1. Definitions: 2. Morbidity indicators: -terminology, -data … · 2020-03-19 · 1. Definitions:...

1. Definitions: 2. Morbidity indicators:

-terminology, -data collection: registration of cases and official source of information -methods of investigations.

3. Morbidity resulting in loss of work and physical ability:-permanent, -temporary -impacts and assessment

4. Socially significant diseases

18.03.2020 Prof. Lydia Katrova, DDS, MPH, PhD 1

1. DEFINITIONS: Morbidity

Disease

Illness

Disorder

Medical condition

Pre disease

Lifestyle disease

Indemnity

Incapacity

Compression of morbidity


Morbidity

Morbidity is an incidence of ill health.

It is measured in various ways, often by the probability that a randomly selected individual in a population at some date and location would become seriously ill in some period of time.

In epidemiology and actuarial science, the term "morbidity rate" can refer to either the incidencerate, or the prevalence of a disease or a medical condition.


http://en.wikipedia.org/wiki/Epidemiology

http://en.wikipedia.org/wiki/Actuarial_science

http://en.wikipedia.org/wiki/Incidence_(epidemiology)

http://en.wikipedia.org/wiki/Prevalence

Disease The term disease broadly refers to any condition that impairs

normal function, and is therefore associated with dysfunction of normal homeostasis.

Commonly, the term disease is used to refer to specificallyinfectious diseases, which are clinically evident diseases that result from the presence of pathogenic microbial agents, including viruses, bacteria, fungi, protozoa, multi-cellular organisms, and aberrant proteins known as prions. Latent, acute or transitory.

Non-infectious diseases are all other diseases, including most forms of cancer, heart diseases, and genetic diseases.

Diseases usually affect people not only physically, but also emotionally, as contracting and living with many diseases can alter one's perspective on life, and one's personality.


http://en.wikipedia.org/wiki/Infectious_disease

http://en.wikipedia.org/wiki/Pathogenic

http://en.wikipedia.org/wiki/Bacteria

http://en.wikipedia.org/wiki/Prion

http://en.wikipedia.org/wiki/Non-infectious_disease

http://en.wikipedia.org/wiki/Cancer

http://en.wikipedia.org/wiki/Heart_disease

http://en.wikipedia.org/wiki/Genetic_disease

Illness Illness and sickness are generally used as synonyms for

disease. However, this term is occasionally used to refer specifically to the patient's personal experience of his or her disease.

In this model, it is possible for a person to have a disease without being ill (to have an objectively definable, but asymptomatic, medical condition), and to be ill without being diseased (such as when a person perceives a normal experience as a medical condition, or medicalizes a non-disease situation in his or her life).

Illness is often not due to infection, but to a collection of evolved responses—sickness behavior by the body—that helps clear infection. Such aspects of illness can include lethargy, depression, anorexia, sleepiness, hyperalgesia, and inability to concentrate.[


http://en.wikipedia.org/wiki/Medicalization

http://en.wikipedia.org/wiki/Evolutionary_medicine

http://en.wikipedia.org/wiki/Sickness_behavior

http://en.wikipedia.org/wiki/Lethargy

http://en.wikipedia.org/wiki/Depression_(mood)

http://en.wikipedia.org/wiki/Anorexia_(symptom)

http://en.wikipedia.org/wiki/Sleepiness

http://en.wikipedia.org/wiki/Hyperalgesia

http://en.wikipedia.org/wiki/Attention

Disorder In medicine, a disorder is a functional abnormality or

disturbance. Medical disorders can be categorized into mental disorders, physical disorders, genetic disorders, emotional and behavioral disorders, and functional disorders.

The term disorder is often considered more value-neutral and less stigmatizing than the terms disease or illness, and therefore is preferred terminology in some circumstances.

In mental health, the term mental disorder is used as a way of acknowledging the complex interaction of biological, social, and psychological factors in psychiatric conditions.

