MedicReS Conference 2017 Istanbul - RESEARCH TOPIC PRIORITIES RELEVANT TO DIFFERING GLOBAL HEALTH PROBLEMS - İrfan Şencan

Çocuk ve Ergen Sağlığı Daire Başkanlığı
Türkiye Halk Sağlığı Kurumu
T.C. Sağlık Bakanlığı
RESEARCH TOPIC PRIORITIES
RELEVANT TO DIFFERING
GLOBAL HEALTH PROBLEMS
Prof. Dr. İrfan Şencan
04.05.2017

WHAT HAS CHANGED?
• social change
– increase in population,
– urbanization
– environmental
modification
– Financial and informatics
globalization
• Successful treatment result against
infectious diseases
• Extension of human life
• chronic diseases are the most
important cause of mortality and
morbidity in all over the world and in
our country

BEHAVIORAL RISK FACTORS OF NCD
• Tobacco use
• Unhealthy nutrition
• Harmful use of alcohol
• Physical inactivity
Source: WHO, 2010, Global Status Report On Noncommunicable Diseases

NON COMMUNICABLE DİSEASES
(CVS Diseases, Diabetus, Cancer and Chronic Obstructive Pulmonary Disease)
• 67.8% of all deaths in the world
• NCD-related deaths occur 48% under 70 years of age in low-
income and middle-income countries
• More than 80% of Heart Disease, stroke and Type 2 Diabetes
can be prevented. Responsible for
– 77% of deaths and disabilities and
– almost 86% of premature deaths in the WHO European
Region

DEATHS FROM NCD’s;
• 31 millon in 2000,
• 38 milyon in 2012
• Estimation: 52 milyon in 2030…
• In 2012, 56 million deaths took place all over the world.
• Of these deaths, 38 million are due to
Noncommunicable Diseases (NCDs), especially
cardiovascular diseases, cancers and chronic airway
diseases.

• Premature deaths (death below 70 year-old) should be
taken into account when assessing deaths due to NCDs.
• In 2012, 42 % of deaths form NCDs were under 70 year-old.
• Premature deaths, which were 14.6 million in 2000, rose to
16 million in 2012 (38 million in total).

Low income
countires
Middle income
countires
High income
countires
Lower-middle
income countires
CAUSES OF DEATH
Communicable Disease
Chronic Diseases
Injures&accidentsSource: WHO, 2014, Global Status Report On Noncommunicable Diseases

• Unhealthy nutrition
• Physical inactivity
• Tobacco Use
• High Blod Pressure
• High Cholesterol Level
%17
ARTACAK
%3
AZALACA
K
CVS DISEASES
DIABETES
CANCER
CHORONIC
AIRWAY
DISEASES
Deaths From NCDs
%17
%3
Maternal and perinatal causes,
nutritional deficiencies
RİSK FACTORS ARE PREVENTABLE, AT
LEAST 80% OF ALL HEART DİSEASE,
STROKE AND TYPE 2 DİABETES.

Turkey is
aging…
• Population above 65 years*:
– 5.7% in 2005
– 8.2% in 2015
– 10.2% in 2023 (TurkStat Elderly Statistics, 2014)
– 20.8% in 2050
9
* TÜİK, http://www.tuik.gov.tr/PreHaberBultenleri.do?id=18620
** Türkiye’nin Demografik Değişimi, http://www.hips.hacettepe.edu.tr/TurkiyeninDemografikDonusumu_220410.pdf
Demographic Change in Turkey**
Male MaleFemale Female
%
%

POPULATION PYRAMID OF TURKEY, 2015
TUİK, Adrese Dayalı Nüfus Kayıt Sistemi Sonuçları, 2015
http://www.tuik.gov.tr/PreHaberBultenleri.do?id=21507
10
Age Group
Male
Female

11
LIFE EXPECTANCY AT BIRTH, (GENDER AND YEARS), 2015, TURKEY
Age

12
LIFE EXPECTANCY AT BIRTH
Age
High Income
countries
Upper-middle-
income
OECD Turkey WHO European
Region
World

13
POPULATION AGES 65 AND ABOVE (% OF TOTAL), %, 2014
High Income
countries
WHO European
Region
Upper-middle-
income
Turkey World

0 1000 2000 3000 4000 5000 6000 7000 8000 9000 10000
İskemik Kalp Hastalığı
İnme
Alt Solunum Yolu Enfeksiyonları
KOAH
Diyare
HIV/AIDS
Trakea, bronş, akciğer kanserleri
Diabetes mellitus
Trafik Kazası
Hipertansif Kalp Hastalıkları
Preterm Doğum Komplikasyonları
Karaciğer Sirozu
Tüberküloz
Böbrek Hastalıkları
Kendini Yaralama
Karaciğer Kanseri
Mide Kanseri
Doğumda Asfiksi ve Doğum Travması
Kolon and rektum kanserleri
Düşmeler
Alzheimer Hastalığı ve Diğer Demans
Göğüs Kanseri
Ölümler( 000s)
2015 Yılı
Ölümleri
2030 Yılı
Ölümleri
2015
2030
http://www.who.int/healthinfo/global_burden_disease/projections/en/ ( Erişim: 14.06.2016)
CHANGING TRENDS IN THE LEADING CAUSES OF DEATH IN THE WORLD, 2015-2030
Breast cancer
Alzheimer and dementia
Falls
Colon and rectum cancer
Asphyxia and trauma at birth
Somach cancer
Lung cancer
Liver cancer
Self-injury
Kidney diseases
Tuberculosis
Cirrhosis
Preterm delivery complications
Hypertensive heart diseases
Traffic accidents
Diabetes
Trachea, bronchus, lung cancer
Hıv/aıds
Diarrhea
Chronic obstructive pulmonary
disease
Lower respiratory tract diseases
Stroke
Ischemic hearth disesases

