Epidemiologic Transition: Changes of fertility and mortality with modernization

1
Epidemiologic TransitionChanges of fertility
and mortality with modernization

• Abdel Omran. The Epidemiologic Transition A
  Theory of the epidemiology of population change.
  Milbank Quarterly. 197149509-538
• http//www.who.int/docstore/bulletin/pdf/2001/issu
  e2/vol.79no.2.159-170.pdf

2
Food Fest Food Fest
3
Imhotep, the "father of medicine". The word
"Imhotep" means "he who comes in peace'
4
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.
5
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
6
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
7
Abdel Omran Evolution of Disease
Charles Darwin Evolution of Species
8
Epidemiology

• Psychiatric Epidemiologists
• Diabetes Epidemiology
• Cardiovascular Epidemiology
• Cancer Epidemiology
• Infectious Disease Epidemiology

9
Instead at looking at individual diseases, we
need to look at the patterns of diseases
10
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.

11
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...
12
Age of Pestilence and Famine

• Characterized by high mortality rates, wide
  swings in the mortality rate, little population
  growth and very low life expectancy

13
Age of Receding Pandemics

• Epidemics become less frequent, infectious
  diseases in general become less frequent, a slow
  rise in degenerative diseases begin to appear

14
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
SESe.g. Mexico, China
15
(No Transcript)
16
(No Transcript)
17
(No Transcript)
18
(No Transcript)
19
Epidemiologic Transition in Developing and
DevelopedCountries
20
(No Transcript)
21
Changing Life Expectancies
22
(No Transcript)
23
(No Transcript)
24
(No Transcript)
25
Increasing Life Expectancy and Causes of Death
100
Other
80
60
Violence
CHD
40
CA
20
Infection
0
40
44
48
52
56
60
64
68
72
76
Population Life Expectancy
26
(No Transcript)
27
Global Homogenety of Mortality Patterns
28
(No Transcript)
29
(No Transcript)
30
NCD
Mortality Rates
Epidemiologic Transition
31
Death Rates for TB in England and Wales
32
Death Rates for TB in England and Wales
TB Bacillus Identified
Chemotherapy
BCG Vaccination
33
Death Rates for Measles in Children in England
and Wales
34
Death Rates for Measles in Children in England
and Wales
Immunization begun
35
NIDDM
CHD
Trauma
CA
Mortality Rates
Epidemiologic Transition
36
(No Transcript)
37
(No Transcript)
38
(No Transcript)
39
(No Transcript)
40
(No Transcript)
41
Importance of Geographic Patterns
42
Incidence of Stomach CAMales
43
Breast Cancer IncidenceFemales
44
CHD Death RatesMales, aged 45-54
45
Cirrhosis Death Rates,Males, aged 45-54
46
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.

47
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

48
Back to Nature

• Improved Physical activity
• A Healthier Diet, less saturated fats, more
  fiber
• Less Stress

49
Transition

• Nomads
• Farmers
• Urban

• 45 yrs
• 60 yrs
• 70 yrs

50
1960
Urban
Rural
rural
urban
Developing Countries
USA
51
2007
Urban
Rural
urban
rural
Developing Countries
USA
52
Causes of Death
Developed
Developing

• Age 15-44
• Accidents
• CA
• CHD
• Age 45-54
• CHD
• CA
• Accidents

• Age 15-44
• Accidents
• CHD
• CA
• Age 45-54
• CHD
• CA
• Accidents