However, the term disorder is also used in many other areas of medicine, primarily to identify physical disorders that are not caused by infectious organisms, such as metabolic disorders.


http://en.wikipedia.org/wiki/Mental_disorder

http://en.wikipedia.org/wiki/Physical_disorder

http://en.wikipedia.org/wiki/Genetic_disorder

http://en.wikipedia.org/wiki/Emotional_and_behavioral_disorders

http://en.wikipedia.org/wiki/Functional_disorder


http://en.wikipedia.org/wiki/Biopsychosocial_model

http://en.wikipedia.org/wiki/Psychiatry

http://en.wikipedia.org/wiki/Metabolic_disorder

Medical condition A medical condition is a broad term that includes all diseases and

disorders. While the term medical condition generally includes mental illnesses,

in some contexts the term is used specifically to denote any illness, injury, or disease except for mental illnesses.

The Diagnostic and Statistical Manual of Mental Disorders (DSM), the widely used psychiatric manual that defines all mental disorders, uses the term general medical condition to refer to all diseases, illnesses, and injuries except for mental disorders. This usage is also commonly seen in the psychiatric literature. Some health insurance policies also define a medical condition as any illness, injury, or disease except for psychiatric illnesses.

As it is more value-neutral than terms like disease, the term medical condition is sometimes preferred by people with health issues that they do not consider deterious.

On the other hand, by emphasizing the medical nature of the condition, this term is sometimes rejected, such as by proponents of the autism rights movement.


http://en.wikipedia.org/wiki/Diagnostic_and_Statistical_Manual_of_Mental_Disorders



http://en.wikipedia.org/wiki/Health_insurance

http://en.wikipedia.org/wiki/Value-neutral

http://en.wikipedia.org/wiki/Autism_rights_movement

Pre-disease

Predisease is a type of disease creep or medicalization in which currently healthy people with risk factors for disease, but no evidence of actual disease, are told that they are sick. Prediabetes and prehypertension are common examples.

Labeling a healthy person with predisease can result in overtreatment, such as taking drugs that only help people with severe disease, or in useful preventive measures, such as motivating the person to get a healthful amount of physical exercise.


http://en.wikipedia.org/w/index.php?title=Disease_creep&action=edit&redlink=1

http://en.wikipedia.org/wiki/Medicalization

http://en.wikipedia.org/wiki/Risk_factor

http://en.wikipedia.org/wiki/Prediabetes

http://en.wikipedia.org/wiki/Prehypertension

http://en.wikipedia.org/wiki/Overtreatment

Tipology of medical conditions In many cases, the terms disease, disorder, morbidity and illness are used

interchangeably. In some situations, specific terms are considered preferable.

There are four main types of disease: pathogenic disease, deficiency disease, hereditary disease,

and physiological disease. Diseases can also be classified as:

communicable and non-communicable. The deadliest disease in humans is:

ischemic heart disease (blood flow obstruction), cerebrovascular disease and lower respiratory infections respectively.

Death due to disease is called death by natural causes.


http://en.wikipedia.org/wiki/Cerebrovascular_disease

http://en.wikipedia.org/wiki/Lower_respiratory_infections

http://en.wikipedia.org/wiki/Death_by_natural_causes

Other terminology Infectious diseases

Contagious diseases

Foodborne illness

Foodborne illness or food poisoning is any illness resulting from the consumption of food contaminated with pathogenic bacteria, toxins, viruses, prions or parasites.

Communicable diseases

Non-communicable diseases

Airborne diseases

Lifestyle diseases


http://en.wikipedia.org/wiki/Foodborne_illness

Lifestyle diseases

A lifestyle disease is any disease that appears to increase in frequency as countries become more industrialized and people live longer, especially if the risk factors include behavioral choices

like a sedentary lifestyle or a diet high in unhealthful foods such as refined carbohydrates, trans fats, or alcoholic beverages.


http://en.wikipedia.org/wiki/Lifestyle_disease

Progressive. Chronic Diseases Progressive disease is a disease whose typical natural

course is the worsening of the disease until death, serious debility, or organ failure occurs.

Slowly progressive diseases are also chronic diseases; many are also degenerative diseases.

