Abstract: The conventional approach to gauging mortality convergence in Europe relies on life expectancy estimates (e0) at the national level. However, mortality can differ within countries significantly. To better apprehend whether Europe's mortality patterns have been converging or diverging over recent decades, we must shift our focus to regional mortality data. This approach is of more than academic significance; it can play a pivotal role in the formulation of policies aimed at promoting social and territorial cohesion within the European Union (EU). Using data from statistical offices, we present annual e0 estimates for 420 regions in 16 EU countries from 1995 to 2019. This selection of countries in this specific time period is particularly interesting in light of the accession of central-eastern European countries to the EU in 2004. In our empirical analysis, we examined whether regions with initially high mortality levels caught up with low-mortality regions (beta-convergence), and we investigated changes in the standard deviation of Europe’s regional e0 distribution over time (sigma-convergence). Our results suggest a mixed picture with respect to mortality convergence in Europe. Indeed, the variation in regional mortality has generally decreased from 1995 to 2019 due to larger gains in e0 for regions with initially high mortality levels. The convergence phase took place mostly during the first half of the entire time period analyzed. Over more recent periods, however, we observe more heterogeneity in the development of e0. Some advantaged regions realized further gains in e0, even as e0 improvements slowed for more disadvantaged regions. In conclusion, our analysis underscores the importance of addressing widening health inequalities. Policies should target disadvantaged regions to retard mortality divergence across Europe.

Background Both enhancing life expectancy as well as diminishing inequalities in lifespan among social groups represent significant goals for public policy. However, there is a lack of methodological tools to simultaneously monitor progress in both dimensions. Additionally, there is a consensus that absolute and relative inequalities in lifespan must be scrutinized together.

Methods We introduce a novel graphical representation that combines national mortality rates with social inequalities, considering both absolute and relative measures. We use French and German data stratified by place of residence to illustrate this representation.

Results For all-age mortality we detect for France a rather continuous pace of decline in both mortality levels and variation. In Germany, substantial progress was made in the 1990s, which was mostly driven by convergence between eastern and western Germany, followed by a period with less progress. Age-specific analyses reveal for Germany some worrying regional divergence trends at ages 35-74 in recent years. This is particularly pronounced among women.

Conclusion Our novel visual approach allows evaluating easily the dynamics of societal progress in terms of longevity, and facilitates meaningful comparisons between populations, even when their current mortality rates differ. The methods we employ can be reproduced easily in any country with longitudinal mortality data stratified by relevant socio-economic information or regions. It is both useful for scientific analyses as well as policy advice.

Abstract: This article presents a detailed analysis of the global mortality burden of the COVID-19 pandemic across 569 regions in 25 European countries. We produce sex-specific excess mortality and present our results using Age-Standardised Years of Life Lost (ASYLL) in 2020 and 2021, as well as the cumulative impact over the two pandemic years. Employing a robust forecasting approach that considers regional diversity and provides confidence intervals, we find notable losses in 362 regions in 2020 (440 regions in 2021). Conversely, only seven regions experienced gains in 2020 (four regions in 2021). Most importantly, we estimate that eight regions suffered losses exceeding 20 years of life per 1,000 population in 2020, whereas this number increased to 75 regions in 2021. The contiguity of the regions investigated in our study also reveals the changing geographical patterns of the pandemic. While the highest excess mortality values were concentrated in the early COVID-19 outbreak areas during the initial pandemic year, a clear East-West gradient appeared in 2021, with regions of Slovakia, Hungary, and Latvia experiencing the highest losses. This research underscores the importance of regional analyses for a nuanced comprehension of the pandemic's impact.

Abstract: The analysis of causes of death is crucial for monitoring the epidemiologic situation and developing adequate policy responses. Yet, various methodological challenges complicate such analysis. The comparability of cause-specific mortality data depends on the proportion of misclassified deaths. To eliminate the bias due to varying proportion of such causes over time and between populations, one has to reassign ill-defined causes to other categories. In this research note, we thoroughly document and provide tools for the practical implementation of a regression-based method for redistributing misclassified causes of death proposed by a French demographer, Sully Ledermann. The method relies on the sub-national cause-specific mortality data to estimate unbiased death rates at both the national and sub-national levels. We refine the Ledermann’s method through elaborating on its mathematical properties, making additional adjustments, and evaluating the performance of the approach through simulations. To illustrate the practical application of the method, we rely on the French regional data on causes of death for the period 1979–2016. To ensure the reproducibility of the obtained results and enable potential users to adapt the program to their data, we provide the R code performing all calculations.

