Regardless of a country’s wealth, cardiovascular diseases and cancers are the most common cause of death for women over age 50, says a new report from the World Health Organization. In developing countries, these deaths occur at earlier ages than in the rich world.
Moreover, tobacco-related deaths in certain Western countries have doubled for this age group in the last four decades, and the best country for a woman to grow old may be Japan.
The study, “Global Mortality Trends and Patterns in Older Women,” also found that cardiovascular diseases account for 45 percent of “older” women’s deaths globally. These types of deaths are also projected to remain the biggest killer of older women for the foreseeable future.
Cancers — mainly lung, breast, colon and stomach — make up another 15 percent of deaths for women 50. Chronic respiratory conditions cause another 10 percent of deaths in women in this age group.
The good news is that in most countries worldwide, female life expectancy at age 50 has been rising. Some countries have shown rapid gains in older women’s life expectancy from 1990 to 2012.
These include Brazil and Japan, where the latter had the highest life expectancy globally in 2012. Brazil and Japan each had gains of four or more years since 1990. Older women in China and in the United States experienced gains of 2.2 and 1.8 years, respectively, slightly less than the global average of 2.3 years and India’s gain of 2.6 years.
In high-income countries, fewer deaths from nontobacco-related cardiovascular disease marks the biggest change in noncommunicable disease mortality among older women. The only rich country with little decline in deaths from cardiovascular diseases is Russia, with a modest 0.44 years’ gain in life expectancy. The slow decline may be related to increased alcohol use, the report says.
Better prevention and management of metabolic risk factors, such as high blood pressure and high cholesterol, for cardiovascular disease is responsible for the overall decrease in rich nations. Low- and middle-income countries, however, did not see as much improvement in controlling heart disease, despite the increased prevalence in wealthy countries of people who are overweight, obese and diabetic. The study suggests that prevention, detection and treatment of noncommunicable diseases are inadequate in many countries.
“Given the substantial reduction in maternal mortality and the increase in the number of older women over the last 10 years, health systems in low- and middle-income countries must adjust accordingly, otherwise this trend will continue to increase,” Dr. John Beard, director of the World Health Organization’s Department of Ageing and Life Course and an author of the report, said.
Educating women at earlier stages in life, especially on sexual health, tobacco and harmful use of alcohol, is vital to reversing the epidemic of chronic diseases, Dr. Beard said.
Surprisingly, the report on older-50 women stressed that even though nontobacco-related heart disease fell worldwide, the rates of tobacco-related deaths more than doubled from 1970 to 2012 in France, Germany and Poland. Tobacco-related deaths also went up in Greece and the United States. The rises in all these countries resulted in a shorter life expectancy for women at age 50.
Dr. Colin Douglas Mathers, another author of the study and a senior scientist at the World Health Organization, pointed to various factors causing the increase in tobacco-related deaths in some Western countries, despite antismoking campaigns.
“There is a lag between tobacco smoking and tobacco-caused deaths, which ranges from around 5-10 years for cardiovascular disease to around 25 years for lung cancer,” he said in an e-mail to PassBlue from Geneva, where he is based. “So rising rates of female smoking in the 1980s and 1990s are causing increasing rates of lung and heart disease now, even though female smoking rates are currently steady or declining in high income countries.”
There may be a peak and then a decline in female death rates from smoking sometime in the future; for some countries, like Australia, the death rates have already peaked and are starting to drop because Australian women started to give up smoking sooner than in some other rich countries, Dr. Mathers said.
So far, female smoking rates remain relatively low in many developing countries, particularly in China, where men smoke at great rates. “If we are not successful in persuading women not to take up smoking, there may be a future epidemic of smoking-related disease in developing countries. So far, that has not happened in most,” Dr. Mathers added.
Bruce Link, a research scientist and professor of epidemiology from Columbia University Mailman School of Public Health in New York, pointed out that even though Europeans smoke more than Americans, this does not mean that Americans are healthier. He said that in a wide span of countries, there are huge health disparities, but there aren’t as many among the top-20 richest nations. For example, the US is not healthier than Spain or France. Heart disease, stroke, cancer and accidents offset less smoking in the US.
A report from the Institute of Medicine of the National Academy reports that Americans have been in poorer health conditions in almost all other developed countries, especially among women.
The US health disadvantage is obvious in many indicators when compared with peer countries, the report says. A large uninsured population and more limited access to primary care, drug abuse, overeating and less physical activity explain some of the shortcomings. Income inequality also contributes to the poorer health of Americans as a group.
Nevertheless, older women are faring somewhat better than older men. Worldwide in 2011, women made up more than half (53 percent) of adults who were 50 years or older and 59 percent of adults 70 and above. (For female life expectancy at birth, increases have also been occurring, but they vary geographically. In 2011, for example, the female advantage at birth was 1 year in Bangladesh, 7 years in Japan and 12 years in Russia.)
Yet some countries faced setbacks during the last two decades or so in rising life expectancy for women over 50. Among them are Russia and Eastern European countries, where the economic transition from communism to a more capitalistic society affected longevity.
South Africa, as with other sub-Saharan African countries, has been tremendously hurt by HIV infections. But it recently experienced gains in female life expectancy at age 50, possibly from increased use of antiretroviral treatment.