The Epidemiologic Transition: A Theory of the Epidemiology of Population Change

Milbank Quarterly (Impact Factor: 3.38). 02/2005; 83(4):731-57. DOI: 10.1111/j.1468-0009.2005.00398.x
Source: PubMed
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    • "Chronic non-communicable diseases (NCDs), such as cardiovascular diseases, diabetes, chronic respiratory diseases and cancer, currently account for approximately 63% of all deaths (or 36 million deaths) worldwide annually (World Health Organization, 2010a). For low-and middle-income countries, the rising rates of NCDs have overtaken the burden of communicable diseases despite the only recent epidemiologic transition (Dans et al., 2011; Omran, 1971, 1983; Wagner & Brath, 2012). Additionally, rapid urbanisation and "
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    ABSTRACT: This study measures and decomposes socioeconomic inequalities in the prevalence of self-reported chronic non-communicable diseases (NCDs) in urban Hanoi, Vietnam. A cross-sectional survey of 1211 selected households was carried out in four urban districts in both slum and non-slum areas of Hanoi city in 2013. The respondents were asked if a doctor or health worker had diagnosed any household members with an NCD, such as cardiovascular diseases, chronic respiratory, diabetes or cancer, during last 12 months. Information from 3736 individuals, aged 15 years and over, was used for the analysis. The concentration index (CI) was used to measure inequalities in self-reported NCD prevalence, and it was also decomposed into contributing factors. The prevalence of chronic NCDs in the slum and non-slum areas was 7.9% and 11.6%, respectively. The CIs show gradients disadvantageous to both the slum (CI = -0.103) and non-slum (CI = -0.165) areas. Lower socioeconomic status and aging significantly contributed to inequalities in the self-reported NCDs, particularly for those living in the slum areas. The findings confirm the existence of substantial socioeconomic inequalities linked to NCDs in urban Vietnam. Future policies should target these vulnerable areas.
    Full-text · Article · Jan 2016 · Global Public Health
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    • "Recent studies of historical trends of mortality rates also have found patterns of cohort mortality declines that may have resulted from decreased exposures to physiological risk factors for chronic morbidities such as infection and inflammation (Finch and Crimmins 2004), increased health capital brought about by technophysio evolution (Fogel and Costa 1997), or a combination of these and other factors across birth cohorts (Zheng 2014). Period mortality declines may be attributable to a changing mix of socioeconomic development, lifestyle changes, and medical innovations in each period (Omran 1971; Olshansky and Ault 1986). Systematic regression analyses that disentangle confounding time-related variables also suggest that, during the second half of the twentieth century, cohort effects have been strong, while period effects have been relatively weak (Yang 2008). "
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    ABSTRACT: This paper investigates historical changes in both single-year-of-age adult mortality rates and variation of the single-year mortality rates around expected values within age intervals over the past two centuries in 15 developed countries. We apply an integrated hierarchical age-period-cohort—variance function regression model to data from the human mortality database. We find increasing variation of the single-year rates within broader age intervals over the life course for all countries, but the increasing variation slows down at age 90 and then increases again after age 100 for some countries; the variation significantly declined across cohorts born after the early 20th century; and the variation continuously declined over much of the last two centuries but has substantially increased since 1980. Our further analysis finds the recent increases in mortality variation are not due to increasing proportions of older adults in the population, trends in mortality rates, or disproportionate delays in deaths from degenerative and man-made diseases, but rather due to increasing variations in young and middle-age adults.
    Full-text · Article · Nov 2015 · Population Research and Policy Review
    • "Mortality trends in high-income countries between 1900 and 1950 showed a clear age-pattern shift: mortality at young ages and from infectious conditions was rapidly receding while mortality at older ages and from chronic conditions began to dominate (Omran, 1971; Preston, 1976). By the 1960s major medical improvements in cardiovascular survival led to an increasing prevalence of heart disease at older ages. "
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    ABSTRACT: The success of the current biomedical paradigm based on a “disease model” may be limited in the future due to large number of comorbidities inflicting older people. In recent years, there has been growing empirical evidence based on animal models suggesting that the aging process could be delayed and that this process may lead to increases in life expectancy accompanied by improvements in health at older ages. In this chapter we explore past, present and future prospects of healthy life expectancy and examine whether increases in average length of life associated with delayed aging link with additional years lived disability-free at older ages. Trends in healthy life expectancy suggest improvements among older people in the U.S., although younger cohorts appear to be reaching old age with increasing levels of frailty and disability. Trends in health risk factors such as obesity and smoking show worrisome signs of negative impacts on adult health and mortality in the near future. However, results based on a simulation model of delayed aging in humans indicate that it has the potential to increase not only the length of life but also the fraction and number of years spent disability-free at older ages. Delayed aging would likely come with additional aggregate costs. These costs could be offset if delayed aging is widely applied and people are willing to convert their greater healthiness into more years of work.
    No preview · Chapter · Nov 2015
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