Objective: To measure the burden of the COVID-19 pandemic in 2020 at the subnational level by estimating excess mortality, defined as the increase in all-cause mortality relative to an expected baseline mortality level. 

Design: Statistical and demographic analyses of regional all-cause mortality data.

Setting: The vital statistics systems of 21 European countries.

Participants: The entire population of 561 spatial units in 21 European countries.

Main Outcome Measures: Losses of life expectancy at ages 0 and 60 for males and females.

Results: We found evidence of a loss in life expectancy in 391 regions, while only three regions exhibit notable gains in life expectancy in 2020. For 12 regions, losses of life expectancy amounted to more than 2 years, and three regions showed losses greater than 3 years. We highlight geographic clusters of high mortality in Northern Italia, Spain and Poland, while clusters of low mortality were found in Western France, Germany/Denmark and Norway/Sweden.

Conclusions: Regional differences of loss of life expectancy are impressive, ranging from a loss of more than 4 years to a gain of 8 months. These findings provide a strong rationale for regional analysis, as national estimates hide significant regional disparities.

Abstract: The Covid-19 pandemic did not affect sub-national regions in a uniform way. Knowledge of the impact of the pandemic on mortality at the local level is therefore an important issue for better assessing its burden. Vital statistics are now available for an increasing number of countries for 2020 and 2021, and allow the calculation of sub-national excess mortality. However, this calculation faces two important methodological challenges: (1) it requires appropriate mortality projection models; (2) small populations implies important uncertainty in the estimates, commonly neglected. We address both issues by adopting a method to forecast mortality at sub-national level and by incorporating uncertainty in the computation of mortality measures. We illustrate our approach to French départements (NUTS 3, 95 geographical units) and produce estimates for 2020 and both sexes. Nonetheless, the proposed approach is so flexibility to allow estimation of excess mortality during Covid-19 in most demographic scenarios as well as for past pandemics.

Abstract: People in higher-level occupations have a longer life expectancy than manual workers but retire later, on average. Which occupational categories spend the most years in retirement? Are any gender differences observed? How do career histories and the pension system affect time spent in retirement? To answer these questions, Florian Bonnet, Carlo-Giovanni Camarda, Emmanuelle Cambois, and Ophélie Merville measure life expectancy across occupational categories at different ages, particularly around retirement ages.

Abstract: Many recent studies show that Europe has had a lower mortality inequality for most ages than the United States over the last thirty years. However, the evolution of the income gradient in mortality all along the twentieth century remains poorly understood. This article uses a unique dataset that gives the annual lifetables and fiscal income for the 90 administrative regions of mainland France from 1922 to 2020. The income gradients in mortality are computed across regions using a traditional method with calendar ages and, alternatively, with mortality milestones to control for the increase in life expectancy over time. The study reveals a systematic reversal of the gradient that occurred around the 1970s for both sexes and all ages or mortality groups when calculated at an aggregated level. Inequality in mortality amongst the oldest age groups has however returned to a level observed at least ten years earlier because of Covid-19, even after controlling for mortality improvements over the period.

Objective: The COVID-19 pandemic is characterized by successive waves that each developed differently over time and through space. We aim to provide an in-depth analysis of the evolution of COVID-19 mortality during 2020 and 2021 in a selection of countries.

Methods: We focus on five European countries and the United States. Using standardised and age-specific mortality rates, we address variations in COVID-19 mortality within and between countries, as well as demographic characteristics and seasonality patterns.

Results: Our results highlight periods of acceleration and deceleration in the pace of COVID-19 mortality, with substantial differences across countries. Periods of stabilization were identified during summer (especially in 2020) among the European countries analysed, but not in the United States. The latter stands out as the study population with the highest COVID-19 mortality at young ages. In general, COVID-19 mortality is highest at old ages, particularly during winter. Compared to women, men have higher COVID-19 mortality rates at most ages and in most seasons.

Conclusions: There is seasonality in COVID-19 mortality for both sexes at all ages, characterized by higher rates during winter. In 2021, the highest COVID-19 mortality rates continued to be observed at ages 75+, despite vaccinations having specifically targeted those ages.