15
MAJOR CAUSES OF PREMATURE MORTALITY CAUSING YLLS AND
PERCENTAGE CHANGE, 1990-2013
Lower respiratory infections
Neonatal deaths
Ischemic heart disease
Congenital anomalies
Diarrheal diseases
Cerebrovascular diseases
Road injuries
Neonatal ensephalopaty
COPD
Neonatal septicemia
Ischemic heart diseases -34%
Cerebrovascular diseases -37%
Lung cancer 17%
Congenital anomalies -58%
COPD -25%
Road injuries -52%
Neonatal deaths -83%
Diabetes -57%
Lower respiratory infection -91%
Stomach cancer -2%
Communicable, maternal, perinatal and nutritional diseases
Noncommunicable diseases
Accidents
Lung cancer
Stomach cancer
Diabetes
Neonatal ensephalopathy -86%
Neonatal septicemia -82%
Diarrheal diseases -98%
1990 2013 % Change 1990-2013
YLLs: Years of life lost
Source: http://www.healthdata.org/print/4295

NCD-RELATED MORTALITY WILL INCREASE
WHO: The Global Burden Of Disease: 2004-2030

CHANGE IN MORTALITY RATE IN CORONARY HEART DISEASE IN MALE AND WOMEN
IN TURKEY, 1988–2008.
Decrease: %34 in man
%28 in woman
250
300
350
400
450
500
550
1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008
Yıl
Erkek
Kadın
Toplam
%000
Tobacco use
Cholesterol level
Access of health care
Gönül Dinç,Kaan Sözmen,Gül Gerçeklioğlu,Hale Arık,Julia Critchley, Belgin Ünal, Medchamps.
Male
Female
Total
Year

40 18
Ölüm Nedenleri 2009 2010 2011 2012 2013 2014 2015 2016
Circulatory system diseases 39,9 39,6 38,8 37,9 39,6 40,0 40,1 39,8
Malign neoplasms 20,7 21,3 21,1 21,1 21,2 20,4 19,9 19,7
Respiratory system diseases 8,9 8,3 10,1 9,7 9,8 10,6 11 11,9
Endocrine (endocrine gland), nutrition and
metabolism related diseases
6,4 6,4 6,3 6,0 5,6 5,1 5,0 5,0
Nervous system and sensory organs diseases - 3,7 3,7 4,3 5,7 4,3 4,8 4,9
Injury and poisoning 4,4 4,4 4,1 4,1 4,1 5,3 4,8 4,4
Others (infectiosus diseases and parasitosis,
mental ve behavioral disorders, Musculoskeletal
and connective tissue diseases etc)
16,3 16,3 15,9 16,9 14,0 14,4 14,4 14,3
Toplam 100 100 100 100 100 100 100 100
DISTRIBUTION OF THE DEATH UNDER 65 YEAR-OLD BY THE YEARS,
TURKEY, 2009 – 2016

0
5
10
15
20
25
30
35
1998 2010
%
*1998 yılı verisi TURDEP I araştırma sonucudur.
*2010 yılı verisi TBSA araştırma sonucudur.
OBESITY TRENDS IN YEARS, TURKEY

20
*WHO, Global Health Status, 2010
**Nutrition and Health Survey in Turkey, 2010
65
62
54
14
30
26
22
3
0
10
20
30
40
50
60
70
Türkiye Amerika Bölgesi Avrupa Bölgesi Güneydoğu Asya Bölgesi
Fazla Kilolu Obez
OBESITY AND OVERWEIGHT RATES, %
Turkey**Turkey *America Region *European Region *South-East Asia Region
Overweight Obesity

21
18
15
5
11.6
13.4
8.5
9.6
0
2
4
6
8
10
12
14
16
18
20
SALTürk 1 SALTürk 2 DSÖ Önerisi Japonya Çin İngiltere ABD
DAILY SALT INTAKE
SALTurk 1, 2008
SALTurk 2, 2012
Global Status of Salt Intake, WHO, 2007
WHO
recommendation
Japan China UK USA

THE LEVEL OF LEISURE TIME PHYSICAL ACTIVITY
CHRONIC DISEASES AND RISK FACTORS SURVEY IN TURKEY, 2011

ALCOHOL CONSUMPTION
15 Yaş Üzeri Nüfusta Alkol Kullanım Oranları
Source Year Total
%
Male
%
Female
%
TÜİK 2008 10,9 18,8 3,3
TÜİK 2010 12,6 21,1 4,4
TUBİM 2011 14,3 21,5 6,8
23
• Pure alcohol consumption per person in the population over 15 years in Turkey is «1,5 lt» in 2010.

