Mortality in two Jewish populations--Montreal and Israel: environmental determinants of differences

COVID-19 mortality among Jews in 2020: a global overview and lessons taught about the Jewish longevity advantage

An extensive body of demographic literature has described Jews as 'long-lifers'. From the mid-nineteenth century onwards, this pattern affected all age groups and was particularly well expressed among Jewish males but was also present among Jewish females. It held good independently of the Jews' socio-economic position. This became known as 'Jewish pattern of mortality'. This paper has two aims. The first aim is to show the impact of COVID-19 on Jewish mortality. This is a study of a global pandemic in the Jewish population which is, to the best of our knowledge, unique in its scope and quality. The second aim is to settle the finding of relatively high mortality from COVID-19 in certain Jewish communities ('Jewish penalty' in relation to COVID-19) with the notion of 'Jewish pattern of mortality'. The author proceeds to show that the status of Jews as a low mortality group under a Western epidemiological regime, when mortality and morbidity are dominated by non-communicable diseases, does not stand in contradiction to a higher vulnerability among Jews to coronavirus. Thus, the paper further develops understanding of mortality of Jews and serves as a contribution to ethnic and religious demography and epidemiology.

Jewish mortality reconsidered

It is known that mortality of Jews is different from the mortality of the populations that surround them. However, the existence of commonalities in mortality of different Jewish communities across the world has not received scholarly attention. This paper aims to identify common features of the evolution of Jewish mortality among Jews living in Israel and the Diaspora. In the paper the mortality of Jews in Israel is systematically compared with the mortality of the populations of developed countries, and the findings from the earlier studies of mortality of Jews in selected Diaspora communities are re-examined. The outcome is a re-formulation and extension of the notion of the 'Jewish pattern of mortality'. The account of this pattern is based on the consistently low level of behaviourally induced mortality, the migration history of Jewish populations and the enduring influence of early-life conditions on mortality at older ages.

The role of smoking in the explanation of the Israeli Jewish pattern of sex differentials in mortality

The difference in life expectancy between women and men among Israeli Jews is very low relative to the difference in other developed countries, and the reasons for this are not fully understood. This paper explores the contribution of smoking to the observed patterns of sex-specific mortality among Israeli Jews, and to the sex difference in mortality exhibited by this population. The results show that the mortality of Israeli Jewish men is low owing to the relatively weak impact of smoking-related mortality, and that this also contributes to an explanation of the small sex difference. The result is explained by the high level of health-protective behaviour of Israeli Jewish men, including a low intensity of smoking (though not a low prevalence). The findings could have implications for some debates on the determinants of divergences and convergences in mortality, and research into the relationship between mortality and the Mediterranean diet.

Myocardial infarction occurrence in Jerusalem: a Mediterranean anomaly

BACKGROUND

The Jewish population of Israel consumes a diet rich in polyunsaturated fatty acids with a relatively low proportion of saturated fat, has a small alcohol intake and a lipid profile characterized by low HDL-cholesterol and high lipoprotein(a) (Lp(a)). It is therefore of interest to compare occurrence rates of coronary heart disease (CHD) with those elsewhere.

METHODS

The community-based event rate of CHD [comprising acute myocardial infarction (AMI) and CHD death] and case-fatality was determined in 1995-1997 by active surveillance among Jewish residents of the Jerusalem District aged 25-64 according to standardized WHO-MONICA criteria. We compared our findings with rates among MONICA populations in 21 countries. Twelve hundred and six events occurred in Jerusalem during approximately 399,000 [correction] person-years (930 non-fatal AMI and 276 CHD deaths).

RESULTS

The age-adjusted incidence of CHD ranked high compared with the 21 countries (men third highest, women eighth highest), far exceeding the Mediterranean countries. In contrast, the pre-hospital mortality rate was low, similar to countries in the Mediterranean basin, and the 28-day case fatality was remarkably low, far lower than for any MONICA population in men, and second lowest in women. Correspondingly, the incidence of non-fatal AMI ranked extraordinarily high (men first, women third). The low case-fatality ranking persisted upon adjustment for treatment differences between populations.

CONCLUSIONS

We report an unusual combination of a high incidence of CHD among Jewish residents of Jerusalem accompanied by extraordinarily low case fatality, the latter suggesting reduced susceptibility to lethal arrhythmias. Determinants of this anomaly require clarification.

