NSM-NCD2013 Symposium 1 - NCD in Malaysia - A Rising Trend

5,029
-1

Published on

By Dr Tahir Aris

Published in: Health & Medicine
0 Comments
2 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
5,029
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
324
Comments
0
Likes
2
Embeds 0
No embeds

No notes for slide

NSM-NCD2013 Symposium 1 - NCD in Malaysia - A Rising Trend

  1. 1. Conference on Non-CommunicableDiseases (NCDs)26-27 March 2013NCDs in Malaysia – A Rising TrendNational Health and Morbidity Survey2011Tahir A1 & Noor Ani A11Institute for Public Health, Ministry of Health MalaysiaNATIONAL HEALTH AND MORBIDITYSURVEY 2011(NHMS 4)
  2. 2. NHMS 2011 Methodology Target Population: cover the residence in the non institutional living quarters(LQ) Sampling Frame: used the National Household Sampling Frame made up ofEnumeration Blocks (EBs) derived from the Populationand Housing Census, Malaysia (2010) Sampling Design: Multistage Random Sampling (28 strata) Stage 1: PSU (EB): 794 Stage 2: SSU (LQ): 9528 All individual in LQ were selectedField Achievement Sample size: based on core topics (Health CareDemands) for analysis up to State (urban/rural): 9,528 LQ Minimum sample size: 680 respondents/strata(DE=2.5, prev: 23%)• Success rate (LQ): 88.2%• Average indiv/LQ: 4.1
  3. 3. 1500000 1000000 500000 0 500000 1000000 15000000-45-910-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475+FemaleEstimated NHMS 2011 Census 2010MalePopulation Pyramid : Comparison Estimated NHMS2011 & Malaysian Population (Census 2010)FINDINGS:1. DIABETES MELLITUS2. HYPERTENSION3. HYPERCHOLESTEROLEMIA4. OVERWEIGHT AND OBESITY5. VEGETABLES AND FRUIT INTAKE15/4/2013 6
  4. 4. DIABETES MELLITUSNON-COMMUNICABLE DISEASESDEFINITION• Total diabetes:Number of subjects with known diabetes plus subjects with Undiagnosed Diabetes• Known Diabetes Mellitus: self reported by subject with confirm diagnosed bymedical personnel.• Undiagnosed Diabetes: Fasting capillary blood glucose  6.1 mmol /L or RandomBlood Glucose  11.2 mmol /L (tested using validated tool: Cardio Check®), amongpeople previously not known to have diabetes.• Impaired Fasting Glucose: Fasting capillary blood glucose 5.6 to < 6.1 mmol/L(tested using validated tool: Cardio Check®), among people previously not knownto have diabetes.
  5. 5. PREVALENCE OF DIABETES, ≥ 18 YEARS, NHMS III (2006)AND NHMS 201111.615.27 7.24.584.24.902468101214162006 2011PREVALENCE(%)DIABETESKNOWN DMUNDIAGNOSED DIABETESIMPAIRED FBSPREVALENCE OF DIABETES, ≥ 30 YEARS, NHMS II(1996) NHMS III (2006) AND NHMS 20118.314.920.86.59.510.71.85.410.14.3 4.75.305101520251996 2006 2011PREVALENCE(%)DIABETESKNOWN DMUNDIAGNOSED DIABETESIMPAIRED FBS
