EPIDEMIOLOGY OF CHRONIC NON COMMUNICABLE DISEASES (NCDs)

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EPIDEMIOLOGY OF CHRONIC NON COMMUNICABLE DISEASES
(NCDs)
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CHRONIC DISEASEAll impairments or deviations
from normal which have one or more of the
following characteristics

• Permanent
• Leave residual disability
• Caused by a non-reversible pathology
• Required special training of the patient for
  rehabilitation
• Required long period of supervision, observation
  or care

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Problems in etiologic investigation of Chronic
Non-Communicable Diseases (NCDs)

• 1.Absence of a known agent
• 2.Multifactor nature of etiology
• 3.Long latent period
• 4.Indefinite onset
• 5.Differential effect of factors on incidence
  and course of

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Prevention of NCDs received little attention by
policy makers, medical professionals, and general
public because

• The extent is less sufficiently examined
• Long delay between cause and effect

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PRIMARY Prevention is possible for most NCDs due
to the following facts

• 1.Large population differences in incidence and
  mortality of NCDs
• 2.Dynamic national trends in incidence and
  mortality rates of most NCDs
• 3.Rapid changes in risk of many NCDs among
  migrant population
• 4,Positive results of intervention trials
• 5.Identification of modifiable risk factors of
  many NCDs

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EPIDEMIOLOGIC TRANSITION

• It is the general shift from acute infectious
  and nutritional deficiency diseases
  characteristic of under development to chronic
  NCDs characteristic of modernization and advanced
  level of development.

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1. Demographic Changes

• Decrease in infant mortality rate
• Decrease in fertility rate
• Both lead to Population aging

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2. Urbanization and Socioeconomic Transformation

• Changes in community relationships
• Changes in life style
  
• Decreased concerns about moral beliefs
• Human mobility
• Expansion of education
• Participation of women in labor force

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3. Changes in Nutritional pattern

• Rapid increase in food energy availability and
  consumption
• Percapita food energy and protein availability
  had increased by 2 folds
• Availability of
• rice increased by 5 folds
• wheat increased by 8 folds
• sugar increased by 3 folds
• fat increased by 3 folds
• No increase in vegetables
• Slight increase in fruits
• Obesity is emerging as a major public health
  problem

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4. Others

• Smoking epidemic
• Increase in alcohol consumption
• Sedentary life style

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EPIDEMIOLOGY OF CARDIOVASCULAR DISEASES
(CVDs)

• Worldwide CVDs are responsible for 1/4th of all
  deaths
• In developed countries they are responsible for
  50 of all deaths
• In developed countries they are responsible for
  23 of all deaths
• Numerically speaking, developing countries are
  experiencing more deaths due to CVDs than
  developed countries.

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In 1990, worldwide about 50 million deaths had
occurred

• CVD 29 First leading
  cause
• Resp.Dis 19 second leading
  cause
• LRTI 8.5
• COPD 4
• TB 4
• CA-Lung 2
• Asthma URTI 0.4

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Developed
Developing
--------------------------------------------------
--50 million deaths 11 million
39 million

• CVDs 49(
  5,390,000) 23 (8,070,000)
• Resp.Dis. 12
  23
• Lung Cancer 5
  1
• COPD 3
  4
• LRTI 3
  10
• TB 0.25
  5

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• In EMR including Iraq, the magnitude of
  morbidity, mortality, disability, human
  suffering and economic cost are huge.
• Demographic, socioeconomic and behavioral
  transformation (urbanization, emergence of modern
  lifestyle, and progressive aging) had led to
  increase CVDs problem.

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• The epidemic of CVDs began in developed countries
  in the 1st half of the 20th century reaching the
  peak in 1960s, then started to decline. In
  developing countries the curve is still rising.
• Inter and within country variation in incidence
  and mortality from CVDs are correlated with
  variation of major risk factors of CVDs.