Secular trends of infectious disease mortality in The Netherlands, 1911-1978: quantitative estimates of changes coinciding with the introduction of antibiotics.

Secular trends of mortality from 21 infectious diseases in the Netherlands were studied by inspection of age/sex-standardized mortality curves and by log-linear regression analysis. An attempt was made to obtain quantitative estimates for changes coinciding with the introduction of antibiotics. Two possible types of effect were considered: a sharp reduction of mortality at the moment of the introduction of antibiotics, and a longer lasting (acceleration of) mortality decline after the introduction. Changes resembling the first type of effect were possibly present for many infectious diseases, but were difficult to measure exactly, due to late effects on mortality of World War II. Changes resembling the second type of effect were present in 16 infectious diseases and were sometimes quite large. For example, estimated differences in per cent per annum mortality change were 10% or larger for puerperal fever, scarlet fever, rheumatic fever, erysipelas, otitis media, tuberculosis, and bacillary dysentery. No acceleration of mortality decline after the introduction of antibiotics was present in mortality from 'all other diseases'. Although the exact contribution of antibiotics to the observed changes cannot be inferred from this time trend analysis, the quantitative estimates of the changes show that even a partial contribution would represent a substantial effect of antibiotics on mortality from infectious diseases in the Netherlands.