Non Communicable Diseases

Epidemiology

Abigiya Wondimagegnehu

Department of Preventive Medicine

School of Public Health
CHS, AAU
 General Objectives

After the end of this session, students will be able to:

▪ Define NCDs and understand it’s characteristics

▪ Comprehend the global burden of NCDs
▪ Identify common risk factors of NCD’s

▪ Realize the association between SES and NCDs (Gender &

NCDs)
▪ Describe the global and national polices and action plans
Definition

• Non communicable diseases (NCD), also known as chronic diseases,

tend to be of long duration and are the result of a combination of genetic,
physiological, environmental and behavioural factors. (WHO, 2023)

• Are diseases that is not transmissible directly from one person to another.

• The term NCDs refers to a group of conditions that are not mainly caused
by an acute infection, result in long-term health consequences and often
create a need for long-term treatment and care. (PAHO, 2023)

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 Characteristics of NCDs

• Complex etiology (causes)

• Multiple risk factors
• Long latency period
• Non-contagious origin (noncommunicable)
• Prolonged course of illness
• Multimorbidity
• Functional impairment or disability

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Epidemiology

• NCDs kill 41 million people each year, equivalent to 74% of all deaths
globally.

• Of all NCD deaths, 77% (31.4 million) are in low- and middle-income
countries.

• Each year, 17 million people die from a NCD before age 70; 86% of these
premature deaths occur in low- and middle-income countries.

(WHO, 2023)

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Epi con…
• Cardiovascular diseases account for most NCD deaths, or 17.9 million
people annually, followed by

✓Cancers (9.3 million),

✓Chronic respiratory diseases (4.1 million), and
✓Diabetes (2.0 million including kidney disease deaths caused by
diabetes).

• These four groups of diseases account for over 80% of all premature NCD
deaths.

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What are the main non-communicable diseases?
Heart disease and stroke Cancer

Diabetes Chronic respiratory

disease
Cardiovascular diseases

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 Types of Cardiovascular Diseases
Cardiovascular diseases (CVDs) are a group of disorders of the heart and
blood vessels. These include:

▪ Coronary heart disease (CHD, ischemic heart disease, heart attack,

myocardial infarction, angina pectoris)
▪ Cerebrovascular disease (stroke, transient ischemic attack)
▪ Hypertensive heart disease
▪ Peripheral vascular disease
▪ Heart failure
▪ Rheumatic heart disease (streptococcal infection)
▪ Congenital heart disease
▪ Cardiomyopathies
 Epidemiology of CVDs
• CVDs are the leading cause of death globally.

• More than half a billion people around the world continue to be affected by
CVDs, which accounted for 20.5 million deaths in 2021 – close to a third of all
deaths globally. Of these deaths, 85% were due to heart attack and stroke.

• Ischaemic heart disease is now the leading cause of premature death in 146
countries for men and 98 countries for women.

• Over three quarters of CVD deaths take place in low- and middle-income
countries.
(world heart report, 2023)

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 Facilitator
Abigiya W (MPH, PhD Fellow )
 Definition
Diabetes is a chronic disease that occurs:
▪ When the pancreas does not produce enough insulin*
▪ When the body cannot effectively use the insulin

*Insulin: A hormone that regulates blood sugar, or glucose.

Hyperglycemia, or raised blood sugar, is a common effect of uncontrolled

diabetes and over time leads to serious damage to many of the body's systems,
especially the nerves and blood vessels.

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 Classification
▪ Type 1 diabetes:
Formerly referred to as insulin- dependent diabetes mellitus (IDDM) or juvenile-
onset diabetes, usually arises in childhood.
▪ Type 2 diabetes:
Formerly called non-insulin-dependent diabetes mellitus (NIDDM) or adult-onset
diabetes, usually occurs after age 40 and becomes more common with increasing
age.

▪ Gestational diabetes:
Other types of diabetes that develops during pregnancy (gestation), which affects
cell use of glucose.

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Estimated total number of adults (20–79 years) with diabetes in 2021

•Approximately 537 million adults are living with diabetes

•Projected to rise to 643 million by 2030 & 783 million by 2045
•3 in 4 adults with diabetes live in LMICs
•541 million adults are at increased risk of developing type 2 DM

Source: IDF, 2022

Proportion of total deaths related to diabetes among people under 60

Source: IDF, 2022

 Cancer
▪Normal cells that have • Cancer is a generic term for a large
changed into cells of; group of diseases indicating a rapid
creation of abnormal cells that grow
• Uncontrolled growth beyond their usual boundaries, and
• Invasive growth which can then invade adjoining parts
• Ability to grow at distance of of the body and spread to other organs
origin

Normal cells Cancerous cells

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 Cancer incidence and mortality worldwide

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Source: Globocan 2020
Cancer as a Cause of Death at Ages < 70 years in 2019

•The global cancer burden is expected to be 28.4 million cases in 2040, a

47% rise from 2020, with a larger increase in transitioning (64% to 95%)
versus transitioned (32% to 56%) countries.

