Santosa Ailiana, Wall Stig, Fottrell Edward, Högberg Ulf, Byass Peter
Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden;
Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden.
Glob Health Action. 2014 May 15;7:23574. doi: 10.3402/gha.v7.23574. eCollection 2014.
Epidemiological transition (ET) theory, first postulated in 1971, has developed alongside changes in population structures over time. However, understandings of mortality transitions and associated epidemiological changes remain poorly defined for public health practitioners. Here, we review the concept and development of ET theory, contextualising this in empirical evidence, which variously supports and contradicts the original theoretical propositions.
A Medline literature search covering publications over four decades, from 1971 to 2013, was conducted. Studies were included if they assessed human populations, were original articles, focused on mortality and health or demographic or ET and were in English. The reference lists of the selected articles were checked for additional sources.
We found that there were changes in emphasis in the research field over the four decades. There was an increasing tendency to study wide-ranging aspects of the determinants of mortality, including risk factors, lifestyle changes, socio-economics, and macro factors such as climate change. Research on ET has focused increasingly on low- and middle-income countries rather than industrialised countries, despite its origins in industrialised countries. Countries have experienced different levels of progress in ET in terms of time, pace, and underlying mechanisms. Elements of ET are described for many countries, but observed transitions have not always followed pathways described in the original theory.
The classic ET theory largely neglected the critical role of social determinants, being largely a theoretical generalisation of mortality experience in some countries. This review shows increasing interest in ET all over the world but only partial concordance between established theory and empirical evidence. Empirical evidence suggests that some unconsidered aspects of social determinants contributed to deviations from classic theoretical pathways. A better-constructed, revised ET theory, with a stronger basis in evidence, is needed.
1971年首次提出的流行病学转变（ET）理论，是随着人口结构随时间的变化而发展起来的。然而，公共卫生从业者对死亡率转变及相关流行病学变化的理解仍不明确。在此，我们回顾ET理论的概念和发展，并结合实证证据进行背景分析，这些证据对原始理论命题既有支持也有矛盾之处。
进行了一项Medline文献检索，涵盖1971年至2013年这四十年间的出版物。纳入的研究需评估人群、为原创文章、聚焦死亡率与健康或人口统计学或ET且为英文。检查所选文章的参考文献列表以获取其他来源。
我们发现这四十年来研究领域的重点有所变化。研究死亡率决定因素广泛方面的趋势日益增加，包括风险因素、生活方式变化、社会经济以及气候变化等宏观因素。尽管ET理论起源于工业化国家，但对其的研究越来越多地聚焦于低收入和中等收入国家而非工业化国家。各国在ET方面的进展在时间、速度和潜在机制上存在不同水平。许多国家都描述了ET的要素，但观察到的转变并不总是遵循原始理论中描述的路径。
经典的ET理论很大程度上忽视了社会决定因素的关键作用，主要是对一些国家死亡率经验的理论概括。本综述表明全球对ET的兴趣日益增加，但既定理论与实证证据之间仅部分一致。实证证据表明，社会决定因素中一些未被考虑的方面导致了与经典理论路径的偏差。需要构建一个基于更强证据基础的、经过修订的ET理论。
