Abstract
Background
Non-communicable diseases (NCDs), such as atherosclerosis and cancers, are a leading cause of death worldwide. An important, yet poorly explained epidemiological feature of NCDs is their low incidence in under developed areas of low-income countries and rising rates in urban areas.
Methods
With the goal of better understanding how urbanization increases the incidence of NCDs, we provide an overview of the urbanization process in sub-Saharan Africa, discuss gene expression differences between rural and urban populations, and review the current NCD determinant model. We conclude by identifying research priorities.
Results
Declining rates of chronic and recurrent infection are the hallmark of urbanization in sub-Saharan Africa. Gene profiling studies show urbanization results in complex molecular changes, with almost one-third of the peripheral blood leukocyte transcriptome altered. The current NCD determinant model could be improved by including a possible effect from declining rates of infection and expanding the spectrum of diseases that increase with urbanization.
Conclusions
Urbanization in sub-Saharan Africa provides a unique opportunity to investigate the mechanism by which the environment influences disease epidemiology. Research priorities include: (1) studies to define the relationship between infection and risk factors for NCDs, (2) explaining the observed differences in the inflammatory response between rural and urban populations, and (3) identification of animal models that simulate the biological changes that occurs with urbanization. A better understanding of the biological changes that occur with urbanization could lead to new prevention and treatment strategies for some of the most common surgical diseases in high-income countries.
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Notes
Sub-Saharan Africa refers to the geographic area of the African continent that lies south of the Sahara. There are 42 countries located on the sub-Saharan African mainland, in addition to six island nations (Madagascar, Seychelles, Comoros, Cape Verde, and Sao Tome and Principe). This grouping is used the World Bank, World Health Organization and United Nations because these countries have similar levels of levels of economic development.
The World Bank classifies countries according to four income groupings. Income is measured using gross national income (GNI) per capita, in US dollars, converted from local currency using the World Bank Atlas method. Classifications as of July 2016 are as follows:
Low-income countries (LICs) = US$1025 or less in 2015
Middle-income countries (MICs) are subdivided: Lower-middle-income = US$1026–US$40,355
Upper-middle-income (UMICs) = US$4036–US$12,475
High-income countries (HICs) = US$12,476 or more
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Funding
This research was supported by grant number R24TW008910 from the Fogarty International Center, National Institutes of Health (NIH). The NIH Common Fund supports the award.
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Bickler, S.W., Wang, A., Amin, S. et al. Urbanization in Sub-Saharan Africa: Declining Rates of Chronic and Recurrent Infection and Their Possible Role in the Origins of Non-communicable Diseases. World J Surg 42, 1617–1628 (2018). https://doi.org/10.1007/s00268-017-4389-5
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DOI: https://doi.org/10.1007/s00268-017-4389-5