Diverse Empirical Evidence on Epidemiological Transition in Low- and Middle-Income Countries: Population-Based Findings from INDEPTH Network Data.
Diverse Empirical Evidence on Epidemiological Transition in Low- and Middle-Income Countries: Population-Based Findings from INDEPTH Network Data.
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DOI：
10.1371/journal.pone.0155753
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Byass P
中科院分区：
文献类型：
--
作者：
Santosa A;Byass P
低收入和中等收入国家往往被描述为处于流行病过渡的中间阶段，但几乎没有基于人口的数据，可以更详细地审查这一情况，并确定可靠的死亡原因。非传染性疾病被广泛视为对人口健康的一个即将到来的威胁，同时感染负担也在不断减轻。INDEPTH网络在中低收入国家的一些卫生和人口监测点收集了经验性人口数据，从而可以更详细地研究死亡率的长期趋势。研究1992-2012年期间INDEPTH网络在非洲和亚洲各站点所有年龄段的死因死亡率趋势。重点是15-64岁年龄组，这是艾滋病毒流行病和新出现的非传染性疾病威胁的主要关切焦点。INDEPTH网络的公共领域数据来自12个网站，每个网站都报告了至少五年的死因特异性死亡率数据。使用标准化的WHO死因推断方法对死亡原因进行归因，并使用INDEPTH标准人群对死亡率进行标准化比较。计算每个研究中心死亡率的年度变化。在12个地点的9，487，418人年期间，共观察到96，255人死亡。对86，039例死亡（89.4%）进行了口头尸检。研究中心之间和随时间推移的死亡率存在显著差异。艾滋病毒相关死亡率在东部和南部非洲各地点占主要地位。15-64岁年龄组的死亡占总死亡率的43%。死亡率总体呈下降趋势，在某些情况下下降速度相当快。孟加拉国的场址反映的是比非洲处于后期过渡阶段的人口，基本上没有受到艾滋病毒/艾滋病的影响。在某种程度上，所观察到的流行病转变模式符合理论预期，尽管艾滋病毒大流行病的影响在某些地方产生了重大影响。受感染减少的驱动，总体死亡率呈下降趋势，这是一种普遍模式。低收入和中等收入国家的人口似乎正处于一个快速转型的时代。
Low- and middle-income countries are often described as being at intermediate stages of epidemiological transition, but there is little population-based data with reliable cause of death assignment to examine the situation in more detail. Non-communicable diseases are widely seen as a coming threat to population health, alongside receding burdens of infection. The INDEPTH Network has collected empirical population data in a number of health and demographic surveillance sites in low- and middle-income countries which permit more detailed examination of mortality trends over time. To examine cause-specific mortality trends across all ages at INDEPTH Network sites in Africa and Asia during the period 1992–2012. Emphasis is given to the 15–64 year age group, which is the main focus of concern around the impact of the HIV pandemic and emerging non-communicable disease threats. INDEPTH Network public domain data from 12 sites that each reported at least five years of cause-specific mortality data were used. Causes of death were attributed using standardised WHO verbal autopsy methods, and mortality rates were standardised for comparison using the INDEPTH standard population. Annual changes in mortality rates were calculated for each site. A total of 96,255 deaths were observed during 9,487,418 person years at the 12 sites. Verbal autopsies were completed for 86,039 deaths (89.4%). There were substantial variations in mortality rates between sites and over time. HIV-related mortality played a major part at sites in eastern and southern Africa. Deaths in the age group 15–64 years accounted for 43% of overall mortality. Trends in mortality were generally downwards, in some cases quite rapidly so. The Bangladeshi sites reflected populations at later stages of transition than in Africa, and were largely free of the effects of HIV/AIDS. To some extent the patterns of epidemiological transition observed followed theoretical expectations, despite the impact of the HIV pandemic having a major effect in some locations. Trends towards lower overall mortality, driven by decreasing infections, were the general pattern. Low- and middle-income country populations appear to be in an era of rapid transition.