Mortality Trends and the Epidemiological Transition in Nauru
ABSTRACT This article aims to examine the epidemiological transition in Nauru through analysis of available mortality data. Mortality data from death certificates and published material were used to construct life tables and calculate age-standardized mortality rates (from 1960) with 95% confidence intervals. Proportional mortality was calculated from 1947. Female life expectancy (LE) varied from 57 to 61 years with no significant trend. Age-standardized mortality for males (15-64 years) doubled from 1960-1970 to 1976-1981 and then decreased to 1986-1992, with LE fluctuating since then from 49 to 54 years. Proportional mortality from cardiovascular disease and diabetes increased substantially, reaching more than 30%. Nauru demonstrates a very long period of stagnation in life expectancy in both males and females as a consequence of the epidemiological transition, with major chronic disease mortality in adults showing no sustained downward trends over 40 years. Potential overinterpretation of trends from previous data due to lack of confidence intervals was highlighted.
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ABSTRACT: Background: Epidemiological transition (ET) theory, first postulated in 1971, has developed alongside changes in population structures over time. However, understandings of mortality transitions and associated epidemiological changes remain poorly defined for public health practitioners. Here, we review the concept and development of ET theory, contextualising this in empirical evidence, which variously supports and contradicts the original theoretical propositions. Design: AMedline literature search covering publications over four decades, from1971 to 2013, was conducted. Studies were included if they assessed human populations, were original articles, focused on mortality and health or demographic or ET and were in English. The reference lists of the selected articles were checked for additional sources. Results: We found that there were changes in emphasis in the research field over the four decades. There was an increasing tendency to study wide-ranging aspects of the determinants of mortality, including risk factors, lifestyle changes, socio-economics, and macro factors such as climate change. Research on ET has focused increasingly on low- and middle-income countries rather than industrialised countries, despite its origins in industrialised countries. Countries have experienced different levels of progress in ET in terms of time, pace, and underlying mechanisms. Elements of ET are described for many countries, but observed transitions have not always followed pathways described in the original theory. Conclusions: The classic ET theory largely neglected the critical role of social determinants, being largely a theoretical generalisation of mortality experience in some countries. This review shows increasing interest in ET all over the world but only partial concordance between established theory and empirical evidence. Empirical evidence suggests that some unconsidered aspects of social determinants contributed to deviations from classic theoretical pathways. A better-constructed, revised ET theory, with a stronger basis in evidence, is needed. Keywords: epidemiological transition; demographic transition; mortality; social determinantsGlobal Health Action 05/2014; 7(23574). DOI:10.3402/gha.v7.23574 · 1.65 Impact Factor
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ABSTRACT: Background South East Asia (SEA) is home to over 30 tribes of indigenous population groups who are currently facing rapid socio-economic change. Epidemiological transition and increased prevalence of non-communicable diseases (NCD) has occured. In Peninsular Malaysia, the Orang Asli (OA) indigenous people comprise 0¿·¿6% (150,000) of the population and live in various settlements. OA comprise three distinct large tribes with smaller sub-tribes. The three large tribes include Proto-Malay (sub-tribes: Orang Seletar and Jakun), Senoi (sub-tribes: Mahmeri and Semai), and Negrito (sub-tribes: Jehai, Mendriq and Batek).Methods We studied the health of 636 OA from seven sub-tribes in the Peninsular. Parameters that were assessed included height, weight, BMI and waist circumference whilst blood pressure, cholesterols, fasting blood glucose and HbA1c levels were recorded. We then analysed cardio-metabolic risk factor prevalences and performed multiple pair-wise comparisons among different sub-tribes and socio-economic clusters.ResultsCardio-metabolic risk factors were recorded in the seven sub-tribes.. Prevalence for general and abdominal obesity were highest in the urbanized Orang Seletar (31¿·¿6¿±¿5¿·¿7%; 66¿·¿1¿±¿5¿·¿9%). Notably, hunter gatherer Jehai and Batek tribes displayed the highest prevalence for hypertension (43¿·¿8¿±¿9¿·¿29% and 51¿·¿2¿±¿15¿·¿3%) despite being the leanest and most remote, while the Mendriq sub-tribe, living in the same jungle area with access to similar resources as the Batek were less hypertensive (16.3¿±¿11.0%), but displayed higher prevalence of abdominal obesity (27.30¿±¿13.16%).Conclusions We describe the cardio-metabolic risk factors of seven indigenous communities in Malaysia. We report variable prevalence of obesity, cholesterol, hypertension and diabetes in the OA in contrast to the larger ethnic majorities such as Malays, Chinese and Indians in Malaysia These differences are likely to be due to socio-economic effects and lifestyle changes. In some sub-tribes, other factors including genetic predisposition may also play a role. It is expected that the cardio-metabolic risk factors may worsen with further urbanization, increase the health burden of these communities and strain the government¿s resources.BMC Public Health 01/2015; 15(1):47. DOI:10.1186/s12889-015-1384-3 · 2.32 Impact Factor
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ABSTRACT: The second epidemiologic transition is defined as “the age of receding pandemics”, wherein mortality declines, life expectancy increases, and population growth occurs. The major causes of death also shifted from predominantly acute infectious diseases to degenerative and “man-made” diseases (Omran, 1983). The aim of this study was to determine the timing of the transition in Zürich (Switzerland) and to investigate patterns of tuberculosis mortality during this period. This is one of the first studies to specifically investigate the timing of the second transition in Zürich, Switzerland. The data sources for this study were Swiss records of mortality from the Staatsarchiv (Canton Archives), Stadtarchiv (City Archives) and a published volume of State Statistics (Historische Statistik der Schweiz). The changes in mortality through time were addressed for all causes of death in the city ofZürichfor the years 1893 to 1933 that is, the time including the second epidemiological transition. After 1933 the structure of the mortality data collection changed as the responsibility was transferred away from the canton archives. Mortality from tuberculosis was then examined in greater detail and compared with changes in living standards as well as population density occurring at the time.Advances in Anthropology 01/2013; 03(02):78-90. DOI:10.4236/aa.2013.32011