International Journal of Epidemiology, Vol 26, 772-781, Copyright © 1997 by International Epidemiological Association
JH Wolleswinkel-van den Bosch, CW Looman, FW Van Poppel and JP Mackenbach
BACKGROUND: The objective of this study is to produce a detailed yet robust
description of the epidemiologic transition in The Netherlands. METHODS:
National mortality data on sex, age, cause of death and calendar year
(1875-1992) were extracted from official publications. For the entire
period, 27 causes of death could be distinguished, while 65 causes (nested
within the 27) could be studied from 1901 onwards. Cluster analysis was
used to determine groups of causes of death with similar trend curves over
a period of time with respect to age- and sex- standardized mortality
rates. RESULTS: With respect to the 27 causes, three important clusters
were found: (1) infectious diseases which declined rapidly in the late 19th
century (e.g. typhoid fever), (2) infectious diseases which showed a less
precipitous decline (e.g. respiratory tuberculosis), and (3) non-infectious
diseases which showed an increasing trend during most of the period
1875-1992 (e.g. cancer). The 65 causes provided more detail. Seven
important clusters were found: four consisted mainly of infectious
diseases, including a new cluster that declined rapidly after the Second
World War (WW2) (e.g. acute bronchitis/influenza) and a new cluster showing
an increasing trend in the 1920s and 1930s before declining in the years
thereafter (e.g. appendicitis). Three clusters mainly contained
non-infectious diseases, including a new one that declined from 1900
onwards (e.g. cancer of the stomach) and a new one that increased until WW2
but declined thereafter (e.g. chronic rheumatic heart disease).
CONCLUSIONS: The results suggest that the conventional interpretation of
the epidemiologic transition, which assumes a uniform decline of infectious
diseases and a uniform increase of non-infectious diseases, needs to be
modified.
ARTICLES
Cause-specific mortality trends in The Netherlands, 1875-1992: a formal analysis of the epidemiologic transition
Department of Public Health, Faculty of Medicine and Health Sciences, Erasmus University Rotterdam, The Netherlands.
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