Dr Ashoo Grover

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Dr Ashoo Grover

  1. 1. Burden of NCDs in India<br />Burden of NCDs in India<br />Dr. Ashoo Grover<br />Scientist<br />ICMR Headquarters, Delhi<br />
  2. 2. THE WORLD HEALTH IS IN TRANSITION<br />EPIDEMIOLOGICAL : NCDS OVERRIDING <br /> INFECTIOUS DISEASES AND DOUBLE <br /> BURDEN OF DISEASES IN MANYDEVELOPING COUNTRIES<br />LIFESTYLES: TOBACCO USE IS INCREASING DIETS ARE RAPIDLY CHANGING PHYSICAL ACTIVITY REDUCING ALCOHOL USE INCREASING OBESITY, DIABETES, HYPERTENSION ARE INCREASING IN MOST PARTS OF THE WORLD,WHILE UNDER-NUTRITION REMAINS A SEVERE ISSUE<br />DEMOGRAPHIC : POPULATION AGEING.<br />GLOBALIZATION : INCREASING GLOBAL INFLUENCES<br />
  3. 3. HEALTH TRANSITION contd……<br />Rapid urbanization<br />Increased industrialization<br />Rising incomes<br />Expanded education, and<br />Improved health care. <br />Improved public health measures have resulted in the control of many infectious diseases, and reduction in mortality and fertility<br />
  4. 4. COMMUNICABLE VERSUS NON-COMMUNICABLE DISEASES<br />Communicable diseases<br />Sudden onset<br />Single cause<br />Short natural history<br />Short treatment schedule<br />Cure is achieved<br />Single discipline<br />Short follow up<br />Back to normalcy<br />Non-communicable diseases<br />Gradual onset<br />Multiple causes<br />Long natural history<br />Prolonged treatment<br />Care predominates<br />Multidisciplinary<br />Prolonged follow up<br />Quality of life after treatment<br />
  5. 5. THE GLOBAL NCD REALITY<br /><ul><li>NONCOMMUNICABLE DISEASE CONTRIBUTE 60 % OF DEATHS AND 43 % OF THE GLOBAL BURDEN OF DISEASE. ALREADY 79% OF THESE NCDS ARE OCCURRING IN DEVELOPING COUNTRIES.
  6. 6. BY 2020 THESE DEATHS WILL ACCOUNT FOR 73% DEATHS AND 60% OF THE DISEASE BURDEN.
  7. 7. HALF OF THESE DEATHS ARE ATTRIBUTABLE TO CARDIOVASCULAR DISEASES.
  8. 8. THERE ARE MORE CVD DEATHS IN INDIA OR CHINA THAN IN ALL DEVELOPED COUNTRIES ADDED TOGETHER.</li></li></ul><li>WORLD Mortality <br />BY BROAD CAUSE GROUP, 2001<br />Total deaths: 56,554,000<br />Noncommunicable<br />conditions<br />(33.1 million)<br />Injuries<br />(5.1 million)<br />Communicable diseases, maternal and perinatal conditions and nutritional deficiencies<br />(18.4 million)<br />Source: WHR 2002<br />
  9. 9. DISTRIBUTION OF CAUSES OF DEATH<br />WORLD, 2001<br />Total deaths: 56,554,000<br />Other NCDs<br />Respiratory infections<br />Respiratory diseases<br />Neuropsychiatric disorders<br />HIV/AIDS<br />Digestive diseases<br />Perinatal conditions<br />Malignant neoplasms<br />Diarrhoeal diseases<br />Tuberculosis<br />Childhood diseases<br />Diabetes<br />Malaria<br />Maternal conditions<br />Nutritional deficiencies<br />Other CD causes<br />Injuries<br />Cardiovascular diseases<br />Source: WHR 2002<br />
  10. 10. WORLD, DALY’s, <br />BY BROAD CAUSE GROUP, 2001<br />Noncommunicable<br />conditions<br />Injuries<br />Communicable diseases, maternal and perinatal conditions and nutritional deficiencies<br />Source: WHR 2002<br />
  11. 11. DISEASE BURDEN (DALY’s)<br />WORLD, 2001<br />Maternal conditions<br />Perinatal conditions<br />Nutritional deficiencies<br />Respiratory infections<br />Other NCDs<br />Malaria<br />Malignant neoplasms<br />Childhood diseases<br />Diabetes<br />Diarrhoeal diseases<br />Neuropsychiatric<br /> disorders<br />HIV/AIDS<br />Tuberculosis<br />Other CD causes<br />Sense organ disorders<br />Cardiovascular diseases<br />Injuries<br />Respiratory diseases<br />Congenital abnormalities<br />Digestive diseases<br />Musculoskeletal diseases<br />Diseases of the genitourinary<br /> system<br />Source: WHR 2002<br />
