Lifestyle and Life Course Epidemiology Group, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
PLoS One. 2012;7(6):e38988. doi: 10.1371/journal.pone.0038988. Epub 2012 Jun 14.
Hong Kong population has experienced drastic changes in its economic development in the 1940s. Taking advantage of Hong Kong's unique demographic and socioeconomic history, characterized by massive, punctuated migration waves from Southern China, and recent, rapid transition from a pre-industrialized society to the first ethnic Chinese community reaching "first world" status over the last 60 years (i.e., in two or three generations), we examined the longitudinal trends in infection related mortality including septicemia compared to trends in non-bacterial pneumonia to generate hypotheses for further testing in other recently transitioned economies and to provide generalized aetiological insights on how economic transition affects infection-related mortality.
We used deaths from septicemia and pneumonia not specified as bacterial, and population figures in Hong Kong from 1976-2005. We fitted age-period-cohort models to decompose septicemia and non-bacterial pneumonia mortality rates into age, period and cohort effects.
Septicaemia-related deaths increased exponentially with age, with a downturn by period. The birth cohort curves had downward inflections in both sexes in the 1940s, with a steeper deceleration for women. Non-bacterial pneumonia-related deaths also increased exponentially with age, but the birth cohort patterns showed no downturns for those born in the 1940s.
The observed changes appeared to suggest that better early life conditions may enable better development of adaptive immunity, thus enhancing immunity against bacterial infections, with greater benefits for women than men. Given the interaction between the immune system and the gonadotropic axis, these observations are compatible with the hypothesis that upregulation of the gonadotropic axis underlies some of the changes in disease patterns with economic development.
香港人口在 20 世纪 40 年代经历了经济发展的巨大变化。利用香港独特的人口和社会经济历史，其特点是大量、间断的来自中国南方的移民潮，以及最近 60 年来从工业化前社会向第一个华人社区达到“第一世界”地位的快速转型（即在两代或三代人内），我们研究了感染相关死亡率的纵向趋势，包括败血症与非细菌性肺炎的趋势相比，以产生假设，在其他最近转型的经济体中进一步检验，并提供关于经济转型如何影响感染相关死亡率的一般性病因学见解。
我们使用了 1976-2005 年香港败血症和非细菌性肺炎死亡病例以及人口数据。我们使用年龄-时期-队列模型将败血症和非细菌性肺炎死亡率分解为年龄、时期和队列效应。
败血症相关死亡与年龄呈指数增长，与时期呈下降趋势。男女两性的出生队列曲线在 20 世纪 40 年代都出现了下降，女性的下降速度更快。非细菌性肺炎相关死亡率也随年龄呈指数增长，但出生于 20 世纪 40 年代的人群出生队列模式没有下降。
观察到的变化似乎表明，更好的早期生活条件可能使适应性免疫更好地发展，从而增强对细菌感染的免疫力，对女性的益处大于男性。鉴于免疫系统和性腺轴之间的相互作用，这些观察结果与假设一致，即性腺轴的上调是经济发展与疾病模式变化之间的一些变化的基础。