  6. 6. PREVALENCE OF DIABETES BY STATE, ≥ 18 YEARS, NHMS201113.422.519.717.12216.71516.224.816.511.6912.3 11.38.815.205101520253035PREVALENCE(%)PREVALENCE OF DIABETES BY STRATA, ≥ 18 YEARS,NHMS 201115.115.67.377.88.55.14.30 2 4 6 8 10 12 14 16 18UrbanRuralPREVALENCE (%)IMPAIRED FBSUNDIAGNOSED DIABETESKNOWN DMDIABETES
  7. 7. PREVALENCE OF DIABETES BY AGE GROUP,≥ 18 YEARS, NHMS 20112.14.9 5.39.410.917.620.626.731.636.236.630.331.900.8 0.82.63.47.69.115.117.923.125.520.319.42.14.14.56.8 7.51011.411.613.713.11110.112.54.13.5 4.45.25.54.66.26.1 5.14.35.74.75.1051015202530354018-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75+PREVALENCE(%)DIABETESKNOWN DMUNDIAGNOSED DIABETESIMPAIRED FBSPREVALENCE OF DIABETES BY SEX, ≥ 18YEARS, NHMS 201115.814.677.58.87.15.14.70 2 4 6 8 10 12 14 16 18MaleFemalePREVALENCE (%)IMPAIRED FBSUNDIAGNOSED DIABETESKNOWN DMDIABETES
  8. 8. PREVALENCE OF DIABETES BY ETHNICITY, ≥ 18 YEARS,NHMS 20111713.924.99.377.9714.43.21.696.810.56.15.45.74.34.93.92.60 5 10 15 20 25 30MalayChineseIndiansOther BumisOthersPREVALENCE (%)IMPAIRED FBSUNDIAGNOSED DIABETESKNOWN DMDIABETESPREVALENCE OF DIABETES BY ETHNICITY, ≥ 18 YEARS,NHMS 20111713.924.99.37051015202530Malays Chinese indians Other Bumiputeras OthersPREVALENCE(%)
  9. 9. Burden of Diabetes in Malaysia: Trends & Projectionsby 2020 (Adults age 18 years and above)HYPERTENSIONNON-COMMUNICABLE DISEASES
  10. 10. DEFINITION• HypertensionRespondents recording diastolic blood pressure (DBP) of ≥ 90mm Hg and/or systolic blood pressure of ≥ 140 mm Hg• Known hypertensionself reported by subject with confirmed diagnosis by medicalpersonnel• Undiagnosed hypertensionaverage BP reading of SBP ≥140 mm Hg and / or DBP ≥ 90 mmHg (using validated tool: Omron HEM 907) amongrespondents previously not known to be hypertensive• Total hypertensionKnown + undiagnosed hypertension32.232.7051015202530352006 2011PREVALENCE(%)PREVALENCE OF HYPERTENSION, ≥18 YEARS,NHMS III (2006), NHMS 2011
  11. 11. 32.712.819.80510152025303540Overall Known Hpt Undiagnosed HptPREVALENCE(%)PREVALENCE OF HYPERTENSION, KNOWN HYPERTENSIONAND UNDIAGNOSED HYPERTENSION, ≥18 YEARS, NHMS201136.438.227.932.834.129.928.442.941.128.726.829.140.527.122.532.705101520253035404550PREVALENCE(%)PREVALENCE OF HYPERTENSION BY STATE ≥ 18 YEARS,NHMS 2011
  12. 12. 18.822.712.214.730.937.40 5 10 15 20 25 30 35 40UrbanRuralPREVALENCE OF HYPERTENSION, KNOWN HPT ANDUNDIAGNOSED HPT BY STRATA, ≥ 18 YEARS, NHMS2011HypertensionKnown hptUndiagnosed hptPREVALENCE (%)30.9937.48051015202530354045Urban RuralSTRATAPREVALENCE HYPERTENSION BY STRATA, ≥18 YEARS, NHMS 2011
  13. 13. 8.111.814.322.227.235.84451.66168.774.172.873.412 34.27.411.617.324.63037.939.5 40.8 427.1 9.911.317.919.824.226.7273130.734.732 31.30102030405060708018-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75+PREVALENCE(%) PREVALENCE OF HYPERTENSION, KNOWN HPT ANDUNDIAGNOSED HPT BY AGE GROUP, NHMS 2011Hypertension 2011Known Hpt 2011Newly Hpt 201121.817.811.913.833.731.60 5 10 15 20 25 30 35 40MaleFemalePREVALENCE OF HYPERTENSION, KNOWN HPT,UNDIAGNOSED HPT BY SEX, ≥ 18 YEARS, NHMS 2011HypertensionKnown HptUndiagnosed hptPREVALENCE (%)
