Epidemiological transition in the Americas: changes and inequalities

Abstract

BackgroundIn the last decades, the overall health situation has improved in the Americas; however, health inequality persists. Our aim is to describe the epidemiological transition in the region. MethodsThis descriptive study uses mortality data reported by Pan American Health Organization/WHO countries since 1950. We analysed data from Brazil, Canada, Colombia, Costa Rica, Ecuador, Guatemala, Mexico, the USA, Uruguay, and Venezuela. Data were classified in four groups: (1) communicable, maternal, perinatal, nutritional conditions; (2) non-communicable diseases (NCDs); (3) injuries; and (4) ill-defined causes of death. Data were codified using the International Classification of Disease (ICD) 6–10 and aggregated to guarantee the equivalence among ICD versions. FindingsThe analysis reveals three different stages of epidemiological transition. (1) Completed transition: high burden of NCDs and low infectious diseases since the 1950s (Canada, USA, Uruguay). (2) Recent transition: the increase in the NCD burden that occurred during the 1980s and 1990s (Brazil, Colombia, Costa Rica, Mexico, Venezuela). From 1990 to 2000 in Mexico, deaths decreased from 32% (n=134 167) to 15% (67 322) in group 1 and increased by 50% in group 2 (from 230 343 in 1990, to 309 568 in 2000). Likewise, in Brazil, group 1 decreased from 10% (n=80 992) to 5% (44 284), and NCDs increased from 58% (457 642) to 72% (598 162). (3) Delayed transition: low burden of NCDs and high proportion of infectious diseases (Ecuador, Guatemala). In 1990 in Guatemala, group 1 was responsible for 55% (n=49 067) of all deaths, group 2 for 25% (15 864), and injuries for 3% (6286). In 2006, 30% (n=20 892) of deaths were due to group 1, 46% (32 137) due to group 2, and injuries accounted for 18% (32 137). InterpretationThe Americas are going simultaneously through different stages of the epidemiological transition. In developed countries, NCDs have been predominant since the 1950s, whereas developing countries with inequalities and less access to health care are still facing a delayed transition, presenting a high proportion of deaths due to group 1 and increases in NCDs and injuries. Countries need to redefine their priorities to tackle this triple burden of disease. FundingNone.