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 COPD: An umbrella term
▪ Chronic Obstructive Pulmonary Disease

▪ A progressive disease that affects the lungs,

▪It is an under-diagnosed, life-threatening lung disease and is not
fully reversible.
▪ is a combination of several different but related diseases,
principally chronic bronchitis and emphysema, which are
primarily characterized by difficulty in breathing.
 Chronic Bronchitis vs. Emphysema

Chronic bronchitis Emphysema:

Characterized by a long-term Characterized by destruction of the
cough with mucous production lungs overtime
Epidemiology

• is the third leading cause of death worldwide, causing 3.23 million deaths
in 2019.

• Nearly 90% of COPD deaths in those under 70 years of age occur in low-
and middle-income countries (LMIC).

• Tobacco smoking accounts for over 70% of COPD cases in high-income

countries. In LMIC tobacco smoking accounts for 30–40% of COPD cases.
(WHO, 2023)

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 Risk factors of NCDs

1. Modifiable risk factors: A behavioral risk factor that can be reduced or

controlled by intervention, thereby reducing the probability of disease.
Example: Diet, exercise

2. Non-Modifiable risk factors: A risk factor that cannot be reduced or

controlled by intervention; for example: age, gender, race, and family
history (genetics).

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 Obesity

• Obesity is the most important risk

factor for DM, CVDs, cancers.

• In several studies overweight and

obesity are significantly associated.

• The strength of association varies

across the different NCDs.
 Physical inactivity

▪ Convincing epidemiologic data support

the role of physical activity in preventing
DM and CVDs.

▪ Sedentary behaviours such as

prolonged television watching are
strongly associated with obesity, weight
gain, and risk of NCDs.
 Smoking

▪ Several prospective studies showed

that smoking is causal for Lung
cancer, and a major risk factor for
COPD and modestly increases the
risk of DM, CVD and other types of
cancers
Alcohol consumption
 Stress
▪ Increased mental stress and
activation of the physiologic stress
response from chronic exposure to
stressors, low socioeconomic status
(SES), severe mental health
problems, traumatic events, with
depression or aggressive behaviour
increases the risk of NCDs.
 Unhealthy diet

• Western pattern, characterized

by high consumption of red
meat, processed meat, french
fries, high-fat dairy products,
refined grains, sweets and
desserts, was associated with
an increased risk.
 NCDs & Risk Factors

“Lifestyle diseases” caused by “behaviours”

Socioeconomic status and Non Communicable Diseases

▪ Many studies indicated that lower socioeconomic status and poor health
status are positively associated

▪ Poverty exposes people to NCDs because these people are unable to

practice healthy life-style behavior

▪ Also NCDs expose people to poverty because of the expenses they

incurred for long term treatment
Socioeconomic status and NCDs
 Gender and NCDs

▪ The prevalence of NCDs among women is considerable but does not get
attention of researchers and policy makers.
▪ Combination of our body parts and chromosomes. Eg : during pregnancy

▪ Gender neutrality of policies, research and education programs.

▪ Because of these poorer outcomes for women are observed and gender
inequities increased.

▪ Women with diabetes have high risk of stroke and poor survival
Gender Equality
Earning low income
because of the pay gap
At-risk-of-poverty

Not equal income

distribution

Low Self perceived health

Status Life expectancy

Healthy life years

Access Unmet medical needs

Social and Economic burden of NCDs
 Sustainable Development Goal

SDG Target 3.4 | Noncommunicable diseases and mental health:

By 2030, reduce by one third premature mortality from non-
communicable diseases through prevention and treatment and
promote mental health and well-being

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Economic burden of NCDs
 Social burden of NCD’s
▪ As indicated below, NCDs reduces patients’ social involvement and their visibility in
their community.
 Global Policies and actions plan

1. Global action plan for the prevention and

control of NCDs 2013-2020

• Developed by WHO
• Eight years plan
• Has six objectives
• Many countries including Ethiopia, developed their action plan
according to this.
 Six objectives
To raise the priority accorded to the prevention and control of noncommunicable
Obj 1 diseases in global, regional and national agendas and internationally agreed
development goals, through strengthened international cooperation and advocacy

To strengthen national capacity, leadership, governance, multisectoral action and

Obj 2 partnerships to accelerate country response for the prevention and control of
noncommunicable diseases

