Lindex #1560

Shatenstein B, Kark JD

Mortality in Two Jewish Populations-Montreal and Israel: Environmental Determinants of Differences

International Journal of Epidemiology

1995; 24(4):730-739

This study compared mortality rates of the Jews of Montreal, of Israel as well as of the overall Canadian population 35 years of age and older for the years 1986-1990. Montreal has approximately 96,000 Jews, the majority of whom consider themselves 'traditional' while 24 percent belonged to the orthodox, 31 percent to the conservative, 3.6 percent to the reform and 1.6 percent to the reconstructionist movements. 9.1 percent regarded themselves as secular Jews, 24.6 percent considered themselves 'just Jewish,' while the rest, or 0.6 percent were married to Jews and 5.4 percent refused to respond. Two-thirds of Montreal Jews in 1986 were born in North America, primarily Canada, 4.1. percent immigrated from Western Europe, 16.5 percent came from Eastern Europe, 9.4 percent were from North Africa and 3.8 percent derived from Israel and the Near East.

Death certificates for the years 1986-1990 were abstracted from the two funeral homes serving the Montreal Jewish population and included date of birth, age at death, marital status, place of birth, language spoken at home, local postal code, sex, date of death cause(s) of death, and other data relating to morbidity. Diseases were grouped according to the WHO. Age and sex specific rates causes of death were calculated according to the 1986 Montreal Jewish population and served as denominators. Five year mortality figures were averaged, once consistency was established for each year.

Young Israeli Jews experienced a favorably mortality compared with Montreal Jews and Canadians as seen in Table I. Among Jewish males between the ages of 35 and 44, Israelis compared with their sex and age peers in Montreal was 0.68, p<0.17, while Israeli females in this age range had a rate ratio of 0.63, p<0.19, compared with their Canadian sex peers, and one of 0.65, p<0.21 with their ethnic peers in Montreal. Jewish males residing in Montreal in the age category of 45-54 experienced the lowest mortality with a rate ratio for Israelis males being 1.52, p<0.08 and with their sex peers in Canada of 1.62, p<0.04. Israeli females in this age range had a relatively low mortality rate compared with Montreal Jewish females and somewhat below that of Canadian females. Above the age of 55, Israeli Jews experienced significantly greater mortality compared with Montreal Jews, the rate ratios being 1.18, p<0.0003 and 1.2, p<0.0002 for females. The rate ratio for Canadian and Montreal Jewish males was 1.09, p<0.05. Mortality rates among Montreal Jewish and Canadian women were similar.

The cumulative mortality for all causes for the ages 35-74 as seen in Table II among Montreal Jewish males and females was 0.312 and 0.251, respectively; among Canadians it was 0.425 and 0.251 and among Israeli Jews, 0.406 and 0.299, respectively. These differences were highly significant being p<0.0001 for Jewish males and females of Montreal compared with their Israeli counterparts. The mortality rates of Montreal Jewish women and Canadian women differed also significantly, p<0.003.

  Table 1

  Mortality rates for All Causes Among Males and Females-Canadians (1988), Montreal Jews (1986-1990) and Israeli Jews (1988)
      Population      
  Canada   Montreal   Israel  
  Males Females Males Females Males Females
Age groups and rates per 10,000 of the population            
35-44 18.9 10.5 23.6 16.3 16 10.3
45-54 47.5 28 29.3 29.6 44.5 26
55-64 139 72.9 79.9 43.9 130.3 80.1
65-74 347.5 177.7 241.4 135.8 330.4 238.8
75+ 1014.8 713.4 865.6 742.9 975.9 864.1

Differences between the sexes in all-cause cumulative mortality were highest in Canadians, followed by Montreal Jews and lowest in Israeli Jews.

  Table 2  

  Cumulative Mortality for All Causes: Ages 35-74 - Canadians (1988), Montreal Jews (1986-1990) and Israeli Jews (1988)
  Cumulative Mortality+  
  Males Females
Canadians 0.425**** 0.251***
95% CI (0.414-0.436) (0.244-0.253)
Montreal Jews 0.312 0.202
95% CI (0.273-0.351) (0.172-0.232)
Israeli Jews 0.406** 0.299****
95% CI (0.379-0.434) (0.276-0.322)

+Where significant cumulative differences are shown, they indicate (i) Canadian versus Montreal Jews, or (ii) Israeli Jews versus Montreal Jews, respectively.

Mortality from diseases of the circulatory system as seen in Tables 3 and 4 were higher among Israeli Jews than among Montreal Jews. Differences were far lower for Montreal Jews than for Canadians.

      Table 3      

  Mortality rates for Diseases of the Circulatory System among Canadian Males and Females (1988), Montreal Jews ((1986-1990) and Israeli Jews (1988)
      Population      
  Canada   Montreal   Israel  
  Males Females Males Females Males Females
Age groups and rates per 10,000 of the population            
35-44 4 1.5 2.1 0.3 0.3 1.3
45-54 13.2 5.3 9 3 15.3 0.1
55-64 53.9 19.1 22.8 4.6 51.9 24.8
65-74 148.4 68.2 115.8 36.1 156.2 102.1
75+ 474.4 384.4 400.6 311.8 435.9 439.1

Differences between the sexes in all-cause cumulative mortality were highest in Canadians, followed by Montreal Jews and lowest in Israeli Jews.

  Table 4  

  Cumulative Mortality for Diseases of the Circulatory System: Ages 35-74 - Canadians (1988), Montreal Jews (1986-1990) and Israeli Jews (1988)
  Cumulative Mortality+  
  Males Females
Canadians 0.199**** 0.081****
95% CI (0.192-0.207) (0.076-0.086)
Montreal Jews 0.139 0.043
95% CI (0.114-0.164) (0.029-0.056)
Israeli Jews 0.203**** 0.125****
95% CI (0.185-0.221) (0.109-0.141)

+Where significant cumulative differences are shown, they indicate (i) Canadian versus Montreal Jews, or (ii) Israeli Jews versus Montreal Jews, respectively.

Both male and female Montreal Jews were found to have unexpectedly low mortality rates. The cumulative mortality rates among Montreal Jewish males between the ages of 35 and 74 were 30 percent lower than their age and sex peers in Israel while being 48 percent lower among Montreal Jewish females in the same age range compared with their Israeli Jewish sex peers. Montreal's Jewish population had a favorable mortality in the 35-74 year age range, being 36 percent lower among the males and 24 percent among females. Suggested reasons include social class differences influencing relevant health behaviors and social relationships as well as differences in the ethnic structure of Montreal and Israeli Jews. Another suspected cause is that the comparatively older age structure of Montreal's Jews, compared with that of Israel which consists of more recent immigrants. Relative risks of exposure are therefore implicated. Differences in gender between Jewish women in Canada and Israel suggest differences in health behaviors which are modifiable. The socially cohesive nature of Montreal's Jewish community might play a role, following Durkheim's thesis regarding suicide.

The authors warn against the small, yet unknown biases deriving from the proportion of Montreal Jewish decedents who might have been buried outside of that city as well as the underestimation of that population by the 1986 Census. This would lead to an overestimation of the probable rates reported.