Vaccines for the twenty-first century society

Vaccines have been one of the major revolutions in the history of mankind and, during the twentieth century, they eliminated most of the childhood diseases that used to cause millions of deaths. In the twenty-first century, vaccines will also play a major part in safeguarding people's health. Supported by the innovations derived from new technologies, vaccines will address the new needs of a twenty-first century society characterized by increased life expectancy, emerging infections and poverty in low-income countries.     

The reversal of fortunes: trends in county mortality and cross-county mortality disparities in the United States

Background

Counties are the smallest unit for which mortality data are routinely available, allowing consistent and comparable long-term analysis of trends in health disparities. Average life expectancy has steadily increased in the United States but there is limited information on long-term mortality trends in the US counties This study aimed to investigate trends in county mortality and cross-county mortality disparities, including the contributions of specific diseases to county level mortality trends.

Methods and Findings

We used mortality statistics (from the National Center for Health Statistics [NCHS]) and population (from the US Census) to estimate sex-specific life expectancy for US counties for every year between 1961 and 1999. Data for analyses in subsequent years were not provided to us by the NCHS. We calculated different metrics of cross-county mortality disparity, and also grouped counties on the basis of whether their mortality changed favorably or unfavorably relative to the national average. We estimated the probability of death from specific diseases for counties with above- or below-average mortality performance. We simulated the effect of cross-county migration on each county''s life expectancy using a time-based simulation model. Between 1961 and 1999, the standard deviation (SD) of life expectancy across US counties was at its lowest in 1983, at 1.9 and 1.4 y for men and women, respectively. Cross-county life expectancy SD increased to 2.3 and 1.7 y in 1999. Between 1961 and 1983 no counties had a statistically significant increase in mortality; the major cause of mortality decline for both sexes was reduction in cardiovascular mortality. From 1983 to 1999, life expectancy declined significantly in 11 counties for men (by 1.3 y) and in 180 counties for women (by 1.3 y); another 48 (men) and 783 (women) counties had nonsignificant life expectancy decline. Life expectancy decline in both sexes was caused by increased mortality from lung cancer, chronic obstructive pulmonary disease (COPD), diabetes, and a range of other noncommunicable diseases, which were no longer compensated for by the decline in cardiovascular mortality. Higher HIV/AIDS and homicide deaths also contributed substantially to life expectancy decline for men, but not for women. Alternative specifications of the effects of migration showed that the rise in cross-county life expectancy SD was unlikely to be caused by migration.

Conclusions

There was a steady increase in mortality inequality across the US counties between 1983 and 1999, resulting from stagnation or increase in mortality among the worst-off segment of the population. Female mortality increased in a large number of counties, primarily because of chronic diseases related to smoking, overweight and obesity, and high blood pressure.     

Health transition: examples from the western Pacific.

The Industrial Revolution ushered in a rapid transition from agriculture to industrialization. Some biological effects of this transition included increasing life expectancy, reduced infant mortality, and some decline in fertility. Reduced infant mortality first brought about an increase in life expectancy, but as humans were able to control infectious diseases, child and adult mortality also decreased. Now, accidents and chronic diseases are responsible for most mortality in many age groups. This shift from infectious diseases to accidents and chronic diseases is called the health transition. Japan and US are Pacific Basin countries which have relatively high life expectancy and low infant mortality (1988, 75.54 years vs. 71.38 years, and 4.4 vs. 9.9, respectively). These figures suggest that these countries rather advanced in the health transition. Japan may have better life expectancy than the US because of the effect of environmental factors, ethnic diversity, and health care differentials by social class on cardiovascular disease and cancer mortality. China and Thailand hold intermediate positions (67.98 years (1985-1990) vs. 63.82 years (1985-1986), and 32.4 vs. 39, respectively). Some research indicates that urban conditions and factory work increase the cardiovascular disease risk among the Chinese. Recent research suggests that access to immunization and modern medical care for acute disease are the only critical variables of the health transition rather than other variables. Papua New Guinea is not progressing very well (53.18 years and 58). Papua New Guinea has not yet been able to control infectious diseases, especially malaria. This comparison illustrates that populations progress through the health transition at different rates.     