The opposite of progressive disease is stable disease or static disease: a medical condition that exists, but does not get better or worse.


http://en.wikipedia.org/wiki/Progressive_disease

http://en.wikipedia.org/wiki/Chronic_disease

http://en.wikipedia.org/wiki/Degenerative_disease

Disease burdenDisease burden is a term to identify the impact of a health

problem in an area measured by financial cost, mortality, morbidity, or other indicators. This term is relevant to socially significant conditions

There are several measures (indicators) used to quantify the burden imposed by diseases on people.

The years of potential life lost (YPLL) is a simple estimate of the number of years that a person's life was shortened due to a disease. For example, if a person dies at the age of 65 from a disease, and would probably have lived until age 80 without that disease, then that disease has caused a loss of 15 years of potential life.

YPLL measurements do not account for how disabled a person is before dying, so the measurement treats a person who dies suddenly and a person who died at the same age after decades of illness as equivalent. In 2004, the World Health Organizationcalculated that 932 million years of potential life were lost to premature death.


http://en.wikipedia.org/wiki/Disease_burden

http://en.wikipedia.org/wiki/Disease_burden

http://en.wikipedia.org/wiki/Years_of_potential_life_lost

http://en.wikipedia.org/wiki/World_Health_Organization

Quality-adjusted life yearThe quality-adjusted life year (QALY) and disability-adjusted

life year (DALY) metrics are similar, but take into account whether the person was healthy after diagnosis.

In addition to the number of years lost due to premature death, these measurements add part of the years lost to being sick.

Unlike YPLL, these measurements show the burden imposed on people who are very sick, but who live a normal lifespan.

A disease that has high morbidity, but low mortality, has a high DALY and a low YPLL. In 2004, the World Health Organization calculated that 1.5 billion disability-adjusted life years were lost to disease and injury.

In the developed world, heart disease and stroke cause the most loss of life, but neuropsychiatric conditions like major depressive disorder cause the most years lost to being sick.


http://en.wikipedia.org/wiki/Quality-adjusted_life_year


http://en.wikipedia.org/wiki/Disability-adjusted_life_year

http://en.wikipedia.org/wiki/Heart_disease

http://en.wikipedia.org/wiki/Stroke

http://en.wikipedia.org/wiki/Neuropsychiatric_conditions

http://en.wikipedia.org/wiki/Major_depressive_disorder

The quality-adjusted life year (QALY) and disability-adjusted life year (DALY

Injuries, especially motor vehicle accidents

14% 12% 18% 13% 18% 10%

Cardiovascular diseases, principally heart attacks and stroke

14% 10% 35% 23% 26% 14%

Premature birthand other perinatal deaths

11% 8% 4% 2% 3% 2%

Cancer 8% 5% 19% 11% 25% 13%

Disease category

Percent of all YPLLs lost, worldwide

Percent of all DALYs lost, worldwide

Percent of all YPLLs lost, Europe

Percent of all DALYs lost, Europe

Percent of all YPLLs lost, US and Canada

Percent of all DALYs lost, US and Canada



http://en.wikipedia.org/wiki/Disability-adjusted_life_year

http://en.wikipedia.org/wiki/Injuries

http://en.wikipedia.org/wiki/Motor_vehicle_accidents

http://en.wikipedia.org/wiki/Cardiovascular_disease

http://en.wikipedia.org/wiki/Heart_attacks

http://en.wikipedia.org/wiki/Stroke

http://en.wikipedia.org/wiki/Premature_birth

http://en.wikipedia.org/wiki/Perinatal

“Compression of Morbidity,” The increased life expectancy would be accompanied by a

shortening of the length of morbid life. Fries believed that the same forces that resulted in decreased mortality would be linked to a lower incidence of chronic disease and a higher age of onset of chronic disease (Fries, 2000, 2001, 2002).

Increasing life expectancy has been accompanied by a rectangularization of the survival curve as survival until old age becomes almost universal.

Because he felt that life expectancy had a limiting biological maximum, he postulated that the time with disease would be compressed into a shorter period at the end of life.


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3001754/



An Indemnity / Indemnity Payment

An indemnity is a kind of insurance, in which paymentis made (often in previously determined amounts) forinjuries suffered, not for the costs of recovery.

The indemnity payment is designed not to be a dependent on anything the patient can control.

