Transcript KSU NCD Epidemiology (May 2011).ppt

Non-Communicable Disease:
Epidemiology, Prevention & Control
Ahmed Mandil,
Prof of Epidemiology
KSU College of Medicine
Headlines
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Definitions
Examples
Magnitude of the Problem
Risk Factors
Sources of Data
Prevention & Control
Challenges
Injury epidemiology & prevention
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Definitions (I)
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Chronic health-related state: a state which lasts for a
long time, usually more than 3 months
Chronic exposure:prolonged (long term), usually of low
intensity.
Chronic diseases: those diseases that have uncertain
etiology, multiple risk factors, a prolonged course, do not
resolve spontaneously, and for which a complete cure is
rarely achieved.
Non-communicable diseases (NCD): a miscellaneous
group of health-related conditions, usually not
communicated through infective pathogens, and may
cause impairment, disability, handicap or even premature
death.
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Defintions (II)
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Risk factor: an aspect of personal behavior / life-style, an
environmental exposure, an inborn / inherited characteristic,
which on the basis of epidemiologic evidence, is known to be
associated with health-related condition(s) considered to
important to prevent.
Modifiable risk factor: a determinant that can be modified by
intervention, thereby reducing the probability of occurrence of
disease or other specified outcomes.
Latent period: delay between exposure to a disease-causing
agent and the appearance of manifestations of the disease. E.g.
after exposure to ionizing radiation, there is a latent period of 5
years, on the average, before development of leukemia, and >
20 years before development of certain other malignancies.
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Definitions (III):
Exceptional NCD
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Some NCD were recently proven to be of
infectious origin, e.g. peptic ulcer (Helicobacter
pylori), liver carcinoma (HCV), cancer cervix
(Human Papilloma Virus), leukemia (oncogenic
viruses), etc.
The term chronic may not apply to conditions
as: angina pectoris, Acute Myocardial Infarction
(AMI), anxiety, acute depression
Some infectious diseases are chronic: e.g. T.B.,
HIV / AIDS
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NCD Examples (I)
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Congenital anomalies
Malnutrition (pediatric, geriatric)
Endocrinal / metabolic disorders (e.g. diabetes,
gout)
Cardiovascular diseases (e.g. hypertension;
atherosclerosis; ischemic heart disease [IHD]:
angina, myocardial infarction) .
Locomotor system problems: e.g. arthritis
(acute, chronic)
Chronic respiratory conditions (e.g. bronchial
asthma)
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NCD Examples (II)
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Occupational-related conditions (e.g.
pneumoconiosis)
Neoplasms (benign / malignant; childhood /
adult)
Injuries (intentional / non-intentional)
Sensory loss (e.g. deafness, blindness)
Diseases of senescence (degenerative diseases)
Psychiatric disorders (neuroses, psychoses)
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Magnitude of the Problem (I)
NCD are considered the leading causes of
death and disability on a global scale, and
appear to have been so, for at least the last
two decades of the 20th century. Disease
rates (morbidity and mortality) from these
conditions are accelerating globally,
advancing across regions and social
classes, with special burden in less
developed nations.
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Magnitude of the Problem (II)
Among the many NCDs that contribute importantly to
the global burden of disease, disability and death,
cardiovascular disease (CVD), cancer, diabetes and
chronic respiratory diseases are four of the most
prominent. These four conditions are linked by
common lifestyle determinants such as imbalanced
diet, physical inactivity and tobacco consumption.
They together contribute to 50% of global mortality.
NCD are expected to account for an increasing share
of disease burden, rising globally from 43% in 1998 to
73% by 2020. The expected increase is likely to be
particularly rapid in less developed nations.
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The Regional Situation
 The WHO Region for the Eastern
Mediterranean, NCD account for 52% of all
deaths and 47% of the disease burden in
EMR during the year 2005
 This burden is likely to rise to 60% in the
year 2020
 The conventional risk factors may explain
75% of such NCD
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4 Chronic Diseases result in
52 percent of deaths
EMR Adult Population
Cardiovascular
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Chronic Respiratory
Disease
Type 2 Diabetes
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STEPwise data from some EM countries
Country
Year of field
work
Diabetes
%
Hypertension
%
Overweight &
Obesity %
Iraq
2006
10.4
40.4
66.9
Jordan
2007
16
25.5
67.4
Saudi Arabia
2005
17.9
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Syrian Arab
Republic
2003
19.8
28.8
56.3
Kuwait
2005
16.7
24.6
81.2
Egypt
2005
16.5
33.4
76.4
Sudan
2005
19.2
23.6
53.9
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Risk Factors
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Aging of the population
Use of motor vehicles (automobiles)
Life-style changes
 Poor / unbalanced / unhealthy nutrition
 Tobacco consumption / addiction
 Physical inactivity
 Harmful use of alcohol consumption
Obesity
Other social and behavioral factors.
