CAUSE-SPECIFIC MORTALITY TRENDS IN THE NETHERLANDS, 1875-1992 - A FORMAL ANALYSIS OF THE EPIDEMIOLOGIC TRANSITION

Background. The objective of this study is to produce a detailed yet r obust description of the epidemiologic transition in The Netherlands. Methods. National mortality data on sex, age, cause of death and calen dar year (1875-1992) were extracted from official publications. For th e entire period, 27 causes of death could be distinguished, while 65 c auses (nested within the 27) could be studied from 1901 onwards. Clust er analysis was used to determine groups of causes of death with simil ar trend curves over a period of time with respect to age-and sex-stan dardized mortality rates. Results. With respect to the 27 causes, thre e important clusters were found: (1) infectious diseases which decline d rapidly in the late 19th century (e.g. typhoid fever), (2) infectiou s diseases which showed a less precipitous decline (e.g. respiratory t uberculosis), and (3) non-infectious diseases which showed an increasi ng trend during most of the period 1875-1992 (e.g. cancer). The 65 cau ses provided more detail. Seven important clusters were found: four co nsisted mainly of infectious diseases, including a new cluster that de clined 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 tha t the conventional interpretation of the epidemiologic transition, whi ch assumes a uniform decline of infectious diseases and a uniform incr ease of non-infectious diseases, needs to be modified.