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

2
Abdel Omran Evolution of Disease
Charles Darwin Evolution of Species
3
The New NCD Epidemiology and Prevention

• Systems approach
• Disease Monitoring
• Telecommunications Backbone
• Deming approaches to Prevention

4
(No Transcript)
5
Epidemiology

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

6
Instead at looking at individual diseases, we
need to look at the patterns of diseases
7
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.

8
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...
9
Age of Pestilence and Famine

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

10
Age of Receding Pandemics

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

11
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
12
Stages of the Epidemiologic Transition

• Pestilence and Famine
• Receding Pandemics
• Degenerative and man-made diseases

13
(No Transcript)
14
(No Transcript)
15
(No Transcript)
16
(No Transcript)
17
(No Transcript)
18
(No Transcript)
19
Epidemiologic Transition in Developing and
DevelopedCountries
20
(No Transcript)
21
(No Transcript)
22
(No Transcript)
23
(No Transcript)
24
(No Transcript)
25
(No Transcript)
26
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
27
(No Transcript)
28
(No Transcript)
29
(No Transcript)
30
(No Transcript)
31
(No Transcript)
32
(No Transcript)
33
(No Transcript)
34
NCD
Mortality Rates
Epidemiologic Transition
35
Death Rates for TB in England and Wales
36
Death Rates for TB in England and Wales
TB Bacillus Identified
Chemotherapy
BCG Vaccination
37
Death Rates for Measles in Children in England
and Wales
38
Death Rates for Measles in Children in England
and Wales
Immunization begun
39
NIDDM
CHD
Trauma
CA
Mortality Rates
Epidemiologic Transition
40
(No Transcript)
41
(No Transcript)
42
(No Transcript)
43
(No Transcript)
44
(No Transcript)
45
(No Transcript)
46
CHD Death RatesMales, aged 45-54
47
Incidence of Stomach CAMales
48
Breast Cancer IncidenceFemales
49
Cirrhosis Death Rates,Males, aged 45-54
50
Death Rates for StrokeMales, aged 45-54
51
High Incidence of NCDs in Developed Countries

• Cardiovascular
• CHD
• Deep Vein Thrombosis
• Respiratory
• Emphysems
• Lung CA
• Female Genital
• Endometriosis
• Endometrial CA

52
High Incidence of NCDs in Developed Countries

• Breast
• Breast CA
• Fibrocystic Disease
• Male Genital
• Prostrate CA
• Metabolic
• NIDDM

53
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.

54
Back to Nature

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

55
Transition

• Nomads
• Farmers
• Urban

• 45 yrs
• 60 yrs
• 70 yrs

56
1960
Urban
Rural
rural
urban
Developing Countries
USA
57
2003
Urban
Rural
urban
rural
Developing Countries
USA
58
Life Expectancy in Developing Countries
59
Changing Life Expectancies
60
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

61
Other Transitions

• Agriculture
• Forestry
• Toxicity
• Urbanization
• Fossil Fuel
• Nutrition

62
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.
63
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?