epidemiologic transition: changes of fertility and mortality with modernization abdel omran. the...
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Epidemiologic Transition:Changes of fertility and mortality
with modernizationAbdel 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
Epidemiology
Psychiatric Epidemiologists Diabetes Epidemiology Cardiovascular Epidemiology Cancer Epidemiology Infectious Disease Epidemiology
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
0
10
20
30
40
50
60
70
80
1945 1960 1980 1995
Developing
Developed
40 44 48 52 56 60 64 68 72 76
Population Life Expectancy
0
20
40
60
80
100
InfectionCA
CHD
Other
Violence
Increasing Life Expectancy and Causes of Death
Death Rates for TB in England and Wales
0
500
1000
1500
2000
2500
3000
3500
4000
4500
1840 1855 1875 1895 1915 1935 1948 1958 1968
Death Rates for TB in England and Wales
0
500
1000
1500
2000
2500
3000
3500
4000
4500
1840 1855 1875 1895 1915 1935 1948 1958 1968
TB Bacillus Identified
Chemotherapy
BCG Vaccination
Death Rates for Measles in Children in England and Wales
0
200
400
600
800
1000
1200
1400
1850 1870 1890 1910 1930 1950 1970
Death Rates for Measles in Children in England and Wales
0
200
400
600
800
1000
1200
1400
1850 1870 1890 1910 1930 1950 1970
Immunization begun
Incidence of Stomach CAMales
0 20 40 60 80 100
Nigeria
India
US White
US NW
UK
Finland
Iceland
Columbia
Japan
Breast Cancer IncidenceFemales
0 5 10 15 20 25 30
Japan
Nigeria
Brazil
Singapore
Jamaica
Poland
UK
US NW
US Whites
CHD Death RatesMales, aged 45-54
0 500 1000 1500
Thailand
Guatamala
Japan
Egypt
Italy
Bulgaria
US
UK
Scotland
Finland
Cirrhosis Death Rates,Males, aged 45-54
0 10 20 30 40 50 60 70 80 90
UK
Scotland
Hong Kong
US
Japan
Italy
France
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
Causes of Death
Age 15-44 Accidents
CA
CHD Age 45-54 CHD
CA
Accidents
Age 15-44 Accidents
CHD
CA
Age 45-54 CHD
CA
Accidents
Developed Developing
48
Health Transition – Developed Countries
Currently, most developed countries are in the third stage of the health transition:
– fertility rates are low
– causes of diseases and deaths have shifted from infectious to chronic diseases.
49
Health Transition – Developed Countries …
All developed countries in Europe, North America and Asia are seen as having arrived in the latter stage of the health transition in the 1970s, although there were large differences with regard to timing, particularly in the onset the decline in fertility.
In these countries, declining fertility rates and increased life expectancy have led to the ageing, or so‑called 'greying', of the population.
50
Health Transition – Developing Countries
The health situation in developing countries varies greatly from one country to another.
In most, there is still very low life expectancy; this is due largely to malnutrition and the lack of safe drinking water, which are compounded by poor healthcare facilities.
In other countries, however, particularly in Asia and Latin America, chronic diseases have now become more important than infectious diseases.
51
Health Transition – Developing Countries …
The same large variation is reflected in the demographic situation.
In countries such as China and Thailand fertility rates are very low; in others they are very high.
Due to sub‑national differences of an economic, social or ecological nature, there may also be large differences within a single country.
52
Health Transition – Developing Countries …
It is widely believed that, with increasing economic growth, developing countries will follow the same pattern of health transition as Europe and North America.
Many countries, especially the poorest, will not 'trade' infectious diseases for chronic diseases; instead, they may even suffer a 'double burden' of disease.
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