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  • Beneficiary Profile: Yesterday, Today, and Tomorrow Dorothy P Rice, Sc.D. (Hon.)

    CHANGING DEMOGRAPHIC STRUCTURE OF THE POPULATION

    Growth of the Elderly Population

    The distribution of the population in the United States has shifted with considerable rapidity in both the number and proportion of the population 65 years of age or over. This population group has grown and will continue to grow at a rapid rate for the re- mainder of the 20th century and is ex- pected to increase well into the next cen- tury. In the 50-year period 1940-90, the elderly population grew twice as fast as the population under 65 years of age. The U.S. Bureau of the Census (1993) projects that a similar differential rate of growth for the elderly population will continue in the next 50-year period, 1990-2040.

    At the turn of the century, there were only 3.1 million elderly people, 4.0 percent of the total population (Table 1). Forty years later the number of elderly had tripled to 9 million, as the proportion in- creased to 6.8 percent. By 1994 the elderly population had more than tripled again, to 33.2 million persons, comprising 12.7 per- cent of the total population. The growth of the elderly population is attributable to the increased survival of the large generations of Americans born during the first quarter of this century, when birth rates were higher than they are today. The aging of the 19 million immigrants who entered the United States in the first three decades of

    Dorothy P Rice is Professor Emeritus at the Institute for Health & Aging, University of California, San Francisco. The opinions expressed are those of the author and do not necessarily reflect those of the University of California or the Health Care Financing Administration.

    HEALTH CARE FINANCING REVIEW/Winter 1996/Volume 18, Number 2

    this century also contributed to this growth. Because of the aging of the baby boomers born between 1946 and 1965, more than one out of five Americans will be 65 years of age or over by the year 2030, and the total number is projected to be 70 million, more than doubling in the 36-year period 1994-2030 (U.S. Bureau of the Census, 1995).

    Within the group 65 years of age or over, the number and proportion of the oldest old population have also increased rapidly. In 1900, fewer than 125,000 persons were 85 years or over, comprising 4 percent of the elderly; by 1994, there were 3.5 million persons in this age group, or 11 percent of the elderly. In the 46-year period 1994-2040, the very old population is projected to qua- druple and will comprise 18 percent of the elderly, the fastest growing segment of the population. This growth in the number of oldest old persons is explained by the ag- ing of the baby-boom generation into old age and by continuing declines in mortality at advanced ages that many scientists pre- dict. These projections are middle-series projections of the U.S. Bureau of the Cen- sus, based on assumptions of slightly in- creasing fertility rates, increasing life ex- pectancy from 76 years in 1993 to 82.6 years in 2050, and net immigration of 880,000 persons each year (U.S. Bureau of the Census, 1993).

    Mortality

    In 1993, 2.3 million people died in the United States, a rate of 8.8 per 1,000 popu- lation. Because the population has been ag- ing, a more accurate picture of mortality

    23

  • Table 1 Number and Distribution of the Population, by Age Group: United States, 1900-2050

    trends is provided by the age-adjusted death rate, which eliminates the distortion associated with changing age composition. Thus, the crude death rate declined 9 per- cent, while the age-adjusted death rate for the total population declined 39 percent during the 43-year period 1950-93. Exami- nation of the trend clearly shows two sepa- rate periods: (1) a moderate decline from

    ' Middle-series projections. SOURCES: U.S. Bureau of the Census: Current Population Reports, Series P-23, No. 128 and P-25, No.1018; and Statistical Abstract of the United States, Washington, DC, 1995.

    1950 to 1970, in which the age-adjusted mortality rate declined at an average an- nual rate of 0.8 percent; and (2) a rapid de- cline from 1970 to 1993, at 1.5 percent annually (Table 2).

    Trends in mortality rates for the elderly population show a similar pattern. Changes in mortality for those 65-84 years of age were small from 1950 to 1970, but the rate

    24

    HEALTH CARE FINANCING REVIEW/Winter 1996/volume 18, Number 2

    65 Years of Age or Over

    Year All Ages Total 65-74 75-84 85 or Over

    Actual 1900 76,303

    Number in Thousands

    772 1 233,084 2,189

    1910 91,972 3,950 2,793 989 167

    1920 105,711 4,933 3,464 1,259 210 1930 122,775 6,634 4,721 1,641 272 1940 131,669 9,019 6,375 2,278 365 1950 150,697 12,270 8,415 3,278 577

    1960 179,979 16,675 11,053 4,681 940

    1970 203,235 19,973 12,443 6,122 1,408 1980 226,546 25,550 15,581 7,729 2,240 1990 248,718 31,080 18,046 10,012 3,022 1994 260,341 33,159 18,712 10,925 3,522

    Projected' 2000 276,241 35,322 18,551 12,438 4,333 2010 300,431 40,104 20,978 13,157 5,969 2020 325,942 53,349 30,910 15,480 6,959 2030 349,993 70,175 37,984 23,348 8,843 2040 371,505 77,014 33,968 29,206 13,840

