Epidemiologic Transition:

Changes of fertility and mortality

with modernization
Abdel Omran. The Epidemiologic Transition: A Theory of
the epidemiology of population change. Milbank
Quarterly. 1971;49:509-538

http://www.who.int/docstore/bulletin/pdf/2001/issue2/vol.79no.2.1
59-170.pdf
 Lecture

■ Epidemiologic Transition
■ Geographic Studies, what do they tell us?
 Abdel Omran
Evolution of Disease

Charles Darwin
Evolution of Species
 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
 Epidemiologic Transition in
Developing and Developed
Countries
80
70
60
50
Developing
40
Developed
30
20
10
0
1945 1960 1980 1995
 14 years

35 years
Increasing Life Expectancy and
Causes of Death
100

Other
80

60
Violence
40
CHD

20 CA
Infection
0
40 44 48 52 56 60 64 68 72 76

Population Life Expectancy

 Infectious Diseases
Mortality Rates

NCD

Epidemiologic Transition
 Death Rates for TB in England
and Wales
4500
4000
3500
3000
2500
2000
1500
1000
500
0
1840 1855 1875 1895 1915 1935 1948 1958 1968
 Death Rates for TB in England
and Wales
4500
4000 TB Bacillus
3500 Identified
3000
2500
2000
Chemotherapy
1500
BCG Vaccination
1000
500
0
1840 1855 1875 1895 1915 1935 1948 1958 1968
 Death Rates for Measles in
Children in England and Wales
1400
1200

1000
800
600
400

200
0
1850 1870 1890 1910 1930 1950 1970
 Death Rates for Measles in
Children in England and Wales
1400
1200

1000
800
600
400 Immunization begun

200
0
1850 1870 1890 1910 1930 1950 1970
 NIDDM CHD
Trauma
Mortality Rates

CA

Epidemiologic Transition
 Importance of
Geographic Patterns
 Incidence of Stomach CA
Males
Japan
Columbia
Iceland
Finland
UK
US NW
US White
India
Nigeria

0 20 40 60 80 100
 Breast Cancer Incidence
Females
US Whites

US NW

UK

Poland

Jamaica

Singapore

Brazil

Nigeria

Japan

0 5 10 15 20 25 30
 CHD Death Rates
Males, aged 45-54
Finland
Scotland
UK
US
Bulgaria
Italy
Egypt
Japan
Guatamala
Thailand

0 500 1000 1500

 Cirrhosis Death Rates,
Males, aged 45-54
France

Italy

Japan

US

Hong Kong

Scotland

UK

0 10 20 30 40 50 60 70 80 90
High Incidence of NCDs in
Developing Countries
✽ Possible Infectious Etiology
Macronodular Cirrhosis
Hepatocellular Carcinoma
Rheumatic Heart Disease
Iron deficiency anemia
✽ Related to Nutrition Deficiency
Endemic Goiter
Malnutrition Related Diabetes.
High Incidence of NCDs in Developed Countries
Cardiovascular
CHD
Deep Vein Thrombosis
Respiratory
Emphysema
Lung CA
Female Genital
Endometriosis
Endometrial CA
Breast
Breast CA
Fibrocystic Disease
Male Genital
Prostrate CA
Metabolic
NIDDM
 Back to Nature

 Improved Physical activity

 A Healthier Diet, less saturated
fats, more fiber
 Less Stress
 Transition

 Nomads 45 yrs
 Farmers 60 yrs
 Urban 70 yrs
 1960
Urban Rural

rural urban

USA Developing
Countries
 2006
Urban Rural

urban
rural

USA Developing
Countries
 Causes of Death
Developed Developing
■ Age 15-44 Age 15-44
Accidents Accidents
CA CHD
CHD CA
■ Age 45-54 Age 45-54
CHD CHD
CA CA
Accidents Accidents