Transcript Epidemiologic Transition: Changes of fertility and mortality with

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
Abdel Omran
Evolution of Disease
Charles Darwin
Evolution of Species
The New NCD Epidemiology
and Prevention
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Systems approach
Disease Monitoring
Telecommunications Backbone
Deming approaches to Prevention
Epidemiology
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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
Stages of the Epidemiologic
Transition
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Pestilence and Famine
Receding Pandemics
Degenerative and man-made diseases
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
BCG Vaccination
1000
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
CHD Death Rates
Males, aged 45-54
Finland
Scotland
UK
US
Bulgaria
Italy
Egypt
Japan
Guatamala
Thailand
0
500
1000
1500
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
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
Death Rates for Stroke
Males, aged 45-54
Japan
Finland
Scotland
Italy
UK
Thailand
US
Egypt
0
10
20
30
40
50
60
70
80
High Incidence of NCDs in
Developed Countries
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Cardiovascular
CHD
Deep Vein Thrombosis
 Respiratory
Emphysems
Lung CA
 Female Genital
Endometriosis
Endometrial CA
High Incidence of NCDs in
Developed Countries
 Breast
Breast CA
Fibrocystic Disease
 Male Genital
Prostrate CA
 Metabolic
NIDDM
High Incidence of NCDs in
Developing Countries
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Possible Infectious Etiology
Macronodular Cirrhosis
Hepatocellular Carcinoma
Rheumatic Heart Disease
Iron deficiency anemia
 Related to Nutrition Deficiency
Endemic Goiter
Malnutrition Related Diabetes.
Back to Nature
 Improved Physical activity
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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
2003
Urban
Rural
urban
rural
USA
Developing
Countries
Life Expectancy in Developing
Countries
70
60
50
40
30
20
10
0
1950
1975
1985
1995
Changing Life Expectancies
70
60
50
40
1950
1990
30
20
10
0
Africa
India
Latin America
Causes of Death
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
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
Other Transitions
Agriculture
 Forestry
 Toxicity
 Urbanization
 Fossil Fuel
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 Nutrition
Systems Analysis
Attempts to build a replica of the real world and
experiment with it in order to obtain a better
understanding of what is observed
Systems approach
The Need for the Development of a
systems approach to Epidemiology
EPI systems
Interplay of factors that cause one disease
to increase while another falls.
Questions for readers of
Epidemiologic Transition lecture by Ron LaPorte
(developed by Supercourse Team)
•
What might the epidemiologic transition tell
us about the evolution of chronic diseases?
•Over the past 100 years, life expectancy and
causes of death have become homogenous
world wide. Why is this important?