Infectious Diseases and Epidemiologic Transition in Victorian Britain? Definitely

TIME SERIES ANALYSIS OF INFECTIOUS DISEASE MORTALITY IN UKRAINE (1965-2015)

Background Global mortality transitions are driven by the epidemiologic transition, resulting in a rise in non-communicable diseases (NCDs), which are partly shaped by the nutrition transition and associated chronic conditions. In low- and middle-income countries, these shifts are often viewed as primarily urban phenomena. Rural populations may therefore be overlooked in efforts to prevent and manage NCDs, despite facing critical public health challenges. Objective This study examines changing patterns of adult mortality and causes of death in rural Senegal to illustrate ongoing mortality, epidemiologic, and nutrition transitions. Methods Using data from three rural sites in the Senegalese Health and Demographic Surveillance System, we analysed adult mortality from 1985 to 2020. We calculated all-cause and cause-specific mortality rates among individuals aged 15 to 70 years, based on causes of death determined through verbal autopsy. Results Mortality declined across all age groups. Deaths from communicable diseases, maternal conditions, and undernutrition decreased substantially. NCDs have surpassed communicable diseases as the leading cause of death. Causes of death associated with undernutrition have declined, while diet-related NCDs have increased. Conclusions Adult mortality is declining in the three rural Senegalese sites studied, due to a decline in epidemics. However, NCDs now pose a major rural health threat, consistent with epidemiologic transition theory. The reversal between mortality patterns associated with undernutrition and diet-related NCDs may signal an ongoing nutrition transition. Strong health systems are crucial for both preventing and treating NCDs, and robust health information systems are needed to support deeper analysis of this issue.

Brazil has been undergoing a period of epidemiological and demographic transition, which has included an improvement in the quality of death certificate registrations and major changes in the patterns of mortality from infectious and parasitic diseases. This article outlines the changes in the mortality patterns that were observed in the country and in its states during the decade of the 1980s. We used data from the Ministry of Health Mortality Information System, classified according to the International Classification of Diseases, 9th Revision. Our analysis showed important changes in mortality patterns in Brazil. Mortality from infectious diseases decreased by 41% among men and by 44% among women. While these types of changes were especially noticeable in the states of the North and Northeast, these states still have the highest mortality rates in the country. The changes particularly affected the extreme limits of the age continuum, most especially children under 1 year of age. Within the group of infectious and parasitic diseases, we also assessed the mortality due to intestinal infectious diseases, tuberculosis, and septicemia. We found that in the 1980s there was a major decrease in the rates of mortality due to intestinal infectious diseases and to tuberculosis. However, there was an increase in the risk of death from septicemia during the decade. In conclusion, we find that the rate of mortality caused by infectious and parasitic diseases remains high in Brazil. Therefore, Brazilian health authorities still need to give priority attention to this cause of death.

BackgroundThis study aims to examine the stages of mortality and epidemiologic transition in Bangladesh where detailed studies are not well documented but significant decline in fertility and mortality have been...

Background: The causes of death have changed with regard to the epidemiological and demographic events in society. There is no evidence of prior research into the epidemiological transition in Turkey. This transition in Turkey should be observed starting with the Ottoman Empire period (19th to early 20th century). However, information about the Ottoman Empire is quite limited.Aims: To discuss the epidemiological and demographic transitions in Turkey, using demographic, educational and urbanization data in our present study.Study Design: A descriptive archive study.Methods: Mortality statistics dating from 1931 and published by the Turkish Statistical Institute were analysed, and the causes of death were coded and classified according to ICD-10. Other data were obtained from the published reports and studies regarding the issue.Results: In the 1930s, Turkey’s life expectancy was low (aged 40 years), fertility and mortality rates were high (respectively 45% and 31%), and the main causes of death were infectious diseases. Nowadays, life expectancy is close to 80 years, the total fertility rate has dropped to 2.1 per woman, and the main causes of death are chronic diseases and cancer. The population rate in the urban areas has increased steadily from 24.2% in 1927 to 77.3% in 2012. level of education has also increased during this period. In 1935, less than 10% of women were literate, and in 2013 90% were literate. Qualitative and quantitative increase have been observed in the presentation and access of healthcare services compared to the early years of the Republic.Conclusion: Turkey has been undergoing a modernization period in the last 200 years, and it is believed that the epidemiological and demographic transitions result from this period. This process has led to urbanization and an increase in the level of education, as well as a decrease in premature deaths, lower fertility rates, and an increase in the elderly population and chronic diseases. It is therefore our conclusion that Turkey needs policies regarding the elderly population and the management of chronic diseases.

