non-communicable disease: epidemiology, prevention & control

Non-Communicable Disease: Epidemiology, Prevention & Control

Ahmed Mandil, Hafsa RaheelDept of Family & Community Medicine

KSU College of Medicine

Headlines Definitions Examples Misconceptions Magnitude of the Problem Risk Factors Sources of Data Prevention & Control

April 19, 2023 2NCD Epi

Definitions (I) 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.


Defintions (II)

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.


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


NCD Examples (I) 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)


NCD Examples (II) 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)


MISCONCEPTIONS

April 19, 2023 NCD Epi 8

Reality: chronic diseases are concentrated among the poor


Reality: almost half in people under age 70


Reality: chronic diseases affect men and women almost equally


Reality: 80% of premature heart disease, stroke and type 2 diabetes is preventable, 40% of cancer is preventable


Reality: inexpensive and cost-effective interventions exist


MAGNITUDE OF THE PROBLEM


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.


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.


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


Cardiovascular

Chronic RespiratoryDisease Type 2

DiabetesCancer

Chronic Diseases result in percent of deaths

452

EMR Adult Population


RISK FACTORS


NCD Causal Pathway

20April 19, 2023 NCD Epi

Risk Factors (I)

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.


Risk factors (II)

Modifiable Cigarette smoking High Blood pressure Elevated serum

Cholesterol Diabetes Life style changes

(dietary patterns, physical activity)

Stress factors Alcohol abuse

Non-Modifiable Age Sex Family Hx Genetic factors Personality? Race


Risk factors (III): EMR

Tobacco use 16-65% Hypertension 12-35% Diabetes 7-25% Overweight-obesity 40-70% Dyslipidemia 30-70% Physical Inactivity 80-90%


Sources of 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)


PREVENTION & CONTROL


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)


NCD Prevention and control (II)

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.


NCD Prevention and control (III)

Primary prevention Population Strategy High Risk strategy

Secondary prevention Tertiary prevention


Population strategy Health promotion & education Behavioral changes: balanced healthy

diet, tobacco control, physical activity, weight reduction, especially children & adolescents

Blood pressure control Self care Stress management


High Risk approach Identify high risk people and families, e.g.

those with family history with an NCD (e.g. DM, hypertension); high serum cholesterol, etc

Providing specific advice: helping them to exercise, reduce weight, diet control, etc


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).


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


NCD Prevention and control:(V): Tertiary prevention

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)


References 11. Last J. A dictionary of epidemiology. 5th

Edition. Oxford, New York, Toronto: Oxford University Press, 2008.

2. Remington PL, Brownson RC, Wegner MV. Chronic disease epidemiology and control. 3rd Edition. Washington, D.C.: American Public Health Association, 2010.

3. WHO. 2008-2013 Action Plan for the Global Strategy for the Prevention and Control of Non-communicable Diseases. Geneva: WHO, 2008


References 24. Fadhil I. Diabetes and other non-

communicable diseases: An Eastern Mediterranean Perspective. WHO, 2009

5. Kuh D, Ben Shlomo Y. A life course approach to chronic disease epidemiology. Oxford, New York, Toronto: Oxford University Press, 1997.

6. Newcomer RJ, Benjamin AE. Indicators of chronic health conditions. Baltimore, London: The Johns Hopkins University Press, 1997.


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