    2050 392,031 80,109 34,628 26,588 18,893

    Actual 1900 100.0

    Percent Distribution

    4.0 2.9 1.0 0.2

    1910 100.0 4.3 3.0 1.1 0.2

    1920 100.0 4.7 3.3 1.2 0.2 1930 100.0 5.4 3.8 1.3 0.2 1940 100.0 6.8 4.8 1.7 0.3 1950 100.0 8.1 5.6 2.2 0.4 1960 100.0 9.3 6.1 2.6 0.5 1970 100.0 9.8 6.1 3.0 0.7 1980 100.0 11.3 6.9 3.4 1.0

    1990 100.0 12.5 7.3 4.0 1.2 1994 100.0 12.7 7.2 4.2 1.4

    Projected' 2000 100.0 12.8 6.7 4.5 1.6

    2010 100.0 13.3 7.0 4.4 2.0 2020 100.0 16.4 9.5 4.7 2.1 2030 100.0 20.1 10.9 6.7 2.5 2040 100.0 20.7 9.1 7.9 3.7 2050 100.0 20.4 8.8 6.8 4.8

  • SOURCES: National Center for Health Statistics: Health, United States, 1994, DHHS Pub. No. (PHS) 95-1232, 1995; and Monthly Vital Statistics Report, Vol. 43, No. 6(S), December 8,1994, Hyattsville, MD.

    x

    x

    Table 2 Number of Deaths per 100,000 Resident Population and Percent Change:

    Selected Years, United States, 1950-93

    Year

    Average Percent Change

    Average Annual Change

    Total Percent Change

    Age and Cause of Death 1950 1960 1970 1980 1993 1950-70 1970-93 1950-93 Zn All Causes

    All Ages, Age-Adjusted 840.5 760.9 714.3 585.8 513.3 -0.8 -1.5 -39.0 All Ages, Crude 963.8 954.7 945.3 878.3 880.0 -0.1 -0.3 -8.7 65-74 Years of Age 4,067.7 3,822.1 3,582.7 2,994.9 2,617.1 -0.6 -1.4 -35.7 75-84 Years of Age 9,331.1 8,745.2 8,004.4 6,692.6 5,951.6 -0.8 -1.3 -36.2 85 Years of Age or Over 20,196.9 19,857.5 17,539.4 15,980.3 15,481.7 -0.7 -0.5 -23.3

    Diseases of the Heart All Ages, Age-Adjusted 307.2 286.2 253.6 202.0 145.3 -1 -2.5 -52.8 65-74 Years of Age 1,839.8 1,740.5 1558.2 1,218.6 848.2 -0.8 -2.5 -53.9 75-84 Years of Age 4,310.1 4,089.4 3,683.8 2,993.1 2,182.9 -0.8 -2.3 -49.4

    O 85 Years of Age or Over 9,150.6 9,317.8 7,891.3 7,777.1 6,668.9 -0.7 -0.7 27.1C 3

    a Malignant Neoplasms All Ages, Age-Adjusted 125.4 125.8 129.8 132.8 132.6 0.2 0.1 5.7 65-74 Years of Age 692.5 713.9 751.2 817.9 876.1 0.4 0.7 26.5

    N 75-84 Years of Age 1,153.3 1,127.4 1,169.2 1,232.3 1,366.9 0.1 0.7 18.5 85 Years of Age or Over 1,451.0 1,450.0 1,320.7 1,594.6 1,807.7 -0.1 1.4 24.6

    Cerebrovascular Diseases All Ages, Age-Adjusted 88.8 79.7 66.3 40.8 26.5 -1.5 -4.1 -70.2 65-74 Years of Age 549.7 469.2 384.1 219.5 135.8 -1.8 -4.6 -75.3 75-84 Years of Age 1,499.6 1,491.3 1,254.2 788.6 479.1 -0.9 -4.3 -68.1 85 Years of Age or Over 2,990.1 3,680.5 3,014.3 2,288.9 1,607.7 0.4 -2.8 -46.2

  • of decline increased significantly from 1970 to 1993. This marked acceleration in de- clining mortality rates across the age range has had a significant impact on the demo- graphic structure of the population in the recent past and is the basis for optimistic population projections in the future.

    In 1900, infectious diseases (particularly influenza and tuberculosis) were the lead- ing causes of death, accounting for one- fifth of all deaths in the United States. The rapid decline in the death rates for these causes has been evident throughout the developed world. Improvements in sanita- tion, nutrition, housing, and education con- tributed to the decline. Similarly, advances in medical care, such as immunization and' the use of antibiotics, are associated with declining mortality. Heart disease, cancer, and stroke have been the leading causes of death among the elderly since 1950.

    More recently, however, decreases in death rates from some of the major chronic diseases, mainly the cardiovascular dis- eases, including heart and cerebrovascular diseases, have been evident. Heart disease continues to be the leading cause of death in the United States, and as such is the pre- dominant influence on total mortality. The age-adjusted heart disease death rate de- creased 53 percent from 1950 to 1993. Among the elderly, the death rates for heart disease declined 54 percent for those 65-74 years or age, 49 percent for those 75- 84 years of age, and 27 percent for those 85 years of age or over. Some suggested ex- planations for the decline in heart disease mortality include: decreased smoking, im- proved management of hypertension, im- proved life styles, decreased dietary intake of saturated fats, more widespread physical activity, improved medical emergency services, and more widespread use and increased efficacy of coronary care units.

    Malignant neoplasms, or cancer, are the second-leading cause of death for all ages

    and for the elderly in the United States. Age-adjusted death rates from c