AEPI555D: Emergence of Chronic Disease in Modern Populations

1. Lecture 1: Emergence of
chronic diseases

2. Chronic disease topics and themes
• Emergence of chronic diseases in modern populations
• Disability and frailty as examples of the new chronic
conditions
• Quality of life as a key metric
• Multivariable risk and risk prediction
• Social networks and transmission of chronic disease risk
• Fetal origins and life course exposures
• Translational epidemiology
• Chronic disease surveillance systems
• Geospatial risk factors
• Complexity and chronic disease

3. Prolongation of life expectancy among modern populations one of the major
accomplishments of modernity. Characteristics of modern societies include:
A. a worldview predicated on the European Enlightenment and subsequent scientific
revolution , the idea of the world as an open transformation by human intervention;
B. economic institutions based on industrial production and a capitalistic market
economy;
C. political institutions that include the nation-state, nationalism and mass democracy.
D. social dynamism characterized by non-hierarchical, diverse and rapidly changing
culture and conventions
Conversations with Anthony Giddens: Making Sense of Modernity 1998. pg.94

4. Fig. 1. Record female life expectancy from 1840 to the present [suppl. table 2 (1)].
The linear-regression trend is depicted by a bold black line (slope = 0.243) and the
extrapolated trend by a dashed gray line. The horizontal black lines show asserted
ceilings on life expectancy, with a short vertical line indicating the year of publication
(suppl. table 1). The dashed red lines denote projections of female life expectancy in
Japan published by the United Nations in 1986, 1999, and 2001 (1): It is encouraging
that the U.N. altered its projection so radically between 1999 and 2001.

5. Variability of life-expectancy over time
Yrs
• Classical Greece 28
• Classical Rome 28
• Medieval Britain 33
• 19th Century
Western Europe 37
BCE
17,000-7,000 2,500 1,400 800-700
Galor, Oded and Moav, Omer, "Natural Selection and the Evolution of Life Expectancy"
(October 12, 2005). Minerva Center for Economic Growth Paper No. 02-05
Available at SSRN: http://ssrn.com/abstract=563741

6. Demographic transition
http://www.geographyalltheway.com/
ib_geography/ib_population/
ib_demographic_transition_model.htm

7. http://www.prb.org/

8. Nature 2009, 460; 741-743

10. Gavrilov L.A., Heuveline P.“Aging of Population.” In: Paul Demeny and
Geoffrey McNicoll (Eds.)The Encyclopedia of Population. New York,
Macmillan Reference USA, 2003

11. phe.rockefeller.edu/death/

14. Compression of morbidity and mortality
hypotheses

15. Some characteristics of chronic diseases
• Person
– Multiple, non-specific risk factors
– Disability prominent
– Impact on quality of life important
– Primary, secondary and tertiary prevention
• Place
– Asynchrony of emergence in different populations
• Time
– Duration of disease
– Epidemic curve
– Long latency
– Fetal/childhood origin
– Time dependency of risk factors
• Societal
– Expensive
– Substantial socioeconomic, racial and geographic variability

16. ASCVD CVA Cancer Asthma Diabetes PUD CKD
Tobacco X X X X X X X
Alcohol X X X X
Folate X X
Cholesterol X X X
HBP X X X
Obesity X X X X X
Inactivity X X X X
Stress X X X
Occupation X X X X
Infectious
agents
? X ? X X ?
Multifactorial etiology of chronic diseases

17. MMWR. 1999; 48;649-656

19. Copyright restrictions may apply.
Greenland, P. et al. Int. J. Epidemiol. 2002 31:1129-1134; doi:10.1093/ije/31.6.1129