Epidemiologic Transition: Changes of fertility and mortality with modernization Abdel Omran Abdel Omran The Epidemiologic Transition: A Theory of the epidemiology of population change. Milbank Quarterly. 1971;49: The Epidemiologic Transition: A Theory of the epidemiology of population change. Milbank Quarterly. 1971;49:

Charles Darwin Evolution of Species Abdel Omran Evolution of Disease

The New NCD Epidemiology and Prevention  Systems approach  Disease Monitoring  Telecommunications Backbone  Deming approaches to Prevention

Epidemiology  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 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

Stages of the Epidemiologic Transition  Pestilence and Famine  Receding Pandemics  Degenerative and man-made diseases

Epidemiologic Transition in Developing and Developed Countries

35 years 14 years

Population Life Expectancy Infection CA CHD Other Violence Increasing Life Expectancy and Causes of Death

Epidemiologic Transition Mortality Rates Infectious Diseases NCD

Death Rates for TB in England and Wales

TB Bacillus Identified Chemotherapy BCG Vaccination

Death Rates for Measles in Children in England and Wales

Immunization begun

Epidemiologic Transition Mortality Rates CA CHD NIDDM Trauma

CHD Death Rates Males, aged 45-54

Incidence of Stomach CA Males

Breast Cancer Incidence Females

Cirrhosis Death Rates, Males, aged 45-54

Death Rates for Stroke Males, aged 45-54

High Incidence of NCDs in Developed Countries ] Cardiovascular CHD CHD Deep Vein Thrombosis Deep Vein Thrombosis ] Respiratory Emphysems Emphysems Lung CA Lung CA ] Female Genital Endometriosis Endometriosis Endometrial CA Endometrial CA

High Incidence of NCDs in Developed Countries ] Breast Breast CA Breast CA Fibrocystic Disease Fibrocystic Disease ] Male Genital Prostrate CA Prostrate CA ] Metabolic NIDDM NIDDM

High Incidence of NCDs in Developing Countries ] Possible Infectious Etiology Macronodular Cirrhosis Macronodular Cirrhosis Hepatocellular Carcinoma Hepatocellular Carcinoma Rheumatic Heart Disease Rheumatic Heart Disease Iron deficiency anemia Iron deficiency anemia ] Related to Nutrition Deficiency Endemic Goiter Endemic Goiter Malnutrition Related Diabetes. Malnutrition Related Diabetes.

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

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

1960 Urban Rural USA Developing Countries ruralurban

2003 Urban Rural USA Developing Countries rural urban

Life Expectancy in Developing Countries

Changing Life Expectancies

Causes of Death n Age Accidents Accidents CA CA CHD CHD n Age CHD CHD CA CA Accidents Accidents Age Accidents CHD CA Age CHD CA Accidents DevelopedDeveloping

Other Transitions  Agriculture  Forestry  Toxicity  Urbanization  Fossil Fuel  Nutrition

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.

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? 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? Over the past 100 years, life expectancy and causes of death have become homogenous world wide. Why is this important?