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Non-communicable diseases A global overview

Non-communicable diseases A global overview. David Leon. Outline. Definition Non-communicable disease mortality worldwide The Epidemiological Transition Global Burden of Disease Study Major risk factors Blood pressure Cholesterol Smoking Infection and non-communicable diseases.

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Non-communicable diseases A global overview

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  1. Non-communicable diseasesA global overview David Leon

  2. Outline • Definition • Non-communicable disease mortality worldwide • The Epidemiological Transition • Global Burden of Disease Study • Major risk factors • Blood pressure • Cholesterol • Smoking • Infection and non-communicable diseases

  3. What are non-communicable diseases?

  4. Classifying deaths and diseases(WHO) • Communicable diseases [Group I] • Those where death is directly due to the action of a communicable agent • Non-communicable diseases • Diseases [Group II] • Cancer, diseases of various organ systems (eg respiratory, cardiovascular etc.), diabetes, mental health etc. • External causes (injuries, poisonings and violence) [Group III]

  5. Importance of non-communicable diseases mortality

  6. A global problem • In 2004 there were 59 million deaths world-wide • Non-communicable diseases accounted for 60% of these deaths and injuries and violence 10%. • By 2020 it is estimated that non-communicable disease will account for 73% of all deaths GBD 2004 Update, 2008

  7. The epidemiologic transition(Omran, 1971) Change in the balance of disease in a population from communicable diseases to non-communicable disease

  8. Females Males 1-14 25-44 45-64 65-74 Decline in proportion of total mortality due to infectious diseases England & Wales, 1911-94, by age

  9. Different countries at different stages of the epidemiological transition

  10. Non-communicable diseases as % of all deaths by global region (all ages)

  11. Urbanisation

  12. http://www.indiaimages.com/street/street_life2_large.jpg

  13. Urbanisation

  14. Drivers of the epidemiological transition in low and middle income countries • Population ageing • Major socio-economic changes (especially urbanisation) • changes in risk factors such as diet, physical activity, smoking etc.

  15. Global Burden of Disease (GBD) Study

  16. GBD 2001 mortality estimates • 107 countries had collected “useable” information on cause of death from registration systems • 55 countries (42 in sub Saharan Africa) no information on adult mortality • Estimates based on many assumptions and extrapolations

  17. Global Burden of Disease Study • First GBD study started in 1992 by World Bank. • Second GBD study (in collaboration with WHO) conducted 2001 • Extensive synthesis of all available data to give set of mortality estimates by age, sex, region and cause worldwide – for the first time • 2001 GBD study covers 135 causes of death, 17 sub-regions, based on aggregation of country-level information

  18. Global Burden of Disease2004 Update (published 2008) http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_full.pdf

  19. Distribution of deaths in the world by sex, 2004 GBD report 2004 update, 2008

  20. Mortality rates among men and women aged 15–59 years, region and cause-of-death group, 2004 GBD report 2004 update, 2008

  21. Projected global deaths for selected causes, 2004–2030 GBD report 2004 update, 2008

  22. Effect of key risk factors on mortality

  23. Combining data … Prospective studies collaboration

  24. Prospective Studies Collaboration • Established chiefly to investigate associations of blood pressure and cholesterol with cause-specific mortality • Individual data on 900 000 participants without any previous history of vascular disease from 61 prospective cohort studies • 55 000 vascular deaths (34 000 ischaemic heart disease [IHD], 12 000 stroke, 10 000 other)

