Public Health 150 Non-communicable Diseases

1. Public Health 150Non-communicable Diseases Zuo-Feng Zhang, MD, PhD Professor of Epidemiology October 31, 2011

2. What are NCDs? • NCD is a medical condition or disease, which is not infectious • NCDs are diseases or medical conditions with long duration and relatively slow progression • NCDs are usually called “Chronic Diseases”

3. Why NCDs Are Important in Public Health? • 57 million deaths that occurred globally in 2008 • 36 million – 63.2%, almost two thirds – were due to NCDs • 9 million death that occurred among people under age 60 • mainly cardiovascular diseases, cancers, diabetes and chronic lung diseases

4. UN High-Level meeting on NCDs, September 19-20, 2011

6. Number of deaths for leading causes of death in the US • Heart disease: 631,636 • Cancer: 559,888 • Stroke (cerebrovascular diseases): 137,119 • Chronic lower respiratory diseases: 124,583 • Accidents (unintentional injuries): 121,599 • Diabetes: 72,449 • Alzheimer's disease: 72,432 • Influenza and Pneumonia: 56,326 • Nephritis, nephrotic syndrome, and nephrosis: 45,344 • Septicemia: 34,234

12. US

14. Cardiovascular Diseases • CVDs include diseases of the heart, vascular diseases of the brain and diseases of blood vessels. • CVDs are responsible for over 17.3 million deaths per year and are the leading causes of death in the world WHO. Global Atlas on Cardiovascular Disease Prevention and Control. Mendis S, Puska P, Norrving B editors. World Health Organization, Geneva 2011

15. Heart and Brain WHO. Global Atlas on Cardiovascular Disease Prevention and Control. Mendis S, Puska P, Norrving B editors. World Health Organization, Geneva 2011

16. Proportion of Death caused by CVDs WHO. Global Atlas on Cardiovascular Disease Prevention and Control. Mendis S, Puska P, Norrving B editors. World Health Organization, Geneva 2011

17. Distribution of CVDs

20. What Is Tumor/Cancer?

21. Tumor is a disorder of cells • A neoplasm (Greek, Neo-New, plasma, thing formed) is the autonomous growth of tissue that have escaped the normal restraints on cell proliferation and exhibit varying degrees of fidelity to their precursors. • It is usually appears as a tumor ( a swelling) made of mass of cells.“Abnormal growth of cells”, “Unlimited growth of cells”.

22. Tumors • In general, neoplasms are irreversible, and their growth is for the most part, autonomous.

23. Benign versus Malignant Tumors • Benign tumors do not penetrate (invade) adjacent tissue borders, nor do they spread (metastasize) to distant sites. • They remain localize overgrowths in the area in which they arise • Benign tumors are more differentiated than malignant tumors, that is, they are more closely resemble their tissue of origin.

24. Invasion and Metastasis • Malignant tumors (cancer) are capable of invasion (spread of the neoplasms into adjacent structures) and metastasis (implantation of the neoplasms into noncontiguous sites).

25. Oral Premalignant Lesions Oral submucous fibrosis Oral Leukoplakia Erythroplakia Second Primary Cancers following a first primary oral cancer Invasive oral cancer Esophageal Cancer Oral Cancer Lung Cancer

27. Cancer Statistics • 12.7 million new cases in 2008 • 7.6 million deaths from cancer (13.3% of overall deaths) in 2008

28. Incidence and Mortality, World 2008

30. Cancer

31. Cancer

33. Cancer

34. Projected demographic effects on cancer incidence and mortality

35. Projected demographic effects on cancer incidence and mortality

36. Cancer Incidence and Mortality in China and World, 2008 Incidence and Mortality are per 100,000 Population: China: 1,331,460,000; World: 6,775,235,700; China/World: 19.65%

37. Age Standardized Incidence Rates (/100,000) Source: GLOBOCAN 2002

42. COPD • Chronic obstructive pulmonary disease (COPD) is a life-threatening lung disease that interferes with normal breathing – it is more than a “smoker’s cough”. • An estimated 64 million people have COPD worldwide in 2004.1 • More than 3 million people died of COPD in 2005, which is equal to 5% of all deaths globally that year. • Almost 90% of COPD deaths occur in low- and middle-income countries. • The primary cause of COPD is tobacco smoke (through tobacco use or second-hand smoke). • The disease now affects men and women almost equally, due in part to increased tobacco use among women in high-income countries. • COPD is not curable, but treatment can slow the progress of the disease. • Total deaths from COPD are projected to increase by more than 30% in the next 10 years without interventions to cut risks, particularly exposure to tobacco smoke.

43. COPD

44. Diabetes

45. Diabetes • More than 346 million people worldwide have diabetes. • There is an emerging global epidemic of diabetes that can be traced back to rapid increases in overweight, obesity and physical inactivity.

46. Diabetes Diabetes is predicted to become the seventh leading cause of death in the world by the year 2030. • Total deaths from diabetes are projected to rise by more than 50% in the next 10 years.

47. Diabetes There are two major forms of diabetes. • Type 1 diabetes is characterized by a lack of insulin production and type 2 diabetes results from the body's ineffective use of insulin. A third type of diabetes is gestational diabetes. • This type is characterized by hyperglycaemia, or raised blood sugar, which has first appeared or been recognized during pregnancy.

48. Diabetes Type 2 diabetes is much more common than type 1 diabetes. • Type 2 accounts for around 90% of all diabetes worldwide. Reports of type 2 diabetes in children – previously rare – have increased worldwide. In some countries, it accounts for almost half of newly diagnosed cases in children and adolescents.

49. Diabetes • Cardiovascular disease is responsible for between 50% and 80% of deaths in people with diabetes. • Diabetes has become one of the major causes of premature illness and death in most countries, mainly through the increased risk of cardiovascular disease (CVD).

50. Diabetes Diabetes is a leading cause of blindness, amputation and kidney failure. • Lack of awareness about diabetes, combined with insufficient access to health services and essential medicines, can lead to complications such as blindness, amputation and kidney failure.