This document discusses non-communicable diseases (NCDs) and their epidemiology. It notes that NCDs like cardiovascular diseases, cancer, diabetes and respiratory diseases have a complex etiology involving multiple risk factors. The main risk factors are behavioral like tobacco use, poor diet, physical inactivity and metabolic factors like high blood pressure, cholesterol and blood glucose. NCD prevention involves strategies at different levels from primordial to prevent risk factors, to primary prevention of diseases, to secondary prevention of complications and tertiary management of disability. India faces a growing NCD burden associated with aging, lifestyle changes and environmental factors.

1. Epidemiology of
Non-Communicable
Diseases
DR CHINTU CHAUDHARY
ASSISTANT PROFESSOR
DEPT. OF COMMUNITY MEDICINE
ADESH INSTITUTE OF MEDICAL SCIENCES & RESERACH

2. COMMUNICABLE VERSUS
NON-COMMUNICABLE DISEASES
Communicable diseases
 Sudden onset
 Single cause
 Short natural history
 Short treatment
schedule
 Cure is achieved
 Single discipline
 Short follow up
 Back to normalcy
Non-communicable
diseases
 Gradual onset
 Multiple causes
 Long natural history
 Prolonged treatment
 Care predominates
 Multidisciplinary
 Prolonged follow up
 Quality of life after
treatment

3. NON- COMMUNICABLE DISEASES INCLUDE
 Cardiovascular ( hypertension, coronary artery
disease, stroke )
 Nervous and mental ( mania, depression)
 Musculoskeletal ( arthritis)
 Respiratory (asthma, emphysema, bronchitis)
 Cancer
 Diabetes
 Obesity
 Blindness
 Degenerative disorders
 Accidents

4. BURDEN OF NON
COMMUNICABLE DISEASES
4
WHO 2014 –GLOBAL BURDEN OF DISEASES –COUNTRY PROFILE-INDIA

5. 5

6. NON MODIFIABLE RISK FACTORS
A risk factor that cannot be reduced or controlled
by intervention;
 AGE
 SEX
 RACE
 FAMILY HISTORY (GENETICS)

7. MODIFIABLE RISK FACTORS
7

8. METABOLIC RISK FACTORS
“Metabolic" refers to the biochemical processes
involved in the body's normal functioning
• Behaviors (modifiable risk factors) can lead
to metabolic/physiologic changes.
• WHO has prioritized the following four
metabolic risk factors:
‒ Raised blood pressure
‒ Raised total cholesterol
‒ Elevated glucose
‒ Overweight and obesity

9. Disease
outcomes
• Heart disease
• Stroke
• Diabetes
• Cancer
• Respiratory diseases
Disease
outcomes
• Heart disease
• Stroke
• Diabetes
• Cancer
• Respiratory diseases
Physiological
risk factors
• Body mass index
• Blood pressure
• Blood glucose
• Cholesterol
Physiological
risk factors
• Body mass index
• Blood pressure
• Blood glucose
• Cholesterol
Behavioral risk
factors
• Tobacco
• Alcohol
• Physical
inactivity
• Nutrition
Behavioral risk
factors
• Tobacco
• Alcohol
• Physical
inactivity
• Nutrition
The causal chain explains the risk
factor approach for surveillance of
non communicable diseases

10.  Rise in life expectancy and increasing number of
senior citizens
 Changing lifestyles: faulty diet, alcohol intake,
sedentary life, obesity, stress,Tobacco
 Exposure to environmental risk factors- air pollution
 Increasing population
SOCIO-ENVIRONMENTAL
FACTORS

11. WEB OF CAUSATION
Changes in life style stress
Abundance of food lack of physical activity smoking emotional
disturbance
aging
Obesity hypertension
Hyperlipidemia thrombotic tendency
changes
artery
walls
Coronary arthrosclerosis coronary occlusion
Myocardial
infarction

12. CHARACTERISTICS OF NCD
 Complex etiology (causes)
 Multiple risk factors
 Prolonged course of illness
 Functional impairment or disability
 Long latent period: it is the period between the first
exposure to suspected cause and the eventual
development of disease. This makes it difficult to
link suspected causes with outcomes.
 Indefinite onset : Most NCDs are slow in onset and
development. Distinction between diseased and non
diseased may be difficult to establish.

13. PREVENTION OF NCD
LEVELS OF PREVENTION
1. Primordial
2. Primary
3. Secondary
4. Tertiary
For healthy people
For unhealthy people

14. 1. Primordial prevention- Prevention of the
emergence or development of risk factors
in countries or population groups in which
they have not yet appeared. Efforts are
directed towards discouraging children
from adopting harmful life styles.
2. Primary prevention- Action taken prior to
the onset of disease which removes the
possibility that the disease will ever occur.
Can be divided into population & high risk
strategy.

15. PREVENTION OF NCD
INTERVENTIONS
 Health promotion
 Specific protection
 Adequate nutrition
 Safe water and sanitation
Primary prevention

16. Secondary prevention-
 Action which halts the progress of the
disease at its incipient stage and prevents
complications. Mostly curative.
Disadvantage - patient has already suffered
mental & physical anguish & community to
loss of production. Often more expensive
&less effective.
Intervention – EARLY DIAGNOSIS AND
TREATMENT

17. Tertiary prevention-
 All measures available to reduce
impairments & disabilities, minimize
suffering due to departure from good
health & promote patient’s adjustment to
irremediable conditions.
 Intervention – DISABILITY LIMITATION
AND REHABILITATION

18. RESPONSE TO NCD
Centrally sponsored schemes:
National iodine deficiency disorders control programme
National programme for control of blindness
National programme for prevention and control of cance, diabetes,
cardiovascular diseases and stroke.