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. CONCLUSION: 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.