A significant shift in cause-of-death structure has occurred in China duxkg the
past half century. As elsewhere, this shift in mortality pattern has been referred to as
the epidemiological transition. A review of the literature showed that systematic
studies on epidemiological transition in developing countries were limited but
especially those of China. The literature also indicated that such studies were
necessary tofixllyunderstand the process of population aging and fixture health trends
in these comitries. The present study was designed to fill this knowledge gap. Its
conceptual framework was based on the epidemiological transition theory developed
by Omran and related views by others. The literature review distinguishes at least
three epidemiological transitions,that is,the shift in leading causes of death from
famine to commimicable diseases (the first transition), firom commimicable to
nonconmimicable diseases (the second transition) and from one set of
noncoimnimicable diseases to another (the third transition). Moreover, four basic
components of epidemiological change were identified to evaluate each transition,
including shift in causes of deatli,its nature, chaages in age and sex mortality patterns
and effects of a transition on survival.
The study is a secondary data analysis. Two analytical approaches —~ timeseries
analysis and cross-sectional analysis ? were employed. The mortality measures
used were mainly life table functions. The data for time-series analysis were available
national time-series mortality data reconstructed by others and those for crosssectional
analysis were China's mortality data of 1993 which came from the death
reporting system run by National Health Statistics Information Center. The quality of
data was assessed and found to be broadly reliable and some necessary adjustments
were made.
This study focused on the second epidemiological transition. The fijadings
showed that the broad trend in China tended to be similar to that in developed
countries. However,the process of the transition was quite different from that in
developed countries in many aspects,such as pace,timing and patterns of changes k
mortality level and causes of death, because of differences in the relative effects of
various factors affecting mortality and their historical changes.
The results suggested that during the shift from communicable to
noncommimicable diseases in China, the proportion of deaths from some povertyrelated
noncommimicable diseases first rose and then declined. The rise of relative
importance of noncoinmxMiicable diseases was largely caused by more rapid
disappearance of communicable diseases (relative effect) and increased survival
chance (demographic effect). It was also affected by rapid rise of death rates from
some so-called diseases of affluence (absolute effect) especially in the later stages of
the transition. The transition favored females over males,children and young adults
over the old and rich over poor regions. The age distribution of death was shifting
towards older ages,which was mainly affected by the cause-of-death transformation
in the initial stages and by the delays of age at deatli from noncommimicable diseases
in the later stages ofthe transition.
In sum, the study was usefiil for developing some patterns of epidemiological
transition m developing countries. Some prospects for fixture mortality trends,
kcqplications of the transition and limitations oftbe study were also discussed