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NCD RISK FACTORS, EMR
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Tobacco use
Hypertension
Diabetes
Overweight-obesity
Dyslipidemia
Physical Inactivity
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16-65%
12-35%
7-25%
40-70%
30-70%
80-90%
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Sources of data on NCD Data
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Mortality statistics
Hospital records (especially discharge)
Disease registries (e.g. cancer / diabetes /
hypertension registries)
Interview surveys
Occupational medical records
Sickness and disability insurance statistics
Drugs' dispensing statistics (prescribed, overthe-counter)
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NCD Prevention and control (I)
Goals:
 To reduce disease incidence
 To prevent / delay onset of disability
 To alleviate severity of disease
 To prolong the individuals’ life
(Inshaa-Allah)
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NCD Prevention and control (II)
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Important issues:
One of the most important objectives of NCD control is
the change of the public's perception of NCD from one
of "inevitability" to that of "preventability".
NCD control is based on avoidance of the most
important risk factors (e.g. tobacco addiction, physical
inactivity, poor nutrition), all of which are behavioral
factors, often difficult to change.
Healthy behaviors should be promoted early on in life
through comprehensive school health education and
efforts to change behavior in children and young
people.
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NCD Prevention and control:
(III) Primary prevention
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Directed at susceptible persons, before they
develop a certain NCD, thus aims at reducing
incidence.
Needs establishment of risk factors, beforehand (community-specific).
Examples: Tobacco prevention programs,
promotion of physical
activity,
dietary
recommendations (for balanced diets suitable
for age, gender, physical activities, growth &
development, weather, community).
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NCD Prevention and control:
(IV): Secondary prevention
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Directed at asymptomatic individuals, but have
developed biological changes resulting from the
disease, thus aims at reducing prevalence.
Goal: early detection, management, avoiding /
reducing undesirable consequences / complications.
Examples: screening programs (e.g. for diabetes,
hypertension, cancer), recommended when: natural
history permits early detection, available screening
tests for early detection, acceptable to the population
at risk; effective management regimens
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NCD Prevention and control:
(V): Tertiary prevention
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Tertiary prevention:
Directed at preventing disability in people who have
symptomatic disease, thus aims at trying to improve
quality of life.
Goal: prevention of progression of a disease and its
complications; provision of rehabilitation.
Examples: screening for / management of diabetic
complications
(e.g.
retinopathy);
orthopedic
prosthesis (e.g. for fracture-hip); physiotherapy (e.g.
for cardiovascular stroke / paralysis / sports injuries’
victims)
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NCD Prevention and control:
(VI): Role of Different Agencies
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Public (governmental) agencies: fund/conduct
research; establish standards; provide financing for
medical care; deliver medical services to the poor;
monitor health status of the population.
Voluntary (non-governmental): fund research; provide
public and professional education; stimulate social and
legislative changes; create visibility for prevention and
control through their large cadre of volunteers.
Medical care sector: delivers services; provides
preventive medicine through primary care; establishes
professional guidelines that improve the quality of life.
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NCD Prevention and control:
(VII) Challenges - 1
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Information on NCD (need for
establishment /effectiveness of
surveillance activities).
Applied research
Choosing / maintaining healthy
behaviors
Social and political policies (laws,
regulations)
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NCD Prevention and control:
(VII) Challenges - 2
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Communication of health risk (proper health
promotion)
High risk and population-based approaches
Cost of health care
Access to health-care services (cooperation
between public / private systems, multisectoral cooperation, health insurance
initiatives).
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INJURY EPIDEMIOLOGY &
PREVENTION
Definitions
Injury
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“Acute exposure to physical agents such
as mechanical energy, heat, electricity,
chemicals,
and
ionising
radiation
interacting with the body in amounts or at
rates that exceed the threshold of human
tolerance. In some cases, injuries result
from the sudden lack of essential agents
such as oxygen or heat.”
