The uneven tides of the health transition
The uneven tides of the health transition
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DOI：
10.1016/s0277-9536(01)00172-1
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发表时间：
2002-07-01
影响因子：
5.4
通讯作者：
Gwatkin, DR
中科院分区：
文献类型：
--
作者：
Heuveline, P;Guillot, M;Gwatkin, DR
由于所有发展中国家的所有国民收入水平的死亡率都出现了惊人的下降，流行病学转变理论表明，死因模式应该从特别是在婴儿和儿童中流行的传染病转向老年人非传染性疾病造成的问题。全球估计证实了这一预期，而后一种情况造成的死亡率已成为世界范围内的主要疾病，导致一些观察家主张公共卫生议程进行相应的转变。在本文中，我们通过研究全球估计中隐藏的重要贫困梯度来细微差别这一发现。我们的结果表明了世界上最贫穷和最富有人口之间仍然存在的死因差异。我们发现，在三个主要死亡原因中，最贫困人口（第一五分位数）的死亡率均高于最富裕人口（第五五分位数），但最贫困人口的超额死亡率主要是由于传染病发病率较高（超额死亡人数的 77%）。总体而言，这些疾病仅占世界死亡人数的 34.2%，但仍然是世界最贫困 20% 人口的主要死亡原因（占所有死亡人数的 58.6%）。此外，这些结果对于世界最贫困人口国际分布的替代估计来说似乎是可靠的。在认识到非传染性疾病议程正在出现的同时，我们强调许多国家的传染病“未完成的议程”。由于受这些疾病影响的人群主要是贫困人口，出于公平考虑，应警惕过早摆脱这些疾病。 (C) 2002 Elsevier Science Ltd. 保留所有权利。
As spectacular mortality reductions have occurred in all developing nations at all national income levels, the epidemiologic transition theory suggests that cause-of-mortality patterns should shift from communicable diseases especially prevalent among infants and children to problems resulting from non-communicable conditions at older ages. Global estimates confirm this expectation, and mortality from these latter conditions has become predominant worldwide, leading some observers to argue for a corresponding shift in the public health agenda. In this paper, we nuance this finding by studying the important poverty-gradient concealed in the global estimates.Our results demonstrate the remaining cause-of-death disparities between the world's poorest and richest populations. We find that the poorest population (1st quintile) experiences higher mortality than the richest population (5th quintile) in each of the three main groups of mortality causes but that the excess mortality of the poorest population is mostly due to the higher incidence of communicable diseases (77% of excess deaths). Overall, those diseases only account for 34.2% of deaths in the world but still dominate mortality causes among the poorest 20% of the world population (58.6% of all deaths). Moreover, these results appear robust to alternative estimates of the international distribution of the world's poorest people.While recognizing the emerging agenda of the non-communicable conditions, we thus underscore the "unfinished agenda" of communicable diseases in many countries. As populations affected by these diseases are predominantly among the poorer, equity considerations should caution against a premature shift away from these diseases. (C) 2002 Elsevier Science Ltd. All rights reserved.