Economic Crisis Leads to Decline in Mortality

A new study reveals that a population-wide weight loss during an economic crisis in Cuba during the 1990’s led to a drop in death from diabetes and coronary heart disease (CHD), which rebounded once the country recovered.

Researchers at the University of Alcala (UAH; Madrid, Spain) conducted repeated cross sectional surveys and ecological comparison of secular trends nationwide and in the province of Cienfuegos (Cuba) between 1980 and 2010, to evaluate associations between population-wide loss and gain in weight with diabetes prevalence, incidence, and mortality, as well as cardiovascular and cancer mortality trends. The participants included a representative sample of 1,657 (1991), 1,351 (1995), 1,667 (2001), and 1,492 (2010) adults in Cienfuegos, and a representative sample of 14,304 (1995), 22,851 (2001), and 8,031 participants (2010) in all of Cuba.

The main outcome measures included changes in smoking habits, daily energy intake, physical activity, and body weight using Cuban national and regional surveys. Data for diabetes prevalence and incidence were obtained from national population based registries.

The results showed rapid declines in diabetes and CHD, accompanied by an average population-wide loss of 5.5 kg. In 1995, the 33.5% prevalence of overweight and obesity increased again following a rebound in population weight, and was immediately followed by a 116% increase in diabetes prevalence, and 140% increase in diabetes incidence; by 2010, they had exceeded pre-crisis prevalence levels (52.9%). Six years into the weight rebound phase, diabetes mortality had increased by 49%, and a deceleration in the rate of decline in mortality from CHD was also observed. The study was published early online on April 11, 2013, in BMJ.

“The data are a notable illustration of the potential health benefits of reversing the global obesity epidemic,” concluded lead author Manuel Franco, MD, and colleagues. “This period lasted an additional six years, during which energy intake status gradually recovered and physical activity levels were progressively reduced. In 2002, mortality rates returned to the pre-crisis pattern.”

It was recognized early in the course of the global epidemic of type 2 diabetes that variation in the prevalence of the disease among populations could be explained largely by relative weight. But despite predictions on the effect of the obesity and diabetes epidemics on life expectancy, it is unclear to what extent they can alter the downward trend of cardiovascular diseases prevalence observed in many countries. Furthermore, lack of adequate data for public health precludes the empirical assessment of comparable trends across the developing world.

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