  25. Blood pressure and cardiovascular mortality

  26. Age Number deaths Stroke 40-49 414 0·36 (0·32-0·40) 50-59 1372 0·38 (0·35-0·40) 60-69 2939 0·43 (0·41-0·45) 70-79 4327 0·50 (0·48-0·52) 80-89 2636 0·67 (0·63-0·71) IHD 40-49 1322 0·49 (0·45-0·53) 50-59 5594 0·50 (0·49-0·52) 60-69 10 450 0·54 (0·53-0·55) 70-79 10 852 0·60 (0·58-0·61) 80-89 5649 0·67 (0·64-0·70) Other vascular 40-49 386 0·43 (0·38-0·48) 50-59 1377 0·50 (0·47-0·54) 60-69 2549 0·53 (0·51-0·56) 70-79 3227 0·64 (0·61-0·67) 80-89 2251 0·70 (0·65-0·75) 0·25 0·35 0·5 0·7 1·0 Relative risk (& 95% CI) for 20 mmHg lower usual systolic BP Cardiovascular mortality: Age-specific effects for 20 mmHg lower usual SBP 55 345 deaths at ages 40-89 26

  27. Cholesterol and cardiovascular mortality

  28. Ischaemic Heart Disease mortality (33 744 deaths) and total cholesterol Age at risk 80-89 256 128 70-79 64 60-69 32 50-59 16 Hazard ratio ( 95% CI) 40-49 8 4 2 1 0·5 4·0 5·0 6·0 7·0 8·0 Usual total cholesterol (mmol/L) UDV3:[VEP.PSC.FIGURES.TCHOL.240907]ihd-by-agesex-hettrend.ctrl: 24-SEP-2007 14:47:08.14

  29. Different for stroke

  30. Stroke mortality (11 663 deaths) and total cholesterol by age 64 Age 80-89 32 16 70-79 8 Hazard ratio (& 95% CI) 4 60-69 2 40-59 1 4·0 5·0 6·0 7·0 8·0 Usual total cholesterol (mmol/L) UDV3:[VEP.PSC.FIGURES.TCHOL.240907]stroke-by-agecause-trend.ctrl: 24-SEP-2007 14:47:18.56

  31. Smoking

  32. % of deaths aged 35-69 years attributable to smoking in 2000 Source : http://www.deathsfromsmoking.net/

  33. Risk of myocardial infarction increases with every single cigarette smoked per day INTERHEART study 52 countries 12 461 cases, 14 637 controls Odds Ratio of Myocardial Infarction Never 1-2 3-4 5-6 7-8 9-10 11-12 13-14 15-16 17-18 19-20 >=21 Number of cigarettes smoked per day Source : K. K. Teo et al Tobacco use and risk of myocardial infarction in 52 countries in the INTERHEART study Lancet 368 (9536):647-658, 2006.

  34. Smoking causes more deaths from cardiovascular disease than cancer Deaths attributed to smoking among men (all ages) in Russia, 2000 All cancers = 77,000 Cardiovascular disease = 148,000 Source : http://www.deathsfromsmoking.net/

  35. Things are getting worse not better

  36. Smoking in men in Russia is not declining Rural Urban St Petersburgh/Moscow Russian Longitudinal Monitoring Survey Source : Perlman et al Tob.Control 16 (5):299-305, 2007

  37. Smoking in women in Russia is increasing St Petersburgh/Moscow Urban Rural Russian Longitudinal Monitoring Survey Source : Perlman et al Tob.Control 16 (5):299-305, 2007

  38. Giving up smoking reduces risk

  39. Some non-communicable diseases have infectious etiology

  40. Trends in stomach cancer mortality Age standardised mortality per 100,000 Source : WHO HFA database

  41. Helicobacter pylori bacterium - a causal factor for stomach cancer

  42. The Helicobacter pylori story …... • Marshall BJ,.Warren JR. Unidentified curved bacilli in the stomach of patients with gastritis and peptic ulceration. Lancet 1984;1:1311-5. • Marshall BJ, Armstrong JA, McGechie DB, Glancy RJ. Attempt to fulfil Koch's postulates for pyloric Campylobacter. Med.J.Aust. 1985;142:436-9.

  43. Summary • Non-communicable diseases are now the most common cause of death world wide • Increasing rates in low and middle income countries because of change in lifestyles (urbanisation) • Key risk factors have very large effects • Interventions are effective and can reduce burden • The need to combine results and have large studies

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