Progression of the epidemiological transition in a rural South African setting: findings from population surveillance in Agincourt, 1993-2013.
Progression of the epidemiological transition in a rural South African setting: findings from population surveillance in Agincourt, 1993-2013.
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DOI：
10.1186/s12889-017-4312-x
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发表时间：
2017-05-10
影响因子：
4.5
通讯作者：
Tollman S
中科院分区：
文献类型：
--
作者：
Kabudula CW;Houle B;Collinson MA;Kahn K;Gómez-Olivé FX;Clark SJ;Tollman S
几乎所有低收入和中等收入国家都在经历一场流行病转型，其进展比高收入国家经历的变化更大。观察到的死亡率和疾病模式的变化表明，大多数低收入和中等收入国家的过渡具有逆转、部分变化和同时发生不同程度不同类型疾病的特点。对这种经常缺乏的转移负担的本地化描述，对于指导分散的卫生和社会系统有效地瞄准有限的资源至关重要。基于对二十多年来死亡数据的严格汇编，本文对南非农村人口的流行病学转变进行了全面评估。我们从阿金库尔健康和社会人口监测系统的死亡数据中估计总体和特定原因的死亡危险，作为性别、年龄和时间段的函数，并对变化和差异进行统计测试，以评估1993-2013年期间流行病学转变的进展。从1990年代初到2007年，人口经历了流行病转变的逆转，主要是受艾滋病毒/艾滋病和结核病相关死亡率上升的推动。近年来，由于艾滋病毒/艾滋病和结核病相关死亡率的下降，这一过渡正在沿着积极的轨道进行。然而，在大多数年龄组中，死因分布尚未达到1990年代初的水平。这一转变的特点还包括持续的性别差异，女性的积极进展比男性更快。这一典型的南非农村人口正在经历一场旷日持久的流行病学转变。艾滋病毒/艾滋病和抗逆转录病毒治疗、非传染性疾病风险因素以及复杂的社会和行为变化相互交织和相互作用，将影响在降低可预防的死亡率和改善整个生命周期的健康方面继续取得进展。需要综合医疗规划和方案交付，以改善艾滋病毒和非传染性疾病治疗的可及性和坚持性。这些在较长一段时间内来自当地和农村环境的发现有助于提供必要的证据，以进一步完善和推进流行病学转变理论。本文的在线版本(doi：10.1186/s12889-0174312-x)包含补充材料，授权用户可以使用。
Virtually all low- and middle-income countries are undergoing an epidemiological transition whose progression is more varied than experienced in high-income countries. Observed changes in mortality and disease patterns reveal that the transition in most low- and middle-income countries is characterized by reversals, partial changes and the simultaneous occurrence of different types of diseases of varying magnitude. Localized characterization of this shifting burden, frequently lacking, is essential to guide decentralised health and social systems on the effective targeting of limited resources. Based on a rigorous compilation of mortality data over two decades, this paper provides a comprehensive assessment of the epidemiological transition in a rural South African population. We estimate overall and cause-specific hazards of death as functions of sex, age and time period from mortality data from the Agincourt Health and socio-Demographic Surveillance System and conduct statistical tests of changes and differentials to assess the progression of the epidemiological transition over the period 1993–2013. From the early 1990s until 2007 the population experienced a reversal in its epidemiological transition, driven mostly by increased HIV/AIDS and TB related mortality. In recent years, the transition is following a positive trajectory as a result of declining HIV/AIDS and TB related mortality. However, in most age groups the cause of death distribution is yet to reach the levels it occupied in the early 1990s. The transition is also characterized by persistent gender differences with more rapid positive progression in females than males. This typical rural South African population is experiencing a protracted epidemiological transition. The intersection and interaction of HIV/AIDS and antiretroviral treatment, non-communicable disease risk factors and complex social and behavioral changes will impact on continued progress in reducing preventable mortality and improving health across the life course. Integrated healthcare planning and program delivery is required to improve access and adherence for HIV and non-communicable disease treatment. These findings from a local, rural setting over an extended period contribute to the evidence needed to inform further refinement and advancement of epidemiological transition theory. The online version of this article (doi:10.1186/s12889-017-4312-x) contains supplementary material, which is available to authorized users.