We would like to thank Graham Mooney and Andrew Noymer and Beth Jarosz for their responses to our ‘Second Opinion’ on ‘Infectious Disease and the Epidemiological Transition in Victorian Britain’.1 Mooney offers a robust attack on our general claim that the importance of infectious diseases as a cause of death in the nineteenth century has been overstated, while seeming to accept what we say about epidemics, while Noymer and Jarosz take us to task on what counts as an infectious disease and also provide a critique of the specific limitations of our claims when applied to New England. We are pleased that our piece generated such reactions and hope that the debate will continue.

Background: Residents of Aboriginal areas are known to experience a higher mortality than the general population, but little is known about the trends in this gap. We therefore examined the patterns of epidemiological transition and the trends of inequality in cause-specific mortality in Aboriginal areas in Taiwan. Methods: Mortality data from 1974 through 1998 were collected to analyze changes in mortality patterns. Age-specific and age-adjusted mortality rates for selected causes of death in Aboriginal areas and those in Taiwan as a whole were calculated. Mortality rate ratios (Aboriginal areas/Taiwan) were used as the indicator of inequality. Results: In 1974, one-third of deaths in Aboriginal areas were due to communicable diseases; this proportion had decreased to one-tenth by 1998. The proportion of deaths from non-communicable diseases increased from 54% to 70% during the same period. The increase in age-specific mortality rate ratios between Aboriginal areas and Taiwan as a whole between 1974-7 and 1995-8 was most prominent in the 0-9 year and 25-49year age groups. Mortality from lung cancer, cervical cancer, diabetes, ischemic heart disease, liver cirrhosis, and traffic accidents showed steeply increasing trends in Aboriginal areas. Except for suicide all causes of death showed increasing trend of inequality. Conclusions: The pattern of epidemiological transition in Aboriginal areas was different from those in Taiwan. Despite the decreasing of some causes of death, the inequality between Aboriginal areas and Taiwan was increasing.

Abstract. Khariri, Andriani L. 2020. The predominance of non-communicable diseases and unhealthy eating patterns. Pros Sem Nas Masy Biodiv Indon 6: 624-627. Indonesia in the last decade has a double burden, namely infectious and non-communicable diseases. This is related to the slow decline in the incidence of infectious diseases and even tends to persist, but on the other hand the incidence of non-communicable diseases is moving fast enough and more dominating its impact. The World Health Organization (WHO) reports that nearly two-thirds of deaths worldwide are caused by non-communicable diseases. The mortality rate due to non-communicable diseases is expected to continue to increase worldwide with the largest increases occurring in low and middle-income countries. The main risk factors for non-communicable diseases include unhealthy community dietary behavior. This paper examines several types of non-communicable diseases that are affected due to unbalanced and unhealthy consumption behavior as a risk factor. In the results of the Basic Health Research (Riskesdas), several non-communicable diseases found a high prevalence such as stroke, hypertension, diabetes mellitus, heart disease, cancer and chronic kidney failure. In the list of diseases that are the highest causes of death in Indonesia, non-communicable diseases dominate the treats, whereas infectious diseases are only tuberculosis, which still plays the second highest cause of death after stroke. The burden faced by the Indonesian people in tackling health problems is increasing with the existence of an epidemiological transition marked by a shift in causes of death for all ages from infectious diseases to non-communicable diseases.