Background: Influenza mortality has dramatically decreased in France since the 1950s. Annual death rates peaked during two pandemics: the Asian flu (1956–1957) and the Hong Kong flu (1969–1970).

Objective: This study’s objective is to evaluate whether the second pandemic created a structural change in the dynamics of influenza mortality in France.

Methods: We employ a new database on influenza mortality since 1950 at the subnational level (90 geographic areas) to estimate statistical models to find out whether a structural change happened and to explain the differences in mortality rates across geographic areas. Influenza mortality increased between 1950 and 1969 and decreased from 1970 onward.

Conclusions: The Hong Kong flu is identified as the event of a structural break. After the break, geographical differences are less explained by regional characteristics such as income, density, or aging ratio. The Hong Kong flu was found to be associated with a major change in influenza mortality in France. Change in health practices and policies induced a decline in mortality that started in 1970, just after the pandemic. The health benefits are notably important for senior citizens and for the poorest regions.

Contribution: We employ a new database on influenza mortality since 1950 at the subnational level (90 geographic areas). Change in health practices and policies induced a decline in mortality that started in 1970, just after the pandemics. The health benefits are notably important for senior citizens and for the poorest regions.

Abstract: National authorities publish COVID-19 death counts, which are extensively re-circulated and compared; but data are generally poorly sourced and documented. Academics and stakeholders need tools to assess data quality and to track data-related discrepancies for comparability over time or across countries. “The Demography of COVID-19 Deaths” database aims at bridging this gap. It provides COVID-19 death counts along with associated documentation, which includes the exact data sources and points out issues of quality and coverage of the data. The database — launched in April 2020 and continuously updated — contains daily cumulative death counts attributable to COVID-19 broken down by sex and age, place and date of occurrence of the death. Data and metadata undergo quality control checks prior to online release. As of mid-December 2021, it covers 21 countries in Europe and beyond. It is open access at a bilingual (English and French) website with content intended for expert users and non-specialists. Data and metadata are available for each country separately and pooled over all countries.

Background: Research on annual migration between regions of the same country is scarce because statistical sources are often lacking. Consequently, little is known about migration between French regions during the Second World War.

Objective: Propose a new method to estimate the annual populations of each region and deduce the annual migration flows between regions of the same country. Use this method to present the chronology of inter-regional migration flows in France during the Second World War.

Methods: Annual regional populations are estimated using census populations and death-by-cause statistics at the local level. Death-by-cause statistics can be used to dissociate symmetrical mortality, which trends in the same way in the national territory, from asymmetrical mortality, which trends differently. This makes it possible to deduce the trend in the mortality rate and populations at the local level.

Results: Analysis of French migration reveals that (1) a large proportion of the population (up to 60%) was displaced from the north to the south in 1940 and 1941; (2) the demarcation line did not prevent population movements; (3) the demographic scars of war were still present in 1946 since not all the refugees from the northwest and northeast returned.

Contribution: This new method for analyzing annual migration flows between regions could be replicated to study other specific historical events. This paper also proposes a quantitative historical analysis of migration in France during the Second World War and shows that some territories were emptied of more than half their population in a few months.

Abstract : This article analyzes the evolution of spatial inequalities in mortality across 90 French territorial units since 1806. Using a new database, we identify a period from 1881 to 1980 when inequalities rapidly shrank while life expectancy rose. This century of convergence across territories was mainly due to the fall in infant mortality. Since 1980, spatial inequalities have levelled out or occasionally widened, due mainly to differences in life expectancy among the elderly. The geography of mortality also changed radically during the century of convergence. Whereas in the 19th century high mortality occurred mainly in larger cities and along a line from North-west to South-east France, it is now concentrated in the North, and Paris and Lyon currently enjoy an urban advantage.

Background: Debates concerning the French territorial divide are deep in France. However, there is little historical data on French demography at the local level for the 20th century available to study these territorial disparities.

Objective: The main objective is to present a new demographic database built at the departmental level for the 20th century, as well as the methods used to build this database.

Methods: The database was constructed by digitizing a large part of the raw data available in the French archives and by using new statistical sources for military deaths and deportees during the two World Wars. The methods used are both the methodological protocol of the Human Mortality Database and a set of methods which take into account the specificities of the French departments.

Contribution: With this database, the French departmental lifetables by sex and year including military deaths and deaths in deportation will be available, as well as the departmental populations by age, sex and year between 1901 and 2014.

