The Health Transition and Mortality among Older Adults in Latin America, the Caribbean, Asia and Africa

McEniry, Mary
Working paper no. 2010-02


The dramatic mortality decline of the 1930s-1960s in developing countries may have created a larger pool of adult survivors of poor childhood conditions. If hypotheses regarding the importance of early life exposures on adult health have merit, we would expect to observe that the health of older adults from these cohorts would be unduly influenced by these exposures. We examined this conjecture by selecting a cross-national sample of adults 60 years and older that were born during different stages (regimes) of the health transition using data from major studies on aging in Latin America (Costa Rica, Mexico, major cities), the Caribbean (Puerto Rico), Asia (China, India, Indonesia, Bangladesh, Taiwan), Africa (Ghana, South Africa), the US, the UK and the Netherlands. We estimated mortality risk and constructed Waaler-type surfaces to estimate expected relative mortality risk. For countries with mortality data we found: (1) strong effects of early childhood conditions (markers of nutrition and indicators of childhood health) on adult heart disease and diabetes, especially in the mid-to-late regimes (Puerto Rico, Mexico); but (2) no significant effects or weaker effects of these early childhood conditions on adult mortality when heart disease and diabetes were controlled for, especially in the mid-to-late paced regimes; (3) higher observed relative risk for diabetics and those with heart disease but mixed results for obesity; (4) higher excess of relative risk of dying for diabetes and heart disease in mid-to-late regimes. Using modified Waaler surfaces for countries without mortality, we found higher expected relative risk of mortality in mid-to-late regimes. Implications: in some instances, future trends in life expectancy in the developing world may be negatively affected as a result of poor adverse childhood conditions in cohorts who are now experiencing increasing prevalence of heart disease and diabetes.