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
http://www.who.int/docstore/bulletin/pdf/2001/issue2/vol.79no.2.1
59-170.pdf
Imhotep,
the "father of medicine". The word
"Imhotep" means "he who comes in
peace'
Prevention in Egypt
Herodotus, after his visit to Egypt in the
Vth century B.C., stated that Egyptians
were, with the Libyans, the healthiest
people. This must have implied a good
deal of sanitation. Cleanliness, was
religious as well a hygienic obligation.
Medicine is a science from which one learns
the states of the human body with respect to
what is healthy and what is not, in order to
preserve good health when it exists and
restore it when it is lacking
Ibn Sina, the opening to the Qanun fi al-tibb
Medicine is a science from which one learns
the states of the human body with respect to
what is healthy and what is not, in order to
preserve good health when it exists and
restore it when it is lacking
Ibn Sina, the opening to the Qanun fi al-tibb
Abdel Omran
Evolution of Disease
Charles Darwin
Evolution of Species
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
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
Changing Life Expectancies
20 yrs
80
75
70
65
60
55
50
45
40
5 yrs
US
Egypt
1945
1975
1995
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
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
2007
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