Social-medical aspects of Major chronic diseases

Social-medical aspectsSocial-medical aspects
of major chronicof major chronic
diseasesdiseases

From all diseases certain groups of diseasesFrom all diseases certain groups of diseases
are allocated which have special influence onare allocated which have special influence on
public health and demand purposeful medico-public health and demand purposeful medico-
social measures.social measures.
According to the social importance amongAccording to the social importance among
these diseases the first place is occupied bythese diseases the first place is occupied by
cardiovascular diseases.cardiovascular diseases.
They come first among the reasons ofThey come first among the reasons of
mortality rate of the population (more half of allmortality rate of the population (more half of all
death rate), first among the reasons of constantdeath rate), first among the reasons of constant
disability (20-22 %), second among the reasonsdisability (20-22 %), second among the reasons
of the general morbidity of the population (22 %)of the general morbidity of the population (22 %)
and effect people, mainly of middle and old age.and effect people, mainly of middle and old age.

Country CVD
deaths
Total deaths Country CVD
deaths
Total deaths
Russian Federation 1,167 2,502 Greece 353 864
Bulgaria 1,008 1,775 Germany 347 973
Romania 867 1,751 Sweden 335 799
Hungary 842 2,131 Norway 332 879
Poland 735 1,722 New Zealand 318 841
Czech Republic 598 1,377 Portugal 311 1,116
Argentina 531 1,344 Belgium 307 1,049
Scotland 560 1,172 South Korea 304 1,325
Ireland 457 1,072 Netherlands 299 890
Finland 438 1,085 Italy 293 919
China – Rural 413 1,260 Canada 280 849
Northern Ireland 406 983 Mexico 273 1,172
Colombia 397 1,166 Israel 270 868
China – Urban 389 1,003 Australia 253 767
Austria 369 938 Spain 252 908
United States 360 1,024 Switzerland 245 806
Denmark 360 1,144 France 213 966
England/Wales 357 908 Japan 186 743
Death Rates in Men for Cardiovascular Disease (CVD) in the World (per 100,000)

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Death Rates in Women for Cardiovascular Disease (CVD) in the World (per 100,000)
Country CVD deaths Total deaths Country CVD deaths Total deaths
Russian Federation 540 1,001 England/Wales 165 564
Bulgaria 504 839 Denmark 159 728
Romania 480 877 Portugal 154 511
Hungary 380 928 Germany 149 490
Poland 325 742 Finland 148 466
Colombia 286 748 Belgium 138 522
China – Rural 279 799 Israel 139 535
China – Urban 273 663 New Zealand 139 526
Czech Republic 273 659 Netherlands 132 515
Argentina 227 642 Sweden 132 461
Scotland 220 711 Canada 122 489
Mexico 197 773 Norway 119 485
Ireland 196 624 Italy 116 418
United States 183 627 Australia 113 432
Northern Ireland 183 581 Spain 99 373
South Korea 177 561 Switzerland 95 408
Greece 170 429 Japan 85 341
Austria 168 469 France 78 409

In Ukraine more than 60,0 % of theIn Ukraine more than 60,0 % of the
population die of diseases of the bloodpopulation die of diseases of the blood
circulation system every decade and forcirculation system every decade and for
every 100 thousand inhabitants more thanevery 100 thousand inhabitants more than
710 person die annually.710 person die annually.
Diseases of heart and vessels are theDiseases of heart and vessels are the
principal reason of physical disability. Itsprincipal reason of physical disability. Its
result consist 20-22 % of all cases ofresult consist 20-22 % of all cases of
constant disability.constant disability.

Causes Number of
deaths
Percentage
of deaths
Total Deaths 55,694,041 100
Communicable diseases,
maternal and perinatal
conditions, and nutritional
deficiencies
17,777,114 31.9
Noncommunicable conditions 32,854,682 59.0
Injuries 5,062,246 9.1
Leading Causes of Mortality in the World

Causes Number of deaths Percentage of
deaths
Communicable diseases, maternal and perinatal
conditions, and nutritional deficiencies
17777114 31.9
Infectious and parasitic diseases 10456814 18.8
Respiratory infections 3941189 7.1
Lower respiratory infections 3866321 6.9
HIV/AIDS 2942901 5.3
Perinatal conditions 2439088 4.4
Diarrheal diseases 2124032 3.8
Tuberculosis 1660411 3.0
Childhood diseases 1385456 2.5
Malaria 1079877 1.9
Maternal conditions 495448 0.9
Nutritional deficiencies 444574 0.8
Protein-energy malnutrition 270758 0.5
STDs excluding HIV 216608 0.4
Meningitis 156392 0.3
Hepatitis C 127519 0.2
Tropical diseases 123757 0.2