(Source: Gibson, 1961; Haddon, 1963)
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Definitions
Violence
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“The intentional use of physical force or
power, threatened or actual, against
oneself, another person, or against a
group or community, that either results
in or has a high likelihood of resulting in
injury, death, psychological harm,
maldevelopment or deprivation.”
(Source: WHO, 1996)
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The Global Injury
Problem
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5 million deaths worldwide = 9% of all
deaths (2000)
12% of global burden of disease
Road traffic “incidents” are the leading
cause of injury deaths worldwide
90% of injury deaths occur in low- and
middle-income countries
Highest number of deaths in S.E. Asia &
Western Pacific regions
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The Epidemiological Model
Host
Environment
Vector
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Agent
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The Ecological Model
Society
Community
Relationship
Individual
Complex Linkages
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Source: Krug E et al., eds., 2002.
VIP
Temporal
Targeted
Approach
primary
universal
passive
secondary
selective
active
tertiary
indicated
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Engineeri
ng
Evaluation
VIP
Environment
al
modification
strategie
s
Educatio
n/empo
wermen
t
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Enforceme
nt
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VIP Public Health Approach
Defining Characteristics
Population-based
 Multidisciplinary
 Evidence-based
 Collective action
 Prevention
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The Public Health Approach
(1) Surveillance
What is the problem?
(2) Risk factor
identification
What are the causes?
(3) Develop and
evaluate
interventions
What works?
(4) Implementation
How is it done?
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Severity
Setting
Categorizing
Injury
Activity
Mechanism
Intent
Nature
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Injury Pyramid
Deaths
Injuries resulting
in hospitalization
Injuries resulting in
ambulatory and
emergency treatment
Injuries resulting in treatment in
Primary care settings
Injuries treated by paramedics only
(school nurse, physiotherapist, first aid)
Untreated injuries or injuries which were
not reported
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Types of data and potential sources of
information
Mortality
• Death certificates
• Reports from mortuaries
Morbidity and Health-related
• Hospitals
• Medical records
Self Reported
• Surveys
• Media
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Community-based
• Demographic records
• Local government records
Law enforcement
• Police records
• Prison records
Economic-social
• Institutional or agency records
• Special studies
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Source: adapted from Krug et al., eds., 2002
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Leading Causes of Mortality and Burden of Disease
world, 2004
Mortality
DALYs
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
%
Ischaemic heart disease
12.2
Cerebrovascular disease
9.7
Lower respiratory infections
7.1
COPD
5.1
Diarrhoeal diseases
3.7
HIV/AIDS
3.5
Tuberculosis
2.5
Trachea, bronchus, lung cancers 2.3
Road traffic accidents
2.2
Prematurity, low birth weight 2.0
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1.
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10.
%
Lower respiratory infections
6.2
Diarrhoeal diseases
4.8
Depression
4.3
Ischaemic heart disease
4.1
HIV/AIDS
3.8
Cerebrovascular disease
3.1
Prematurity, low birth weight 2.9
Birth asphyxia, birth trauma
2.7
Road traffic accidents
2.7
Neonatal infections and other 2.7
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Source: WHO, 2004
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Ten leading causes of burden of disease,
world, 2004 and 2030
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References 1
1.
2.
3.
Last J. A dictionary of epidemiology. 5th
Edition. Oxford, New York, Toronto: Oxford
University Press, 2008.
Remington PL, Brownson RC, Wegner MV.
Chronic disease epidemiology and
control. 3rd Edition. Washington, D.C.:
American Public Health Association, 2010.
WHO. 2008-2013 Action Plan for the
Global Strategy for the Prevention and
Control of Non-communicable Diseases.
Geneva: WHO, 2008
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References 2
4.
5.
6.
Fadhil I. Diabetes and other noncommunicable diseases: An Eastern
Mediterranean Perspective. WHO, 2009
Kuh D, Ben Shlomo Y. A life course
approach to chronic disease
epidemiology. Oxford, New York, Toronto:
Oxford University Press, 1997.
Newcomer RJ, Benjamin AE. Indicators of
chronic health conditions. Baltimore,
London: The Johns Hopkins University Press,
1997.
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