From the point of view of the insurer, the indemnitymechanism avoids the moral hazard problem of victimspending too much in recovery. (Econterms)


http://economics.about.com/gi/dynamic/offsite.htm?site=http://www.econterms.com

Health index

The number of cases of healthy persons per unit of medically examined population. The proportion of healthy persons in regards of the total number of examined people.

38% report they are in perfect health.

36% are suffering rarely from a disease.

22% are chronically ill, often experiencing some ill condition or suffering some form of impairment.

Life expectancy without disability (up to 65 years in good health).

7-9 years shorter for Bulgarian population.


2. Morbidity registration and assessment

1. Morbidity statistics

2. Morbidity indicators:

-terminology,

-data collection: registration of cases and official source of information

-methods of investigations.


morbidity statistics Morbidity (illness) statistics are widely used by epidemiologists in

the analysis of ill-health within human populations.

There are two major types of morbidity rate:

the prevalence rate and the incidence rate.

The prevalence rate gives an indication of the number of individuals in a population suffering from a particular condition at any time,

while the incidence rate shows how many individuals develop a condition within a particular period of time, usually one year.

Morbidity rates are generally presented for specific conditions rather than as a general rate, and may be reported as absolute numbers within a year (for example 200 cases of rabies),

or as incidence rates per thousand population, to facilitate comparisons between different sub-populations (such as sexes, age-groups, or occupations).


Morbidity indicators: Group indicators measuring the loss of health. Statistics on the spread of the disease among the

general population and in separate medical units by age,s ex, professional etc. groups of registered diseases.

proportional morbidity: the proportion of all of the diseased persons in the population that have the particular disease under discussion.

morbidity rate: the ratio of diseased to healthy people in the population. The ratio of sick to well people in a community.

The ratio is said to be standardized when it is expressed as a proportion of the expected rate compared with a standard group.

It is also expressed as a proportional rate when it is stated as a proportion of all of the cases of illness due to all causes in the group.

The frequency of the appearance of complications following a surgical procedure or other treatment. Avoid the jargonistic use of this word as a synonym of disease.


Data collection: registration of cases and official

source of information

Unlike mortality rates, which are uniquely reported in official statistics,

morbidity statistics are available from a variety of sources, including the following: official statistics on contagious diseases and other notifiable

illnesses,

hospital in-patient records,

records of claims for sickness benefit,

and local or national interview surveys which obtain self-report data on ill-health.

cause-of-death statistics,

over the years it has become...key tool in various fields (morbidity and hospital statistics, health economics


http://www.encyclopedia.com/doc/1O88-mortality.html

http://www.encyclopedia.com/doc/1O88-officialstatistics.html

Morbidity investigations Epidemiology

Epidemiology is a method for the diagnosis of social medicine in the study of health and disease as a phenomenon for the total population and for population groups;

Corresponds to the clinical examination and diagnosis in clinical medicine


3. Morbidity resulting in loss of work and physical ability

-permanent,

-temporary

-impacts and assessment


Studying of morbidity assists also to determine:

Risk factors

Diseases predisposition and mechanisms of spread

Prevention of diseases


Field of action of epidemiology unlike clinical medicine:

Time: the disease process in the past, present and future (prediction)

Contingent: sick and healthy, experimental and control groups

Factors: home, work, public environment


Epidemiological analyzis

Issue Order

Information available

Formulation of hypothesis,

Descriptive, explanatory, analytical

Risk factors: household, labour, social


Morbidity index: Incidence

Number of newly registered diseases

----------------------------- х 1000average annual number of the population


Morbidity Indicator: Prevalence

Number of registered new and old diseases------------------------------ х 1000 Average annual number of population


health index

Number of healthy people

index of health = --------------------------х100

Number of examined


Units of measurement

Morbidity scores or predicted morbidity are assigned to ill patients with the help of systems such as the APACHE II, SAPS II and III, Glasgow Coma scale, PIM2, and SOFA.

Morbidity scores help decide the kind of treatment or medicine that should be given to the patient.