Causes Number of deaths Percentage of deaths
Noncommunicable conditions 32854682 59.0
Cardiovascular diseases 16700626 30.0
Malignant neoplasms 6929505 12.4
Ischaemic heart disease 6894057 12.4
Cerebrovascular disease 5101447 9.2
Respiratory diseases 3541692 6.4
Chronic obstructive pulmonary disease 2522983 4.5
Digestive diseases 1923366 3.5
Trachea/bronchus/lung cancers 1212626 2.2
Neuropsychiatric disorders 948157 1.7
Diseases of the genitourinary system 824867 1.5
Diabetes mellitus 809686 1.5
Cirrhosis of the liver 796645 1.4
Stomach cancer 743936 1.3
Congenital abnormalities 656561 1.2
Liver cancer 626119 1.1
Nephritis/nephrosis 620076 1.1
Colon/rectum cancer 579000 1.0

Causes Number of
deaths
Percentage of
deaths
Injuries 5062246 9.1
Unintentional 3402833 6.1
Intentional 1659412 3.0
Road traffic accidents 1259839 2.3
Other unintentional injuries 856557 1.5
Self-inflicted 814779 1.5
Violence 520393 0.9
Drowning 449540 0.8
Poisoning 315482 0.6
War 310363 0.6
Falls 283218 0.5
Fires 238198 0.4

Influence of diseases of system of bloodInfluence of diseases of system of blood
circulation grows constantly with age.circulation grows constantly with age.
Mortality rate from cardiovascular diseases inMortality rate from cardiovascular diseases in
the age of 60 and older is 67.0-74.0 timesthe age of 60 and older is 67.0-74.0 times
higher than at the age of under 20.higher than at the age of under 20.
Much slower in comparison with mortalityMuch slower in comparison with mortality
rate the general morbidity grows: at the age ofrate the general morbidity grows: at the age of
70 and older it exceeds 30 times morbidity in70 and older it exceeds 30 times morbidity in
the age of 15-19 years.the age of 15-19 years.
As to ischemic disease of heart, morbidityAs to ischemic disease of heart, morbidity
growth here is much higher: at the age of 70growth here is much higher: at the age of 70
and older it is 75.0 times higher than at 25-29.and older it is 75.0 times higher than at 25-29.

Dynamics of primary mortalityDynamics of primary mortality ofof
cardiovascular diseasescardiovascular diseases
The bases groups of cardiovascularThe bases groups of cardiovascular
diseases for the last years ,grew: a heartdiseases for the last years ,grew: a heart
attack of a myocardium - from 86,3 inattack of a myocardium - from 86,3 in
1985 up to 107,8 in 1995 (on 1001985 up to 107,8 in 1995 (on 100
thousand adult), a stenocardia - accordingthousand adult), a stenocardia - according
to 106,2 up to 289,9, hyper tonic disease -to 106,2 up to 289,9, hyper tonic disease -
from 514,1 up to 827,5, vascular defectsfrom 514,1 up to 827,5, vascular defects
of brain - with 246,8 up to 581,5 on 100of brain - with 246,8 up to 581,5 on 100
thousand adult.thousand adult.

Social features.Social features.
In the age of 20-39 years hyper tonicIn the age of 20-39 years hyper tonic
disease among countrymen makes 38 ‰,disease among countrymen makes 38 ‰,
city - 13,8 (in 2,8 times is higher), in thecity - 13,8 (in 2,8 times is higher), in the
age of 40-59 years accordingly 142,1 andage of 40-59 years accordingly 142,1 and
54,9 ‰ (in 2,6 times is higher).54,9 ‰ (in 2,6 times is higher).
Vascular defects of brain in the age ofVascular defects of brain in the age of
40-59 years at countrymen meet in 340-59 years at countrymen meet in 3
times more often in comparison with city.times more often in comparison with city.

Social features.Social features.
Diseases of system of bloodDiseases of system of blood
circulation system among mothers ofcirculation system among mothers of
incomplete families is in 2,1 times higherincomplete families is in 2,1 times higher
in comparison with complete, includingin comparison with complete, including
concerning rheumatism - in 4,9, ischemicconcerning rheumatism - in 4,9, ischemic
heart disease of - in 2,7, vascular defectsheart disease of - in 2,7, vascular defects
of brain - in 2,0, diseases of arteries andof brain - in 2,0, diseases of arteries and
veins - in 2,1, than hyper tonic disease -veins - in 2,1, than hyper tonic disease -
in 1,9 times is higher.in 1,9 times is higher.

HEART DISEASEHEART DISEASE
Mortality rateMortality rate
 a.a. Coronary heart disease (CHD)Coronary heart disease (CHD) is theis the
leading cause of death in the United States.leading cause of death in the United States.
There are over 500,000 deaths per year,There are over 500,000 deaths per year,
constituting over 35% of all deaths in theconstituting over 35% of all deaths in the
United States.United States.
 b.b. Mortality rate from CHDMortality rate from CHD is more thanis more than
250 individuals per 100,000 population in the250 individuals per 100,000 population in the
United States.United States.
 c.c. Twenty-five percent of CHD deaths occur inTwenty-five percent of CHD deaths occur in
individuals under the age of 65 years.individuals under the age of 65 years.