  12. 12. Mortality <br />BY BROAD CAUSE GROUP AND WHO REGION, 2001<br />Communicable diseases, maternal and perinatal conditions and nutritional deficiencies<br />Noncommunicable<br />conditions<br />Injuries<br />75%<br />50%<br />25%<br />AFR<br />AMR<br />EMR<br />EUR<br />SEAR<br />WPR<br />Source: WHR 2002<br />
  13. 13. DALY’s<br />BY BROAD CAUSE GROUP AND WHO REGION, 2001<br />Communicable diseases, maternal and perinatal conditions and nutritional deficiencies<br />Noncommunicable<br />conditions<br />Injuries<br />75%<br />50%<br />25%<br />AFR<br />AMR<br />EMR<br />EUR<br />SEAR<br />WPR<br />Source: WHR 2002<br />
  14. 14. <ul><li>Major NCDs responsible for some 19 million deaths worldwide annually
  15. 15. both the developed and developing world sharing the burden more or less equally.
  16. 16. All NCDs, account for at least 40 % of all deaths in developing countries and 75% in industrialized countries
  17. 17. Cardiovascular diseases (CVDs) are the first cause of mortality
  18. 18. Cancer is the third one</li></li></ul><li>Estimated and projected proportion of deaths due to non-communicable diseases, India, 1990-2010<br />100%<br />90%<br />80%<br />70%<br />Injuries<br />60%<br />Communicable diseases<br />Proportion (%)<br />50%<br />40%<br />Non communicable diseases<br />30%<br />20%<br />10%<br />0%<br />1990<br />2000<br />2010<br />Year<br />
  19. 19. Stroke<br />Ischemic heart diseases<br />Diabetes<br />Burden of major non-communicable diseases, India, 2004<br />
  20. 20. Six key “risk factors” for Non-Communicable Diseases<br />Tobacco use in any form (smoking ,chewing, snuff).<br />Alcohol abuse<br />Life-style changes (easy dietary patterns, physical inactivity)<br />Environmental risk factors e.g. air and water pollution, occupational hazards <br />Failure or inability to obtain preventing health services (e.g. for hypertension control, tobacco control, management of diabetes etc.<br />Stress factors<br />
  21. 21. Lifestyle Risk factors <br />Improper nutrition <br />Sedentary life<br />Alcohol and <br />Tobacco<br />
  22. 22. Cancer Scenario-India<br />2.5-3 million cases of cancer<br />8 million detected in 2001<br />3-3.5 lakh deaths each year<br />500% increase in cancer in India by 2025<br />280% due to ageing and 220% due to tobacco use<br />Tobacco related cancers 50% (males) and 25% (females)<br />2/3rd are advanced at the time of diagnosis<br />
  23. 23. Estimated Number of Incident Cancers in India, 2001<br />
  24. 24. Cancer facts and figures<br />One in about 15 men and one in about 12 women in the urban areas could develop cancer in their lifetime<br />Cervical cancer and breast cancer are the commonest in females. The latter is more than former in Mumbai and Delhi<br />Cancer lung is the commonest out of all tobacco related cancers in men<br />Cancer of the oesophagus highest in women in Bangalore (8.3/100,000) <br />
  25. 25. Tobacco Use – Global Scenario<br />1.2 billion users, expected to rise to 1.6 by the next two decades <br />3.5 to 4 million deaths annually due to tobacco use expected to rise to 10 million in 2020s.<br /> 7 million in developing countries.<br />
  26. 26. Tobacco Use in India<br />No. of tobacco Users in India.<br />150 Million Men<br />34 Million women<br />No. of smokers<br />105 Million Men<br />7 Million Women<br />No. of Smokeless Tobacco Users<br />66 Million Men <br />30 Million Women<br />
