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European Journal of Epidemiology

, Volume 26, Issue 12, pp 903–914

First Online: 30 November 2011Received: 28 June 2011Accepted: 10 November 2011


During the 1980s and 1990s life expectancy at birth has risen only slowly in the Netherlands. In 2002, however, the rise in life expectancy suddenly accelerated. We studied the possible causes of this remarkable development. Mortality data by age, gender and cause of death were analyzed using life table methods and age-period-cohort modeling. Trends in determinants of mortality including health care delivery were compared with trends in mortality. Two-thirds of the increase in life expectancy at birth since 2002 were due to declines in mortality among those aged 65 and over. Declines in mortality reflected a period rather than a cohort effect, and were seen for a wide range of causes of death. Favorable changes in mortality determinants coinciding with the acceleration of mortality decline were mainly seen within the health care system. Health care expenditure rose rapidly after 2001, and was accompanied by a sharp rise of specialist visits, drug prescriptions, hospital admissions and surgical procedures among the elderly. A decline of deaths following non-treatment decisions suggests a change towards more active treatment of elderly patients. Our findings are consistent with the idea that the sharp upturn of life expectancy in the Netherlands was at least partly due to a sharp increase in health care for the elderly, and has been facilitated by a relaxation of budgetary constraints in the health care system.

KeywordsMortality Life expectancy Elderly Health care A previous version of this paper was prepared for the National Academy of Sciences Panel on Divergent Trends in Life Expectancy in High-Income Countries 34.

Electronic supplementary materialThe online version of this article doi:10.1007-s10654-011-9633-y contains supplementary material, which is available to authorized users.

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Author: Johan Pieter Mackenbach - Lany Slobbe - Caspar Wilhelmus Nicolaas Looman - Agnes van der Heide - Johan Polder - Joop Gar


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