epidemiology of non communicable disease and hypertension

1. EPIDEMIOLOGY OF
NON
COMMUNICABLE
DISEASE
HYPERTENSION

2. Contents
■ Definition of NCD
■ List of NCD
■ Global Scenario/ Indian Scenario
■ Concept of Risk factors/ Multifactorial causation/Web of causation
■ Risk Factors
■ Prevention of NCD
■ Hypertension – Rule of Halves,Tracking of Blood Pressure,

3. Difference between Communicable and Non- Communicable
Difference between Communicable and Infectious

4. Non Communicable Diseases
■ The Commission on Chronic Illness in USA has defined "chronic diseases“ as
■ "comprising all impairments or deviations from normal”, which have one or
more of the following characteristics
a. are permanent
b. leave residual disability
c. are caused by non-reversible pathological alteration
d. require special training of the patient for rehabilitation
e. may be expected to require a long period of supervision, observation or care."

5. ■ chronic conditions are generally those, that have had a duration of
at least 3 months

6. List of NCD
■ cardiovascular, renal, nervous and mental diseases,
■ musculo- skeletal conditions such as arthritis and allied diseases
■ chronic non-specific respiratory diseases (e.g., chronic bronchitis,
emphysema, asthma),
■ permanent results of accidents, senility,
■ blindness,
■ cancer,
■ diabetes,
■ obesity
■ And various other metabolic and degenerative diseases and chronic
results of communicable diseases.
■ Disorders of unknown cause and progressive course are often labelled
"degenerative".

7. Global- situational analysis
• Noncommunicable diseases (NCDs) kill 41 million people each year,
equivalent to 71% of all deaths globally.
• Each year, 15 million people die from a NCD between the ages of 30 and 69
years; over 85% of these "premature" deaths occur in low- and middle-
income countries.
• Cardiovascular diseases account for most NCD deaths, or 17.9 million
people annually, followed by cancers (9.0 million), respiratory diseases
(3.9million), and diabetes (1.6 million).
• These 4 groups of diseases account for over 80% of all premature NCD
deaths.

9. Indian Scenario
■ In India, nearly 5.8 million people (WHO report, 2015) die from NCDs
(heart and lung diseases, stroke, cancer and diabetes) every year or
■ in other words 1 in 4 Indians has a risk of dying from an NCD before they
reach the age of 70.

10. Indian Scenario
■ In a report “India: Health of the Nation’s States” by Ministry of Health
and FamilyWelfare (MOHFW), Government of India (GOI),
■ it is found that there is increase in the contribution of NCDs from 30% of
the total disease burden- ‘disability-adjusted life years’ (DALYs) in 1990
to 55% in 2016 and
■ also an increase in proportion of deaths due to NCDs (among all deaths)
from 37% in 1990 to 61% in 2016.
■ This shows a rapid epidemiological transition with a shift in disease
burden to NCDs.

12. EpidemiologicalTransition ratio
■ the ratio of DALYs caused by CMNNDs (Communicable, Maternal , Neonatal and
Nutritional Diseases) to those caused by NCDs and injuries.
DALYs caused by CMNNDs
DALYs caused by NCDs
>1 – CMNND burden Is more
=1 – CMNND burden Is equal to NCD &
injury
<1 – CMNND burden Is less
The states with ratio 0 .56 - 0. 75 in 2016 = lowest epidemiological
transition level (ETL) ,
those with ratio 0.41-0.55 as lower-middle ETL ,
those with ratio 0.31-0.40 as higher-middle ETL, and those
with ratio 0.30 or less as highest ETL.

15. Causative agent???

16. Multifactorial causation

17. Web of
Causation

18. Risk Factors in NCD

19. Prevention of NCD
1. Protecting people from tobacco smoke and banning smoking in public places,
warning about the dangers of tobacco use, enforcing bans on tobacco
advertising, promotion and sponsorships and raising taxes on tobacco;
2. Restricting access to retailed alcohol, enforcing bans on alcohol advertising and
raising taxes on alcohol;
3. Reduce salt intake and salt content of food;
4. Replacing trans-fat in food with polyunsaturated fat:
and
5. Promoting public awareness about diet and physical activity. including through
mass media.

20. Other ways of prevention
1. Nicotine dependence treatment:
2. Enforcing drink-driving laws:
3. Restrictions on marketing of foods and beverages high in salt, fats and sugar:
4 . Food taxes and subsidies to promote healthy diets:
5. Healthy nutrition environments in schools;
6. Nutrition information and counselling in health care;
and
7. National physical activity guidelines (school based physical activity programmes for
children and workplace programmes for physical activity and healthy diets).

