The changing mortality burden of measles, pertussis, and diarrheal disease in Amsterdam, 1856-1920

Mortality burden declined markedly in the late 19^th and early 20^th centuries. We investigated patterns in disease burden of measles, pertussis, and diarrheal diseases in Amsterdam.

We utilized the Amsterdam Cause-of-death Database, including 481,990 individual death records from 1856 to 1920, and estimated mortality burden for measles, pertussis, and diarrheal disease in years of life lost up to 20 years. We analyzed mortality trends and associations with socio-economic and demographic factors, including population size, school enrollment, and rye prices, using fractional multinomial logistic regressions.

All-cause mortality burden declined from almost 8 life years lost per birth in 1856 to slightly over 2 in 1920. The mortality burden for measles and pertussis was relatively stable, but the mean age at death declined over time. The burden for diarrheal disease declined rapidly after 1885. The most promising factors to explain the changing epidemiology were the water crisis of 1887-1900, which increased diarrheal mortality burden by 3% (95% confidence interval: 1.5-4.4%), and rye prices, which increased measles mortality burden by 0.7% (95% confidence interval: 0.04-1.4%).

These findings highlight the complexity of the epidemiological transition and the importance of socio-economic and demographic changes in understanding the historical patterns of infectious diseases.