Epidemiologic Transition Changes of fertility and mortality with

Epidemiologic Transition: Changes of fertility and mortality with modernization (3) 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

Epidemiology v v v 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 19 th century were primarily related to changing SES. With the 20 th Century more related with disease control activities independent of SES: e. g. Mexico, China

Epidemiologic Transition in Developing and Developed Countries

14 years 35 years

Increasing Life Expectancy and Causes of Death 100 Other 80 60 Violence 40 20 CHD 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 Wales TB Bacillus Identified Chemotherapy BCG Vaccination

Death Rates for Measles in Children in England Wales Immunization begun

Mortality Rates NIDDM CHD Trauma CA Epidemiologic Transition

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 CA Fibrocystic Disease Male Genital Prostrate CA Metabolic NIDDM

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

Transition v v v Nomads Farmers Urban 45 yrs 60 yrs 70 yrs

1960 Urban rural USA Rural urban Developing Countries

2010 Urban Rural urban rural USA Developing Countries

Causes of Death n n Developed Developing Age 15 -44 Accidents CA CHD Accidents CHD CA Age 45 -54 CHD CA Accidents

Conclusion The epidemiologic transition ties together fertility with rise in SES. The Second component is that it present the idea that disease appears in populations like a symphony with disease rising and falling, all in relationship to each other

Review Questions (Developed by the 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?