Homeostasis and the physiological dimension of niche construction theory in ecology and evolution

Niche construction theory (NCT) has been represented as a new and comprehensive theory of evolution, one that breaks the constraints imposed by the dominant and largely gene-selectionist standard evolutionary model that is presently mischaracterized as “Darwinian.” I will argue that NCT is not so much a new theory, as it is a fruitful readmission of a venerable physiological perspective on adaptation, selection and evolution. This perspective is closer in spirit and philosophy to the original (and richer) Darwinian idea developed by Darwin himself, and that animated much of the rich late nineteenth century debate about evolution, heredity, adaptation and development, a debate that was largely eclipsed by the early twentieth century emergence of the Neodarwinian synthesis. I will argue that a full realization of the promise of NCT turns on a full understanding of another intellectual revolution of the nineteenth century, Claude Bernard’s conception of homeostasis, a profound statement of the nature of life that has, through the twentieth century, come to be widely misunderstood and trivialized.     

Changing household composition,labor patterns,and fertility in a highland New Guinea population

The European demographic transition of the nineteenth century is often proposed as a model for demographic change in twentieth century developing nations, and economic development is seen as leading to an inevitable reduction in total fertility in these nations. This paper examines data from the Gainj of Papua New Guinea, a natural fertility population with very low reproductive output, and suggests that the effects of development on fertility change are much more complex than a simple demographic transition model would suggest. Looking at two variables known to contribute significantly to low total fertility among the Gainj, late age at first birth for women and long interbirth intervals, the paper suggests that households, in their recruitment and allocation of labor, may exert a mediating influence in the relationship between economic development and fertility.     

Secular trends of demographic parameters

The aim of this paper is to describe the secular changes of selected demographic parameters and to investigate the possible causes for such changes as well as the biological relevance. We took into account the following parameters: population density, mean live expectancy, average age at marriage of until then unmarried persons, rate of live births, and number of children per woman. The results show that the population density (global and in Germany) especially in the twentieth century increased dramatically. We found a striking increase of life expectancy in Germany. Essential causes are rapid decreases in infant and maternal mortality. Since the 80s of the twentieth century the average age at marriage of until then unmarried persons as well as the number of single mothers show a permanent increase. Generally, the average age of mothers increased (for live and legitimate births). In the past 150 years we found a decrease in fertility rates in Germany. The registered demographic parameters show temporal and regional variations. These differences, especially between East Germany and West Germany, are emphasized.     

Island mortality in the past: some evidence from Greece

This paper explores the course of infant and childhood mortality in the Greek island of Paros from the end of the nineteenth until the mid-twentieth century. For this purpose the method of family reconstitution has been applied to two towns on the island. Official population statistics have been used to derive basic mortality estimates for the Cyclades and Greece as a whole. Reference to other studies concerning island mortality is also made. Hence, there appears the chance to compare insular with mainland mortality and realise that insular mortality presented some distinct features. It is shown that island populations presented lower mortality than the national average until the first decades of the twentieth century. However, by the 1950s Greece's infant and childhood mortality had dropped to the same or even to lower levels than those of the islands.     

A divergent pattern of the sex difference in life expectancy: Sweden and Japan, early 1970s-late 1990s

For most of the 20th century the sex gap in life expectancy in the industrialized countries has widened in favor of women. By the early 1980s a reversal in the long-term pattern of this differential had occurred in some countries, where it reached a maximum and thereafter followed a declining trend. Of particular interest to the present investigation is the anomalous experience of Japan, where unlike other high-income countries the female advantage in life expectancy has been expanding. We contrast the case of Japan with that of Sweden, where, like many other high-income nations, the sex differential in longevity has been narrowing in recent years. We observe that in Sweden, until the early 1980s, the sex gap in life expectancy (female-male) exceeded that of Japan; but this situation reversed in subsequent periods, when the Swedish differential narrowed and that of Japan widened. A decomposition analysis indicates that these divergent patterns since 1980 have resulted mainly from larger than expected reductions in male mortality in Sweden due to heart disease and from accidents and violence, lung cancer and "other" cancers. In Japan, death rates for men and women from heart disease--which is a leading cause of death--have tended to decline more or less at the same pace since the early 1980s; and with regard to lung cancer, and "other" neoplasms, male death rates in Japan have been rising while those of women have either declined or risen more slowly. Moreover, during the 1990s, male and female suicide rates rose in Japan, but the rates for men went up faster. Altogether, the net effect of these divergent mortality trends for men and women in Japan underlie much of the observed widening of its sex differential in longevity in recent years.     