  27. 27. CHD prevalence studies in India<br />Urban<br />Rural<br />
  28. 28. Cardio-vascular diseases (CVD)<br />Morbidity and mortality data<br />CHD deaths=8 lakhs<br />Stroke deaths=6 lakhs<br />Hypertension= 10-15 %<br />RHD deaths=1.5 lakhs<br />RHD prevalence=1-5/1000 (5-15 years)<br />CVD and stroke deaths 23%<br />Source: WHO infobase<br />
  29. 29. Burden of Rheumatic Fever/Rheumatic Heart Disease<br />5.4/100,000<br />2.9/100,000<br />1.0/100,000<br />
  30. 30. Projected proportional increase in population > 65 years age, 2000-2030<br />Italy<br />Japan<br />UK<br />USA<br />China<br />India<br />Chile<br />Mexico<br />0%<br />50%<br />100%<br />150%<br />200%<br />250%<br />Proportion (%)<br />Social Determinants of Health Inequalities, Marmot M, Lancet 2005<br />
  31. 31. Projected population pyramid of India<br />
  32. 32. Growth of elderly population aged 60 and over, by sex, in India 1901-2001<br />
  33. 33. (Source: ICMR Collaboraitve Studies)<br />Estimated Load of NCDs in Older Persons(in millions)<br />
  34. 34. (Source: World Bank Health Sectoral Priorities Review)<br />Estimated and projected mortality rates (per 100,000) by major causes of death in 60+ population INDIA<br />
  35. 35. ESTIMATED BURDEN OF NEUROLOGICAL DISORDERS IN INDIA<br />
  36. 36. Severe mental morbidity in India<br />
  37. 37. Blindness<br /><ul><li>Nationwide study in 1970s for the first time provided figures for blindness in the country
  38. 38. The national program for control of blindness was initiated on this basis</li></ul>Cataract was the commonest --due to senile degeneration<br />
  39. 39. Cataract<br />Study on cataract prevalence found different figures for different areas<br />Increasing backlog of cataract due to less surgeries<br />Different strategies applicable to different areas<br />
  40. 40. Burden of diabetes<br />In the developing countries <br />majority of people with diabetes are in the age range 45-64 years<br />diabetes will be increasingly concentrated in the urban areas<br />Increasingly, there would be more women than men with diabetes<br />DALYS 5.3 millions<br />
  41. 41. Burden of Diabetes in India<br />Mortality Number of deaths (000)<br />Diabetes as a cause 104<br />Attributable to DM 473.7<br />DALYS 5.3 million<br />Murray, Lopez. 1996<br />
  42. 42. Prevalence of Type 2 DM in India<br />Year Author Place Prevalence <br /> urban rural<br /> Tripathi Cuttack 1.2 -<br /> Ahuja N. Delhi 2.3 -<br /> Gupta Multi-centric 3.0 1.3<br /> Murthy Tenali 4.7 -<br /> Ramachandran Kudramukh 5.0 -<br /> Rao, PV Multicentric - 2.8<br /> Ramachandran Chennai 11.6 -<br /> Reddy, KS Delhi 11.0 2.7<br />2000 NUDS (DESI) Multicentric 13.2 -<br />
  43. 43. Prevalence of Type 2 diabetes in India<br />Source: King H et al - Global burden of diabetes 1995-2025 Diabetes Care1998;21:1414-1431.<br />
  44. 44. NON COMMUNICABLE DISEASE PROGRAMMES IN INDIA<br />National cancer control programme<br />National mental health programme <br />National blindness control programme<br />Cardiovascular diseases, stroke and diabetes programme <br />Trauma and accident programme <br />Oral health programme <br />Rehabilitation programme <br />Geriatric care programme <br />
  45. 45. Sources of NCD related data in India<br />
  46. 46. EXISTING REPORTING SYSTEMS FOR NON COMMUNICABLE DISEASES IN INDIA<br />Sentinel surveillance systems<br />National Cancer Registry Programme<br />Periodic surveys/studies<br />Census of India<br />Sample registration systems<br />National sample surveys<br />National family health survey<br />National nutrition monitoring programme<br />
