidence of these so-called "degenerative" diseases. Indeed, much of the propaganda for better personal hygiene at middle life has received its impetus from the discussion of this tendency in American mortality. We must not forget, however, that our returns for causes of death are still far too inaccurate to warrant complete confidence. Only a small proportion of our statements of cause are confirmed by autopsy. Yet, the changes that have occurred in our medical practise with reference to statements of cause of death have not been of such radical character during the last ten years as to invalidate the conclusions drawn. The figures are apparently confirmed by independent analyses made in a number of specialized areas in which it appears that these degenerative diseases have increased at about the same rate as in the registration states. We are warranted in concluding, therefore, in spite of the lack of absolutely accurate data, that the trend of our mortality in middle life is at present unfavorable and that this condition is accompanied by an increasing incidence of the degenerative diseases.The question we now desire to put squarely is this: What are the forces at work in American life which have made for this increased mortality at the adult ages? In a recent paper entitled "The Possibilities of Reducing Mortality at the Higher Age Groups" the writer pointed out some of the conditions of present-day life which he believed tended to increase the death rates from the so-called "degenerative" diseases. In this paper reference was made to the greater use of alcoholic beverages and especially to the deleterious effects of modern conditions of industry. It was assumed that the changing conditions of American industrial life involved a greater strain on the organism, causing it to break down at an earlier age than was formerly the case under the less intense conditions of labor. In the present paper I wish to refer to another element which is apparently at work in the causation of these higher death rates from the diseases above mentioned.
I refer to important changes in the composition and characteristics of the population. The last thirty years have seen a great influx of foreign peoples to this country. The reports of the Department of Labor show that in the period since 1880, 22,300,000 immigrants reached our shores. In the year ending June 30, 1914, the net increase in population due to immigration was 915,000. These immigrants have settled principally in the registration states. In a recent paper. Professor Chapin, of Smith College, has pointed out that the nine states, California, Connecticut, Illinois, Massachusetts, Michigan, New Jersey, New York, Ohio, and Pennsylvania have been receiving over three fourths of the total immigration during the last 25 years. This tendency to concentration of immigration in a few of our eastern states has been so marked that it has been assumed that from 65 to 70 per cent, of the urban growth of the United States is due to immigration. Recent immigration has given a distinctive tone to our urban life.
This immigration to our registration area must, therefore, largely determine the adult mortality which these communities experience. If the immigrants are relatively short lived and suffer especially from the diseases of middle life, then we must expect an increased incidence in the mortality rates from these causes in the area where they congregate, and correspondingly a reduction in the expectation of life in the total population.
While immigrants to America come from all parts of the world, the larger number have come, in recent years, from the countries of southern and eastern Europe. Thus, in the year closing June 30, 1914, 23.3 per cent, of all immigrants came from Italy; 21.0 per cent, from Russia and Finland; 11.1 per cent, from Austria; 11.8 per cent, from Hungary. Together, these four countries supplied America with 67.1 per cent, of its total immigration in this year. The mortality rates prevailing normally in these countries are uniformly higher than those found in the registration area. Thus, according to the latest available figures the crude death rate in Russia was 28.9 per 1,000 in 1909; 18.2 per 1,000 in Italy in 1912; 20.5 per 1,000 in Austria, and 23.3 per 1,000 in Hungary in 1912. We have no right to assume that the mere entry of these foreign peoples has at once a favorable effect upon their mortality. Their adverse conditions of life, especially in our large cities, the economic stress to which they are put, and the dangers in the unskilled trades in which they engage, all would point to a continuance, at least, of the higher death rates from which they suffer in their native countries.
Such a conclusion is certainly warranted by the mortality statistics for the state of New York. In 1910, at the age period 45 to 49, the death rate among native-born white males was 16.6 per 1,000, whereas the rate for the same age period among foreign-born white males was 17.7 per 1,000, or an excess of 6.6 per cent, for the foreign-born. For the age periods 55 to 59, the two rates are 27.0 and 35.4, respectively, showing an excess of 13.2 per cent, in the mortality of the foreign-born white males over the native-born. This excess is marked throughout all the advanced age periods. The advantage in favor of native-born females over foreign-born females is equally striking and begins at an even earlier age period in middle life. Conditions similar to the above have been noted in the vital statistics for the registration area of the United States. This would indicate that the foreign-born whites as well as the native-born of foreign parentage show, at all higher age periods, and for both sexes, a mortality largely in excess of that of the native-born of native parentage.
The statistics of the degenerative diseases indicate, furthermore, that the nativity factor plays an important part in determining the death rates from these diseases. Thus, both in the registration states and cities where this subject has been studied, it has been found that the native-born of native parentage show almost uniformly a lower incidence from Bright's disease, diabetes and cirrhosis of the liver than do the foreign-born and their children. The rates, to be sure, vary considerably with the different nationalities; but taken as a group, the foreign born apparently show a lower resistance to the degenerative processes which these diseases imply. Is it to be wondered at, therefore, that the death rates for large cities and states in the registration area show increases in mortality at the higher age groups? In view of the marked changes that have occurred in the composition and characteristics of our population, it would indeed be surprising if these changes in mortality had not occurred.
It is not the intention of this paper to touch upon immigration as one of our national problems except to state what we should know with regard to our mortality rates; namely, that our large centers of population are showing unfavorable mortality tendencies after middle life and that in all probability these tendencies are dependent upon the character of our immigration.
This conclusion does not in any way make unnecessary the caution and advice which the associates of the Life Extension Institute and other hygienists have taught us. It has already been demonstrated that much can be accomplished by emphasizing the necessity for more careful personal hygiene. This will affect not only our own native stock, but also the foreign race stocks in our population. Indeed, if a full return is to be received from our campaigns for life extension, it is necessary that an attempt be made to instruct the foreign population in the principles of personal and civic hygiene. This will involve very difficult problems of education, but the results will prove as fruitful as those which have been directed toward our better circumstanced classes. The problem of the mortality at the higher age groups is a complex one and many things will need to be done if we hope to accomplish our chief aim, which should be to show a saving in life all along the line, both in our native and foreign-born stocks, not only at the younger ages where American medicine has made brilliant contributions, but more especially after middle life.
- A series of papers presented before the Section for Social and Economic Science of the American Association for the Advancement of Science at a meeting in Philadelphia on December 29, 1914, arranged by the Secretary of the Section, Seymour C. Loomis.
- "Immigration as a Source of Urban Increase," by F. Stuart Chapin, Ph.D., Qtly. Publications of the American Statistical Ass'n, Vol. XIV., Sept., 1914.
- Thirty-third Annual Report, New York State Dept. of Health, pp. 254-55.