The Epidemiological Transition Policy and Planning Implications for Developing Countries (1993) / Chapter Skim
Currently Skimming:
PROJECTING MORBIDITY AND MORTALITY IN DEVELOPING COUNTRIES DURING ADULTHOOD
PROJECTING MORBIDITY AND MORTALITY IN DEVELOPING COUNTRIES DURING ADULTHOOD
Pages 101-125
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 101... ...
Many infectious diseases have both acute and chronic health consequences, and often are cofactors for chronic disease incidence and progression. Lifestyle and dietary habits are also important risk factors for chronic and degenerative diseases.
|
From page 102... ...
based on food-borne viral infection appears to be associated with the global distribution of risk factors and their change over time. There is evidence of viral activity in atherosclerosis' association with ~mmunological factors (Muscari et al., 1990; Tertov et al., 1990)
|
From page 103... ...
by forecasting the physical and cognitive impairments generated by chronic disease. This paper discusses a three-part model to forecast chronic disease, disability, and mortality: the first part describes changes in risk factors; the second predicts disability, morbidity, or mortality as functions of risk factors; and the third assigns costs for health events that reduce productivity or incur medical costs.
|
From page 104... ...
The 1976-1977 Indonesian disability survey used local physicians as inter viewers but did not have formal clinical exams or measure risk factors (Dowd and Manton, 1992~. There are now health surveys of the elderly in 17 countries in three WHO regions (e.g., Andrews et al., 1986; Manton et al., 19871.
|
From page 105... ...
Such a combination assumes that relations estimated from risk factor time-series data in developed countries represent biologically invariant characteristics of chronic disease processes. If this assumption "holds" (relative to the precision of other data employed)
|
From page 106... ...
ageist because risk factor effects may change with age. For example, reducing blood pressure may have adverse effects in an elderly person with preexisting heart disease.
|
From page 107... ...
can be combined with regression coefficients describing risk factor changes estimated from longitudinal studies in developed countries (e.g., Framingham, Kaunas, and Finnish East-West studies; Dowd and Manton, (1992~. In addition, socioeconomic factors may improve a regression's applicability to the population of interest.
|
From page 108... ...
We generalized Equation (3) by substituting a scalar function of risk factor values (predicted from the regressions)
|
From page 109... ...
The output is a cohort life table that shows, for example, how changing a risk factor affects life expectancy, the risk of death from each cause, and ages at which mortality is affected by direct and indirect risk factor effects. The life table also describes age changes in risk factor means and variances due to the deaths of persons with adverse risk factor values, as well as risk factor means and variances for survivors.
|
From page 110... ...
EXAMPLES Risk Factor Intervention The regression and hazard coefficients are estimated from longitudinal data in developed countries and combined with country-specific mortality and risk factor data from developing countries to make forecasts. Illustrative life tables and age-specific risk factor values projected from parameters estimated from longitudinal data are given in Table 1.
|
From page 111... ...
· - ~ ·_I a' v o · - ~ cn au ¢ 4~ c~ a~ v)
|
From page 112... ...
varies little (206 - 220 hectograms per TABLE 2A Mean Levels of Risk Factors in Six Developing Countries for Males Age 30-35 Risk Factors Means Total Systolic BP Diastolic BP BMI Cholesterol Cigarettes (mm/Hg)
|
From page 113... ...
113 Cal au Ct sly - o, Cal a, .~ o V ·_' o a)
|
From page 114... ...
interventions in each of the cohort equa TABLE 3 Projected Changes in Median Age at Death and Total Mortality When Risk Factors Take on "Ideal" Valuesa Median Age at Death Cuba Ghana Mauritius Sri Lanka Tanzania Thailand Total Mortality Baseline (years) 73.10 65.99 73.90 71.51 68.97 70.61 "Ideal" (change in years)
|
From page 115... ...
; the population was younger than in Tanzania so that young persons were affected. Thus, the most important risk factors are associated with differences in the age-specific and sex-specific means and variance of risk factors across countries (e.g., in the least developed countries, cholesterol and BMI are low and blood pressure is elevated; in developed countries the level of detection and treatment of hypertension is high)
|
From page 116... ...
116 ·_1 a' ·_' Lo oo V)
|
From page 117... ...
For frail males, life expectancy was 5.1 years and for frail females, life expectancy was 7.4 years. The strategy used for risk factors can be used to estimate ALE for
|
From page 118... ...
SUMMARY We have discussed strategies for combining multiple data sets to forecast morbidity, disability, and mortality, and presented a three-part model based on mortality and cross-sectional risk factor or disability data from a developing country, and longitudinal risk factor and survival parameter estimates from a developed country. This model assumes invariance of health and functional process parameters (but not distributions)
|
From page 119... ...
public health interventions have been directed toward avoiding risk factors rather than optimizing nutrition in target groups. Thus, although cholesterol levels declined in the United States between 1977 and 1987, there was little recognition of the special nutritional needs of the elderly who are often malnourished (Popkin et al., 19921.
|
From page 120... ...
Lu, and W Li 1991 Serum cholesterol concentration and coronary heart disease in population with low cholesterol concentrations.
|
From page 121... ...
Forman, D 1991 Helicobacter pylori infection: A novel risk factor in the etiology of gastric cancer.
|
From page 122... ...
Lee, I-M., R.S. Paffenbarger, and C-C Hsieh 1991 Physical activity and risk of developing colorectal cancer among college alumni.
|
From page 123... ...
Research Group 1990 Mortality rates after 10.5 years for participants in the multiple risk factor intervention trial. Journal of the American Medical Association 263: 1795- 1801.
|
From page 124... ...
Rose 1991 Strategies of prevention revisited: Effects of imprecise measurement of risk factors on the evaluation of "high-risk" and "population-based" approaches to prevention of cardiovascular disease. Journal of Clinical Epidemiology 44(11)
|
From page 125... ...
Chitson 1991 The relation of physical activity to cardiovascular disease risk factors in Mauritians. American Journal of Epidemiology 134:862-875.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.