The peculiar pattern of mortality of Jews in Moscow, 1993–95

Russian Jews, particularly men, have a large mortality advantage compared with the general Russian population. We consider possible explanations for this advantage using data on 445,000 deaths in Moscow, 1993-95. Log-linear analysis of the distribution of deaths by sex, age, ethnic group, and cause of death reveals a relatively high concentration of endogenous causes and a relatively low concentration of exogenous and behaviourally induced causes among Jews. There is also a significant concentration of deaths from breast cancer among Jewish women. Mortality estimates using the 1994 micro-census population as the denominator reveal an 11-year Russian-Jewish gap in the life expectancy of males at age 20, but only a 2-year life-expectancy gap for women. Only 40 per cent of the Russian-Jewish difference for men, but the entire difference for women, can be eliminated by adjustment for educational differences between the two ethnic groups. Similarities with other Jewish populations and possible explanations are discussed.

Risk profile and prediction of long-term ischemic stroke mortality: a 21-year follow-up in the Israeli Ischemic Heart Disease (IIHD) Project

BACKGROUND

Multinational comparisons demonstrate marked ethnic and regional variation in stroke mortality and risk-factor distribution. We assessed the role of ethnicity and estimated the cumulative effect of multiple risk factors on long-term ischemic stroke mortality.

METHODS AND RESULTS

Civil servants and municipal employees in Israel (n=9734 men; age, >/=42 years), chosen by stratified sampling in 6 prespecified areas of birth (those born in Israel and those who were immigrants from 5 other regional-ethnic strata), were included in the Israeli Ischemic Heart Disease (IIHD) Project. Over a 21-year follow-up period, age-adjusted mortality rates per 10 000 person-years attributed to ischemic stroke (n=282; International Classification of Diseases [ICD]-9 codes 433 to 438) were higher among immigrants to Israel from northern Africa and the Mideast (17.1 to 19.0), than from 3 parts of Europe (11.3 to 12.4). Crude rates per 1000 subjects observed in those born in Asia or Africa (29.4 to 31.2) exceeded rates predicted by risk-factor profiles (21.4 to 24.9). Adjusted hazard ratios were 3.00 for age (per 10 years), 2.15 for left ventricular hypertrophy, 1.69 for systolic blood pressure (BP, per 20 mm Hg), 1.86 for diabetes mellitus, 1.83 for peripheral vascular disease, 1.79 for smoking (>20 cigarettes per day), 1.51 for coronary heart disease, 1.16 for percent cholesterol contained in the HDL fraction (%HDL, per 5% decrease), and 1.88 for diastolic BP (per 12 mm Hg; assessed in an alternative model). Accounting for regression dilution bias and assessed from repeat measurements, we found that hazard ratio estimates associated with diastolic BP, systolic BP, and percent HDL (per increments described) increased to 3.22, 2.23, and 1.23, respectively. Ischemic stroke mortality rates were 30-fold greater among subjects at the highest versus the lowest quintile of predicted probability according to risk-factor profiles (81.2 versus 2.6 per 1000 subjects).

CONCLUSIONS

Assessment of multiple risk factors provides useful quantitative prediction of long-term ischemic stroke mortality risk. Regional-ethnic variations are consistent with a hypothesis that other, undetermined inherent genetic or sociocultural factors act to increase ischemic stroke mortality rates in immigrants to Israel from the Mideast and northern Africa over that predicted by conventional risk factors.

Influences on diet, health behaviours and their outcome in select ethnocultural and religious groups

Diverse cultural components of behavior may have significant impacts on patterns of eating, drinking, and social interaction, irrespective of socioeconomic status. For example, the major world religions prescribe or proscribe specific dietary behaviors; some of these are rooted in historical or geographical origins as well as group folklore; and they have integral roles as expressions of religious piety and group cohesiveness. The literature is replete with ecological observations of between-country differences in disease trends, some of which have been associated with dietary practices. The study of distinct cultural and religious groups (especially migrants acculturating to new environments) and the extent to which they adhere to culturally-based dietary precepts, has advanced our knowledge of psychosocial influences on food habits, nutritional adequacy, and overall health. However, a relatively small proportion of culturally-based research studies conducted to date have explored cross-cultural, ethnic, or religious variables. This paper reviews some population-based differences in dietary habits and other behaviors by ethnocultural group or religious denomination; health consequences and suggestions for future research are discussed.