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10
Degenerative
disease

The true effects of the war cannot be separated from the statistical influences
described on p. 6 (particularly the change in 1940) but rates in recent years appear
to be running lower than during the war. The total death-rate is more than half
accounted for by causes which are mainly degenerative and which, as the more
tractable causes of death at younger ages are conquered, and as the population gets
older, now attain greater relative importance.
Pneumonia
and other
respiratory
diseases
Mortality from pneumonia rose sharply in 1940 and remained higher than
formerly until 1943, when it began to fall, reaching in 1945 and maintaining in 1946,
a level lower than the average of the immediate pre-war years. The rate for "other
respiratory diseases "was distorted in 1940, by the statistical revision, but thereafter
declined fairly steadily. In 1947, however, there was an increase in respiratory
mortality, associated with the severe weather conditions of February and March.
In contrast, 1948 was a year of very light mortality for respiratory disease. The
pneumonia death-rate for 1949 was 0.61 per 1,000 and the rate for "other respiratory
diseases "was 0.15. These fluctuations are similar to those for bronchitis and heart
disease.
Diabetes
Diabetes mortality had been falling steadily between 1939 and 1947, partly as a
result of more effective treatment and partly as a result of the dietary stringency of
the war and post-war years but in the last three years the death rates have been
0.07, 0.06, 0.07, indicating an arrest in the decline. At ages under 55, however,
where treatment is more effective, the number of deaths in 1949 was 26 — which
compares with an average of 29, in 1946-8.
Cancer
The cancer death-rate for all ages for 1949 was 2.10 per 1,000, slightly lower
than in 1948, after two successive years in which slight rises had been recorded.
Cancer is a disease mainly of advanced age and mortality is sensitive to changes
in the average age of the population which has not only been rising naturally consequent
upon the falling birth rate during the pre-war years (see Table 3), but, so far
as mortality statistics are concerned, has also been artificially increased by the
removal of young persons from the civilian population, to which such statistics relate,
by evacuation and mobilisation movements of the war years. Any analysis of
cancer mortality should, therefore, either have specific reference to advanced age
groups or to rates which have been "standardised" for age, i.e., rates which are
still averages over the whole population but averages in which the representation
follows not the actual pattern, disturbed as it is by temporary factors, but a standard
pattern which is kept statistically constant over the period under consideration.
Thus, for England and Wales the crude cancer mortality rates between 1938 and 1945
rose 37 per cent. for males and 7 for females, but the standardised mortality rates
(C.M.I.) were almost stationary, a small rise for males and a small fall in females.