Welcome to my lessons

Huan Zeng, Associate professor 1751776907@qq.com

School of Public Health and Management, CQMU
 Epidemiology
Epidemiology of
of No
No
n-communicable
n-communicable Dise
Dise
ases
ases(NCD)
(NCD)
 contents
1. What is NCD
2. What is Epi of NCD
3. Prevention and control
4. Research methods
5. Epidemiology of some NCD
What is NCD?
 Concept
• non-infectious and non-transmissible
• of long duration or slow progression
• may result in rapid death
• a group of diseases in representation of
tumor, cardiovascular disease, diabetes ,
COPD (chronic obstructive pulmonary dis
ease ), mental health and so on.
NCD=Chronic disease?
• NCDs are distinguished only by their
non-communicable cause, not
necessarily by their duration

• Some chronic diseases of long

duration, such as HIV/AIDS, are
caused by transmittable infections.
What are the

risk factors?
NCD is mostly caused by
occupational, environmental
and lifestyle factors, such as
smoking, pollution, unhealthy
diet, stress or lack of physical
exercise.
(1)Smoking
(2)Drinking
(3)Diet and fatness: such as fat diet
(4)Lack of exercises
(5)Infection: such as Virus Infection
and Tumor
(6)Genetic factors
(7)Others
Risk Factors:
• in developed countries
in developing countries

Malnutrition Pathogen infection

How about the interaction of the risk
factors?
•Multiple factors
•Complex
•Combined effect
•The occurrence and epidemic of
NCD often relates to combined
effects of risk factors
What is Epi of
NCD?
 The Definition of Epi
• The study of the distribution and
determinants of health-related
states or events in specific
populations, and the application of
this study to control of health
problems.
 The Epi of NCD
• The study of the distribution
and determinants of NCD in
specific populations, and the
application of this study to
control of NCD.
Distribution of disease

17
Top 5 states with
Diabetes
(1)Punjab
(2)Gujarat
(3)Tamil Nadu
(4)Kerala
(5)Uttar Pradesh
 Male Female
Percent Prevalence Age standardized prevalence
40

30 Men - 14.9 %
20 Women -13.2 %
10

0 Age standardized for India

20-29 30-39 40-49 50-59 60-69 70-79
Age
population 2011
 Estimated and projected proportion of
deaths due to non-communicable
diseases, India, 1990-2010
100%
90%
80%
Proportion (%)

70% Injuries
60%
Communicable diseases
50%
40% Non communicable diseases
30%
20%
10%
0%
1990 2000 2010
Year
The World Health Statistics 2019
•NCDs collectively caused 41 million deaths
worldwide in 2016, quivalent to 71% of all global
deaths. Additionally, there were nearly 800 000
deaths from suicide.
•Globally in 2016, the risk of a 30-year-old per
son dying from any of the four major NCDs befo
re reaching the age of 70 years was 21.6% for
men and 15.0% for women.

Challenges!!
Do you know

what are the main four NCDs

worldwide?
The main four NCD worldwide

Cardiovascular disease (CVD),

Cancer
Diabetes
Chronic respiratory disease(CRD)
• The highest risks of premature dea
th from NCDs by WHO region were
seen in the WHO South-East Asia
Region for men (26.5%) and in the
WHO African Region for women (20
.1%),
• whereas the highest risks by nation
al income were in lower-middle-inco
me countries for both sexes (26.6
% for men and 19.9% for women).
In China

• NCD accounts for a majority of

all deaths.
• The patient’s number is high, and
it increase quickly.
• The exposure level of main risk
factors raise continuously.
Prevention and control
 Prevention and control
• Global actions
• Primary prevention
• Secondary prevention
• Tertiary prevention
• Surveillance
 Global action

• In 2012, the World Health

Assembly endorsed an important
new health goal: to reduce
avoidable mortality from non-
communicable diseases (NCDs) by
25% by 2025 (the 25 by 25 goal)
Global Non-communicable Disease
Network

•In order to better coordinate efforts

around the globe, in 2009 the WHO
announced the launch of the Global
Non-communicable Disease Network
NCD Alliance
•The NCD Alliance is a global partnership
founded in May 2009 by four international
federations representing cardiovascular
disease, diabetes, cancer, and chronic
respiratory disease.
•The NCD Alliance brings together roughly 900
national member associations to fight non-
communicable disease.
Long term aims of the Alliance
include:
•NCD/disease national plans for all
•A tobacco free world
•Improved lifestyles
•Strengthened health systems
•Global access to affordable and good
quality medicines and technologies
•Human rights for people with NCDs.
• How about the actions
in your country to
tackle NCDs?
• In general, prevention includes a
wide range of activities — known
as “interventions” — aimed at
reducing risks or threats to
health. These are usually grouped
into three categories.

