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Non Communicable Epi

This document discusses non-communicable diseases (NCDs) and their epidemiology. It defines chronic diseases and lists common NCDs such as cardiovascular diseases, cancer, diabetes, and respiratory diseases. It notes the growing problem of NCDs in developing countries and highlights data on cancer, heart disease, hypertension, and diabetes prevalence in India. Risk factors discussed include aging, lifestyle changes, tobacco use, and environmental exposures. It also examines gaps in understanding NCDs' natural histories and levels of prevention. The response to NCDs in India includes national programs and future efforts focused on prevention, health services, and epidemiological data. Criteria for determining causality in epidemiology are also outlined.

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273 views

Non Communicable Epi

This document discusses non-communicable diseases (NCDs) and their epidemiology. It defines chronic diseases and lists common NCDs such as cardiovascular diseases, cancer, diabetes, and respiratory diseases. It notes the growing problem of NCDs in developing countries and highlights data on cancer, heart disease, hypertension, and diabetes prevalence in India. Risk factors discussed include aging, lifestyle changes, tobacco use, and environmental exposures. It also examines gaps in understanding NCDs' natural histories and levels of prevention. The response to NCDs in India includes national programs and future efforts focused on prevention, health services, and epidemiological data. Criteria for determining causality in epidemiology are also outlined.

Uploaded by

piyush_sensational
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPS, PDF, TXT or read online on Scribd
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Epidemiology of NonCommunicable Diseases

Dr. REKHA DUTT

Chronic diseases
definitions:
An impairment of bodily structure or function that
necessitates a modification of the patients 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:
a. Are permanent
b. Leave residual disability
c. Are caused by non reversible pathological alterations
d. Require special training of the patient for rehabilitation
e. May be expected to require a long period of
supervision, observation or care

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

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.

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

Gaps in the natural history of NCD


1.
2.

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

Gaps in the natural history of NCD


Web of causation
Changes in life style

Abundance of food

stress

lack of physical activity

smoking

emotional
disturbance
aging

Obesity
Hyperlipidemia

hypertension
thrombotic tendency
changes
artery
walls

Coronary arthrosclerosis

coronary occlusion

Myocardial
infarction

Gaps in the natural history of NCD


3. 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.
4. Indefinite onset : Most (NCD) are slow in
onset and development. Distinction
between diseased and non diseased
may be difficult to establish.

Prevention of NCD
Levels of prevention
1. Primordial For healthy people
2. Primary
3. Secondary
For unhealthy people

4. Tertiary
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 NCD
Interventions:
Health promotion
Specific protection
Adequate nutrition
Safe water and sanitation

Primary prevention

3. 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
4. Tertiary prevention- defined as all measures available to reduce
impairments & disabilities, minimize suffering due to departure from
good health & promote patients adjustment to irremediable
conditions.Intervention DISABILITY LIMITATION AND
REHABILITATION

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

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

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.

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

ASSOCIATION

SPURIOUS

DIRECT
(CAUSAL)

ONE TO ONE
CAUSAL

INDIRECT

MULTI
FACTORIAL

1. Spurious association:
When an observed
association between a
disease and suspected
factor is not real.
2. 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

Criteria for causality

temporal

coherence

strength

association

biological

specificity

consistency

1. Temporal association: the cause must precede


the effect.
2. Strength of association:
Larger the relative risk greater the likely hood of
causal relation
Dose response and duration response relationship
3. 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

4. Consistency of association:
When results are replicated when studied in
different settings and by different methods.
5. 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.
6. 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.

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