Benjamin Franklin once wrote that “in this world nothing can be said to be certain, except death and taxes”, but just how – and at what age – we are likely to exit the world has changed dramatically over the past 100 years, thanks to changing social structures and advances in medicine and technology.

While once childhood was a perilous period and adult lives were often cut short, life expectancy at birth now tops 80 years in the UK.



The data collated by the Office for National Statistics (ONS) encompasses all causes of death, labelled according to the World Health Organization’s international classification of diseases – hence cancer is split into different types, rather than grouped together. The labels for causes of death are those used at the time the records were made.

Replay

Infant mortality and measles

“The oldest inhabitants recollected no period at which measles had been so prevalent, or so fatal to infant existence; and many were the mournful processions which little Oliver headed, in a hat-band reaching down to his knees, to the indescribable admiration and emotion of all the mothers in the town,” writes Charles Dickens in Oliver Twist, capturing the devastation measles could bring.

Measles was the leading cause of death in children in 1915

Yet even before the introduction of a vaccine against measles in 1968, and subsequently the MMR vaccine in 1988, the rate of deaths attributed to the infection had begun to fall.

The trend has been used by some as evidence of the virus becoming less deadly. But experts say in reality it is down to other factors including better nutrition, improved health services – such as the development of antibiotics, preventing death from secondary infections – and, crucially, reduced overcrowding due to better housing. “Measles is incredibly infectious so if you have got overcrowding it spreads like wildfire,” said Helen Bedford, professor of children’s health at University College London.

Even so, as of 1955 measles was still the eighth leading cause of death in those under 15.

Deaths from measles only became a rarity with the introduction of vaccines – a move that could also have helped to drive a drop in childhood deaths from other diseases, given that measles can leave the immune system weakened for more than two years.

But measles remains a deadly disease. Between January 2016 and July 2017, 35 deaths were reported in Europe, primarily among unvaccinated individuals – a situation that has been blamed, at least in part, on the impact of anti-vaccination campaigns.



“In 2015 [worldwide] there were 134,000 deaths from measles. That’s 15 deaths every hour,” Bedford added.

Andrew Pollard, professor of paediatrics at the University of Oxford, agreed that vaccination was a priority. “The thing we can do today [in vaccination] that would make the biggest difference to child mortality in the world would be to get the extra 20% of children vaccinated against measles who are not currently vaccinated.”

War and traffic

Diseases, whether acute infections or chronic illnesses, account for the vast majority of deaths, regardless of decade. But data for 1945 reveals the impact of another deadly outbreak: war.

In the year the second world war drew to a close, it was the seventh leading cause of death for those aged 14 or under, and the 10th leading cause of death for those aged 15-49. The figures only relate to those who died in England and Wales and do not include deaths abroad, so those who died in world wars overseas are not in the data.

Other societal changes are also reflected in the data. Probably down to both reductions in deaths from infectious diseases and an increase in traffic, in 1945 deaths linked to motor vehicles entered the top 10 causes for the first time, being the second most common cause of death in under 15s with more than 1,050 cases.

Motor vehicles were the second highest cause of death among under 15s in 1945

From 1955 to 1995, “motor vehicle traffic accident involving collision with pedestrian” was the leading cause of death among children under 15, albeit with declining figures. By 2015 it had fallen out of the top 10 causes altogether.



Nick Lloyd, road safety manager at the Royal Society for the Prevention of Accidents, said the decline in deaths was probably down to a number of factors, including the use of child car seats – keeping children inside cars safe – changing car design to reduce the chances of a pedestrian being killed in a collision, better road safety education, the introduction of traffic calming measures and even a reduction in the number of children who walk or cycle to school.

Suicide on the rise

According to the ONS, suicide encompasses deaths that are known to have been down to intentional self-harm and death by injuries where the intent was undetermined.



However, the latter does not apply for those under the age of 15 since such deaths could, for example, be down to abuse or neglect – so although suicide can be recorded as a cause of death for those aged 10 and over, the figures presented here only encompass those for individuals over the age of 14.



Trends in those taking their own life are far from simple - with changes in rates over the last century showing different patterns for different age groups, sexes and even methods.

“The risks for different groups of people are quite different,” said Elizabeth Scowcroft, research manager at the Samaritans.

Taken together, one thing is clear: in recent decades suicide has become one of the leading causes of death among those aged 15-49 – and men are about three times more likely than women to take their own life.

In 2015, suicide was one of the leading causes of death among people aged 15-49

Older population

In 2015 Alzheimer’s disease, vascular dementia and unspecified dementia all made it into the top 10 causes of death for the first time.

It’s far from a straightforward shift and probably down to a combination of factors including longer life expectancy, as more people reach the oldest ages, and better survival of other illnesses.

But this is not the full story. Improvements in diagnosis and changes in the ways in which deaths are recorded or classified have probably also played a role.

Searching all deaths from 1945, for example, there is no mention of dementia or anything similar – yet it is unlikely that there were no deaths at all from diseases that cause dementia.

Dementia was one of the leading causes of death for the over 85s in 2015

One possible clue might lie in the number of deaths in the early to mid 20th century that are classified as “senile decay” or simply “old age”. Since what are now known as dementia and Alzheimer’s disease were once considered a natural part of the ageing process, it is possible that such deaths were, at least in part, swept up under these catch-all labels. The labelling system used in 1965 offers further insights with the appearance of “senile psychosis” and, in 1985, “other cerebral degenerations” – a label which included Alzheimer’s disease and other forms of dementia. It could also be that some deaths now counted as dementia might have been attributed to other illnesses present in an individual.

In the UK the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Other international suicide helplines can be found at befrienders.org.

Methodology

The data was collated by the Office for National Statistics from the general register officer and reflects the causes of death as reported at that time. It’s not possible to accurately draw trends from changes in the specific causes of death as definitions vary over time. No children under the age of one are included in the data.

Death rates are based on the number of deaths attributable to any given cause across all age groups. All the classifications are taken from the international classification of diseases, which is currently managed by the World Health Organization.