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Epidemiology of Non-Communicable Diseases

Epidemiology of Non-Communicable Diseases. Dr. REKHA DUTT. Chronic diseases definitions : An impairment of bodily structure or function that necessitates a modification of the patient’s normal life, and has persisted over an extended period of time.

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Epidemiology of Non-Communicable Diseases

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  1. Epidemiology of Non-Communicable Diseases Dr. REKHA DUTT

  2. Chronic diseases definitions: • An impairment of bodily structure or function that necessitates a modification of the patient’s normal life, and has persisted over an extended period of time. • Diseases comprising all impairments or deviations from normal, which have one or more of the following characteristics: • Are permanent • Leave residual disability • Are caused by non reversible pathological alterations • Require special training of the patient for rehabilitation • May be expected to require a long period of supervision, observation or care

  3. NON- COMMUNICABLE DISEASES INCLUDE • Cardiovascular ( hypertension, coronary artery disease, stroke ) • Renal (nephritis, nephrotic syndrome) • Nervous and mental ( mania, depression) • Musculoskeletal ( arthritis) • Respiratory (asthma, emphysema, bronchitis) • Cancer • Diabetes • Obesity • Blindness • Degenerative disorders • Accidents

  4. The problem: • Cancer : 2.5 million cancer cases in the country and will double in next 2 decades • Coronary heart disease (CHD) data is inadequate : in urban Kerala it is 14% ( 17% in men and 10% in women) • Hypertension : 10% urban and 5% rural • Diabetes :a recent study carried out in 6 cities in India showed an age standardized prevalence of diabetes and impaired glucose intolerance in 12% and 14% respectively. Developing countries are now warned to take appropriate steps to avoid the epidemics of NCD likely to come with socioeconomic and health development.

  5. causes • Rise in life expectancy and increasing number of senior citizens • Changing lifestyles: faulty diet, alcohol intake, sedentary life, obesity, stress • Tobacco • Exposure to environmental risk factors- air pollution • Increasing population

  6. Gaps in the natural history of NCD • Absence of known agent: in most of NCD the cause is not known. • Multifactorial causation: in absence of causative agents, risk factors are studied • An attribute or exposure that is significantly associated with development of disease. • If determinant is modified by intervention, it reduces possibility of occurrence of disease. • Risk factors can be causative, contributory or predictive. • They can be modifiable or non-modifiable • They can be individual or community risk factors • Epidemiological studies are needed to identify risk factors • At-risk approach, at-risk groups, risk factors with diseases

  7. Gaps in the natural history of NCD Web of causation Changes in life style stress Abundance of foodlack of physical activitysmokingemotional disturbance aging Obesity hypertension Hyperlipidemiathrombotic tendency changes artery walls Coronary arthrosclerosiscoronary occlusion Myocardial infarction

  8. Gaps in the natural history of NCD • Long latent period: it is the period between the first exposure to suspected cause and the eventual development of disease. This makes it difficult to link suspected causes with outcomes. • Indefinite onset : Most (NCD) are slow in onset and development. Distinction between diseased and non diseased may be difficult to establish.

  9. Prevention of NCD Levels of prevention • Primordial • Primary • Secondary • Tertiary • Primordial prevention- Prevention of the emergence or development of risk factors in countries or population groups in which they have not yet appeared. Efforts are directed towards discouraging children from adopting harmful life styles. • Primary prevention- Action taken prior to the onset of disease which removes the possibility that the disease will ever occur. Can be divided into population & high risk strategy. For healthy people For unhealthy people

  10. Prevention of NCD Primary prevention Interventions: • Health promotion • Specific protection • Adequate nutrition • Safe water and sanitation • Secondary prevention-Action which halts the progress of the disease at its incipient stage and prevents complications. Mostly curative. Disadvantage - patient has already suffered mental & physical anguish & community to loss of production. Often more expensive &less effective. Intervention – EARLY DIAGNOSIS AND TREATMENT • Tertiary prevention- defined as all measures available to reduce impairments & disabilities, minimize suffering due to departure from good health & promote patient’s adjustment to irremediable conditions.Intervention – DISABILITY LIMITATION AND REHABILITATION

  11. Response to NCD • Centrally sponsored schemes: • National iodine deficiency disorders control programme • National programme for control of blindness • The national cancer control program • Pilot projects: • National mental health, diabetes control, cardiovascular diseases and prevention of deafness, oral health programme

  12. Future : Efforts will be made to improve preventive, promotive, curative and rehabilitative services for NCD.The major thrust will be on: • Well structured information education and communication for primary and secondary prevention of disease. • Reorientation and skill up gradation of health providers • Establishments of referral linkages between primary, secondary and tertiary institutions. • Production and provisions of drugs. • Development of institutions for rehabilitation of disabled persons due to NCD . • Development of hospitals for terminally ill patients, who can not have home based care. • Creation of epidemiological data base on NCD .

  13. Causation in epidemiology Cause :is an event, circumstance, condition, risk factor, exposure, characteristic or a combination of these factors, which results in producing the disease. Necessary cause: Vibrio cholerae is necessary for Cholera. Sufficient cause : are factors and conditions ,which are other than the etiological cause of disease. In sanitary conditions, water conditions, adequate dose of vibrio cholerae,host immunity.

  14. Association and causation : • Association may be defined as the concurrence of two variables more often than would be expected by chance. • It does not necessarily imply a causal relationship. • Correlation indicates the degree of association between two characteristics. • The correlation coefficients range from -1.0 to +1.0

  15. 1.Spurious association: When an observed association between a disease and suspected factor is not real. Direct (causal): One to one relationship Germ theory of disease Necessary cause Sufficient cause Multifactorial causation 3.Indirect association : It is statistical association between a variable and a disease due to presence of another factor known or unknown, that is common to both the variable and disease. This common factor is confounding factor. altitude Iodine deficiency endemic goiter

  16. Criteria for causality

  17. Temporal association: the cause must precede the effect. • Strength of association: • Larger the relative risk greater the likely hood of causal relation • Dose response and duration response relationship • Specificity of association: one to one relationship between cause and effect. • It is difficult in chronic diseases. lung cancer CAD Cigarette smoking ca cervix bronchitis

  18. Consistency of association: When results are replicated when studied in different settings and by different methods. • Biological plausibility : Association agrees with current understanding of the response of cells, tissues, organs and system to stimuli. Food intake and cancer are correlated. The positive association of intestine and rectal carcinoma is logical whereas positive association of food and Ca. skin makes no biological sense. • Coherence of association: Rising consumption of tobacco in form of cigarettes and rising incidence of lung Ca. Fall in RR of lung Ca when smoking is stopped.

  19. thank you

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