Why sickness and death rates do not move parallel to one another over time

Social History of Medicine

Volumn 12, Issue 1, 1999, Pages 101-124

  Riley, James C ^a  

^a INDIANA UNIVERSITY   (United States)

Author keywords

Duration; Friendly societies; Incidence; Lethality; Morbidity; Mortality; Prevalence; Sickness episodes

Indexed keywords

ARTICLE; HISTORY; MORBIDITY; MORTALITY; PUBLIC HEALTH; UNITED KINGDOM;

GREAT BRITAIN; HISTORY, 19TH CENTURY; MORBIDITY; MORTALITY; PUBLIC HEALTH;

EID: 0033110472     PISSN: 0951631X     EISSN: None     Source Type: Journal    
DOI: 10.1093/shm/12.1.101     Document Type: Article

References (32)

1. Exasperation is evident in R. M. Acheson and S. Hagard, Health, Society, and Medicine: An Introduction to Community Mediane (Oxford, 1984), pp. 9-10. R. Philips, Gezondheidszorg in Limburg: Groei en acceptatie van de gezondheidsvoorziening, 1850-1940 (Assen, 1980), p. 18, argues that death rates have to be used as a proxy because sickness is too ambiguous. R. Woods, 'Physician, Heal Thyself: The Health and Mortality of Victorian Doctors,' Social History of Medicine, 9 (1996), 1-30, argues for parallelism and proportionality, and appears to reaffirm that argument in idem., '"Sickness is a Baffling Matter": A Reply to James C. Riley', Social History of Medicine, 10 (1997), 157-63, which responds to my objections in 'The Morbidity of Medical Practitioners', Social History of Medicine, 9 (1996), 467-71. Another argument is advanced by P. Cole, 'Morbidity in the United States,' in C. L. Erhardt and J. E. Berlin (eds.), Mortality and Morbidity in the United States (Cambridge, MA, 1974), p. 65, which is that mortality and morbidity used to be parallel and proportional when 'most serious illnesses resulted from fatal diseases of relatively short duration'.
2. Exasperation is evident in R. M. Acheson and S. Hagard, Health, Society, and Medicine: An Introduction to Community Mediane (Oxford, 1984), pp. 9-10. R. Philips, Gezondheidszorg in Limburg: Groei en acceptatie van de gezondheidsvoorziening, 1850-1940 (Assen, 1980), p. 18, argues that death rates have to be used as a proxy because sickness is too ambiguous. R. Woods, 'Physician, Heal Thyself: The Health and Mortality of Victorian Doctors,' Social History of Medicine, 9 (1996), 1-30, argues for parallelism and proportionality, and appears to reaffirm that argument in idem., '"Sickness is a Baffling Matter": A Reply to James C. Riley', Social History of Medicine, 10 (1997), 157-63, which responds to my objections in 'The Morbidity of Medical Practitioners', Social History of Medicine, 9 (1996), 467-71. Another argument is advanced by P. Cole, 'Morbidity in the United States,' in C. L. Erhardt and J. E. Berlin (eds.), Mortality and Morbidity in the United States (Cambridge, MA, 1974), p. 65, which is that mortality and morbidity used to be parallel and proportional when 'most serious illnesses resulted from fatal diseases of relatively short duration'.
3. Exasperation is evident in R. M. Acheson and S. Hagard, Health, Society, and Medicine: An Introduction to Community Mediane (Oxford, 1984), pp. 9-10. R. Philips, Gezondheidszorg in Limburg: Groei en acceptatie van de gezondheidsvoorziening, 1850-1940 (Assen, 1980), p. 18, argues that death rates have to be used as a proxy because sickness is too ambiguous. R. Woods, 'Physician, Heal Thyself: The Health and Mortality of Victorian Doctors,' Social History of Medicine, 9 (1996), 1-30, argues for parallelism and proportionality, and appears to reaffirm that argument in idem., '"Sickness is a Baffling Matter": A Reply to James C. Riley', Social History of Medicine, 10 (1997), 157-63, which responds to my objections in 'The Morbidity of Medical Practitioners', Social History of Medicine, 9 (1996), 467-71. Another argument is advanced by P. Cole, 'Morbidity in the United States,' in C. L. Erhardt and J. E. Berlin (eds.), Mortality and Morbidity in the United States (Cambridge, MA, 1974), p. 65, which is that mortality and morbidity used to be parallel and proportional when 'most serious illnesses resulted from fatal diseases of relatively short duration'.
