Cause specific mortality trends in Hungary in the light of the theory of the epidemiological transition

Katalin Kovács, Demographic Research Institute, Budapest
László Hablicsek, Demographic Research Institute, Budapest

Hungary, within the classic framework of the epidemiological transition theory represents a “slow variant” of the “semi western” transitional model, which has been rarely investigated. Theoretically the onset of the fourth phase is characterised by falling cardiovascular mortality and diminishing rates of “life style related causes”. In addition the re-emergence of “old” infectious diseases and the emergence of “new” infectious diseases both have been expected, especially in the most vulnerable social groups. The major goal of this paper is to test the above mentioned assumptions on Hungarian mortality data for the period between 1971 and 2007.Cause-specific mortality trends for the period between 1971 and 2007 were created. For the sake of comparability, we examined all (65) causes of death of the “European Shortlist” issued by EUROSTAT. During the study period three different ICD coding systems were used. Continuity between the periods with different coding schemes was checked, and in case of serious discontinuity we fitted the series by discounting. Results: By cardiovascular mortality, Hungary entered into the forth phase of epidemiological transition in the mid 1990’s. The mortality trends of other diseases, however, are very different from what could have been predicted on the basis of theory. There was no evidence for survival or re-emergence of infections, even among the most vulnerable. There was no sign of improvement in causes of death strongly related to the major life-style domains. Finally, external causes, which were all expected to grow, showed the opposite tendency. For several causes trends of those with lower education “followed” the trends of the more educated (e.g. ischaemic heart disease, cerebrovascular diseases, hepatitis, suicide). The “lag-time” between educational classes ranged between 0 and 13 years by causes. For several diseases, trends of the different educational classes were converging (e.g. stomach cancer, tuberculosis).