  14. 14. 21.817.80.05.010.015.020.025.0Male FemalePREVALENCE UNDIAGNOSED HYPERTENSION BY SEX,≥18 YEARS, NHMS 201120.618.317.923.61613.41412.712.94.83432.330.636.420.90 5 10 15 20 25 30 35 40MalaysChineseIndiansOther BumiputrasOthersPREVALENCE (%)HypertensionKnown HptUndiagnosed HptPREVALENCE (%)PREVALENCE OF HYPERTENSION, KNOWN HPT, UNDIAGNOSEDHPT BY ETHNICITY, ≥ 18 YEARS, NHMS 2011
  15. 15. Burden of Hypertension in Malaysia: Trends &Projections by 2020 (Adults age 18 years and above)HYPERCHOLESTROLEMIANON-COMMUNICABLE DISEASES
  16. 16. DEFINITIONA respondent is said to have desirable total cholesterol when level is below5.2 mmol/L, and high total cholesterol when total cholesterol level equals andabove 5.2 mmol/L (ATP III, 2001).• Known hypercholesterolemia:Self-reported by respondents with confirmed diagnosis by a Doctor or Medicalpersonnel.• Undiagnosed hypercholesterolemia:total cholesterol level equals and above 5.2 mmol/L among respondents previouslynot known to have hypercholesterolemia.• Total hypercholesterolemia:Respondents with known hypercholesterolemia plus newly diagnosedhypercholesterolemia.PREVALANCE OF HYPERCHOLESTROLEMIA ≥ 18YEARS, NHMS III (2006) AND NHMS 201120.735.105101520253035402006 2011PREVALENCE(%)
  17. 17. 35.18.426.60510152025303540Overall Known Hyperchol Undiagnosed HypercholPREVALENCE(%)PREVALENCE OF HYPERCHOLESTROLEMIA, KNOWNHYPERCHOLESTROLEMIA AND UNDIAGNOSEDHYPERCHOLESTROLEMIA , ≥18 YEARS, NHMS 2011PREVALENCE OF HYPERCHOLESTROLEMIA BY STATE, ≥ 18YEARS, NHMS 201137.743.433.835.939.731.7 32.745 45.131.934.931.133.529.433.335.10102030405060PREVALENCE(%)
  18. 18. PREVALENCE OF HYPERCHOLESTROLEMIA, KNOWN ANDUNDIAGNOSED BY STRATA, ≥ 18 YEARS, NHMS 201125.330.49.16.634.3370 5 10 15 20 25 30 35 40UrbanRuralPREVALENCE (%)HypercholestrolemiaKnownHypercholestrolemiaUndiagnosedHypercholestrolemiaPREVALENCE OF HYPERCHOLESTROLEMIA, KNOWN ANDUNDIAGNOSED BY AGE GROUP, ≥ 18 YEARS, NHMS 20110.6 1.3 2.5 3.9 5.48.713.6 15.618.723.8 22.6 2217.710.716.119.926.5 29.231.933.135.9 37.3 31.9 34.6 32 36.511.317.422.430.434.640.546.751.455.9 55.7 57.253.954.202040608010012014018-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75+HypercholestrolemiaUndiagnosedHypercholestrolemiaKnownHypercholestrolemiaPREVALENCE(%)
  19. 19. PREVALENCE OF HYPERCHOLESTROLEMIA, KNOWN ANDUNDIAGNOSED BY SEX, ≥18 YEARS, NHMS 201121.5328.68.230.140.20 5 10 15 20 25 30 35 40 45MaleFemaleHypercholestrolemiaKnownHypercholestrolemiaUndiagnosedHypercholestrolemiaPREVALENCE (%)PREVALENCE OF HYPERCHOLESTROLEMIA BY SEX, ≥18YEARS, NHMS 201130.140.2051015202530354045Male FemalePREVALENCE (%)