4. Exasperation is evident in R. M. Acheson and S. Hagard, Health, Society, and Medicine: An Introduction to Community Mediane (Oxford, 1984), pp. 9-10. R. Philips, Gezondheidszorg in Limburg: Groei en acceptatie van de gezondheidsvoorziening, 1850-1940 (Assen, 1980), p. 18, argues that death rates have to be used as a proxy because sickness is too ambiguous. R. Woods, 'Physician, Heal Thyself: The Health and Mortality of Victorian Doctors,' Social History of Medicine, 9 (1996), 1-30, argues for parallelism and proportionality, and appears to reaffirm that argument in idem., '"Sickness is a Baffling Matter": A Reply to James C. Riley', Social History of Medicine, 10 (1997), 157-63, which responds to my objections in 'The Morbidity of Medical Practitioners', Social History of Medicine, 9 (1996), 467-71. Another argument is advanced by P. Cole, 'Morbidity in the United States,' in C. L. Erhardt and J. E. Berlin (eds.), Mortality and Morbidity in the United States (Cambridge, MA, 1974), p. 65, which is that mortality and morbidity used to be parallel and proportional when 'most serious illnesses resulted from fatal diseases of relatively short duration'.
5. Exasperation is evident in R. M. Acheson and S. Hagard, Health, Society, and Medicine: An Introduction to Community Mediane (Oxford, 1984), pp. 9-10. R. Philips, Gezondheidszorg in Limburg: Groei en acceptatie van de gezondheidsvoorziening, 1850-1940 (Assen, 1980), p. 18, argues that death rates have to be used as a proxy because sickness is too ambiguous. R. Woods, 'Physician, Heal Thyself: The Health and Mortality of Victorian Doctors,' Social History of Medicine, 9 (1996), 1-30, argues for parallelism and proportionality, and appears to reaffirm that argument in idem., '"Sickness is a Baffling Matter": A Reply to James C. Riley', Social History of Medicine, 10 (1997), 157-63, which responds to my objections in 'The Morbidity of Medical Practitioners', Social History of Medicine, 9 (1996), 467-71. Another argument is advanced by P. Cole, 'Morbidity in the United States,' in C. L. Erhardt and J. E. Berlin (eds.), Mortality and Morbidity in the United States (Cambridge, MA, 1974), p. 65, which is that mortality and morbidity used to be parallel and proportional when 'most serious illnesses resulted from fatal diseases of relatively short duration'.
6. Exasperation is evident in R. M. Acheson and S. Hagard, Health, Society, and Medicine: An Introduction to Community Mediane (Oxford, 1984), pp. 9-10. R. Philips, Gezondheidszorg in Limburg: Groei en acceptatie van de gezondheidsvoorziening, 1850-1940 (Assen, 1980), p. 18, argues that death rates have to be used as a proxy because sickness is too ambiguous. R. Woods, 'Physician, Heal Thyself: The Health and Mortality of Victorian Doctors,' Social History of Medicine, 9 (1996), 1-30, argues for parallelism and proportionality, and appears to reaffirm that argument in idem., '"Sickness is a Baffling Matter": A Reply to James C. Riley', Social History of Medicine, 10 (1997), 157-63, which responds to my objections in 'The Morbidity of Medical Practitioners', Social History of Medicine, 9 (1996), 467-71. Another argument is advanced by P. Cole, 'Morbidity in the United States,' in C. L. Erhardt and J. E. Berlin (eds.), Mortality and Morbidity in the United States (Cambridge, MA, 1974), p. 65, which is that mortality and morbidity used to be parallel and proportional when 'most serious illnesses resulted from fatal diseases of relatively short duration'.
7. Alfred W. Watson, An Account of an Investigation of the Sickness and Mortality Experience of the I.O.O.F. Manchester Unity . . . 1893-97 (Manchester, 1903); [Henry Ratcliffe], Independent Order of Odd Fellows, Manchester Unity Friendly Society: Supplementary Report, July 1st, 1872 (n.p., n.d.);
8. Alfred W. Watson, An Account of an Investigation of the Sickness and Mortality Experience of the I.O.O.F. Manchester Unity . . . 1893-97 (Manchester, 1903); [Henry Ratcliffe], Independent Order of Odd Fellows, Manchester Unity Friendly Society: Supplementary Report, July 1st, 1872 (n.p., n.d.);
9. and Francis G. P. Neison, Jr., The Rates of Mortality and Sickness According to the Experience of the Five Years, 1871-1875, of the Ancient Order of Foresters Friendly Society . . . (London, 1882).
10. The two female societies paid benefits for childbirth, but those episodes have not been counted as sickness. Health risks associated with childbirth will be discussed in future work.
11. Twentieth-century actuaries have regularly used Watson's tables, adjusting them for different levels of morbidity or mortality. E.g. P. Geddes and J. P. Holbrook, Friendly Societies: A Text-book for Actuarial Students (Cambridge, 1963).
12. Woods, 'Physician, Heal Thyself; Riley, 'The Morbidity of Medical Practitioners'; and Woods, '"Sickness is a Baffling Matter"'.
13. Woods, 'Physician, Heal Thyself; Riley, 'The Morbidity of Medical Practitioners'; and Woods, '"Sickness is a Baffling Matter"'.
14. Woods, 'Physician, Heal Thyself; Riley, 'The Morbidity of Medical Practitioners'; and Woods, '"Sickness is a Baffling Matter"'.
15. J. C. Riley, Sickness, Recovery and Death: A History and Forecast of III Health (Iowa City, 1989), pp. 159-68.