Medical Scientists are beginning to understand better some of the trends in the changing disease and mortality patterns but policymakers need to know how to use this information to make decisions about the priorities for the health sector. This Paper is aimed at x-raying this shift in morbidity and mortality patterns and make recommendations for possible shift in planning and policies. Relevant literatures were reviewed from medical journals, library search and internet source using Google search engine as well as international, national and local journals. The key words employed were: Epidemiological Transition with particular emphasis on policy and planning implications in developing countries. Several studies have outlined definitions, stages and historical perspectives of epidemiological transition, as well as the scenarios in developed and developing countries. The impending challenges and policy and planning implications in the developing countries were suggested and outlined in this paper. It is very obvious that epidemiological transition is here with us as there are transformations in the age, cause, and sex structure of death in developing world. Yet not much progress has been made towards averting the dire consequences. A fundamental policy shift therefore needs to be put in place.

Demographic and epidemiological transition models have seldom been debated within the Brazilian scientific community. This study aims to critically review the studies based on such transition models, analyzing their contributions and limitations for health research in Brazilian cities. Data from the city of Belo Horizonte were used to illustrate the theoretical issues raised in this paper. A total of 10,558 death certificates from 1994 were classified according to underlying cause of death and place of residence (75 geographical areas). Areas were classified according to the proportion of heads of households with low formal education. Population age structures and age- and sex-adjusted mortality rates in the areas were compared. Mortality rates indicate that Belo Horizonte is experiencing a multiple and unequal epidemiological transition process. In the poorer areas, infectious diseases have been replaced by homicides as cause of death in adulthood. The findings suggest that large Brazilian cities have mortality patterns that vary according to social and economic differentials.

Verbal autopsy (VA) is an attractive method for ascertaining causes of death in settings where the proportion of people who die under medical care is low. VA has been widely used to determine causes of childhood and maternal deaths, but has had limited use in assessing causes in adults and across all age groups. The objective was to test the feasibility of using VA to determine causes of death for all ages in Bavi District, Vietnam, in 1999, leading to an initial analysis of the mortality pattern in this area. Trained lay field workers interviewed a close caretaker of the deceased using a combination closed/open-ended questionnaire. A total of 189 deaths were studied. Diagnoses were made by two physicians separately, with good agreement (kappa = 0.84) and then combined to reach one single underlying cause of death for each case. The leading causes of death were cardiovascular and infectious diseases (accounting for 20.6% and 17.9% of the total respectively). Drowning was very prevalent in children under 15 (seven out of nine cases of drowning were in this age group). One month seemed an acceptable minimum recall period to ensure mourning procedures were over. A combination VA questionnaire was an appropriate instrument provided it was supported by adequate training of interviewers. Two physicians were appropriate for making the diagnoses but predefined diagnostic methods for common causes should be developed to ensure more replicable results and comparisons, as well as to observe trends of mortality over time. The causes of death in this study area reflect a typical pattern for developing countries that are in epidemiological transition. No maternal deaths and a low infant mortality rate may be the result of improvements in maternal and child health in this study area. Using the VA gave more precise causes of death than those reported at death registration. Although the validity of the VA method used has not been fully assessed, it appeared to be an appropriate method for ascertaining causes of death in the study area.

It is a common assumption that agriculture and modernization have been detrimental for human health. The theoretical argument is that humans are adapted to hunter-gatherer lifestyles, and that the agricultural and "modern" environments are novel and hence likely to be detrimental. In particular, changes in nutrition, and population size and distribution with the adoption of agriculture, are considered to increase the risk of infectious disease mortality. Similarly, changes due to modern lifestyles, notably changes in nutrition, smoking, exercise, and stress, are thought to be associated with an increased risk of degenerative disease mortality in the industrial environment. This paper reviews the available literature on the history and prehistory of total mortality (the demographic transition) and cause of death (the epidemiologic transition), and finds that neither agriculture nor modernization is associated with increases in mortality, i.e., declines in health. First, mortality does not appear to have increased during the transition to agriculture, or during the early phases of the industrial revolution. Clearly, infectious diseases have declined with modernization. Second, the empirical data, when uncorrected for misclassification of cause of death, do suggest an increase in degenerative disease mortality, at least until the mid 20th century, when these causes of death clearly began to decline. All studies that correct for misclassification of cause of death, however, find that the general decline in degenerative disease mortality began much earlier, perhaps as early as the 1850s in the developed countries. This is about the same time that infectious disease mortality began to decline in these countries. The exception is neoplasms, which increased with modernization until quite recently. Part of the increase in neoplasms may be attributable to increases in smoking during the course of modernization. Nevertheless, the overall risk of degenerative disease mortality appears to have declined with modernization. The fact that the decline in the risk of infectious disease mortality, and the decline in risk of degenerative disease mortality, are largely coordinated suggests that the causes of both declines may be related. Historical trends in morbidity, and potential causes of the decline in infectious and degenerative disease mortality, are briefly considered.