  47. 47. SOURCES OF DATA COLLECTION FOR NON COMMUNICABLE DISEASES IN INDIA<br />Mortality data<br />Medical certificates for death<br />Cause of death surveys<br />Hospital records<br />Morbidity data<br />Registry (Cancer)<br />Special surveys<br />Hospital reports<br />Risk factors<br />Special surveys<br />Registries<br />Cancer (Shift from hospital to community based)<br />RF/RHD (Jai Vigyan Mission)<br />Thalasemia (Jai Vigyan Mission)<br />
  48. 48. NCD Mortality Profile 1998 (Source: WHO NCD Info-base)<br />
  49. 49. NCD Morbidity Profile in India 1998<br />
  50. 50. NCD Risk Factors in India<br />
  51. 51. HETEROGENEITY OF NON-COMMUNICABLE RISK FACTORS IN INDIA<br />Kerala<br />High literacy rate, developed<br />Different<br />dietary <br />patterns<br />Metropolitan city, highly <br />urbanized, heterogeneous <br />population<br />Delhi<br />Different<br />body<br />composition<br />Nested population<br />Terrain, relatively <br />underdeveloped<br />Jammu&<br />Kashmir<br />Different<br />habits<br />Nested population<br />Underdeveloped, Tribes and<br />Terrain<br />Nagaland<br />Bihar<br />Illiterate, Poor population<br />Rural, Agricultural, Tribals<br />
  52. 52. Challenges<br />Huge population<br />Many programmes<br />Rural population<br />Emerging epidemics<br />Unemployed youth<br />Burden of non communicable diseases<br />Opportunity<br />Good sample size<br />Different strategies<br />Complex exposures<br />Interventions<br />Trained workforce<br />Challenges and opportunities<br />
  53. 53. Foetallife<br />Infancy andchildhood<br /> Adolescence <br />Adult Life<br /><ul><li>Established adult risk factors</li></ul>(behavioural/biological)<br /><ul><li>Obesity
  54. 54. Lack of activity
  55. 55. Diet
  56. 56. Alcohol,
  57. 57. Smoking
  58. 58. SE potential</li></ul>Development of non communicable diseases<br /><ul><li>SES
  59. 59. Nutrition
  60. 60. Diseases
  61. 61. Linear growth
  62. 62. Obesity</li></ul>Range of <br />individual <br />risk<br /><ul><li>SES
  63. 63. Maternal nutritional status & obesity,
  64. 64. Fetal growth</li></ul>Accumulated risk<br />Accumulated risk<br />Age<br />Life course approach for the prevention of non communicable diseases<br />
  65. 65. Public health interventions<br />Educational interventions<br />Policy interventions <br />Health beliefs and behaviours (Community; Individual)<br />Enabling environment<br />(Financial, Social, Physical)<br />Desired change<br />
  66. 66. FACTS ABOUT NCDS<br />The burden of diseases due to non communicable diseases in India became almost equal to that due to communicable diseases in 1990<br />The burden of non communicable diseases is increasing while it is declining in developed countries because of surveillance and interventions<br />The life style related modifiable risk factors for non communicable diseases have been identified and the magnitude of their impact is documented<br />
  67. 67. FACTS ABOUT NCDS<br />The major non communicable diseases share common, preventable life style risk factors <br />There is sound evidence that non communicable diseases can be reduced through a package of simple, effective and feasible life style changes<br />The treatment of non communicable diseases is expensive and therefore the key to control is in its primary prevention <br />
  68. 68. THANK YOU<br />

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