Life Expectancy and Death by Diseases of the Circulatory System in Patients with Bipolar Disorder or Schizophrenia in the Nordic Countries

Objective

Excess mortality from diseases and medical conditions (natural death) in persons with psychiatric disorders has been extensively reported. Even in the Nordic countries with well-developed welfare systems, register based studies find evidence of an excess mortality. In recent years, cardiac mortality and death by diseases of the circulatory system has seen a decline in all the Nordic countries, but a recent paper indicates that women and men in Denmark, Finland, and Sweden, who had been hospitalised for a psychotic disorder, had a two to three-fold increased risk of dying from a cardiovascular disease. The aim of this study was to compare the mortality by diseases of the circulatory system among patients with bipolar disorder or schizophrenia in the three Nordic countries Denmark, Sweden, and Finland. Furthermore, the aim was to examine and compare life expectancy among these patients. Cause specific Standardized Mortality Rates (SMRs) were calculated for each specific subgroup of mortality. Life expectancy was calculated using Wiesler’s method.

Results

The SMR for bipolar disorder for diseases of the circulatory system was approximately 2 in all countries and both sexes. SMR was slightly higher for people with schizophrenia for both genders and in all countries, except for men in Denmark. Overall life expectancy was much lower among persons with bipolar disorder or schizophrenia, with life expectancy being from 11 to 20 years shorter.

Conclusion

Our data show that persons in the Nordic countries with schizophrenia or bipolar disorder have a substantially reduced life expectancy. An evaluation of the reasons for these increased mortality rates should be prioritized when planning healthcare in the coming years.     

A Brief History of the Changing Occupations and Demographics of Coleopterists from the 18th Through the 20th Century

Systematic entomology flourished as a branch of Natural History from the 1750s to the end of the nineteenth century. During this interval, the “era of Heroic Entomology,” the majority of workers in the field were dedicated amateurs. This article traces the demographic and occupational shifts in entomology through this 150-year interval and into the early twentieth century. The survey is based on entomologists who studied beetles (Coleoptera), and who named sufficient numbers of species to have their own names abbreviated by subsequent taxonomists. In the eighteenth century, 27 entomologists achieved this level of prominence, of whom 37% were academics, 19% were doctors, 11% had private incomes, 19% were clergymen, and 8% were government officials. Many of those with private incomes were members of the European aristocracy, and all but one were European men. The nineteenth century list included 192 entomologists, of whom 17% were academics, 16% were museum curators, 2% were school teachers, 15% were doctors, 6% were military men, 7% were merchants, 2% were government entomologists, 6% had private incomes, 5% were clergymen, 5% were government officials, and 4% were lawyers. The demographics of entomology shifted dramatically in the nineteenth century. Whereas many of the noteworthy entomologists of the eighteenth century were German, Swedish, or French, in the nineteenth century, many more European countries are represented, and almost one-fifth of the noteworthy entomologists were from the United States. The nineteenth century list, like the eighteenth century list, contains no women. By the twentieth century, 63% of 178 noteworthy systematic entomologists were paid professionals, teaching entomology courses in universities, or studying insect taxonomy in museums and government-sponsored laboratories. Only one person on the twentieth century list had a private income, but women (ten individuals) were included on the list for the first time.     

On abandoning life when it is least difficult

Suicide data from Sweden (1911-1993) and New Zealand (1975-1995) were used to test a hypothesis derived as an extension of the Seasonal Affective Disorder concept. Contrary to the hypothesis, but similar to what Durkheim had reported regarding Central Europe in the nineteenth century, suicides peaked in late spring (May in Sweden, November in New Zealand). Durkheim's hypothesis that there would be more monthly variation in suicides in rural areas was strongly supported. Our hypothesis is that people abandon life when it is least difficult because of a disjuncture between experience and expectation.     

Free markets and dead mothers: the social ecology of maternal mortality in post-socialist Mongolia

Beginning in 1990, Mongolia, a former client state of what was then the Soviet Union, undertook liberal economic reforms. These came as a great shock to Mongolia and Mongolians, and resulted in food shortages, reports of famine, widespread unemployment, and a collapse of public health and health care. Although economic conditions have stabilized in recent years, unemployment and poverty are still at disturbingly high levels. One important consequence of the transition has been the transformation of the rural, primarily pastoral, economy. With de-collectivization, herding households have been thrown into a highly insecure subsistence mode of production, and, as a consequence, have become vulnerable to local fluctuations in rainfall and availability and quality of forage, and many now lack access to traded staples and essential commodities. Household food insecurity, malnutrition, and migration of impoverished households to provincial centers and the capital of Ulaanbaatar are one result. Reductions to investments in the health sector have also eroded the quality of services in rural areas, and restricted access to those services still functioning. Evidence suggests that women are particularly vulnerable to these political-ecological changes, and that this vulnerability is manifested in increasing rates of poor reproductive health and maternal mortality. Drawing on case-study ethnographic and epidemiological data, this article explores the links between neoliberal economic reform and maternal mortality in Mongolia.     

