Patterns of mortality and their changes in France (1968-99): insights into the structure of diseases leading to death and epidemiological transition in an industrialised country.
BACKGROUND
Epidemiological transition theory is based on a succession of specific "patterns" of causes of death in human societies. However, the reality and consistency of patterns of causes of death in a population at a given moment has never been formally and statistically evaluated.


METHODS
Correlation analyses and principal component analysis were used to explore the correlation between age and sex cause-specific death rates and to identify consistent patterns of mortality in France for two periods: 1968-79 and 1988-99.


RESULTS
Cause-specific death rates in France from 1988 to 1999 were found to be strongly and consistently correlated across space and time. The analysis outlines four specific patterns: mortality of 45 - 84-year olds, mostly by neoplasms, cardiovascular and digestive diseases; mortality of the oldest old (>84 years); mortality of 25 - 64-year-old men, notably by HIV infection; and mortality by injury and poisoning of 15 - 44-year olds. These patterns, which cover 96% of the total mortality during the period, differ from those for the period 1968-79 when respiratory diseases and conditions affecting children aged <1 year shaped mortality. They also differ substantially from those predicted by classical epidemiological transition theory.


CONCLUSIONS
This study provides evidence for an evolutionary structure of patterns of mortality in contemporary France and therefore suggests using the concept of epidemiological transition in a less simplistic way than is commonly the case. It also shows much stronger interrelationships between diseases leading to death than is usually believed and suggests that current categorisations of cause-specific mortality in populations need reconsideration.
Coste
J
J
Université Paris-Descartes, Faculté de Medecine, AP-HP, Hôpital Cochin, Paris, France. coste@cochin.univ-paris5.fr
Bernardin
E
E
Jougla
E
E
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death / Q000639:trends*; D003644:Death Certificates; D019049:Developed Countries; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007221:Industry; D008297:Male; D008875:Middle Aged; D025341:Principal Component Analysis; D017678:Sex Distribution