Obj 3 To reduce modifiable risk factors for noncommunicable diseases and underlying
social determinants through creation of health-promoting environments

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 Obj con…

To strengthen and orient health systems to address the prevention and control of
Obj 4 noncommunicable diseases and the underlying social determinants through people-
centred primary health care and universal health coverage

Obj 5 To promote and support national capacity for high-quality research and development
for the prevention and control of noncommunicable diseases

Obj 6 To monitor the trends and determinants of noncommunicable diseases and evaluate
progress in their prevention and control

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 WHO NCD best buys

1. Increase excise taxes and prices on tobacco products.

2. Implement plain/standardized packaging and/or large graphic health
warnings on all tobacco packages.

3. Enact and enforce comprehensive bans on tobacco advertising,

promotion and sponsorship.
4. Eliminate exposure to second-hand tobacco smoke in all indoor
workplaces, public places and public transport.
5. Implement effective mass-media campaigns that educate the public
about the harms of smoking/tobacco use and second-hand smoke.

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 Con…
6. Increase excise taxes on alcoholic beverages.
7. Enact and enforce bans or comprehensive restrictions on exposure to alcohol
advertising (across multiple types of media).
8. Enact and enforce restrictions on the physical availability of alcohol in sales
outlets (via reduced hours of sale).

9. Reduce salt intake through the reformulation of food products to contain less
salt, and the setting of maximum permitted levels for the amount of salt in food.
10. Reduce salt intake through establishing a supportive environment in public
institutions such as hospitals, schools, workplaces and nursing homes, to
enable low-salt options to be provided.

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 Con…

11. Reduce salt intake through behavior change communication and mass-media
campaigns.

12. Reduce salt intake through the implementation of front-of-pack labelling.

13. Implement community-wide public education and awareness campaigns for

physical activity, including mass-media campaigns combined with other
community-based education, motivational and environmental programmes
aimed at supporting behavioral change around physical-activity levels.

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 Con…
14. Provide drug therapy (including glycemic control for diabetes mellitus and control
of hypertension using a total-risk approach) and counselling for individuals who
have had a heart attack or stroke and for persons with high risk (≥ 30%) of a fatal
or non-fatal cardiovascular event in the next 10 years.

15. Vaccination against human papillomavirus (two doses) of girls aged 9 to 13 years.

16. Prevention of cervical cancer by screening women aged 30 to 49 years, either

through visual inspection with acetic acid linked with timely treatment of
precancerous lesions; pap smear (cervical cytology) every 3 to 5 years, linked
with timely treatment of precancerous lesions; human papillomavirus tests every
5 years, linked with timely treatment of precancerous lesions.”

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 Reading Assignment

• National NCD control plan

• National Cancer control plan
• Disease specific guidelines
• NCD steps survey on risk factors
• Progress and overall achievement compared to the global target and
SDGs
• NCD and infections including COVID-19

• Relevant NCD documents are in the reading files folder!!!

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 References

1. WHO. Noncommunicable Diseases Progress Monitor Geneva: World Health

Organization, 2020.
2. World Health Organization. Tackling NCDs: ’best buys’ and other recommended
interventions for the prevention and control of noncommunicable diseases. World
Health Organization; 2017. https:// apps.who.int/iris/handle/10665/259232.
3. Sustainable Development Goal 3. Ensure healthy lives and promote well-being for all
at all ages. Progress Inform; 2018. https:// sustainabledevelopment.un.org/sdg3.

4. World Health Organization. Global Action Plan for the prevention and control of
noncommunicable diseases, 2013-2020. https://
www.who.int/nmh/events/ncd_action_plan/en/; 2013.
5. WHO. Scaling up action against noncommunicable diseases: how much will it cost?
Geneva: World Health Organization, 2011.
 References
6. Martine Audibert, Pascale Combes Motel, Alassane Drabo. Global burden of disease
and economic growth. CERDI, Etudes et Documents,. 2012;12.
7. WHO. Who Guide to Identifying The Economic Consequences of Disease and Injury.
Geneva, Switzerland.: WHO, 2009.
8. World Economic Form, WHO. From burden to best buys. Reducing the economic impact
of NCD in LMIC. Geneva: World Economic Forum.
9. World cancer declaration progress report. Tomorrow is now: our journey to 2025.
https://www.uicc.org/wcd-report; 2016.
10. NCD Alliance. Ensuring healthy lives for all: noncommunicable diseases and universal
health coverage. https://ncdalliance.org/ resources/ensuring-healthy-lives-for-all-ncds-
and-uhc.
11. World Heart report 2023 confronting the world’s number one killer
12. GLOBOCAN 2020
13. International Diabetic Federation 2022 Atlas
Thank you