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Smoking and Alzheimer's disease: an alternative hypothesis.

a long term decline or increase in the disability incidence rates. Over the 20th century, French male mortality rates declined substantially, and we would argue that it is quite implausible to assume that the mortality rates of disabled men would not have declined along with those of non-disabled men. In the French male population, life expectancy has not remained unchanged, and it is not reasonable to expect outflows from the disabled state to remain unchanged. We made the arbitrary assumption that the relative risk of death for disabled versus nondisabled people remained constant at 3.66 in the published simulations. We also carried out simulations where the relative risk ranged from 1 to 10 and also varied with age. We found that the results were not highly sensitive to the value assumed and did not affect our conclusions. In response to criticism of the constant relative risk assumption, we have carried out additional simulations in which we assume that the ratio of the mortality risk for disabled male to the average mortality risk for all males remains constant at its value in the year 1945, and so is independent of changes in disability prevalence. This had very little effect on the estimated health expectancies under any of the scenarios and confirms our published comment that the results are not highly sensitive to assumptions about the mortality rates for disabled people.