Abstract : Becker et al. (2005) maintain that including life expectancy gains in a welfare indicator result in a reduction of inequality between 1960 and 2000 twice as great as when measured by per capita income. We discuss their methodology and show it determines the convergence result. We use an alternative methodology, based on Fleurbaey and Gaulier (2009), which monetizes differences in life expectancy between countries at each date rather than life expectancy gains. We show that including life expectancy has no effect on the evolution of world inequality.

Abstract: The growth in life expectancy (LE) slows down recently in several high-income countries. Among the underlying dynamics, uneven progress in LE across social groups has been pointed out. However, these dynamics has not been extensively studied, partly due to data limitations. In this paper, we utilize the recent change in French census mortality follow-up data (EDP) and apply P-spline models to explore this area. We estimate LEs across five occupational classes (OCs) and indicators of lifespan heterogeneity (edagger) within these OCs, for seven triennial periods (2011–2013 to 2017–2019). First, we found a similar ranking of OCs along the LE gradient over time and across genders, from manual workers to higher-level OCs. Noteworthy, the lowest LE in women overlaps with the highest one in men. Second, we observe varying progress of LEs. In women, LE increases in higher-level OCs meanwhile it levels off in manual workers, so that the OCs gap widens (up to 3.4 years in 2017–2019). Conversely, in men LE stalls in higher-level OCs and increases in manual workers so that the gap, which is much larger than in women (+5.7 years in 2017–2019), is tending to narrow. Finally, the lifespan homogenizes in OCs only when LE is low. Overall, the limited LE progress in France results from LE stalling in the middle of the gender-OC gradient, though LE increases at both ends. At the lower end, LE progress and lifespan homogenization suggest that  laggards benefit recently improvements achieved earlier in other OCs. At the upper end, LE progress may come from a vanguard group within higher-lever OC, benefiting new sources of improvements. These findings underscore the need for further research to explore the diverse mortality dynamics coexisting in the current health landscape.

Abstract: Understanding the relationship between life expectancy at birth (e0) and the gross domestic product per capita (GDPpc) is relevant for cohesion policies in the European Union (EU) because it might imply that economic convergence (or divergence) is accompanied by narrowing (or widening) health gaps. Previous studies have studied the association between GDPpc and e0 almost exclusively based on national data. It is certainly more appropriate, however, to study the relationship at the subnational level because levels and trends in both variables, e0 and GDPpc, vary substantially across Europe’s regions. Accordingly, our study aims to examine whether the economic performance of regions predicts their e0 level. We build Preston curves from regression models using regional data for 21 European countries, divided into 506 regions. Mortality data comes from statistical offices and GDPpc can be obtained from the Eurostat database. The period 2008 to 2019 is particularly interesting as it follows the EU enlargement to central-eastern European countries in 2004. In our analysis, spatial units refer to NUTS-2 or NUTS-3 regions, depending on the size of the country. Our results suggest that there is indeed a positive association between GDPpc and e_0. Similarly, to Preston’s original analysis, we observe an upward shift in the curve, indicating that factors exogenous to a region’s GDPpc level play an important role in explaining e_0 gains as well. Yet, the relationship differs between geographical areas and we also find examples such as women in Germany, Austria, Poland, and the Netherlands where it does not seem to hold.

Abstract: This paper proposes homogeneous annual series on the income distribution of French metropolitan départements for the period 1960-69 and 1986-2018. We rely on unpublished and newly digitised archives of the French Ministry of Finance. They consist of fiscal tabulations that are a summary of households’ income tax declarations. Based on these raw sources, we interpolate the whole income distribution of French metropolitan départements after 1986. Before 1986, we need more assumptions as only households liable to French income tax filed income tax declarations at that time. We propose a methodology to estimate the number and average income of non-taxable households before 1986 that also allows us to reconstruct the income distribution of French metropolitan départements for the period 1960-69.

Abstract: The 2019 widespread protests have brought back the issue of territorial inequalities in France. Following these debates, this paper analyses the evolution of income inequalities between French departments over the past 50 years. It highlights the dramatic rise in inequality within the capital region, which have tripled since the end of the 1960s and have increased ninefold since the early 1980s.  This evolution contrasts with the sharp decline in regional inequality observed in the whole country (60%). Using an original dataset providing regional income distributions, this paper shows that this increase within the capital region is largely due to the polarisation of the top income households. In 2019, the income of a Top 1% household in the city of Paris equals 113 years of income of a Bottom 50% household in the suburban department of Seine-Saint-Denis. These evolutions raise questions about the national social cohesion and the likelihood of social conflicts in France.

