Our objective is to assess epidemiological transition in urban Maharashtra in India in past two decades. We used the medically certified causes of death (MCCD) data from urban areas of Maharashtra, 1990–2006. Cause-specific death rate was estimated, standardized for age groups, and projected by using an exponential linear regression model. The results indicate that the burden of mortality due to noncommunicable conditions increased by 25% between 1990 and 2006 and will add 20% more by 2020. Among specific causes, the “diseases of the circulatory system” were consistently the leading CoD between 1990 and 2006. The “infectious and parasitic disease” and “diseases related to respiratory system” were the second and third leading causes of death, respectively. For children and young population, the leading cause of death was the “certain conditions originating in the prenatal period” and “injury and poisoning,” respectively, among both sexes. Among adults, the leading cause of death was “infectious and parasitic diseases.” In case of the adult female and elderly population, “diseases of circulatory system” caused the most deaths. Overall the findings foster that socioeconomically developed and demographically advanced urban Maharashtra bears the double burden of disease-specific mortality. 1. Introduction Omran [1] laid the foundation for the “epidemiological transition theory,” which builds upon the demographic transition and the changing patterns in disease prevalence [2]. Epidemiological transition is marked by a shift in the cause of death profile to reflect the predominance of noncommunicable diseases as the mean age of the population advances [1, 3]. This shift from communicable (predominance of infectious and parasitic) to noncommunicable (chronic and degenerative) diseases is classified into four stages: first stage being the stage of pestilence and famine, followed by the stage of receding pandemics; third is the stage of degenerative and man-made disease, and finally, the stage of delayed degenerative diseases [1, 3–5]. Epidemiological transition is expected to progress faster in urban and industrialized areas than in rural areas. Urbanization is associated with improved sanitation, nutrition, and health systems which reduce the burden of infectious diseases and related mortality, particularly among vulnerable populations [6, 7]. During the last decade as a consequence of rapid demographic transition and growing proportion of the adult and older population, the epidemiological profile of low and middle income countries reflects the diseases of
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