Adolescent Mortality in The Netherlands. II 1

Summary 1. The number of adolescents increased since 1900 from about 500,000 to well over 800,000: their percentage of the total population decreased from 10 to 7.5 per cent. 2. During the last fifty years adolescent mortality decreased to one seventh, in 1955 it amounts to 5.4 per 10,000 (for boys and girls 6.2 and 3.6 respectively). This decrease has been almost as rapid as the decline in infant and school child mortality. Pre‐school child mortality decreased even more, viz. to one tenth. After the Second World War the decrease in adolescent mortality has accelerated. 3. In the 15–19 age group mortality among girls has decreased most. At the beginning of the 20th century there existed a slight excess mortality among girls, mainly caused by a higher tuberculosis rate. Since 1930 there has been an excess male mortality amounting to more than 75 per cent mainly caused by accidents. Apart from tuberculosis mortality there has always existed an excess mortality among boys. 4. Up to 1920 tuberculosis caused about 50 per cent of the total mortality of the 15–19 age group. For girls this percentage even amounted to 60 per cent. In 1950/52 only 9 per cent of total mortality was caused by tuberculosis. In 1953/54 accidents are the leading cause of death in adolescence (38 per cent of the total mortality), neoplasms rank second (18 per cent) and tuberculosis comes in the fifth place (3 per cent). 5. Tuberculosis mortality among adolescents decreased from 186 per 100,000 (about 1900) to merely 0.6 in 1955. This spectacular decrease was even more rapid for girls than for boys. The excess mortality among girls from tuberculosis, however, still exists. Both world wars have had an unfavourable, though temporary, influence on tuberculosis mortality among adolescents; the trend has remained the same. 6. Mortality from accidents has hardly decreased. The relative importance of death from accidents, therefore, has increased since 1900 and accidents now form the leading cause of death also for this age‐group. Mortality from accidents among boys is three to four times as high as among girls. Nowadays traffic accidents are the greatest single cause of accident mortality (40–50 per cent). About 1920 drowning was the leading cause of accident mortality. The significance of drowning has decreased absolutely as well as relatively. 7. During both world wars adolescent mortality increased. The increase during the First World War was partly caused by an increased tuberculosis mortality, but mainly by the epidemic of “Spanish flu” in 1918/1919. During the Second World War the increase was caused mainly by a greater number of deaths from accidents. Mortality from accidents increased to 160 per 100,000 in 1945. The greater part of this increase in mortality from accidents was directly caused by the war. In 1944/1945 there was a sharp increase in the number of deaths from unknown causes (from 3 to 100 per 100,000). Deaths from tuberculosis increased as well, though not to the same degree as in 1914/1918. 8. There are regional differences in adolescent mortality. In 1950/1954 mortality of the 15–19 age group was lowest in Western Holland. Adolescent mortality in towns with more than 100,000 inhabitants is lower than in smaller communities. This difference is only in part accounted for by a lower tuberculosis and accident mortality. 9. Seasonal influences in. adolescent mortality are manifest. During the last few decades there has been a peak during summer, caused mainly by the higher number of accidents. Excluding accidents, there is a higher mortality in. spring more or less corresponding to the total adolescent mortality figures of around 1900. 10. Sweden, Denmark, France, and England and Wales show about the same development as The Netherlands, though on another level. Total adolescent mortality has rapidly decreased, tuberculosis mortality has decreased even more quickly, accident mortality has decreased little if at all, and excess male mortality has increased significantly. Compared with these countries The Netherlands are in a favourable position as regards both total mortality and mortality from specific causes. Only Denmark has a lower tuberculosis mortality. 