Social life factors affecting the mortality, longevity, and birth rate of total Japanese population: effects of rapid industrialization and urbanization

To expand upon the findings that lower mortality was found in Japanese urban areas in contrast to the Western model where in the US and Britain the risk of death was higher in metropolitan areas and conurbations, 22 social life indicators are examined among 46 prefectures in Japan in terms of their effect on age specific mortality, life expectancy, and age adjusted marriage, divorce, and birth rates. The effects of these factors on age adjusted mortality for 8 major working and nonworking male populations, where also analyzed. The 22 social life factors were selected from among 227 indicators in the system of Statistical Indicators on Life. Factor analysis was used to classify the indicators into 8 groups of factors for 1970 and 7 for 1975. Factors 1-3 for both years were rural or urban residence, low income and unemployment, and prefectural age distribution. The 4th for 1970 was home help for the elderly and for 1975, social mobility. The social life indicators were classified form 1 to 8 as rural residence in 1970 and 1975, urban residence, low income, high employment, old age, young age, social mobility, and home help for the elderly which moved from 8th place in 1970 to 1st in 1975. Between 1960-75, rapid urbanization took place with the proportion of farmers, fishermen, and workers declining from 43% in 1960 to 19% in 1975. The results of stepwise regression analysis indicate a positive relationship of urban residence with mortality of men and women except school-aged and middle-aged women, and the working populations, as well as life expectancy at birth for males and females and ages 20 and 40 years for males. Rural residence was positively associated with the male marriage rate, whereas the marriage rate for females was affected by industrialization and urbanization. High employment and social mobility were positively related to the female marriage rate. Low income was positively related to the divorce rate for males and females. Rural residence and high employment were positively related to the birth rate. The birth rate is higher in rural areas. Mortality of professional, engineering, and administrative workers was slightly lower than the total working population, while sales workers, those in farming, fishing, and forestry, and in personal and domestic service had significantly higher mortality. The mortality of the nonworking population was 6-8 times higher than sales, transportation, and communication, and personal and domestic service as well as the total population.     

Macro-Economic Conditions and Infant Health: A Changing Relationship for Black and White Infants in the United States

We study whether the relationship between the state unemployment rate at the time of conception and infant health, infant mortality and maternal characteristics in the United States has changed over the years 1980-2004. We use microdata on births and deaths for years 1980-2004 and find that the relationship between the state unemployment rate at the time of conception and infant mortality and birthweight changes over time and is stronger for blacks than whites. For years 1980-1989 increases in the state unemployment rate are associated with a decline in infant mortality among blacks, an effect driven by mortality from gestational development and birth weight, and complications of placenta while in utero. In contrast, state economic conditions are unrelated to black infant mortality in years 1990-2004 and white infant mortality in any period, although effects vary by cause of death. We explore potential mechanisms for our findings and, including mothers younger than 18 in the analysis, uncover evidence of age-related maternal selection in response to the business cycle. In particular, in years 1980-1989 an increase in the unemployment rate at the time of conception is associated with fewer babies born to young mothers. The magnitude and direction of the relationship between business cycles and infant mortality differs by race and period. Age-related selection into motherhood in response to the business cycle is a possible explanation for this changing relationship.     

Osteology of a slave burial population from Barbados,West Indies

A unique seventeenth–nineteenth century slave cemetery population from Newton plantation, Barbados, allows examination of craniodental characters in relation to ethnohistorical data. Age-at-death estimates suggest life expectancy at birth of 29 years and low infant mortality; historical demography, however, suggests life expectancy of 20 years and very high infant mortality. Tooth decay, bilateral tooth loss, periodontal disease, root hypercementosis, and severe enamel hypoplasia are high in frequency. The teeth yield evidence of such cultural practices as pipe-smoking and incisor mutilation. Several skeletal features reflect periodic near-starvation. Directional and fluctuating dental asymmetry, relative tooth size, and hypoplasia distribution suggest slaves experienced considerable weaning trauma; metabolic stress at this time exceeded that of prenatal and immediate postnatal periods. Odontometrics and dental and cranial nonmetric traits indicate that modern Blacks are intermediate between the ancestral slaves and modern Whites but more similar to the latter, suggesting effects of environmental covariance exceed those of genetic admixture. Nonmetric trait distributions show nonrandom patterns according to area of burial in the cemetery, a possible result of family segregation.     

