Multiple causes of death and the epidemiological transition in American Samoa
Crews, D.E.
Social Biology 35(3-4): 198-213
1988
ISSN/ISBN: 0037-766X PMID: 3241989 DOI: 10.1080/19485565.1988.9988702Document Number: 351984
Multiple-cause mortality data were used to examine changing patterns of mortality beween 1950 and 1979 in American Samoa. This period coincided with a transition from infectious to chronic diseases as the primary causes of death. The available data indicate that as mortality rates from infections declined, the first chronic disease to increase in frequency was cancer. The absence of a lag period suggests that increased cancer mortality may be a consequence of life extension in the presence of modernization. In contrast, mortality rates from cardiovascular diseases tended to increase only after a lag period. As mortality from infections declined, ischemic heart disease replaced infections as the leading cause of death, in either a total-mentions or an underlying-cause model of mortality. The transition to degenerative disease mortality in American Samoa was neither as rapid nor as simple as a tabulation by underlying cause of death indicates. Patterns of change were interrelated.