--Primary prevention,
--Secondary prevention
• --Tertiary prevention
 Primary prevention
To protect healthy people from developing
a disease or experiencing an injury
Before the occurrence.
For example:
•education about good nutrition, the
importance of regular exercise, and the
dangers of tobacco, alcohol and other
drugs
 Primary prevention
For example:
•immunization against infectious
disease
•controlling potential hazards at
home and in the workplace
 Primary prevention
Two-pronged strategy

1.Population strategy
2.High risk strategy(target
at high-risk population)
 Secondary prevention
• Happen after an illness or serious
risk factors have already been
diagnosed.
• Aim to halt or slow the progress of
disease (if possible) in its earliest
stages; in the case of injury, goals
include limiting long-term disability
and preventing re-injury.
Secondary prevention
For example:
•telling people to take daily, low-dose aspirin to
prevent a first or second heart attack or
stroke.
•recommending regular exams and screening
tests in people with known risk factors for
illness.
•providing suitably modified work for injured
workers.
 Tertiary prevention
• Focuses on helping people manage
complicated, long-term health
problems such as diabetes, heart
disease, cancer and chronic
musculoskeletal pain.
• The goals include preventing
further physical deterioration and
maximizing quality of life.
 Tertiary prevention
For example:
•cardiac or stroke rehabilitation
programs
•chronic pain management programs
•patient support groups
• A combination of primary,
secondary and tertiary
interventions are needed to
achieve a meaningful degree of
prevention and protection.
 Surveillance of NCD
Aims
•Study the distribution and diversification
(differs from time, space and countries).
•Reveal the risk factors and explore the
mechanism of disease.
•Put forward and evaluate prevention strategy
Surveillance of new diagnosis
 Which disease
 Which place

 Which population

 Which time

Representative
Continuous
 Example: cancer
 Method to locate new diagnosis
hospitals
pathology laboratories
office records of physician
outpatient treatment facilities
death certificate
 Be useful
 Monitoring historical trends in disease burden
 Identify population subgroups with heavy
burden of disease
 Generating hypotheses about risk factors

 Prioritizing allocation of health resources

 Monitoring process towards health objectives

Research
methods
Research methods

1. Descriptive Study
cross-sectional study, ecological stu
dy,screening, surveillance of disease
2. Analytical study
cohort study
case-control study
3. Experimental Epidemiology
determine the cause finally
evaluate prevention measure
4. Behaviroal Epidemiology

(1)Concept
It‘s the subject focusing on rel
ationship between population behav
ior, disease,health, the influencing
factors and behavior intervention.
(2)Behaviral intervention
determining the target risk
factors, devising the plan and
implementation.

Intervention measures:
Government rule of law, educati
on, school conduction, family adv
ise……
5.The approach of health economics
clarify and resolve the problems
of health service associate with e
conomy

• cost-effectiveness analysis(benefi
t-cost ratio:B/C)
• cost-utility analysis(QALY,DQLY)
• cost-benefit analysis
6. Human genome epidemiology

• Evaluate distribution of
genetic variations of NCD in
different populations.
 Epidemiology of CVD
(cardio-varscular disease)
 First. summary
 CVD refers to a group of vascular disease, i
ncluding myocardial infarction, stroke, hype
rtension, disease of pulmonary circulation an
d peripheral vascular disease.
 a major threat to public health.
 has emerged as the dominant chronic diseas
e in many parts of the world, it is predicte
d to become the main cause of disability an
d death worldwide.
Second. Epidemiology Characteristics
In China it has the fallowing characteristics:

1. An increase in the incidence of the middle aged

2. The incidence, prevalence and mortality are als
o on an increase in rural areas and less economic
ally developed regions
3. The disability caused by cardiovascular disease
is more severe in China than in western countries
4. The incidence and prevalence of cerebral vascul
ar disease are higher than vascular disease of t
he heart whereas an inversed pattern is observe
d in western countries
In most Western societies:

Cardiovascular disease — commonly re

ferred to as heart attack and hyper
tension, respectively — are the maj
or causes of sickness and death.
 Third. Risks
1. hypertension
Hypertension is often a silent
CVD risk factor and its prevalence is
steadily increasing.
The relationship between BP and CVD morb
idity and mortality begins in patients whose BP i
s higher than optimal levels (115/75 mmHg)
2. lipid level

Low high-density lipoprotein cholesterol

(HDL-C) level (<40mg/dl) are associated with
an increased risk of CVD even if the total
cholesterol level is <200mg/dl.
 3. smoking

Smoking represents an important and

rapidly growing avoidable global cause of
CVD and total death. Worldwide more than
1 to 3 billion people smoke cigarette or other
tobacco products.
 4. diabetes mellitus
Diabetes mellitus and impaired glucose
tolerance represent strong risk factors for
vascular disease including CHD.

Diabetes mellitus is also associated

with a number of other CHD risk factors.
Including high triglyceride levels, low
high-density lipoprotein levels, central
obesity and hypertension.
5. physical inactivity
In the developed countries the
widespread prevalence of physical i
nactivity produces a high populatio
n-attributable risk of CVD

In United States approximately 25% of the popu

lation does not participate in any leisure time phys
ical activity and only 22% report engaging in susta
ined physical activity for at least 30 minutes on 5 o
r more days a week.
6. mental stress, depression

7. heredity
Forth.Prevention and control

 Primary prevention
 Seconday prevention
 Tertiary prevention
Approach:

1.Control blood pressure

2.Stabilize lipid level
3.quitting smoking
4.losing weight
5.getting regular exercise
6.managing stress
What have you learned
about NCD?
 Review
1. What is NCD
2. What is Epi of NCD
3. Prevention and control
4. Research methods
5. Epidemiology of CVD