EPIDEMIOLOGY OF CHRONIC
NON COMMUNICABLE
DISEASES (NCDs)
CHRONIC DISEASE
All impairments or deviations from normal
which have one or more of the following
characteristics :
•
•
•
•
Permanent
Leave residual disability
Caused by a non-reversible pathology
Required special training of the patient for
rehabilitation
• Required long period of supervision,
observation or care
Problems in etiologic investigation
of Chronic Non-Communicable
Diseases (NCDs):
1.Absence of a known agent
2.Multifactor nature of etiology
3.Long latent period
4.Indefinite onset
5.Differential effect of factors on incidence
and course of
Prevention of NCDs received little
attention by policy makers, medical
professionals, and general public
because:
• The extent is less sufficiently examined
• Long delay between cause and effect
PRIMARY Prevention is possible
for most NCDs due to the following
facts:
1.Large population differences in incidence and mortality of
NCDs
2.Dynamic national trends in incidence and mortality rates
of most NCDs
3.Rapid changes in risk of many NCDs among migrant
population
4,Positive results of intervention trials
5.Identification of modifiable risk factors of many NCDs
EPIDEMIOLOGIC TRANSITION
It is the general shift from acute infectious
and nutritional deficiency diseases
characteristic of under development to
chronic NCDs characteristic of
modernization and advanced level of
development.
1. Demographic Changes
• Decrease in infant mortality rate
• Decrease in fertility rate
Both lead to Population aging
2. Urbanization and Socioeconomic
Transformation
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•
•
•
•
•
Changes in community relationships
Changes in life style
Decreased concerns about moral beliefs
Human mobility
Expansion of education
Participation of women in labor force
3. Changes in Nutritional pattern
• Rapid increase in food energy availability and consumption
• Percapita food energy and protein availability had increased by 2
folds
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

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

Availability of:
rice increased by 5 folds
wheat increased by 8 folds
sugar increased by 3 folds
fat increased by 3 folds
No increase in vegetables
Slight increase in fruits
• Obesity is emerging as a major public health problem
4. Others:
• Smoking epidemic
• Increase in alcohol consumption
• Sedentary life style
EPIDEMIOLOGY OF
ARDIOVASCULAR DISEASES
(CVDs)
• Worldwide CVDs are responsible for 1/4th of all
deaths
• In developed countries they are responsible for
50% of all deaths
• In developed countries they are responsible for
23% of all deaths
• Numerically speaking, developing countries are
experiencing more deaths due to CVDs than
developed countries.
In 1990, worldwide about 50 million
deaths had occurred
• CVD
• Resp.Dis
LRTI
COPD
TB
CA-Lung
Asthma+ URTI
29% First leading cause
19% second leading cause
8.5%
4%
4%
2%
0.4%
Developed
Developing
----------------------------------------------50 million deaths
11 million
39 million
•
•
•
•
•
•
CVDs
Resp.Dis.
Lung Cancer
COPD
LRTI
TB
49%( 5,390,000)
12%
5%
3%
3%
0.25%
23 %(8,070,000)
23%
1%
4%
10%
5%
• In EMR including Iraq, the magnitude of
morbidity, mortality, disability, human
suffering and economic cost are huge.
• Demographic, socioeconomic and
behavioral transformation (urbanization,
emergence of modern lifestyle, and
progressive aging) had led to increase
CVDs problem.
• The epidemic of CVDs began in developed
countries in the 1st half of the 20th century;
reaching the peak in 1960s, then started to
decline. In developing countries the curve is still
rising.
• Inter and within country variation in incidence
and mortality from CVDs are correlated with
variation of major risk factors of CVDs.