Diversity in causes of death: A new framework to account for multiple causes of death

BACKGROUNDThe structure of causes of death has changed in low-mortality countries, with recent trends showing increasing cause diversity.However, most research overlooks that several conditions often contribute to the process leading to death. OBJECTIVEThis paper develops a framework for studying cause-of-death diversity that accounts for multiple causes of death (MCoD). METHODSWe introduce novel MCoD life tables to estimate cause diversity based on agestandardized metrics.Two dimensions of diversity are assessed: the average number of causes contributing to death and how diverse these causes are.For the latter dimension, two indexes derived from the Gini-Simpson index are proposed, each based on a different perception of the role of the contributing causes in the process leading to death.All metrics are decomposable and applied to data from Denmark, France, Spain, and the United States. RESULTSThe results show increased cause diversity, both in terms of the average number of causes and how evenly deaths are distributed across groups of causes.MCoD yields higher diversity than the underlying causes of death (UCD), confirming that relying solely on UCD downplays the complexity of the mortality process.However, the increase over time in diversity is more modest when using MCoD compared to UCD.The main driver