Epidemiological transition in Trinidad and Tobago, West Indies 1953-1992.
BACKGROUND
This study aimed to describe trends in age-specific mortality from diabetes mellitus, hypertension, cerebrovascular disease and ischaemic heart disease in Trinidad and Tobago between 1953 and 1992 and to relate them to earlier changes in infant mortality rates.


METHODS
Average annual age-specific mortality rates per 100 000 were calculated for 5-year time periods from 1953-1957 to 1988-1992 and plotted by mid-year of birth for cohorts born 1874-1882 to 1944-1952. Regression analyses were performed to test associations between adult mortality rates, and infant mortality rates for the same birth cohorts and period of death.


RESULTS
Infant mortality declined from 180 per 1000 in 1901 to 10 per 1000 in 1992. Age-standardized mortality from diabetes mellitus increased, in men, from 60 in 1958-1962 to 278 in 1988-1992, in women the increase was from 89 to 303. Mortality from hypertension declined, in men, from 232 in 1953-1957 to 73 in 1988-1992, and in women, from 206 to 67. Cerebrovascular mortality increased, in men, from 341 in 1953-1957 to 451 in 1963-1967 before declining to 224 in 1988-1992. In women cerebrovascular mortality increased from 292 in 1953-1957 to 361 in 1963-1967 before declining to 196 in 1988-1992. There was evidence of a deceleration in cerebrovascular mortality for cohorts born after 1908-1918. Ischaemic heart disease mortality remained constant. Mid-cohort infant mortality rates were not associated with adult mortality after adjusting for age and period of death.


CONCLUSIONS
Declining infant mortality was subsequently associated with declining mortality from cerebrovascular disease and hypertensive disease and increasing mortality from diabetes mellitus but there was no association with ischaemic heart disease mortality. These relationships were confounded by secular changes associated with year of death.
Gulliford
M C
MC
Commonwealth Caribbean Medical Research Council, Port of Spain, Trinidad, Department of Public Health Medicine, Guy's and St. Thomas' Medical and Dental Schools, London SE1 7EH, UK.
D000328:Adult; D017677:Age Distribution; D002423:Cause of Death / Q000639:trends*; D002561:Cerebrovascular Disorders / Q000401:mortality*; D003920:Diabetes Mellitus / Q000401:mortality*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000401:mortality*; D007223:Infant; D007226:Infant Mortality / Q000639:trends*; D016015:Logistic Models; D008297:Male; D017202:Myocardial Ischemia / Q000401:mortality*; D011159:Population Surveillance; D012922:Social Change; D014300:Trinidad and Tobago / Q000453:epidemiology