Mortality Trends in a Rapidly Developing Economy in Taiwan Part I: Comparison with the USA and Japan 1976-1983

Abstract

The mortality experience of Taiwan was examined for two time periods (1976 and 1983) to determine the magnitude and direction of change in age-adjusted mortality and to identify deviation from the expected progress by comparison with two industrialized nations, the USA and Japan. Between 1976 and 1983 the overall mortality showed an annual average of nearly 2% decrease, mostly contributed by the marked reduction in the number of young. Significant reductions were also observed for deaths from strokes, rheumatic heart disease, ill-defined conditions, cancer of the stomach, and infectious diseases such as tuberculosis. A disturbing increase in suicide as well as accidents primarily caused by motor vehicles was noted. In general, cancer increased, to an alarming degree for environmentally implicated cancers such as lung, pancreas, nasopharynx, brain and liver in men.

When compared to that of the USA or Japan, the mortality experience of Taiwan showed the following increases: overall female mortality, accidental deaths, suicide among elderly women, deaths from strokes, ulcers, asthma, and liver, nasopharyngeal and cervical cancers. However, the overall cancer mortality rate was still much lower than that either in the USA or Japan. Despite marked reductions in infectious disease mortality, deaths from tuberculosis were nearly 40 times those of the USA. Although deaths from ill-defined conditions decreased by half during this study period, they were still high, particularly among elderly women (13% of all deaths and 22 times higher than the USA), which probably reflects inadequate medical services for women.

The role of the Taiwanese government in the financing of health services was found to be far smaller than that of the USA or Japan. Expanding health care expenditure by the government is desirable if improvement in the maldistribution of medical services is to be achieved and the untoward health effects of rapid industrialization is to be reduced.

Keywords

Comparison of mortality Industrialization Japan Standardised Mortality Ratio Taiwan United States

Get full access to this article

View all access options for this article.

References

1. Wen CP : Health in the midst of economic development in Taiwan. Med Care 1974; 12: 85–94.

2. Department of Health, Executive Yuan; Taiwan Provincial Health Department. Health Statistics I. General Health Statistics. Republic of China, 1976, 1983.

3. National Center for Health Statistics. Vital Statistics of the United States: 1983, Volume II. Mortality Part A: US Department of Health and Human Services, 1987.

4. Ministry of Health and Welfare; Vital Statistics. Vol 1-3 Japan, 1983.

5. Tsai SP , Wen CP : Methodological issues of standardized mortality ratio (SMR) in occupational cohort studies. Int J Epidemiol 1986; 15: 8–21.

6. Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Deaths. Geneva: WHO, 1977.

7. National Center for Health Statistics , Health, United States, 1985. DHHS Pub. No. (PHS) 86-1232. Public Health Service. Washington: US Government Printing Office, 1985.

8. Wen CP , Gershoff SN : Changes in serum cholesterol and coronary heart disease mortality associated with changes in post war Japanese diet. Am J Clin Nutr 1973; 26: 616–9.

9. Ueshima H , Tatara K , Asakura S : Declining mortality from ischemic heart disease and changes in coronary risk factors in Japan. 1956-1980. Am J Epidemiol 1987; 125: 62–72.

10.

10. Kyu TL , Nail R , Sherman LA , Milano M : Geographic pathology of myocardial infarction. Part I. Myocardial infarction in orientals and whites in the US. Am J Cardiol 1964; 13: 30–40.

11.

11. Gurunanjappa SB , Smith NJ : Comparability ratios by age: based on deaths of metropolitan policy holders. APJPH 1984; 74: 71–3.

12.

12. Monthly Vital Statistics Report , Provisional Statistics. Washington DC: DHEW, National Center for Health Statistics, 1960; 28: No. 12.

13.

13. Wen CP : Secular suicidal trend in post war Japan and Taiwan: an examination of hypotheses. Int J Soc Psychiatry 1974; 20: 8–17.

14.

14. Beasley RP , Hwang LY : Epidemiology of hepatocellular carcinoma. In: Vyas GN , Dienstag JL , Hoofnagle JH , eds. Viral Hepatitis and Liver Disease. Orlando, Florida: Grune & Stratton, Inc, 1984, 209–24.

15.

15. Chen DS , Hsu NH , Sung JL , et al: A mass immunization program in Taiwan against hepatitis B virus infestation in infants of hepatitis B surface antigen-carrier mothers. JAMA 1987; 257: 2597–603.

16.

16. Kircher T , Anderson RE : Cause of death: proper completion of death certificate. JAMA 1987; 258: 349–52.

17.

17. Measuring Health Care 1960-1983 Expenditure , Costs and Performance. OECD Social Policy Studies No. 2. Paris, France: Organization for Economic Co-operation and Development, 1985.

18.

18. Morrow CK : Health Care Guidance: Commercial Health Insurance and National Health Policy. New York: Praeger Publishers, 1976.