  20. 20. PREVALENCE OF HYPERCHOLESTROLEMIA KNOWN ANDUNDIAGNOSED, BY ETHNICITY, ≥ 18 YEARS, NHMS 2011PREVALENCE (%)30.322.224.123.923.6811.211.35.91.638.433.435.529.825.20 5 10 15 20 25 30 35 40 45MalaysChineseIndiansOtherBumiputrasOthersHypercholestrolemiaKnownHypercholestrolemiaUndiagnosedHypercholestrolemia33.2526.17 26.425.6827.07152025303540Malay Chinese Indian Other Bumiputra OthersPrevalencePREVALENCE UNDIAGNOSED HYPERCHOLESTROLEMIA BY ETHNICITY,NHMS 2011
  21. 21. Burden of Hypercholesterolaemia in Malaysia: Trends& Projections by 2020 (Adults age 18 years and above)NUTRITIONAL STATUSNON-COMMUNICABLE DISEASES
  22. 22. DEFINITIONBMI STATUS (CPG 2004)• Underweight ≤ 18.5• Normal = 18.5 – 22.9• Pre-obese = 23.0 – 27.4• Obese ≥ 27.5BMI STATUS (WHO 1998)• Underweight ≤ 18.5• Normal = 18.5 – 24.9• Overweight = 25.0 – 29.9• Obese ≥ 30• Abdominal obesity (aged > 18years old) =- Men ≥ 108- Women ≥ 808.331.127.233.38.347.215.129.40.010.020.030.040.050.060.0CPG2004WHO1998PREVALENCE(%)NATIONAL PREVALENCE OF NUTRITIONALSTATUS ≥ 18 YEARS, NHMS 2011UNDERWEIGHTNORMALOBESITYPRE-OBESE /OVERWEIGHT
  23. 23. 25.28.5 8.348.4 47.216.629.1 29.44.414 15.10102030405060NHMS (1996) NHMS (2006) NHMS (2011)PREVALENCE(%) NATIONAL PREVALENCE OF NUTRITIONALSTATUS (WHO, 1998), NHMS II (1996), NHMSIII (2006), NHMS 2011UNDERWEIGHTNORMALOVERWEIGHTOBESITY26.333.527.233.30 5 10 15 20 25 30 35 40OBESITYOVERWEIGHTPREVALENCE (%)PREVALENCE OF NUTRITIONAL STATUS,≥ 18 YEARS, NHMS III (2006) AND NHMS 2011(CPG2004)NHMS 2011NHMS 2006
  24. 24. PREVALENCE OF PRE-OBESE BY STATES,≥ 18 YEARS, NHMS 2011 (CPG 2004)3334.035.233.731.3 32.236.331.429.132.3 32.734.532.436.9 36.30.05.010.015.020.025.030.035.040.045.0PREVALENCE(%)PREVALENCE OF OBESITY BY STATES,≥ 18 YEARS, NHMS 2011 (CPG 2004)29 28.229.4 29.328.2 28.226.930.134.628.2 28.121.126.722.827.40.05.010.015.020.025.030.035.040.045.0PREVALENCE(%)
  25. 25. 33.732.427.326.30 5 10 15 20 25 30 35 40UrbanRuralPREVALENCE (%)PREVALENCE OF PRE-OBESE/OBESITY BYSTRATA, ≥ 18 YEARS NHMS 2011OBESITYPRE-OBESE16.118.524.228.131.1 31.635.132.634.430.727.717.8 16.815.724.526.135.4 35.741.038.640.3 39.4 40.2 41.0 40.136.905101520253035404518-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79PREVALENCE(%)PREVALENCE OF PRE-OBESE/OBESITY BY AGEGROUP ≥ 18 YEARS, NHMS 2011OBESITYPRE-OBESE
  26. 26. 35.8030.7024.9629.610.00 5.00 10.00 15.00 20.00 25.00 30.00 35.00 40.00MALEFEMALEPREVALENCE (%)OBESITYPRE-OBESEPREVALENCE OF PRE-OBESE/OBESITY BY SEX≥ 18 YEARS, NHMS 201133.435.829.833.5283219.735.725.213.80 5 10 15 20 25 30 35 40MalayChineseIndiansOther BumisOthersPREVALENCE %PREVALENCE OF PRE-OBESE/OBESITY BYETHNICITY, ≥ 18 YEARS NHMS 2011OBESITYPRE-OBESE
  27. 27. OBESITY AMONG POPULATION < 18YEARSDEFINITION• Obesity among children is defined as BMI forage ≥+2SD.