50-year mortality trends in children and young people: a study of 50 low-income, middle-income, and high-income countries

India is undergoing rapid epidemiological transition as a consequence of economic and social change. The pattern of mortality is a key indicator of the consequent health effects but up-to-date, precise, and reliable statistics are few, particularly in rural areas. Deaths occurring in 45 villages (population 180 162) were documented during a 12-month period in 2003-04 by multipurpose primary healthcare workers trained in the use of a verbal autopsy tool. Algorithms were used to define causes of death according to a limited list derived from the international classification of disease version 10. Causes were assigned by two independent physicians with disagreements resolved by a third. A total of 1354 deaths were recorded with verbal autopsies completed for 98%. A specific underlying cause of death was assigned for 82% of all verbal autopsies done. The crude death rate was 7.5/1000 (95% confidence interval, 7.1-7.9). Diseases of the circulatory system were the leading causes of mortality (32%), with similar proportions of deaths attributable to ischaemic heart disease and stroke. Second was injury and external causes of mortality (13%) with one-third of these deaths attributable to deliberate self harm. Third were infectious and parasitic diseases (12%). Tuberculosis and intestinal conditions each caused one-third of deaths within this category. HIV was assigned as the cause for 2% of all deaths. The fourth and fifth leading causes of death were neoplasms (7%) and diseases of the respiratory system (5%). Non-communicable and chronic diseases are the leading causes of death in this part of rural India. The observed pattern of death is unlikely to be unique to these villages and provides new insight into the rapid progression of epidemiological transition in rural India.

BackgroundRapid urbanization in low- and middle-income countries reinforces risk and epidemiological transition in urban societies, which are characterized by high socioeconomic gradients. Limited availability of disaggregated morbidity data in these settings impedes research on epidemiological profiles of different population subgroups.ObjectiveThe study aimed to analyze the epidemiological transition in the emerging megacity of Pune with respect to changing morbidity and mortality patterns, also taking into consideration health disparities among different socioeconomic groups.DesignA mixed-methods approach was used, comprising secondary analysis of mortality data, a survey among 900 households in six neighborhoods with different socioeconomic profiles, 46 in-depth interviews with laypeople, and expert interviews with 37 health care providers and 22 other health care workers.ResultsThe mortality data account for an epidemiological transition with an increasing number of deaths due to non-communicable diseases (NCDs) in Pune. The share of deaths due to infectious and parasitic diseases remained nearly constant, though the cause of deaths changed considerably within this group. The survey data and expert interviews indicated a slightly higher prevalence of diabetes and hypertension among higher socioeconomic groups, but a higher incidence and more frequent complications and comorbidities in lower socioeconomic groups. Although the self-reported morbidity for malaria, gastroenteritis, and tuberculosis did not show a socioeconomic pattern, experts estimated the prevalence in lower socioeconomic groups to be higher, though all groups in Pune would be affected.ConclusionsThe rising burden of NCDs among all socioeconomic groups and the concurrent persistence of communicable diseases pose a major challenge for public health. Improvement of urban health requires a stronger focus on health promotion and disease prevention for all socioeconomic groups with a holistic understanding of urban health. In order to derive evidence-based solutions and interventions, routine surveillance data become indispensable.