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.