Predicted morbidity describes the morbidity of patients, and is also useful when comparing two sets of patients or different time points in hospitals.


http://www.diffen.com/difference/Category:Medicine

Database/Reports World Health Statistics (compiled by World Health

Organization) contains a compilation of data pertaining to diseases, mortality, causes of death, and mortality rates.

Publications like MMWR (Morbidity and Mortality Weekly Report, by Center for Disease Control and Prevention, USA), and databases like EMDB (European hospital Morbidity Database, Europe), and NHMD (National hospital morbidity Database, Australia) maintain patient health and disease records and health information and recommendations accessible to physicians, nurses, and other healthcare professionals.


http://www.diffen.com/difference/Data_vs_Information

Other indicators Structure of morbidity: percentage distribution of different

diseases from the total of ill people. Mortality structure: cause of death, in particular from Socially

significant diseases: Lethality: percentage of deaths caused by a disease from the

total number of registered cases with the same disease

Number died from a disease Lethality =-----------------------------------------x 100

all suffering from this disease


Structure of morbidity, the structure of the current prevalence

Structure of morbidity

Structure of the current prevalence

Hidden diseases Iceberg of morbidity

Advancement in medicine and health care

Increased life expectancy rate


Standartized structure of mortality from oncological diseases


2. Morbidity with temporary or permanent disability

Meaning:

loss of resources of society,

degrading the quality of life of the people;

Indicators: annual average number of lost days due to illness,

sick leaves, average count average annual count lost days for one person,

Structure of morbidity

Standards of indemnity expertise


Concepts of incapacity

Biological, social, and legal aspects of the definition of the employment office in Geneva:

Weak, handicapped, a person who, because of severe, lasting physical and/or mental disability unfit fully or partially for work and is unable to perform everyday self care and need assistance.


Temporary incapacity/indemnity Temporary disability incapacity/indemnity is present

in cases in which the insured person is unable or prevented from working due to: accident; disease, occupational diseases; treatment abroad, sanatorialrecovery treatment; urgent medical check or examination; quarantine; removal from work following the recommendation of health authorities;

Watch sick or contagious member of the family; accompanying a sick family member for a medical examination; testing and treatment at the same or at a different place in the country or abroad; pregnancy and childbirth; watching a healthy child returned from kindergarten due to quarantine in the kindergarden.


Morbidity with temporary incapacity

Duration

labor problems expertise

efficiency Indicators

Indemnity expertise

Occupational law.

Indicators


Permanent incapacity and socially dysfunctional individuals

Disability: a system of social and health insurance, duration, consequences,

1st group – with assistance in individual care, without working.

2nd group-work in special conditions 3rd group-work in the profession, but the relaxed

mode


INCAPACITY as a result of hereditary or acquired chronic disease

1. impairment;

2. defiсit, deficiency;

3. disability, handicap.


Disablement as a result of diseases

1. impairment Groups: healthy, conventionally healthy hidden, acutely ill, chronically ill consequences of chronic diseases:

2. disability (impairment) 2. incapacity, (deficit, deficiency)

3. 3. social failure, (disability, handicap) screening, treatment, rehabilitation, dispensary, djankov said.

defiсit, deficiency)

disability, handicap)



Primary (congenital diseases)/General Dynamics and causality: 1.2 3 years, indicators: intense, structured, standardized. Tables for disablement (likely a disease will lead to this). Sources of information on disability: primary expert papers on TEMP, NELKO

Learning disability:

INTERNATIONAL CLASSIFICATION OF DISEASES 11 Each ICD entity can be seen from different dimensions or “parameters”. For example,

there are currently 13 defined main parameters in the Content Model (see below) to describe a category in ICD.

ICD Entity Title - Fully Specified Name Classification Properties - disease, disorder, injury, etc. Textual Definitions - short standard description Terms - synonyms, other inclusion and exclusions Body System/Structure Description - anatomy and physiology Temporal Properties - acute, chronic or other Severity of Subtypes Properties - mild, moderate, severe, or other scales Manifestation Properties - signs, symptoms Causal Properties - etiology: infectious, external cause, etc. Functioning Properties - impact on daily life: activities and participation Specific Condition Properties - relates to pregnancy etc. Treatment Properties - specific treatment considerations: e.g. resistance Diagnostic Criteria - operational definitions for assessment ICD exists in 41 Languages in electronic versions and its expression in multiple

languages will be systematically pursued in ICD11.


