.

1. Association Between Passive Smoking &
Cardiovascular Disease Among Woman of
Low Socio Economic Status of Urban
Community in Bangladesh
DR. RISHAD CHOUDHURY ROBIN
ID: 59031975
DR.PH. STUDENT, FACULTY OF PUBLIC HEALTH, NU

2. Non Communicable Disease (NCD)
 Non communicable diseases are diseases of long duration and generally
slow progression. (WHO)
 Main NCDs are
 Cardiovascular Disease
 Cancer
 Cornice Respiratory Disease
 Diabetes

3. NCD Characteristics
Long term
treatment
Limit productivity
Acute care for
complications
More then one
drug
Can be debilitating
and disabling
Involvement of
family and friends
for holistic health
care
Preventable,
avoidable and
manageable
Finical burden
More then one
health care
provider

4. Risk Factor for NCD
 Behavioural risk factors:
 Tobacco use
 Physical inactivity
 Unhealthy diet
 Harmful use of alcohol
 Physiological and metabolic risk
factors:
 Raised blood pressure
 Overweight/ obesity
 Raised blood glucose
 Raised cholesterol
 Social determinants:
 Educational level
 Household income
 Access to health care

5. Global Burden of NCD
 NCDs are leading cause of death in the world.
 NCDs representing 63% of all annual deaths.
 NCDs kill more than 38 million people each year.
 More then 9 million NCD deaths occur before the age of 60.
 Some 80% of all NCD deaths occur in low- and middle-income countries.

6. Global Burden of NCD (Cont.)

7. Global Burden of NCD (Cont.)
 Number of NCD deaths annually (WHO)
 Cardiovascular diseases:17.5 million
 Cancers: 8.2 million
 Respiratory diseases: 4 million
 Diabetes: 1.5 million
 These 4 groups of diseases account for 82% of all NCD deaths.
 By 2030, low-income countries will have 8 times more deaths attributed
to NCDs than high-income countries.

8. NCD Death by WHO
17.5
8.2
4
1.5
0 2 4 6 8 10 12 14 16 18 20
CVD
Cancer
RD
Dm
Million
CVD
Cancer
RD
Dm

9. Global NCD targets by WHO
(2025 Goal)
 25% reduction of premature mortality
 30% reduction of tobacco use
 25% reduction of high blood pressure
 10% reduction of harmful use of alcohol
 10% reduction of physical inactivity
 30% reduction of salt intake
 0% increase of Diabetics
 80% availability of essential medicine
 50% availability of drugs
25
30
25
10
10
30
Reduction (%)
premature
mortality
tobacco use
high blood
pressure
harmful use of
alcohol
physical inactivity
salt intake

10. NCD in South-East Asia Region
 NCDs are top killers in the South-East Asia Region (SEAR), causing 7.9
million deaths annually.
 NCDs kill people at a relatively younger age in SEAR compared to the
rest of the world; one-third 34% of deaths in SEAR occur in those below
the age of 60 years.
 Cardiovascular diseases, cancers, chronic respiratory diseases and
diabetes account for the majority of NCD.

11. NCD in South Asia
 Almost half of the adult disease burden in South Asia is attributable to non-
communicable diseases.
 Environmental factors are the major determinants of almost all non-
communicable diseases.
 Obstacles to managing the non-communicable diseases epidemic in South
Asia include
 Sedentary lifestyles
 Extreme poverty
 Inadequate health systems

12. NCD in Bangladesh
 NCDs now impose the largest health burden in Bangladesh.
NCDs (inclusive of injuries) accounts for 61 % of the total disease
burden.
 NCDs are estimated to account for 59% of total deaths.
 Cardiovascular diseases (CVD), injuries, mental health, cancer,
chronic respiratory diseases, and diabetes are the major NCDs in
Bangladesh.

13. NCD in Bangladesh (Cont.)
32
9
17
10
11
3
18
Communicable, maternal, perinatal and
nutritional conditions
Injuries
Cardiovascular diseases
Cancers
Chronic respiratory diseases
Diabetes
Other NCDs
PROPORTIONAL MORTALITY (% OF TOTAL DEATHS, ALL AGES, BOTH SEXES)

14. NCD in Bangladesh (Cont.)
 Adult risk factors Males Females
 Current tobacco smoking (2013) 44.4% 1.8%
 Total alcohol per capita consumption, in litres of pure alcohol (2010) 0.3% 0.0%
 Raised blood pressure (2008) 24.0% 23.6%
 Obesity (2008) 0.9% 1.3%
(World Health Organization - Noncommunicable Diseases (NCD) Country Profiles, 2014)

15. NCD in Thailand
 Cardiovascular diseases, cancers, chronic respiratory diseases, and
diabetes are among the most significant emerging health concerns
in Thailand,
 73% of deaths in Thailand as a result of NCDs (higher than the
global average).
 In 2002, cardiovascular diseases were the single largest contributor
to mortality in Thailand, estimated by the WHO to represent 20% of
all death (WHO).