  28. 28. PREVALENCE OF OBESITY AMONG CHILDREN<18 YEARS BY STATES, NHMS 20115.5 5.86.44.7 57.23.49 8.87.35.53.286.37.46.102468101214PREVALENCE(%)6.55.55 5.2 5.4 5.6 5.8 6 6.2 6.4 6.6UrbanRuralPREVALENCE %PREVALENCE OF OBESITY AMONGCHILDREN < 18 YEARS, BY STRATA ,NHMS 2011
  29. 29. 6.5 6.76.34.90123456780-4 5-9 10-14 15-17PREVALENCE(%)PREVALENCE OF OBESITY AMONG CHILDREN< 18 YEARS BY AGE GROUP, NHMS 20117.64.6012345678910Male FemalePREVALENCE(%)PREVALENCE OF OBESITY AMONG CHILDREN< 18 YEARS BY SEX, NHMS 2011
  30. 30. INTAKE OF FRUITS/VEGETABLESNON-COMMUNICABLE DISEASESDEFINITION• Inadequate intake: Intake of less than 5servings of fruits and/or vegetables per day(based on WHO definition for the preventionof chronic diseases)
  31. 31. 92.994.890.195.7 93.690.9 92.3 93 95.689.8 92 95.1 94.790.7 94.2020406080100120JohorKedahKelantanMelakaNegeriSembilanPahangPenangPerakPerlisSelangorTerengganuSabah&WPLabuanSarawakWPKualaLumpurWPPutrajayaPREVALENCE%PREVALENCE OF VEGE/FRUIT INTAKE <5SERVINGS BY STATE, ≥ 18 YEARS, NHMS 201192.592.194.20 20 40 60 80 100MALAYSIAUrbanRuralPREVALENCE (%)PREVALENCE OF VEGE/FRUIT INTAKE <5SERVINGS AMONG ADULTS, ≥ 18 YEARS,NATIONAL AND BY STRATA, NHMS 2011
  32. 32. 97.4 95 94.4 91.8 90.6 90.6 91.7 90.4 89 90.1 89.793.6 96.202040608010012018-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79PREVALENCE% PREVALENCE OF VEGE/FRUIT INTAKE <5SERVINGS BY AGE GROUP, ≥ 18 YEARS, NHMS201192.892.10 10 20 30 40 50 60 70 80 90 100MaleFemalePREVALENCE %PREVALENCE OF VEGE/FRUIT INTAKE<5 SERVINGS BY SEX, ≥ 18 YEARS, NHMS 2011
  33. 33. 92.490.994.894.892.60 10 20 30 40 50 60 70 80 90 100MalaysChineseIndiansOtherBumisOthersPREVALENCE %PREVALENCE OF VEGE/FRUIT INTAKE <5SERVINGS BY ETHNICITY, ≥ 18 YEARS, NHMS2011PHYSICAL ACTIVITYNON-COMMUNICABLE DISEASES
  34. 34. ‘Active’ Physical ActivityCombination of walking, moderate-intensity or vigorous-intensity activitiesachieving a minimum of at least 600MET-minutes/week.• IPAQ Short Form ( revised Nov 2005)DEFINITIONTREND OF ‘ACTIVE’ PHYSICAL ACTIVITY, NHMS III (2006) ANDNHMS 201156.364.8010203040506070NHMS 2006 NHMS 2011PREVALENCE(%)
  35. 35. PREVALENCE OF ‘ACTIVE’ PHYSICAL ACTIVITY BY STATE,NHMS 2011PREVALENCE OF ‘ACTIVE’ PHYSICAL ACTIVITY BY STRATA,NHMS 2011.
