Epidemiology of Non-
Communicable Diseases
DR CHINTU CHAUDHARYASSISTANT PROFESSOR
DEPT. OF COMMUNITY MEDICINEADESH INSTITUTE OF MEDICAL SCIENCES &
RESERACH
COMMUNICABLE VERSUS NON-COMMUNICABLE DISEASES
Communicable diseases
Sudden onset Single cause Short natural history Short treatment
schedule Cure is achieved Single discipline Short follow up Back to normalcy
Non-communicable diseases
Gradual onset Multiple causes Long natural history Prolonged treatment Care predominates Multidisciplinary Prolonged follow up Quality of life after
treatment
NON- COMMUNICABLE DISEASES INCLUDE Cardiovascular ( hypertension, coronary
artery disease, stroke ) Nervous and mental ( mania, depression) Musculoskeletal ( arthritis) Respiratory (asthma, emphysema, bronchitis) Cancer Diabetes Obesity Blindness Degenerative disorders Accidents
BURDEN OF NON COMMUNICABLE
DISEASES
4
WHO 2014 –GLOBAL BURDEN OF DISEASES –COUNTRY PROFILE-INDIA
5
NON MODIFIABLE RISK FACTORS
A risk factor that cannot be reduced or controlled by intervention;
AGE SEX RACE FAMILY HISTORY (GENETICS)
MODIFIABLE RISK FACTORS
7
METABOLIC RISK FACTORS “Metabolic" refers to the biochemical processes involved in the body's normal functioning
• Behaviors (modifiable risk factors) can lead to metabolic/physiologic changes. • WHO has prioritized the following four metabolic risk factors: ‒ Raised blood pressure ‒ Raised total cholesterol ‒ Elevated glucose ‒ Overweight and obesity
Disease outcomes
• Heart disease • Stroke• Diabetes• Cancer• Respiratory diseases
Physiological risk factors
• Body mass index• Blood pressure• Blood glucose• Cholesterol
Behavioral risk factors
• Tobacco• Alcohol• Physical
inactivity• Nutrition
The causal chain explains the risk factor approach for surveillance of non communicable diseases
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
SOCIO-ENVIRONMENTAL FACTORS
WEB OF CAUSATIONChanges in life style stress
Abundance of food lack of physical activity smoking emotional disturbance aging
Obesity hypertension
Hyperlipidemia thrombotic tendency changes artery walls
Coronary arthrosclerosis coronary occlusion
Myocardialinfarction
CHARACTERISTICS OF NCD
Complex etiology (causes) Multiple risk factors Prolonged course of illness Functional impairment or disability 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 NCDs are slow in onset and development. Distinction between diseased and non diseased may be difficult to establish.
PREVENTION OF NCDLEVELS OF PREVENTION
1. Primordial
2. Primary
3. Secondary
4. Tertiary
For healthy people
For unhealthy people
1. 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.
2. 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.
PREVENTION OF NCDINTERVENTIONS
Health promotion Specific protection Adequate nutrition Safe water and sanitation
Primary prevention
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-
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
RESPONSE TO NCD
Centrally sponsored schemes:National iodine deficiency disorders control programmeNational programme for control of blindnessNational programme for prevention and control of cance, diabetes, cardiovascular diseases and stroke.
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