Changing cardiovascular disease mortality and advancing longevity : Hong Kong, Shanghai and Taipei
Creators: name: Zhao, Jiaying
Publisher: name: The Australian National University
Year: 2013
Subjects: subject: Cardiovascular system Diseases Mortality China
subject: Cardiovascular system Diseases Epidemiology
subject: Longevity China

description: During the first three stages of the epidemiologic transition, increases in life expectancy are attributed to the replacement of infectious and parasitic diseases by degenerative diseases as major causes of death (Omran 1971). In the fourth stage, life expectancy increases further, largely due to the reduction of cardiovascular disease (CVD) mortality (Olshansky &amp; Ault 1986). This remarkable transition has been documented in Western countries since the mid-1960s. However, few studies of the Greater China Region have examined the role of decreasing CVD mortality in improving life expectancy or have sought to explain how rapid socioeconomic development is associated with trends in CVD mortality. Even fewer studies have assessed CVD mortality based on multiple cause of death (MCD). This thesis aims to understand the role of changing CVD mortality in the increasing longevity observed to accompany rapid socioeconomic development in three Chinese cities - Hong Kong, Shanghai and Taipei - from the mid-1970s to 2007. As the most modernized areas in the Greater China Region, these cities are at the forefront of the region's CVD mortality decline. The analyses reveal that CVD mortality reduction in the three cities made an important contribution to the increase in life expectancy during the past three decades. This contribution is similar to that in selected Western populations (Australia, England and Wales, France and Sweden) and other East Asian populations (Japan and Taiwan). Unlike these Western populations but similar to the East Asian populations, the contribution of falling cerebrovascular disease mortality to increases in life expectancy was much larger than that of falling ischemic heart disease mortality. Overall, the decrease in CVD mortality in the three cities was mainly driven by the improved availability and affordability of medical treatment and prevention. Institutional factors (especially increased accessibility to quality health care and more inclusive governance) played an important role in the CVD mortality decline. The onset of an increase in the sex ratio of CVD mortality occurred earlier in the Western populations than in Japan, Taiwan, and the three cities. Within a population, elevated sex ratios of CVD mortality appeared in later birth cohorts that had spent a large part of their childhood and early to middle adulthood in a more developed environment. The increase in the sex ratio of CVD mortality in the three cities and the selected populations is likely to be related to changes in diet and an increasingly sedentary lifestyle associated with the Nutrition Transition under economic development. MCD data analyses for Shanghai and Taipei suggest that the decline in CVD mortality led to an increased risk of dying from other degenerative diseases at older ages (e.g. neoplasms, diabetes). The analyses also suggest that the comorbidity of CVD with other diseases at time of death is gradually increasing, with a reduction in the lethality of CVD over time. These findings may contribute to a better understanding of the global epidemiologic, nutrition, and health transitions. The lessons and experience gained from the three cities may benefit other populations undergoing rapid economic development or economic transition.