Epidemiology and Prevention:

Chronic Non-communicable
Diseases
 Cindie Rose T. Tumlos M.D.
Bachelor of Science in Medical Biology
Filamer Christian University
SY 2021-2022 Second Semester
Prayer
Heavenly Father, we are grateful for this opportunity to
learn together and we ask for your guidance, grace, and comfort.
As we go on through our lessons today, please enlighten our
minds, that we may be able to understand it.
 We thank you for the ability to study and for many gifts and
talents you have given us. Help us always to use them in such a
way that they honor You. In Jesus’ name. Amen

ATTENDANCE
 Chronic disease epidemiology:
the basis of prevention
• Chronic diseases are the major cause of death in almost all
countries and account for 36 million deaths each year

• 61% of the world’s deaths

• 48% of the global burden of disease
Chronic disease epidemiology: the basis of
prevention
The leading chronic diseases are:
• cardiovascular disease (CVD), especially coronary heart disease
and stroke (17.5 million deaths)
• cancer (7.5 million deaths)
• chronic respiratory disease (4 million deaths)
• diabetes (1.1 million deaths)
• Injuries – 1/10 of deaths –traffic crashes, occupational
injuries and interpersonal violence
• Mental health
• Visual impairment and blindness
• Hearing impairment and deafness, oral diseases
• Genetic disorders
• Myocardial infarct, stroke and diabetes will account for
four in ten deaths among adults (35–64 years) •
Projections suggest that over the next 10 years deaths
due to chronic noncommunicable diseases will increase
by 17%
 Causation framework

•
Epidemiology helps to identify modifiable
causes of disease
Social determinants of health
• The social determinants of health are the conditions in which
people live and work.
• Addressing social determinants is fairest way to improve health
for all people
• Good medical care is vital
• Social position, housing conditions and occupational risks
 Natural History

• Agent
• Time frame
• Nature of the disease
• Synergism in disease causation
AGENT CHARACTERISTICS
• Absence of a single necessary agent
• Known “causes” are risk factors
– Obesity
– Elevated cholesterol levels
– Hypertension
Major categories of etiological agents
 occupational environment lifestyle = LIFE

TIME
FRAME
• Years or
decades
• No
multiplication of causative agent •
Multiple low dose exposures (chemicals)
NATURE OF THE DISEASE
• “CHRONIC DISEASE”
• Permanent
• Leaves residual disability
• Caused by nonreversible pathological alterations •
Requires long periods of care, supervision or observation
Synergism in disease causation
• Asbestos and lung cancer (Risk ratio = 8)
• Smoking + asbestos and lung cancer (Risk ratio = 90) •
produces illness in the prime of life even with low level
exposures
ESTIMATED GLOBAL WORK RELATED

MORTALITY INJURIES 25%

RESPIRATORY 21%
OTHERS 8% HEART

DISEASE 19% CANCER 34%

 Definition of
Prevention

Actions aimed at eradicating, eliminating or

minimizing the impact of disease and
disability
 Levels of prevention
Primordial
Primary
 Secondary
Tertiary
Primordial prevention
• Consists of actions to modify population health determinants
and inhibit the establishments factors known to increase the
future risk of disease
• It addresses determinants at the systemic level rather than
modifying personal risk factors.
• Examples
 – Improve sanitation
– Promoting lifestyles
Primordial prevention
Aim:
• Avoid the spread of unhealthy lifestyles and consumption
patterns
• National policies and programs on nutrition •
Programs to promote regular physical activity
Primary prevention
• The purpose of primary prevention is to limit the incidence of
disease by controlling specific causes and risk factors. •
Involves preventing the development of the disease among
those known to be risk.
• More than half of the Filipinos population is at risk of
developing cancer, diabetes mellitus and cardiovascular
disease
Secondary prevention
• Secondary prevention aims to reduce the more serious
consequences of disease through early diagnosis and
 treatment
• It is directed at the period between the onset of disease
and the normal time of diagnosis, and aims to reduce
the prevalence of disease
Secondary prevention
• Implies early detection and prompt treatment of disease
in order to prevent the onset of complications or other
disease conditions in those who already have the disease
–Hypertensive patients- compliance to therapy is important in
order to prevent progression to heart attack or
stroke • Periodic health examination
• Screening for disease is the major component of the
physician’s overall preventive responsibility
Tertiary prevention
• Tertiary prevention is aimed at reducing the progress or
complications of established disease and is an
important aspect of therapeutic and rehabilitation
medicine
• Measures intended to reduce impairments and
disabilities, minimize suffering
 Tertiary prevention
• Involves preventing further disability and providing
access to rehabilitation services among those with
complications from cancer, cardiovascular disease and
diabetes
PRIMORDIAL PRIMARY SECONDARY treatment
PREVENTION PREVENTION PREVENTION TERTIARY
• Prevent • Prevent onset of
PREVENTION
• Early
development of risk disease diagnosis and prompt • Reduce
factors morbidity and mortality

Screening
• Screening people for disease – or risk factors which
predict disease – is motivated by the potential benefits
of secondary prevention through early detection and
treatment
Definition
• Screening is the process of using tests on a large scale
to identify the presence of disease in apparently healthy
people.
• Screening tests do not usually establish a diagnosis, but
rather the presence or absence of an identified risk
 factor, and thus require individual follow-up and
treatment.
• Screening can also be used to identify high exposure to
risk factors.
Types of screening
There are different types of screening, each with specific aims: •
mass screening aims to screen the whole population • multiple
or multiphasic screening uses several screening tests at the
same time
• targeted screening of groups with specific exposures, e.g.
workers in lead battery factories, is often used in
 environmental and occupational health
• case-finding or opportunistic screening is aimed at patients
who consult a health practitioner for some other purpose
Screening test
• A test is reliable if it provides consistent results, and valid if it
correctly categorizes people into groups with and without
disease, as measured by its sensitivity and specificity.
• Sensitivity is the proportion of people with the disease in the
screened population who are identified as ill by the screening
test. (When the disease is present, how often does the test detect it?)
• Specificity is the proportion of disease-free people who are so
identified by the screening test. (When the disease is absent, how
often does the test provide a negative result?)
Sensitivity
• Ability of the test to correctly identify patients who have the
disease
• The percentage of “true positive” results

Specificity
• Ability of the test to correctly identify patients who do not
have the disease
• The percentage of “true negative” results
Answer Key
Which is not a type of level of prevention
a. Primordial
b. Primary
c. Secondary
d. Tertiary
e. Quarternary
Answer Key
• Implement blood pressure and cholesterol
monitoring/screening- Prevention
Secondary
• Develop a community based exercise program for obese,
hypertensive and diabetic Tertiary Prevention
patients-
• Provide health education in the local area for prevention of
disease related to multiuse of Primary Prevention
needles-
• Promoting healthy Primordial Prevention
lifestyle
Thank you!
• Give examples/types of NCDs?
• Characteristics of NCDs? •
Modifiable risk factors? •
Non-modifiable risk factors?