目的:探讨1860-1870年代维多利亚地区麻疹和猩红热是否协同流行,澳大利亚可以被定性为联合犯罪,我们应用Sawchuk的方法,特里普,和Samakaroon(社会科学与医学2022,295,112956)量化了两个主要共同发生的流行病事件(1867,1875)在预期寿命(LE)变化方面的影响。Sawchuk等人。假设存在收获效应,在流行后的“休耕期”中,LE的统计学显着增加表明,作为识别历史合社的标准。我们测试了另一个假设,即相同的方法可以识别短期疤痕效应。
方法:使用年度特定年龄和特定原因的死亡统计数据和人口普查人口数据,我们为基线期构建了删节期生命表,潜在的共病年,以及两个时期(1860年代和1870年代)的“休耕”年。我们使用Z检验比较了出生时的LE。我们根据Arriaga的方法分解了年龄原因特异性死亡率,以确定年龄和原因特异性对LE变化的贡献。
结果:LE在1867年(1864-1865年)显着低于基线,但在“休耕”年(1869年)则没有。1875年和1878年“休耕”年的LE均显着低于基线(1871-1873)。年龄原因特定的分解在1867年和1875年表现出类似的麻疹和猩红热联合作用模式。
结论:1875年麻疹/猩红热合并高峰后出现疤痕效应的证据支持将该事件解释为合并症。我们建议短期的疤痕效应可以作为识别历史综合症的有用的附加标准。
OBJECTIVE: To explore whether synergistic epidemics of measles and scarlet fever in 1860s-1870s Victoria, Australia could be characterized as syndemics, we apply the methods of Sawchuk, Tripp, and Samakaroon (Social Science & Medicine 2022, 295, 112956) to quantify the impact of each of the two major co-occurring epidemic events (1867, 1875) in terms of life expectancy (LE) changes. Sawchuk et al. posit the presence of a harvesting effect, indicated by a statistically significant increase in LE in the immediate post-epidemic \"fallow period\", as a criterion for identification of a historical syndemic. We test an alternate hypothesis that the same methods can identify a short-term scarring effect.
METHODS: Using annual age- and cause-specific death statistics and census population data, we constructed abridged period life tables for baseline period, potential syndemic year, and \"fallow\" year for each of the two periods (1860s and 1870s). We compared LE at birth using Z-tests. We decomposed age-cause-specific mortality according to Arriaga\'s method to identify age-and cause-specific contributions to LE change.
RESULTS: LE was significantly lower than baseline (1864-1865) in 1867 but not in the \"fallow\" year (1869). LE in 1875 and the 1878 \"fallow\" year were both significantly below baseline (1871-1873). Age-cause-specific decomposition showed similar patterns for 1867 and 1875 for measles and scarlet fever combined effects.
CONCLUSIONS: Evidence of a scarring effect following the 1875 measles/scarlet fever combined peak supports the interpretation of this event as a syndemic. We suggest the short-term scarring effect can be a useful additional criterion for identifying historical syndemics.