11. At a continued cumulation of favourable factors a decrease of adolescent mortality to three per ten thousand seems possible before long. Mortalité des adolescents aux Pays‐Bas. Gette analyse est une des premières études détaillées sur la mortalité des adolescents. Aux Pays‐Bas, le niveau de la mortalité des adolescents a baisséà un septième pendant ces derniers 50 ans. II a atteint 5,4 pour dix milles (7,2 pour les garçons et 3,6 pour les filles). La mortalité des filles a diminué plus rapidement que cello des garçons. II y a eu depuis 1930 un excès de mortalité masculine parmi les adolescents, dû principalement aux accidents. En 1920 la tuberculose causait encore 60 % de la mortalité parmi les adolescents. En 1953/1954 ce pourcentage est de trois. L'importance relative de la mortalité par suite d'accidents s'est accrue à un tel point, que les accidents sont devenus la, principale cause de décès aussi pour ce groupe dâge. Geux de la circulation jouent le plus grand rôle. Des influences saissonières sont plus manifestes que les différences entre les régions rurales et urbaines. La mortalité des adolescents aux Pays‐Bas est favorable, comparéà celle d'autres pays d'Europe ocoidentale. Une accumulation continue de facteurs favorables conduira à un niveau de trois pour dix mules pour la mortalité des adolescents. Die Sterblichkeit der Adoleszenten in den Niederlanden. Die vorliegende Analyse ist eine der ersten speziellen Untersuchungen über die Sterblichkeit von Adoleszenten. Während der letzten 50 Jahre ist die Sterblichkeit von Adoleszenten in den Niederlanden auf ein Siebtel zurückgegangen und hat 5,4 auf zehntausend erreicht (d.h. 7,2 für Knaben und 3,6 für Mädchen). Bei den Mädchen hat die Sterblichkeit viel schneller abgenommen als bei den Knaben. Seit 1930 überflügelt die Sterblichkeit männlicher Adoleszenten die der Mädchen, vor allem infolge höherer Sterblichkeit bei Unfällen der Knaben. Tuberkulose machte in 1920 noch 50 Prozent der totalen Sterblichkeit der Adoleszenten aus, in 1953/54 nur drei Prozent. Sterblichkeit durch Urifälle ist im Verhältnis zur totalen Sterblichkeit dermassen angestiegen, dass auch für dieses Lebensalter Unfälle die hauptsächliche Todesursache sind, wobei Verkehrsunfälle die Hauptrolle spielen. Saisoneinflüsse sind deutlicher nachweisbar als Differenzen zwischen städtischen und ländlichen Gegenden. Im Vergleich mit anderen westeuropäischen Ländern ist die Sterblichkeit der Adoleszenten in den Niederlanden günstig. Eine fortgesetzte Akkumulation günstiger Momente wird dazu führen, dass die Sterblichkeit der Adoleszenten in kurzem auf drei pro zehntausend zurückgehen wird. Mortalidad de los adolescentes en log Paises Bajos. Este análisis es una de las primeras revisiones especiales realizadas sobre la mortalidad de los adolescentes. Durante los últimos 50 años la mortalidad de los adolescentes en los Países Bajos ha disminuido en un séptimo, alcanzando el 5.4 por diez mil (7.2 para los varones y 3.6 para las hembras). En las muchachas la mortalidad ha diminuido rnucho mas aprisa que en los varones. Desde 1930 la mortalidad de los adolescentes varones va detrás de la de las hembras, principalmente por una mayor incidericia de accidentes mortales en los primeros. En 1930 la tuberculosis determinó aun el 50% de la mortalidad de los adolescentes; en 1953/54 solo el 3 %. La mortalidad por accidentes en relación con la mortalidad total ha aumentado, debiendo señalarse que para esta época de la vida los accidentes son la causa principal de muerte, desempeñando el papel fundamental los accidentes de tráfico. Las influencias estaciones son más claramente comprobables que las diferencias entre los sectores urbanos y rurales. En comparación con otros países del occidente europeo, la mortalidad de los adolescentes en los Países Bajos es favorable. Una continuada acumulación de circunstancias favorables conducirá a que, en corto plazo, la mortalidad de los adolescentes disminuya al tres por diez mil.