Abstract: This paper combines new data and methods to uncover the location of top income earners in France since 1960. We construct homogeneous annual top income  series of 95 French metropolitan regions for the periods 1960-1969 and 1986-2019. We find that the spatial concentration of the top income earners in France has followed a U-shaped curve: an high concentration in the early 1960s, a decline in the following decades, a strong increase since the early 2000s. In the 1960s, top income earners were over-represented in the two largest French urban areas (Paris and Lyon) and in the North-East industrial part of France. Today, top income earners are still over-represented in the two largest French urban areas but also near foreign borders, in particular Switzerland. The shift from an industrial economy to a services economy, in which high skilled workers cluster in the largest metropolitan areas to benefit from agglomeration economies, explains most of these changes.

Abstract: In the past two hundred years, European cities, especially huge metropolises such as London, Paris or Berlin, went from urban graveyards to healthy cocoons. Despite a growing literature, this peculiar evolution remains under-investigated. Building on a novel database that covers a century and a half of mortality in Paris and its surrounding area, we analyze in great detail the urban mortality transition. We explore three directions. First, we study the changing patterns of mortality between different groups, in particular contrasting the evolution of mortality for men and women. Second, we assess the role of different causes of death in the decline and in the differences between groups. Third, we link change in mortality with economic transformations, in terms of both the average economic growth and the degree of economic inequality within the city.

Abstract: In this paper, we propose (1) to evaluate the global burden of COVID-19 pandemic in France in 2020 and 2021 at the finest geographic level used by Eurostat in the Nomenclature of Territorial Units for Statistics, and (2) to compare this burden with other mortality crises which occurred during the 20th and 21st centuries. We leverage an extensive dataset comprising a lengthy time series of mortality data sourced from reliable records, stratified by age-groups and gender, for nearly 90 French d ́epartements. Our analytical approach involves modeling this dataset using a non-parametric approach (P -splines) within a Composite Link Model framework, while intentionally excluding years that are unequivocally identified as crises in relevant literature. The impact and burden of each crisis are subsequently assessed by computing age-specific differences between observed mortality rates and those predicted by our models. While our approach allows for the computation of a wide range of demographic indicators to evaluate the impact of each crisis, we focus on results for age-standardized years of life lost (ASYLL). Our results reveal geographic hot spots for each crisis as well as differences in magnitude between crises.

Abstract : La France est l’un des pays européens avec le taux de suicide le plus élevé. De plus, les disparités territoriales du taux de suicide y sont très élevées, posant la question de l’évolution de ces inégalités, et de l’association entre ces inégalités et les inégalités de développement. Ainsi, dans ce papier, nous questionnons l’association entre inégalité de mortalité par suicide et inégalité de développement au niveau départemental, de 1979 à 2016. L’existence d’une large proportion de décès répertoriée en “cause de décès inconnue ou mal définie” (près de 10% des décès) nécessite pour répondre à cette question de retraiter les taux de mortalité par cause. Nous utilisons la méthode de Ledermann (1955) pour estimer des taux de mortalité corrigés par tranche d’âge et sexe, pour chaque département. Nous mesurons les inégalités de suicide ainsi que le gradient territorial de ces inégalités grâce à une adaptation de la méthode de Currie et Schwandt (2016). Nous montrons que les inégalités absolues de suicide stagnent chez les jeunes hommes. De plus, le gradient territorial des inégalités de suicide tend à augmenter, laissant craindre un effet Matthieu grandissant.

Abstract: This paper analyzes the spatial distribution of population in the French departments since 1851, using a new demographic dataset presented in Bonnet (2018). This evolution can be described as the sequence of three phases called “hyper-centralization”, “hyper-centralization thwarted”, “multipolarization”. I analyze this process by disentangling intrinsic growth and migrations and point out some geographical regions which cumulate impairments. Moreover, the age profile of inequalities has changed along the 150 years: today, it has an inverted U-shape and is maximum for young workers. Finally, age structures are more and more differentiated: the spatial specialization according to age has increased since 1950.