Epidemiologic Transition: Changes of fertility and mortality ...

Epidemiologic Transition: Changes of fertility and mortality with modernization Abdel Omran. The Epidemiologic Transition: A Theory of the epidemiology of population change. Milbank Quarterly. 1971;49:509-538 http://www.who.int/docstore/bulletin/pdf/2001/issue2/ vol.79no.2.159-170.pdf Lecture

Epidemiologic Transition Geographic Studies, what do they tell us? Abdel Omran Evolution of Disease Charles Darwin Evolution of Species

Epidemiology Psychiatric Epidemiologists Diabetes Epidemiology Cardiovascular Epidemiology Cancer Epidemiology

Infectious Disease Epidemiology Instead at looking at individual diseases, we need to look at the patterns of diseases Mortality is the fundamental factor in the dynamics of population growth and causes of death. Mortality has no fixed upper limits.

Thus if fertility approached its upper maximum, depopulation would still occur. During the epidemiologic transition, a long-term shift occurs in mortality and disease patterns whereby pandemics of infection are replaced by degenerative and man-made diseases...

Age of Pestilence and Famine Characterized by high mortality rates, wide swings in the mortality rate, little population growth and very low life expectancy Age of Receding Pandemics Epidemics become less frequent, infectious diseases in general

become less frequent, a slow rise in degenerative diseases begin to appear The shifts in disease patterns in the 19th century were primarily related to changing SES. With the 20th Century more related with disease control activities independent of SES: e.g. Mexico, China

Epidemiologic Transition in Developing and Developed Countries 80 70 60 50 Developing Developed

40 30 20 10 0 1945 1960 1980

1995 14 years 35 years Increasing Life Expectancy and Causes of Death 100 Other

80 60 Violence CHD 40 20

CA Infection 0 40 44 48

52 56 60 64 68

Population Life Expectancy 72 76 Mortality Rates Infectious Diseases NCD

Epidemiologic Transition Death Rates for TB in England and Wales 4500 4000 3500 3000 2500 2000 1500

1000 500 0 1840 1855 1875 1895

1915 1935 1948 1958 1968 Death Rates for TB in England

and Wales 4500 TB Bacillus Identified 4000 3500 3000 2500 2000

Chemotherapy 1500 1000 BCG Vaccination 500 0 1840

1855 1875 1895 1915 1935 1948

1958 1968 Death Rates for Measles in Children in England and Wales 1400 1200 1000 800

600 400 200 0 1850 1870 1890 1910

1930 1950 1970 Death Rates for Measles in Children in England and Wales 1400 1200

1000 800 600 Immunization begun 400 200 0 1850 1870

1890 1910 1930 1950 1970

Mortality Rates NIDDM CHD Trauma CA Epidemiologic Transition

Importance of Geographic Patterns Incidence of Stomach CA Males Japan Columbia Iceland Finland UK US NW

US White India Nigeria 0 20 40 60

80 100 Breast Cancer Incidence Females US Whites US NW UK Poland Jamaica

Singapore Brazil Nigeria Japan 0 5 10 15

20 25 30 CHD Death Rates Males, aged 45-54 Finland Scotland

UK US Bulgaria Italy Egypt Japan Guatamala Thailand 0 500

1000 1500 Cirrhosis Death Rates, Males, aged 45-54 France Italy Japan US

Hong Kong Scotland UK 0 10 20 30

40 50 60 70 80 90

High Incidence of NCDs in Developing Countries Possible Infectious Etiology Macronodular Cirrhosis Hepatocellular Carcinoma Rheumatic Heart Disease Iron deficiency anemia

Related to Nutrition Deficiency Endemic Goiter Malnutrition Related Diabetes. High Incidence of NCDs in Developed Countries Cardiovascular CHD Deep Vein Thrombosis Respiratory

Emphysema Lung CA Female Genital Endometriosis Endometrial CA Breast Breast CA Fibrocystic Disease Male Genital Prostrate CA Metabolic

NIDDM Back to Nature Improved Physical activity A Healthier Diet, less saturated fats, more fiber Less Stress Transition

Nomads Farmers Urban 45 yrs 60 yrs 70 yrs

1960 Urban rural USA Rural urban Developing

Countries 2006 Urban Rural urban rural USA

Developing Countries Causes of Death Developed Developing

Age 15-44 Age 15-44 Accidents CA CHD Accidents CHD

CA Age 45-54 CHD CA Accidents Age 45-54 CHD CA Accidents

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