Am J Epidemiol. 2017 Jun 8. doi: 10.1093/aje/kwx203. [Epub ahead of print]
The Rise of the Current Mortality Pattern of the United States, 1890-1930.

Maeda H1.
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This article examines how the epidemiologic transition and the reduction of the urban mortality penalty gave rise to the current mortality regime, and demonstrates how the 1918 influenza pandemic signaled its advent. This article approaches those issues by analyzing urban-rural mortality differentials from 1890 to 1930. Until 1910 infectious diseases dwarfed degenerative diseases, and, generally, the more urban the location was, the higher infectious disease, and overall, mortality was, a direct relationship. But by 1930 degenerative diseases had eclipsed infectious diseases, and infectious disease mortality had ceased to differ between cities and rural areas. The 1918 influenza pandemic broke out toward the end of these changes, and the larger the city was, the lower influenza, and overall, mortality was in that year, an inverse relationship. Such gradations characterized a new mortality regime emerging in the late 1910s, and foreshadowed urban-rural mortality differentials in 1930 of those aged 45 or older, the group whose high degenerative disease death rates would symbolize that regime. A shift from a direct to an inverse relationship between urban environment and mortality accompanying a shift in leading causes of death from infectious to degenerative diseases, these twin changes brought about the current mortality regime.
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PMID: 28595333 DOI: 10.1093/aje/kwx203