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
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

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
CARDIOVASCULAR 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 29% First leading cause
Resp.Dis 19% second leading cause
LRTI 8.5%
COPD 4%
TB 4%
CA-Lung 2%
Asthma+ URTI 0.4%
Developed Developing
----------------------------------------------------
50 million deaths 11 million 39 million
CVDs 49%( 5,390,000) 23 %(8,070,000)
Resp.Dis. 12% 23%
Lung Cancer 5% 1%
COPD 3% 4%
LRTI 3% 10%
TB 0.25% 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.