A few remarks about mortality and health 1) Mortality – death – easy to measure 2) Morbidity – diseases -- more difficult to measure 3) Mortality has implication for population size, growth, age structure 4) Today, mortality is an imperfect picture of the health status of a population. 5) Unlike fertility, the preference for lower mortality is universal, not cultural.Causes of Death 1) Group 1 – Infectious and parasitic diseases (communicable diseases) a. Due to external agent: virus or bacterium b. Also includes maternal diseases, perinatal and nutritional deficiencies 2) Group 2 –degenerative or chronic diseases (non communicable diseases) 3) Group 3 – external injuries a. Deaths not due to diseaseSource: US Department of Health and Human Services, CDC, NCHSEpidemiologic Transition 1) Definition (associated with Omran) 2) Demography, population health, epidemiology 3) Focus not only on mortality but also on morbidity 4) Stages a. Age of pestilence and famine b. Age of receding pandemics c. Age of degenerative & man-made diseases d. Age of delayed degenerative diseases?Change in levels of mortality Stage 1 Stage 2 Stage 3 Stage 4 CDR 30-50 ≈30 <20 ≈10 e0 30 50 65-70 70+Features of epidemiologic transition 1) Decrease in volatility a. “Crisis” and “background” mortality both high in past 2) Shift in causes of death 3) Shift in age pattern of mortality 4) Favors women over men 5) Emergence of socioeconomic differentialsDecline in mortality crisesChange in cause of deathContinued decline in death due to degenerative diseases 101001,00010,000Deaths per 100,000 population (log scale)Figure 25. Death rates for leading causes of death for all ages:United States, 1950-2002NOTES: Rates are age adjusted. Causes of death shown are the five leading causes of death for all ages in 2002. C LRD is chronic lower respiratory diseases. Starting in 1999, data were coded according to ICD -10. See D ata T ab le for d ata p oints grap h e d a n d add itio nal n otes.SOURCE: Centers for Disease C ontrol and Prevention, National Center for Health S ta tistics, N ation al Vital S tatistics S ystem . A ll c a u s e sHeart DiseaseYearCancerStrokeU n in te n tio n a l in ju r ie sCLRD19501960 1970198019851990 19952002Change in age patterns of deathAge distribution of death 1) Shift from young ages to older ages 2) Reflects changing causes of death 3) Increased survivorship 4) Major implications for population growthTrends in sex differences in life expectancy0123456781750 1800 1850 1900 1950 2000DenmarkNetherlandsNorwaySwedenDifferenceNordic countries0123456781750 1800 1850 1900 1950 2000USE&WNew ZealandCanadaAustraliaDifferenceAnglo-Saxon countriesSource: Jaques Vallin - George Myers Memorial LectureGrowing SES differentials SES differentials in the U.S. have widened over time, especially among males, and especially among males ages 65-74Explanations 1) Economic development – e.g., housing 2) Advances in medical, scientific technology 3) Improved sanitation and hygiene 4) Improved food supply and nutritionVariation in Epidemiologic Transition 1) Early vs. later transitions a. Role of SES improvements vs. technological improvements. b. Endogenous vs. exogenous change c. Relative economic circumstancesRecent trends 1) Regional variation a. Africa and AIDS b. Eastern Europe/Russia – East-West Gap 2) US and other developed countries a. Smoking b.
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