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Health transition and emerging cardiovascular disease in developing countries: situation and strategies for prevention

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Title: Health transition and emerging cardiovascular disease in developing countries: situation and strategies for prevention


1
Health transition and emerging cardiovascular
disease in developing countries situation and
strategies for prevention
Pascal Bovet, MD, MPH, Senior Lecturer Institute
of Social and Preventive Medicine Group for
Epidemiologic Transition and Cardiovascular
Disease University of Lausanne,
Switzerland http//www.hospvd.ch/iumsp http//www.
hospvd.ch/iumsp/info/gct/index.htm
IUMSP-GCT
2
  • Definition of the health transition
  • Trends of disease patterns in populations
  • The 4 stages of the epidemiological transition
  • The cardiovascular disease transition
  • Engines of the health transition
  • Urbanization, demographic, epidemiologic,
    socioeconomic and health care
  • Other determinants of NCDs
  • Predicted trends in disease patterns, Global
    Burden of Disease
  • The double burden of disease
  • Impact of NCDs on public health
  • Evidence for the preventability of CVD
  • Strategies for the primary prevention of CVD
  • Public health response to emerging CVD

IUMSP-GCT
3
The health transition
  • Originally described in the 1970s (Omran, later
    Olshansky, Ault)
  • As socioeconomic development proceeds, mortality
    and fertility rates shift from high to low rates,
    populations get larger and older, and disease
    pattern shifts from one dominated by infectious
    diseases, perinatal diseases and nutritional
    disorders to one dominated by NCDs
  • conventional classification of 4 stages relating
    socioeconomic development and disease patterns
  • Key to understanding current and future health
    patterns
  • useful tool to anticipate health needs in
    developing countries experiencing early stages of
    health transition
  • particularly in countries where data on mortality
    and risk factors are scarce

IUMSP-GCT
4
  • Definition of the health transition
  • Trends of disease patterns in populations
  • The 4 stages of the epidemiological transition
  • The cardiovascular disease transition
  • Engines of the health transition
  • Urbanization, demographic, epidemiologic,
    socioeconomic and health care
  • Other determinants of NCDs
  • Predicted trends in disease patterns, Global
    Burden of Disease
  • The double burden of disease
  • Impact of NCDs on public health
  • Evidence for the preventability of CVD
  • Strategies for the primary prevention of CVD
  • Public health response to emerging CVD

IUMSP-GCT
5
Health transition proportionate mortality over
time (US, 1900-1970, Omran)
100
Other causes
Violence
80
Diabetes
Stroke
60
Heart disease
Percent of all deaths
Cancer
Dis. of early infancy
40
Diarrhea enteritis
Pneumonia
20
Other infectious d.
Tuberculosis
0
1900
1910
1920
1930
1940
1950
1960
1970
IUMSP-GCT
6
Health transition proportionate mortality by
broad cause of death (US, 1900-1970)
100
Other
80
Violence
60
Percent of all deaths
Cancer
40
CVD
20
Infectious
0
1900
1910
1920
1930
1940
1950
1960
1970
IUMSP-GCT
7
Health transition mortality rates (US, 1910-1970)
(up to gt1000 earlier)
IUMSP-GCT
8
The health transition favors the young over the
old(Age-specific mortality rates, US, 1890-1970)
IUMSP-GCT
9
  • Definition of the health transition
  • Trends of disease patterns in populations
  • The 4 stages of the epidemiological transition
  • The cardiovascular disease transition
  • Engines of the health transition
  • Urbanization, demographic, epidemiologic,
    socioeconomic and health care
  • Other determinants of NCDs
  • Predicted trends in disease patterns, Global
    Burden of Disease
  • The double burden of disease
  • Impact of NCDs on public health
  • Evidence for the preventability of CVD
  • Strategies for the primary prevention of CVD
  • Public health response to emerging CVD

IUMSP-GCT
10
The 4 stages of the health transition
IUMSP-GCT
11
  • Definition of the health transition
  • Trends of disease patterns in populations
  • The 4 stages of the epidemiological transition
  • The cardiovascular disease transition
  • Engines of the health transition
  • Urbanization, demographic, epidemiologic,
    socioeconomic and health care
  • Other determinants of NCDs
  • Predicted trends in disease patterns, Global
    Burden of Disease
  • The double burden of disease
  • Impact of NCDs on public health
  • Evidence for the preventability of CVD
  • Strategies for the primary prevention of CVD
  • Public health response to emerging CVD

IUMSP-GCT
12
Transition in cardiovascular disease patterns
along the health transition
  • Late stage of health transition
  • High income economies
  • IHD gt stroke
  • Stroke of ischemic origin
  • Older age
  • Lower case fatality
  • Early stage of health transition
  • Low middle income economies
  • Stroke gt IHD
  • Stroke of hemorrhagic origin
  • Younger age (stroke, IHD)
  • Higher case fatality

IUMSP-GCT
13
Differences in proportionate CVD mortality across
regions at different stages of development, 1990
100
IHD
80
CVA
60
Cardio myopathies
40
Rheumatic
20
0
India
West
China
East
Middle
East
Europe
Latin
Sub-
America
Saharan
IUMSP-GCT
14
The high burden of stroke in developing
countries stroke mortality rates in selected
countries, age 40-69
IUMSP-GCT
15
High toll of NCD/CVD in middle age in developing
countries mortality by broad cause, Seychelles,
1993-1995

16
Stages of the health transition focus on the
type and regional distribution of
cardiovascular disease
17
A model of the health transition accounting for
mortality rates of diseases and types of CVD
IUMSP-GCT
18
How to interpret the health transition across
populations at different stages of development
emergence and decline of CVD
IUMSP-GCT
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