The Promise of Prevention: The Effects of Four Preventable Risk Factors on National Life Expectancy and Life Expectancy Disparities by Race and County in the United States

Background

There has been substantial research on psychosocial and health care determinants of health disparities in the United States (US) but less on the role of modifiable risk factors. We estimated the effects of smoking, high blood pressure, elevated blood glucose, and adiposity on national life expectancy and on disparities in life expectancy and disease-specific mortality among eight subgroups of the US population (the “Eight Americas”) defined on the basis of race and the location and socioeconomic characteristics of county of residence, in 2005.

Methods and Findings

We combined data from the National Health and Nutrition Examination Survey and the Behavioral Risk Factor Surveillance System to estimate unbiased risk factor levels for the Eight Americas. We used data from the National Center for Health Statistics to estimate age–sex–disease-specific number of deaths in 2005. We used systematic reviews and meta-analyses of epidemiologic studies to obtain risk factor effect sizes for disease-specific mortality. We used epidemiologic methods for multiple risk factors to estimate the effects of current exposure to these risk factors on death rates, and life table methods to estimate effects on life expectancy. Asians had the lowest mean body mass index, fasting plasma glucose, and smoking; whites had the lowest systolic blood pressure (SBP). SBP was highest in blacks, especially in the rural South—5–7 mmHg higher than whites. The other three risk factors were highest in Western Native Americans, Southern low-income rural blacks, and/or low-income whites in Appalachia and the Mississippi Valley. Nationally, these four risk factors reduced life expectancy at birth in 2005 by an estimated 4.9 y in men and 4.1 y in women. Life expectancy effects were smallest in Asians (M, 4.1 y; F, 3.6 y) and largest in Southern rural blacks (M, 6.7 y; F, 5.7 y). Standard deviation of life expectancies in the Eight Americas would decline by 0.50 y (18%) in men and 0.45 y (21%) in women if these risks had been reduced to optimal levels. Disparities in the probabilities of dying from cardiovascular diseases and diabetes at different ages would decline by 69%–80%; the corresponding reduction for probabilities of dying from cancers would be 29%–50%. Individually, smoking and high blood pressure had the largest effect on life expectancy disparities.

Conclusions

Disparities in smoking, blood pressure, blood glucose, and adiposity explain a significant proportion of disparities in mortality from cardiovascular diseases and cancers, and some of the life expectancy disparities in the US. Please see later in the article for the Editors'' Summary     

Life expectancy of the 20th century Venda: A compilation of skeletal and cemetery data

Little information is available on the 20th century mortality rates of rural black South African groups, such as the Venda. The purpose of this study was to apply abridged life tables in order to estimate life expectancy from both skeletal remains and death registry information of modern South African communities. Comparisons were also made with prehistoric and contemporary groups as a means to better evaluate life expectancy for this time period. The sample consisted of 160 skeletons of known Venda origin and burial registry information for 1364 black South Africans from the Rebecca Street and Mamelodi Cemeteries in Pretoria, South Africa. Standard anthropological techniques were applied to determine sex and estimate age from the skeletal remains. The stationary and non-stationary life table models were used to analyse the data. A high rate of child mortality, low juvenile and adult mortality with a steady increase in mortality after the age of 30 years was observed for both the Venda and the cemetery samples. Throughout the 20th century, life expectancy was shown to increase for black South Africans. However, due to the widespread HIV infection/AIDS of the 21st century, infant and young adult mortality rates continue to rise at such a speed that the decline in mortality seen for South Africans in the last 50 years will most likely to be lost in the next decade due to this disease.     

