The changing burden of disease

Nineteenth-century societies were still confronted by a large number of mostly highly infectious diseases with high fatality rates, among them cholera and tuberculosis. According to the epidemiological transition theory this dominant pattern of causes of death began to give way from approximately 1870 onwards to a pattern dominated by so-called degenerative diseases which include various forms of cancer, cardiovascular diseases and strokes. Although the general outline of this theory is widely accepted by fellow researchers, there are two limitations. First, the theory is based on highly aggregated data, such as national statistics, which, especially during the nineteenth century, reflect above all the high proportions of infant mortality. Second, the theory does not take into account any socio-economic differences in mortality and causes of death. It is assumed that people from lower socio-economic classes, living in poor housing conditions and often suffering from structural undernourishment, were more prone to die from certain infectious diseases than people from higher socio-economic groups. These two shortcomings can only be solved with the help of micro-data and cause of death information at the level of individuals including information such as age, sex and occupation or other socio-economic indicators. These types of sources are very rare in western Europe. One of the few cities that actually has individual level cause of death data is Amsterdam. Between 1854 and 1940 the city officials maintained registers recording every single person dying in Amsterdam. Apart from the cause of death, the registers state the sex, age, address, marital status and occupation of each individual. With this data, the epidemiological transition theory can finally be tested with more accuracy.