The epidemiologic transition revisited: Compositional models for causes of death by age and sex
The epidemiologic transition revisited: Compositional models for causes of death by age and sex
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DOI：
10.1111/j.1728-4457.2002.00205.x
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发表时间：
2002-06-01
影响因子：
2.5
通讯作者：
Murray, CJL
中科院分区：
文献类型：
--
作者：
Salomon, JA;Murray, CJL
几十年来，研究人员注意到，随着死亡率水平的变化，死因模式发生了系统性变化。 “流行病学转变”的概念影响了对不同社会健康演变以及卫生系统对这些变化的反应的思考。本文根据 1950 年以来按年龄和性别划分的死亡原因构成的经验规律重新审视流行病学转变，并考虑流行病学转变理论是否为理解最近的模式提供了一个持久的框架。分析了三大原因组的按年龄性别划分的死亡率： 第 1 组（传染病、孕产妇和围产期原因以及营养缺乏）；第 2 组（非传染性疾病）；第 3 组（伤害），使用最广泛的按原因划分的死亡率国际数据库，包括 1, 576 个国家/地区的观察年以及新的成分数据统计模型。这些分析将死因模式的变化与全因死亡率和人均收入水平的变化联系起来。结果证实，总体死亡率的下降伴随着许多年龄组的病因构成的系统性变化。这些变化在儿童中最为明显，对于儿童来说，随着总体死亡率的下降，第 1 组导致死亡率下降；而在年轻人中，男性（从第 3 组转向第 2 组）与女性（转向第 2 组，然后转向第 3 组）的模式存在显着不同。该分析得出的基本模式为从高死亡率到低死亡率环境的流行病学转变提供了见解。
For decades, researchers have noted systematic shifts in cause-of-death patterns as mortality levels change. The notion of the "epidemiologic transition" has influenced thinking about the evolution of health in different societies and the response of the health system to these changes. This article re-examines the epidemiologic transition in terms of empirical regularities in the cause composition of mortality by age and sex since 1950, and considers whether the theory of epidemiologic transition presents a durable framework for understanding more recent patterns. Age-sex-specific mortality rates from three broad cause groups are analyzed: Group 1 (communicable diseases, maternal and perinatal causes, and nutritional deficiencies); Group 2 (noncommunicable diseases); and Group 3 (injuries), using the most extensive international database on mortality by cause, including 1, 576 country-years of observation, and new statistical models for compositional data. The analyses relate changes in cause-of-death patterns to changing levels of all-cause mortality and income per capita. The results confirm that declines in overall mortality are accompanied by systematic changes in the composition of causes in many age groups. These changes are most pronounced among children, for whom Group 1 causes decline as overall mortality falls, and in younger adults, where strikingly different patterns are found for men (shift from Group 3 to Group 2) compared to women (shift toward Group 2 then Group 3). The underlying patterns that emerge from this analysis offer insights into the epidemiologic transition from high-mortality to low-mortality settings.