16. Watson, Sickness and Mortality Experience, counted episodes continuing into each subsequent year of his five year reference period anew, thereby correctly counting the number of cases in progress each year but overcounting the number of episodes, especially at higher ages.
17. At certain ages between 10 and 40 female mortality often surpassed male in those years, but female life expectancy consistently surpassed male.
18. J. C. Riley, Sick, Not Dead: The Health of British Wotkingmen during the Mortality Decline (Baltimore, 1997), p. 166.
19. E. Shorter, Bedside Manners: The Troubled History of Doctors and Patients (New York, 1985).
20. The numerator for the all cases rate is a count of all sicknesses; the denominator consists of time at risk. For the new cases rate the numerator is the sum of all new episodes and the denominator the net time at risk, in this instance net of sickness time since it is not possible to observe people who contracted a second disease or injury when already sick. To illustrate the basic difference between all cases and new cases, using an extreme example, new cases of myasthenia gravis in Denmark during the period 1970-87 occurred at a rate of 4.4 per million people per annum, but many cases carried over from earlier years. Hence MG point prevalence occurred at a rate of 77 per million per annum. Finn E. Somnier, Niels Keiding, and Olaf B. Paulson, 'Epidemiology of Myasthenia Gravis in Denmark: A Longitudinal and Comprehensive Population Survey', Archives of Neurology, 48 (1991), 733-9. That is, a particular disease with a prolonged course may exhibit a low rate of new cases but a much higher rate of all cases.
21. The number of lethal episodes excludes sudden deaths (i.e. those not preceded by sicknesses long enough to qualify for friendly society benefits, meaning fewer than three to six days), and deaths that occurred outside the reference period. The denominator includes cases that carried into the reference period plus new cases that began during the reference period.
22. At the highest ages, above about 75, the incidence risk is influenced by friendly society rules concerning how much time had to pass before a member could initiate a new claim at full pay, and in the Ashbourne society as early as 70 by a provision allowing members to draw a small but continuous pension in lieu of intermittent but larger sickness benefits. Geddes and Holbrook, Friendly Societies; Derbyshire Record Office, Matlock, Ashbourne Female Friendly Society, D662A, PF51-58.
23. Those episodes are counted through the period in which they are under observation. Of the eight, six were already protracted when the records end.
24. Riley, Sick, Not Dead.
25. But see Evelyn Thiltgès, Josianne Duchêne, and Guillaume Wunsch, 'Causal Theories and Models in the Study of Mortality,' in A. D. Lopez, G. Caselli and T. Valkonen (eds.), Adult Mortality in Developed Countries: From Description to Explanation (Oxford, 1995), pp. 21-36.
26. Thus the complete duration follows an episode through to its conclusion. For example, an episode that began at age 30 and continued until age 60 would, in measuring sickness experience among people aged 25-44, have only the initial 15 years of its length counted under sickness time. But under complete duration its entire length would be included.
27. Moreover, prior health experience also influences current mortality and morbidity risk: J. C. Riley and G. Alter, 'The Sick and the Well: Adult Health in Britain during the Health Transition', Health Transition Review, Supplement, 6 (1996), 19-44.
28. G. Alter and J. C. Riley, 'Sickness, Recovery, and Sickness Redux: Transitions into and out of Sickness in Nineteenth-Century Britain', Indiana University Population Institute for Research and Training Working Paper 98-2.
29. Riley, Sick, Not Dead, p. 166.
30. Friendly societies selected members, admitting only people deemed healthy. However, they refused few applicants because of poor health, accepting more than 95 per cent of the people who applied. Here the initial five years of membership have been excluded in order to avoid selection effects. G. Alter and J. C. Riley, 'Frailty, Sickness, and Death: Models of Morbidity and Mortality in Historical Populations', Population Studies, 43 (1989), 25-46.
31. See Riley, Sick, Not Dead, for more detail about friendly societies, their rules and usages, and the various ways in which their rules influenced the propensity to make a sickness claim.
32. This table updates information about two of the four societies, Morcott and Ashbourne, which originally appeared in Riley and Alter, 'The Sick and the Well'.