Socially significant diseases

International classification of diseases causes of deaths

from 1986, No10.

Etiologo-pathological topical principle


MOST FREQUENT DESEASES Hypertension,

Diabetes,

Chronic Obstructive Pulmonary Disease

Neoplastic processes

Most important national priorities.

These diseases, affecting primarily people in active, working age are a common cause for development of complications, disabilities and even fatal end

when they aren't diagnosed on time or have been treated and controlled improperly.

Cardiovascular,

Brain and

Malignant: Lung, colon, breast

Endocrine: diabetes mellitus, Ulcers, Obesity

Alcohol and tabaco or drug abuse

Mental

Birth Traumas,

Genetic


DIABETIC COMPLICATIONS RISKS

Diabetic neuropathy-98,2%

Diabetic retinopathy-33%

Diabetic nephropathy-7%

Macrovascular complications-10,5%


Contribution to premature deaths


CANCER MORBIDITY RATES MEN lung cancer- 75,4% colorectal cancer- 52% prostate cancer- 54% gastric cancer- 19% pancreatic cancer- 7%

WOMEN breast cancer- 84% colorectal cancer- 50% cervix cancer- 31% gastric cancer- 15% pancreatic cancer-7%


The most important factors for SSD

Ishemic Heart Disease-30-69 year group, 60% of the causes for death, a 20% increase in Bulgaria:

Brain vascular disease -35-64 year, the risk is atherosclerosis, nutrition, obesity, immobilization, cigarettes, smoking, alcohol drinking, overweight-constellation First we examine recent change in the prevalence of the four major diseases that are causes of death that we have discussed previously: heart disease, stroke, cancer, and diabetes.


PREMATURE DEATHS, FACTORS Income is a prime determinant of Canadians’ premature years of

life lost and premature mortality from a range of diseases.[

Numerous studies indicate that income levels during earlychildhood, adolescence, and adulthood are all independentpredictors of who develops and eventually succumbs to disease.[

In Canada almost a quarter of excess premature years of life lost(mortality prior to age 75) can be attributed to incomedifferences among Canadians. These calculations are obtained byusing the mortality in the wealthiest quintile of urbanneighbourhoods as a baseline and considering all deaths abovethat level to be “excess” related to income differences. Theseanalyses indicate that 23% of premature years of life lost toCanadians can be accounted for by differences existing betweenwealthy and other Canadians


Chronic Diseases deaths


Cerebrovascular conditions, Cerebrovascular conditions, primarily stroke, comprise the other major

cause of CVD deaths. One of every five CVD deaths in 2005 wasattributed to stroke (Kung et al., 2008). Nevertheless, mortality fromstrokes experienced one of the largest declines in both absolute deathrates and age-standardized death rates between 1970 and 2002 (Jemal,Ward, Hao, & Thun, 2005). However, men benefited more than womenfrom this decline. Men, but not women, experienced significant declinein the mortality rates occurring in the month after experiencing astroke when comparing a period centered in the mid-1960s with onecentered at the end of the 1990s (Carandang et al., 2006).

Stroke incidence does not appear to have changed consistently over theperiod, whereas mortality was declining. Stroke incidence was reportedto be higher in the 1980s than the 1970s, and the 1990s appear to havebeen a period of some, but inconsistent, decline





Trends in Cancer Mortality and Morbidity

Cancer is the next most important cause of mortality after CVD accounting for about a quarter of deaths (22.8% in 2005; Kung et al., 2008). Overall mortality rates from cancer declined little until recent years (Kung et al., 2008). From 1970 to 2000, the decline in cancer mortality rates contributed to less than a third of a year in the increase in life expectancy (Beltrán-Sánchez et al., 2008); however, mortality rates from a number of important cancers have decreased in recent years (Jemal, Murray, et al., 2005; Preston & Ho, 2010). Cancer is really a number of different diseases with different risk factors, treatments, and trends. About 50% of all cancer deaths in 2005 in the United States were cancer of lungs, colon/rectum/anus, prostate, and breast so we focus on these cancers in our discussion (Kung et al., 2008).








