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

1. 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

2. Abdel Omran Evolution of Disease Charles Darwin Evolution of Species

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

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

5. 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.

6. 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...

7. Age of Pestilence and Famine Characterized by high mortality rates, wide swings in the mortality rate, little population growth and very low life expectancy

8. Age of Receding Pandemics Epidemics become less frequent, infectious diseases in general become less frequent, a slow rise in degenerative diseases begin to appear

9. 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

14. Epidemiologic Transition in Developing and DevelopedCountries

15. 14 years 35 years

19. 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

21. Global Homogenety of Mortality Patterns

24. Infectious Diseases NCD Mortality Rates Epidemiologic Transition

25. Death Rates for TB in England and Wales TB Bacillus Identified Chemotherapy BCG Vaccination

26. Death Rates for Measles in Children in England and Wales Immunization begun

27. NIDDM CHD Trauma CA Mortality Rates Epidemiologic Transition

33. 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.

34. 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

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

36. Nomads Farmers Urban 45 yrs 60 yrs 70 yrs Transition

37. 1960 Urban Rural rural urban Developing Countries USA

38. 2010 Urban Rural urban rural Developing Countries USA

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

40. 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

41. 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?