Life expectancy in a western and immigrant receiving population (El Ejido, SE Spain)

This study deals with the mortality pattern of El Ejido population, an agricultural Spanish community with a sub-tropical climate, located on the western Mediterranean coast (Andalusia). Based on the incorporation of modern agrarian techniques, this region has experienced a great economic development. Its demographic consequences were relevant, such as the arrival of immigrants throughout the second half of the twentieth century. The analysis of several demographic parameters shown in the abridged life table has revealed a small but non-random decrease of mortality during the last two decades of the past century. Furthermore, from the low value reached by the current entropy coefficient (H = 0.131), and the comparison of El Ejido life-expectancy at birth (e0) with Spain and Andalusia, we concluded that: a) The current mortality of El Ejido has approached a theoretical situation, where all deaths tend to take place at the age of 78.09 (its e0), and the death probability is very low at earlier ages. b) Some peculiar characteristics of its immigration as well as the high influence of the great public health system reached currently in Spain, reveal that El Ejido mortality does not depend on its remarkable immigration.     

北京市居住区林木健康评价

为了揭示北京市居住区林木健康变化特征及影响因素,提供北京市居住区林木健康经营对策。对北京市85个居住区林木进行健康特征调查,在建立林木健康评价模型评价林木健康状况的基础上,采用方差分析法和多重比较法分析不同类型居住区林木健康差异。结果表明:不同类型居住区林木健康指标差异显著(P0.05),各指标变化规律不完全一致;不同类型居住区地表覆盖情况、光污染程度、树干倾斜度、栽植截干、树势、冠形、干形等方面普遍较差。北京市居住区林木健康指数在0.60—0.80之间,健康等级呈现右偏正态分布特点,健康林木比例为3. 65%,亚健康林木(56. 07%)最多,其次是中等健康林木(36.68%),不健康林木有3.50%,濒死林木仅占0.10%。居住区林木健康指数在不同区域和不同来源间差异不显著(P0.05),在不同时期间差异显著(P0.05),健康指数大小分别为:三—四环=四—五环五—六环二环内=二—三环;福利房商品房保障房;2009—2013年2003—2008年=1998—2002年=1991—1997年1956—1990年。北京市居住区林木生长处于亚健康状态,潜在影响因子如地表覆盖情况、光污染程度、树干倾斜度等指标是限制北京市居住区林木生长的重要因子。适当减小夜间照明影响、增加有机地表覆盖、避免过度的修枝截干和加强林木养护管理是当前北京市居住区林木健康生长的保障。     

Urban and rural differences in mortality and causes of death in historical Poland

The purpose of this paper is to document and interpret urban-rural differences in mortality in the past. To this end, we used data on mortality in Wielkopolska, Poland, in the 19th century and at the beginning of the 20th century. The data on mortality in rural areas (N = 1,173,910 deceased), small towns (N = 573,903 deceased), and Poznań, the capital of the Wielkopolska region (N = 86,352 deceased), were gathered from original Prussian statistical yearbooks (Preussische Statistik). Causes of death were also analyzed (rural areas, N = 449,576 deceased; small towns, N = 238,365 deceased; Poznań, N = 61,512 deceased). Mortality measures such as crude death rate (CDR), infant death rate (IDR), and neonatal and postneonatal death rates were calculated. Life tables were constructed for both stationary and stable population models and measures of the opportunity for natural selection calculated (Crow's index I(m), potential gross reproduction rate R(pot), and biological state index I(bs)). Relative frequencies of leading causes of death were computed. Stratification depending on the place of residence was evident in all mortality measures as well as in the values of the life tables and the measures of the opportunity for natural selection, but it was reverse of what is observed today in developed countries. In Poznań (a large industrial city), the mortality situation was the least favorable. It was caused by large population density, lack of water supply and sewage systems (up to 1896), and bad working conditions. The values of CDR ranged between 26.89-31.46, and IDR between 190.6-280.5. Newborn life expectancy (for a stable population model) was 31.6 years, I(m) = 0.79, R(pot) = 0.85, and I(bs) = 0.47. The most common causes of death were tuberculosis, other diseases of the respiratory and circulatory systems, dysentery and diarrhea, and cancer. These diseases were less common in rural areas, so they had the most favorable values of mortality measures (CDR between 22.87-27.32, IDR between 181.8-219.4, life expectancy of newborn e(0) = 42.12, I(m) = 0.55, R(pot) = 0.93, I(bs) = 0.60). Infectious diseases (other than tuberculosis), frailty at birth, and frailty in old age were the most frequent causes of death in rural areas. Small towns (population <20,000) had a mortality intermediate between city and rural areas.