CANCER MORBDITY TRENDS Because three of the most important cancers—breast, prostate, and

colorectal—are often identified through screening rather than symptoms, it is hard to interpret general increases in incidence over time reported in cancer registries because they are affected by screening policies and programs (Garcia, 2010; Preston & Ho, 2010). For men, total cancer incidence in the United States appears to have leveled-off from 1995 to 2001, although incidence of prostate cancer slightly increased during this period (Jemal, Murray, et al., 2005). For women, there was a continuous increase in all cancer incidence of about 0.3% per year from 1987 to 2001, mainly due to increases in cancer of breast and lung and bronchus. After 2002, decreased use of hormone therapy among postmenopausal women appears to have contributed to some reduction in breast cancer incidence. It is clear that cancer survival has increased, but this has not resulted from major changes in cancer incidence, with the exception of lung cancer (Garcia, 2010; Preston & Ho, 2010). The pattern of lengthening survival from cancer with only recent decreases in incidence would lead to an increasing number of cancer survivors in the population, and data on the prevalence of cancer survivors show this







SOCIAL DETERMINANTS Among the not-wealthy, mortality by heart

disease and stroke are especially related to income differences. Importantly, premature death by injuries, cancers, infectious disease, and diabetes are also all strongly related to not being wealthy in Canada. These rates are especially high among the least well-off Canadians


Socially significant diseases PreventionObjectives: plan at national level,

Primary prevention, the integration of the efforts of the science, practice, politics sub-programs:

-events, epidemiology

-trends and determinants, and dissemination of information, quality control


Trends in Diabetes Mortality and Morbidity Diabetes is the sixth leading cause of death in the United States (Kung et al.,

2008). Age-adjusted death rates for diabetics are about twice that for people without diabetes, and about two to four times that for people with heart disease (Geiss, Herman, & Smith, 1995). Diabetes is also an important contributor to mortality from other conditions, and it is often listed as a contributing factor to deaths that are assigned to other causes (McEwen, Kim, Hann, & Ghosh, 2006). Age-adjusted death rates from diabetes declined from 1970 to the mid-1980s but increased substantially (about 47%) from 1987 to 2002 (Jemal, Ward, et al., 2005).

The lifetime risk of diabetes for Americans born in the year 2000 is estimated to be 33% for men and 36% for women (Narayan, Boyle, Thompson, Sorensen, & Williamson, 2003). Age-adjusted incidence rates of diabetes doubled between 1980 and 2008 for both men and women between the ages of 18 and 79 (Center for Disease Control and Prevention, 2010). There are numerous studies reporting an increasing prevalence of diabetes in the United States over the last few decades (Crimmins, 2004; Engelgau et al., 2004; Martin et al., 2009). Increasing prevalence and incidence of diabetes is assumed to be related to the growing problem of obesity, and it is projected to continue to increase (Honeycutt et al., 2003). Trends in diabetes mortality, incidence, and prevalence all point to growing population health problems from this condition.












CVD CVD is also a major cause of morbidity. Results from the

Framingham Heart Study show that, at age 50, the lifetime risk for developing CVD was 51.7% for men and 39.2% for women (Lloyd-Jones et al., 2006). The Framingham Heart Study also shows that when methods of diagnosis are taken into account incidence rates for a first MI remained relatively stable between 1960–1969 and 1990–1999 (Parikh et al., 2009); however, trends differ by gender. For men, there was no clear trend in incidence of MI before 1980, but a decline characterizes most of the 1980s and 1990s, although two studies report small increases in incidence rates in the late 1990s




Are socially important the diseases we treat? greater prevalence- yes rejuvenate- yes Multifactor causes -continuous operation- no severe complications- not-high and premature mortality -incapacity-not -great resources – large groups of the population – to 50/50 priorities, health policy


Thank you for your attention

Anny Questions:


1. Definitions: 2. Morbidity indicators: -terminology, -data … · 2020-03-19 · 1. Definitions:...

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