Introduction to Non-Communicable Diseases

Ahmed Mandil, Prof of Epidemiology KSU College of Medicine

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Headlines

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:

associated 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 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

   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 28 April 2020 NCD Epi 5

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 20 th 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. 28 April 2020 NCD Epi 8

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 28 April 2020 NCD Epi 10

4 Chronic Diseases result in 52 percent of deaths

EMR Adult Population

Cardiovascular Chronic Respiratory Disease Type 2 Diabetes Cancer

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STEPwise data from some EM countries Country Iraq Jordan Saudi Arabia Syrian Arab Republic Kuwait Egypt Sudan

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Year of field work 2006 2007 2005 2003 Diabetes % 10.4

Hypertension % 40.4

16 25.5

17.9

19.8

26 28.8

Overweight & Obesity % 66.9

67.4

56.3

2005 2005 2005 16.7

16.5

19.2

24.6

33.4

23.6

81.2

76.4

53.9

NCD Epi 12

Risk Factors

     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 16-65% 12-35% 7-25% 40-70% 30-70% 80-90%

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Sources of data on NCD Data

       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, over the-counter) 28 April 2020 NCD Epi 15

NCD Prevention and control (I)

Goals:

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To reduce disease incidence

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To prevent / delay onset of disability To alleviate severity of disease

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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 people.

comprehensive school health education and efforts to change behavior in children and young 28 April 2020 NCD Epi 17

NCD Prevention and control: (III)

Primary prevention

   Directed at susceptible persons , before they develop a certain NCD, thus aims at reducing incidence.

Needs establishment of risk factors , before hand (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

   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 28 April 2020 NCD Epi 19

NCD Prevention and control:

(V): Tertiary prevention

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Tertiary prevention:

Directed at preventing disability in people who have symptomatic quality of life .

disease, thus aims at trying to improve 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) 28 April 2020 NCD Epi 20

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

 Information on NCD (need for establishment /effectiveness of surveillance activities).

 Applied research  Choosing / maintaining healthy behaviors  Social and political policies (laws, regulations) 28 April 2020 NCD Epi 22

NCD Prevention and control:

( VII) Challenges - 2

    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, multi sectoral cooperation, health insurance initiatives). 28 April 2020 NCD Epi 23

References 1

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Last J.

A dictionary of epidemiology

University Press, 2008. . 5 th Edition. Oxford, New York, Toronto: Oxford Remington PL, Brownson RC, Wegner MV.

Chronic disease epidemiology and control .

3 rd 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 28 April 2020 NCD Epi 24

References 2

4.

5.

6.

Fadhil I.

Diabetes and other non communicable diseases: An Eastern Mediterranean Perspective

.

WHO, 2009 Kuh D, Ben Shlomo Y.

epidemiology A life course approach to chronic disease

. Oxford, New York, Toronto: Oxford University Press, 1997. Newcomer RJ, Benjamin AE.

Indicators of chronic health conditions

1997

.

. Baltimore, London: The Johns Hopkins University Press, 28 April 2020 NCD Epi 25