Terms: Epidemiologic Transition

Gaziano 2005

Stage 1 Malnutrition and infectious diseases are the leading causes of mortality and morbidity

Stage 2 Improved nutrition and public health leads to increase in CNCDs

Stage 3 Increased fat and caloric intake, widespread tobacco use, CNCD deaths surpass deaths from infections and malnutrition

Stage 4 CVD and cancer are the leading causes of morbidity and mortality; primary and secondary prevention efforts lead to declines in age-adjusted CVD

Projections of Global Mortality and Burden of Disease from 2002 to 2030. Mathers & Loncar. PLoS Med November 2006 | Volume 3 | Issue 11 | e442.

Disability Adjusted Life Years (DALYs)

Mortality – years of life lost due to the disease

Disability - decrease in healthy or functional years of life due to disease or injury (Experts decide based on previous research that some domain of function is reduced by some percent over so many years due to disease/injury.)

DALYs, thus, are estimates of health lost due to death and disability.

Cause-specific Mortality

Population Reference Bureau (Cohn 2007)

WHO: Facts related to chronic diseases; Yach 2004, Strong 2005

Global Burden of NCDs• Chronic Non-communicable diseases (NCDs) are the major

cause of death and disability worldwide (except in South Asia and Sub-Saharan Africa)

• NCDs now account for 59% of all deaths and 48% of the global burden of disease

• Death rates for NCDs are higher in the developing world compared to the developed world

• Top diseases:• Cardiovascular disease • Cancer• Chronic respiratory diseases• Type 2 Diabetes• Obesity • Mental health and psychiatric conditions

Increase in ‘Dual Burden’ in LMIC• Low and middle income countries (LMIC) are now and will

suffer increasingly from the dual presence of both infectious/communicable diseases and NCDs

• Child survival to age 5 years• TB, HIV, malaria• Adult, esp age 40-80 yrs, hypertension, obesity, type 2

diabetes, coronary artery disease• Risk behaviors – tobacco use, excess alcohol use, risky

sexual exposures

• Impact on design of health care systems, both clinical and public health

• Need for broader range of clinical specialists, esp for NCDs