21. Integrated approach
■ To develop an overall integrated programme for the Prevention and
Control of NCDs as part of primary health care systems
■ Recently, the WHO has developed a survey methodology known as "the
STEPS Non-communicable Disease Risk Factors Survey
■ The methodology prescribes three steps - questionnaire, physical
measurements, and biochemical measurements.

23. Hypertension
■ Hypertension, also known as high or raised blood pressure, is a condition in
which the blood vessels have persistently raised pressure.
■ Primary or Essential AND Secondary

25. Measurement of Blood Pressure
■ Three sources of errors have been identified in the recording of blood pressure :
■ (a) Observer errors : e .g., hearing acuity, interpretation o f Korotkow sounds.
■ (b) Instrumental errors : e.g., leaking valve, cuffs that do not encircle the arm. If the cuff
is too small and fails to encircle the arm properly then too high a reading will be
obtained; and
■ (c) Subject errors : e.g., the circumstances of examination. These include the physical
environment, the position of the subject, external stimuli such as fear, anxiety, and so
on

26. Ice Berg Phenomenon

27. Rule of Halves

28. Tracking of Blood Pressure
■ Range of BP ( normal, high or low) during childhood would probably continue in the
same "track" as adults.

29. Risk Factors of Hypertension
■ Non- Modifiable:
■ Age - Blood pressure rises with age in both sexes and the rise is greater in those with
higher initial blood pressure.
■ Sex- early childhood- no difference, adolescence- men have higher BP, late in life-
reverses
■ Genetic- inheritance is polygenic
■ Ethnicity – eg: Black Americans of African origin have been demonstrated to have higher
blood pressure levels than whites.

30. Risk Factors of Hypertension
■ Modifiable
■ Obesity: "Central obesity" indicated by an increased waist to hip ratio, has been positively
correlated with high blood pressure in several populations.
■ Salt Intake: high salt intake (i.e. , 7-8 g per day) increases blood pressure proportionately.
■ Saturated Fat : The evidences suggest that saturated fat raises blood pressure as well as
serum cholesterol
■ DIETARY FIBRE : Several studies indicate that the risk of CHO and hypertension is
inversely related to the consumption of dietary fibre

31. Risk Factors of Hypertension
■ Modifiable
■ ALCOHOL: High alcohol intake is associated with an increased risk of high blood
pressure
■ PHYSICAL ACTIVITY: Physical activity by reducing body weight may have an indirect
effect on blood pressure.
■ Stress- Virtually all studies on blood pressure and catecholamine levels in young people
revealed significantly higher noradrenaline levels in hypertensives than in normotensives.
■ SES- initial – high income level group, later lower level

32. Prevention of Hypertension
The WHO has recommended the following approaches in the prevention of hypertension :
1. Primary prevention
(a) Population strategy
(b) High-risk strategy
2. Secondary prevention

33. Primary
■ all measures to reduce the incidence of disease in a population by
reducing the risk of onset

34. Population strategy
■ population approach is based on the fact that even a small reduction in the average
blood pressure of a population would produce a large reduction in the incidence of
cardiovascular complications such as stroke and CHD
(a) NUTRITION
(b) WEIGHT REDUCTION
(c) EXERCISE PROMOTION
(d) BEHAVIOURAL CHANGES
(e) HEALTH EDUCATION
(f) SELF-CARE

36. High Risk Strategy
■ 'to prevent the attainment of levels of blood pressure at which the institution of treatment
would be considered“
■ Detection, tracking

37. Secondary Prevention
■ (i) EARLY CASE DETECTION
■ (ii) TREATMENT
■ {iii) PATIENT COMPLIANCE

38. NPCDCS
■ National Program for Prevention and Control of Cancer, Diabetes, CVD and
Stroke( NPCDCS)
■ Objectives:
• Prevent and control common NCDs through behaviour and life style changes,
• Provide early diagnosis and management of common NCDs,
• Build capacity at various levels of health care for prevention, diagnosis and
treatment of common NCDs,
• Train human resource within the public health setup viz doctors, paramedics and
nursing staff to cope with the increasing burden of NCDs
• Establish and develop capacity for palliative and rehabilitative care.

39. References
■ Text book of park; edition 25th
■ https://www.nhp.gov.in/healthlyliving/ncd2019
■ https://www.who.int/health-topics/hypertension#tab=tab_1
■ https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases
■ https://www.nhp.gov.in/national-programme-for-prevention-and-control-of-c_pg