16. NCD in Thailand (Cont.)
24
7.1
22.3
8.8
0
5
10
15
20
25
30
Current tobacco
smoking (2011)
Total alcohol
per capita
consumption, in
litres of pure
alcohol (2010)
Raised blood
pressure (2008)
Obesity (2008)
Prevalence (%) of NCD
Current tobacco smoking (2011)
Total alcohol per capita
consumption, in litres of pure
alcohol (2010)
Raised blood pressure (2008)
Obesity (2008)

17. NCD in Thailand (Cont.)
18
11
29
17
9
4
12
Proportional mortality (% of total deaths, all ages, both sexes)
Communicable, maternal, perinatal and
nutritional conditions
Injuries
Cardiovascular diseases
Cancers
Chronic respiratory diseases
Diabetes
Other NCDs

18. Smoking and Cardiovascular diseases (CVD)
 Passive or Second hand smoking:
Involuntary smoking is the exposure to second-hand tobacco smoke which
is a mixture of exhaled mainstream smoke and side stream smoke released
from a smouldering cigarette or other smoking device (cigar, pipe, bidi,
etc.)(WHO)
 Cardiovascular diseases:
It is a group of disorders of the heart and blood vessels and include
coronary heart disease, cerebrovascular disease, peripheral arterial
disease, Rheumatic heart disease, Congenital heart disease, Deep vein
thrombosis and pulmonary embolism. (WHO)

19. Global Burden of Smoking
 Tobacco is the number one cause of preventable death in the world today.
 80% of the world's smokers live in low- and middle-income countries.
 Tobacco-related illness already kills 6 million people a year worldwide.
 If current patterns persist, smoking will kill more than 8 million a year by 2030.
(European Commission 2004, WHO 2003, 2008)

20. Global Burden of Smoking(Cont.)
 In adults, second-hand smoke causes cardiovascular and respiratory diseases.
In infants, it causes sudden death. In pregnant women, it causes low birth weight.
 Almost half of children regularly breathe air polluted by tobacco smoke in public
places.
 Second-hand smoke causes more than 600,000 premature deaths per year.
 In 2004, children accounted for 28% of the deaths attributable to second-hand
smoke.
(WHO,2016)

21. Percentage of Males Smoking
WHO Report on the Global Tobacco Epidemic (2008)

22. Percentage of Females Smoking
WHO Report on the Global Tobacco Epidemic (2008)

23. Distribution of Total Deaths of Passive
Smoking
Lower respiratory
infection
Asthma Lung cancer Ischaemic heart
disease
27
6 4
63
%
(Global estimate of the burden of disease from second-hand smoke WHO 2011)

24. Global Barden of CVD
 17.5 million people die of CVD representing 31% of all global deaths.
 16% of deaths from CVD in men and 5% in women are due to smoking in EU.
 Over 3 quarters of CVD deaths occur in low- and middle-income countries.
 Among total NCD death 37% are caused by CVDs.
 Passive smoking cause 10% increase of CVD.
 Secondhand smoke increase their risk of developing heart disease by 25–30%.
 Secondhand smoke increases the risk for stroke by 20−30%.
(WHO, American Heart Association, CDC)

25. Distribution of Major Causes of Death
31
27
9
33
0
5
10
15
20
25
30
35
CARDIOVASCULAR
DISEASES
COMMUNICABLE,
MATERNAL, PERINATAL
AND NUTRITIONAL
CONDITIONS
INJ URIES OTHER NCDS
%
(Global Atlas on cardiovascular disease prevention and control WHO 2011)

26. CVD Death According to Risk Factor
2200
2300
2400
2700
2800
2900
3200
3400
5100
7500
0 1000 2000 3000 4000 5000 6000 7000 8000
INDOOR SMOKE FROM SOLID FUELS
CHILDHOOD UNDERWEIGHT
ALCOHOL USE
UNSAFE SEX
HIGH CHOLESTERL
OVERWEIGHT AND OBESITY
PHYSICAL INACTIVITY
HIGH BLOOD GLUCOSE
TOBACCO
RAISED BLOOD PRESSURE
Attributable deaths due to selected risk factors (in thousands)
(Global Atlas on cardiovascular disease prevention and control WHO 2011)

27. Smoking in Bangladesh
 More than half of Bangladeshi men over the age of 25 years smoke cigarettes or
bidis.
 44.4 % men smoke in Bangladesh.
 Among woman it is only 1.8 %.
 46.7% of the women reported high exposure to Passive smoking.
 14.6% men die in Bangladesh due to smoking.
 5.7 % women die due to smoking in Bangladesh.
(WHO 2013, Nicotine & Tobacco Research 2015)
0
5
10
15
ManWoman

28. Tobacco Use in Bangladesh
29%
5%
5%47%
14%
Exclusively smoke cigarettes
Exclusively smoke bidi
Smoke both cigarettes and bidi
Only smokeless tobacco
Duel use of smoke and smokeless tobacco
(ICT Bangladesh Enumeration 2012)

29. CVD in Bangladesh
 397.2 per 1000,000 died in CVD.
 444.7 per 1000,000 male died in CVD.
 372.1 per 1000,000 female died in CVD.
 221.7 per 1000,000 died in Ischemic Heart Disease.
 108.3 per 1000,000 died in Cerebrovascular disease.
(Emerging burden of cardiovascular disease in Bangladesh. J Atherosscler Thromb, 2016)

30. CVD in Bangladesh (Cont.)
Top Ten Cause of Death in Bangladesh
1) Cerebrovascular disease
2) Ischemic heart disease
3) Neonatal encephalopathy
4) Lower respiratory infect
5) Neonatal preterm birth
6) Drowning
7) Neonatal sepsis
8) Intestinal infection
9) COPD
10) Self harm

31. Smoking status in Urban Community
(Dhaka)
 Cigarette smoking prevalence was 21.6%.
 Prevalence of smoking among men is 35.7% .
 Prevalence of smoking among women 4.9%.
 Prevalence of smoking among student is 29% of the students and 68% of the
slum dwellers.
(Cigarette smoking prevalence in Dhaka (Bangladesh). Das Gesundheitswesen 2010)

32. Thank You