Better non-communicable disease outcomes: challenges and opportunities for health systems,
Turkey. WHO European Region Office
TOBACCO SMOKING RATES, 1993–2012

*1998 yılı verisi TURDEP 1 araştırması sonucudur.
*2011 yılı verisi Türkiye Kronik Hastalıklar araştırması sonucudur.
0
2
4
6
8
10
12
14
1998 2011
TRENDS IN DIABETES IN TURKEY

26
TRENDS IN HYPERTENSION IN TURKEY

27
8,2milyon
7,4milyon
6,7milyon
3,1milyon
3,1milyon
1,5milyon
1,5milyon
1,5milyon
1,3milyon
Kanser
İskemikkalp
hastalığı
İnme
KOAH
AltSolunum
YoluEnfeksiyonu
HIV/AİDS
İshal
Diabet
TrafikKazası
DEATH CAUSES IN THE WORLD
Source: 2012, WHO
Ischemicheart
diseases
Cancer
ChoronicObst.
RespTractInf
Stroke
UpperResp.Tract
Infections
Diarrhea
Diabetes
Traffic
accident

28
DEATH CAUSES IN TURKEY
Source: TÜİK
%
Ischemıc heart and other heart
dıseases
Respiratory system
diseases
Stroke and hypertensive diseases
Cancer

29
236.3
246.5
256.4
279 280.5
269.7 261.4
275 277.7
267.9
246.8
142.9 149.7 158.1 165.1 172 173.3 168.7
182.2 188.2 186.5
173.6
0
50
100
150
200
250
300
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
YSH/100.000
Erkek
Kadın
TRENDS IN CANCER IN TURKEY
Male
Female

30
10 MOST COMMON CANCERS IN TURKEY
(in 100.000 – 2014)
Breast
Thyroid
Colorectal
Corpus uteri
Trachea, bronchus, lung
Stomach
Ovarian
Non-hodgkin's lymphoma
Brain, neural system
Cervix
Trachea, bronchus, lung
Prostate
Colorectal
Bladder
Stomach
Non-hodgkin's lymphoma
Kidney
Larynx
Thyroid
Brain, neural system
Male Female

31
0
500
1000
1500
2000
2500
Age-specificrate
Male
Female
AGE DISTRIBUTION OF CANCER IN TURKEY
(2104)

32
81.0
83.4 81.6 80.0
71.1
52.5 53.6 51.9 51.0
45.2
16.1 16.3 18.2 18.5 16.3
6.9 6.7 8.0 8.6 7.5
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
2010 2011 2012 2013 2014
YSH/100.000
Tütünle İlişkili Erkek
Akciğer Erkek
Tütünle İlişkili Kadın
Akciğer Kadın
TOBACO RELATED CANCERS AND LUNG CANCER
• Male: Mouth, pharynx, esophagus, stomach, colorectal, liver, pancreas, larynx, lung, kidney, bladder, leukemia
• Female: Mouth, pharynx, esophagus, stomach, colorectal, liver, pancreas, larynx, lung, cervix, over, kidney, bladder, leukemia
Tobacco-related Male
Lung Male
Tobacco-related Female
Lung Female
YSH: Age Standardized Rate

33
4.3 4.8 4.9 4.9 4.5
10.2
11.4 11.6 11.4
10.7
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
2010 2011 2012 2013 2014
YSH/100.000
erkek
kadın
OBESİTY RELATED CANCERS
• Female: Esophagus, colorectal, gall bladder, pancreas, breast, uterine, over, kidney
• Male: Esophagus, colorectal, pancreas, kidney
Male
Female
YSH: Age Standardized Rate

NEW INFECTIOUS DISEASES IN THE WORLD
• Due to many factors like ecological changes, increase in population
densities, ease of travel between countries, widespread use of
antibiotics, new viral or bacterial infections are observed and they
threatens humankind
– Mers-Cov
– Ebola Virus
– Zika Virus
– …..
• Necessity of research on new vaccines and drugs
• Studies on antibiotic resistance
34

NON-CONTAGIOUS DISEASES
• World population is growing day after day
• Beyond this, the proportion of the elderly population is increasing
• Incidence of childhood obesity and diabetis is increasing due to
sedentary living and non-healthy diet
• Preventive approach is the priority to avoid the diseases
– Demographic researches for cause and result relations
• Cost effective treatments are necessary for unprevented diseases
– New drug studies, genetic studies etc
Slayt No 35

CONCLUSIONS
• With developing and changing world, there are variations in
both contagious and non-contagious (chronic diseases, cancer
etc) diseases
• The important thing is to catch the up-to-date to the best
• Contributions to improve the evidence-based medicine are
necessary for the sake of the individual, the population, the
country and the world
Slayt No 36

Thank you…
Slayt No 37

MedicReS Conference 2017 Istanbul - RESEARCH TOPIC PRIORITIES RELEVANT TO DIFFERING GLOBAL HEALTH PROBLEMS - İrfan Şencan

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