  36. 36. PREVALENCE OF ‘ACTIVE’ PHYSICAL ACTIVITY, BY AGEGROUP, NHMS 2011PREVALENCE OF ‘ACTIVE’ PHYSICAL ACTIVITY BY SEX, NHMS2011
  37. 37. PREVALENCE OF ‘ACTIVE’ PHYSICAL ACTIVITY, BY ETHNICITY,NHMS 2011NON-COMMUNICABLE DISEASESALCOHOL
  38. 38. DEFINITION• Alcoholic beverages in this context encompassed any drinkcontaining ethanol irrespective of its concentration and,inclusive of those consumed for medical purposes such asalcoholic tonic• Non drinker is a respondent who never consume alcoholicbeverages in their life time• Ever drinker is a respondent who had history of consumingalcoholic beverages at least once in their life time• Current drinker is a respondent who still consuming alcoholicbeverages for the past 12 months• Ex-drinker is a respondent who had stopped drinkingalcoholic beverages for the past 12 monthsDEFINITION• Binge drinking is consumption of ≥ 6 standard drink per-sitting• Heavy episodic drinking is consumption of ≥ 6 standard drink per-sitting at least once occasion weekly.• Low risk drinker is a respondent who consumed alcohol accordingto low risk guideline and is generally indicated when the AUDITscore is between 0 – 7.• Risky drinker is a respondent who consumed alcohol in excess oflow risk guideline and is generally indicated when the AUDIT scoreis between 8 – 19.• Probable Alcohol Dependence is a respondent who consumedalcohol beyond the low risk guideline and is generally indicatedwhen the AUDIT score is 20 or aboveValidated tool: Alcohol Use Disorder Identification Test (AUDIT)
  39. 39. PREVALENCE OF CURRENT DRINKER, ≥ 13 YEARS,NHMS III (2006) AND NHMS 201111.111.60246810122006 2011PREVALENCE(%)YEARPREVALENCE OF CURRENT DRINKER, BINGE DRINKERAND HEAVY EPISODIC BY STRATA, ≥ 13 YEARS, NHMS 201112.66.11.18.94.70.80246810121416Urban RuralPREVALENCE(%)binge drinkercurrent drinkerheavy episodicdrinker
  40. 40. PREVALENCE OF CURRENT DRINKER, BINGE DRINKER ANDHEAVY EPISODIC DRINKER BY AGE GROUP, ≥ 13 YEARS,NHMS 20111.66.915.713.714.7 14.313.912.4119.7 9.88.45.44.90.63.58.378.36.3 6.4 6.754 4.13.71.7 1.50.30.7 1.40.91.3 1 1.3 1.2 1.5 0.8 1.60.5 0.10.902468101214161810-14years15-19years20-24years25-29years30-34years35-39years40-44years45-49years50-54years55-59years60-64years65-69years70-74years75+yearsCurrent drinkerBinge drinkerHeavy episodicdrinkerPREVALENCE(%)PREVALENCE OF CURRENT DRINKER, BINGE DRINKERAND HEAVY EPISODIC BY SEX, ≥ 13 YEARS, NHMS 201117.29.11.95.72.20.202468101214161820Male FemalePREVALENCE(%)binge drinkercurrent drinkerheavy episodicdrinker
  41. 41. PREVALENCE OF CURRENT DRINKER, BINGE DRINKER ANDHEAVY EPISODIC DRINKER BY ETHNICITY, ≥ 13 YEARS, NHMS20110.9 0.50.127.512.12.418.88.31.120.312.82.211.36.70.905101520253035Malay Chinese Indian OtherBumiputerasOthersPREVALENCE(%)Current drinkerBinge drinkerHeavy episodicdrinkerPATTERN OF DRINKING BY RISK, ≥ 13 YEARS, NHMS 201135.649.214.01.20102030405060Abstinence Low-risk Risky Probable dependencePREVALENCE(%)
  42. 42. COMPARISON OF ‘DRINKING RISKS’ GLOBAL VS NHMS 2011Babor & Higgins-Biddle, WHO, 20010%10%20%30%40%50%60%70%80%90%100%Global NHMS 201140 3635 49201451Ex drinkerLow (score : 0 - 7)Risky (score : 8 - 19)P. Dependence
  43. 43. Conclusion• Inter-sectoral collaboration with communityparticipation is an important strategy to curbthe NCD problems. Preventing the primaryrisk factors of NCDs, namely tobacco use, poordiets, harmful use of alcohol and physicalinactivity, is a top priority to reverse the risingtrends in NCDs.Conclusion
  44. 44. “Research is not a luxury, but an essentialtool to facilitate & improve managerialdecision-making”WHO Technical Series No. 819It’s Not What You Know,But What You Do With What YouKnow

×