Morbidity.Morbidity.
 CHD accounts for about 1.5 millionCHD accounts for about 1.5 million
myocardial infarctions (Mis) eachmyocardial infarctions (Mis) each
yearyear

PrevalencePrevalence
 a.a. About 4.6 million Americans haveAbout 4.6 million Americans have
CHD.CHD.
 b.b. The gender differentialThe gender differential is much moreis much more
prominent in white populations; whiteprominent in white populations; white
men are more likely than white women tomen are more likely than white women to
suffer Ml and sudden death. In general,suffer Ml and sudden death. In general,
women have a greater risk of anginawomen have a greater risk of angina
pectoris; men have a greater risk of Mlpectoris; men have a greater risk of Ml
and sudden death.and sudden death.

Time trends.Time trends.
Age-adjusted CHD death rates in the UnitedAge-adjusted CHD death rates in the United
States for the decade ending in 1985 declined byStates for the decade ending in 1985 declined by
more than 30 % over the previous decade. Thismore than 30 % over the previous decade. This
recent decline in CHD mortality is related to:recent decline in CHD mortality is related to:
 a. Improvements in life-style and related CHDa. Improvements in life-style and related CHD
risk factor levels (e.g., reduced cholesterol,risk factor levels (e.g., reduced cholesterol,
reduced smoking, possibly increased exercise)reduced smoking, possibly increased exercise)
 b. Better diagnosis and treatment (e.g.,b. Better diagnosis and treatment (e.g.,
coronary care units, coronary artery bypasscoronary care units, coronary artery bypass
grafts, treatment of hypertension)grafts, treatment of hypertension)

 Problem № 2 of public health is aProblem № 2 of public health is a
cancer. In general, among 50 millioncancer. In general, among 50 million
people which die in the world each year,people which die in the world each year,
5 millions die from cancer. In the5 millions die from cancer. In the
advanced countries the part of canceradvanced countries the part of cancer
among the reasons of death reaches 20 %.among the reasons of death reaches 20 %.
 In Ukraine this particle is much lowerIn Ukraine this particle is much lower
12-13 %. And frequency of death has12-13 %. And frequency of death has
made in 1995 -200,8 died inhabitants permade in 1995 -200,8 died inhabitants per
100 thousand.100 thousand.

Primary morbidity of cancer is ratherPrimary morbidity of cancer is rather
small: for the last decade it has made insmall: for the last decade it has made in
Ukraine 271,1 cases on 100 thousandUkraine 271,1 cases on 100 thousand
inhabitants; general morbidity - 1206,9; ainhabitants; general morbidity - 1206,9; a
so-called index of accumulation (the rate ofso-called index of accumulation (the rate of
general morbidity and primary = 4,5).general morbidity and primary = 4,5).

Sexual features of mortality rate andSexual features of mortality rate and
morbidity of cancermorbidity of cancer

So, if in the age of 30th years it makes almostSo, if in the age of 30th years it makes almost
20 %, in the age of 70 years and older - almost20 %, in the age of 70 years and older - almost
100 %.100 %.
 Indices of morbidity of men and women isIndices of morbidity of men and women is
different. Under the age of 50 years diseasedifferent. Under the age of 50 years disease
among women (on 20-30 %) prevails due toamong women (on 20-30 %) prevails due to
diseases of female genitals; after 60 yearsdiseases of female genitals; after 60 years
disease of men considerably exceeds same atdisease of men considerably exceeds same at
women ( by 70-100 %).women ( by 70-100 %).

The general parameters ofThe general parameters of
mortality from cancermortality from cancer (by 100(by 100
thousand inhabitants)thousand inhabitants)
1975 - 140,6; 1980 - 149,5; 1985 - 168,8; 1990 - 195,4;1975 - 140,6; 1980 - 149,5; 1985 - 168,8; 1990 - 195,4;
1995 - 200,8. At the end of 70th the tendencies of1995 - 200,8. At the end of 70th the tendencies of
mortality from cancer of a stomach and organs ofmortality from cancer of a stomach and organs of
respiratory system were crossed at the certain decrease inrespiratory system were crossed at the certain decrease in
mortality rate from a cancer of a stomach (1975 - 33,3;mortality rate from a cancer of a stomach (1975 - 33,3;
1980 - 30,5; 1985 - 30,6; 1990 - 29,8; 1995 - 28,1) and1980 - 30,5; 1985 - 30,6; 1990 - 29,8; 1995 - 28,1) and
prompt growth of mortality rate from a cancer ofprompt growth of mortality rate from a cancer of
respiratory system organs (1975 - 28,3; 1980 - 32,6;respiratory system organs (1975 - 28,3; 1980 - 32,6;
1985 - 39,7; 1990 - 49,1; 1995 - 47,2). Mortality from1985 - 39,7; 1990 - 49,1; 1995 - 47,2). Mortality from
cancer of respiratory system achieved also a step risecancer of respiratory system achieved also a step rise
(1975 - 8,1; 1980 - 9,3; 1985 - 11,3; 1990 - 13,1; 1995 -(1975 - 8,1; 1980 - 9,3; 1985 - 11,3; 1990 - 13,1; 1995 -
15,1).15,1).

CHRONIC OBSTRUCTIVECHRONIC OBSTRUCTIVE
PULMONARY DISEASE (COPD)PULMONARY DISEASE (COPD)
 a. The 1986 death rate for COPD was 26.5a. The 1986 death rate for COPD was 26.5
individuals per 100,000 population. Deathsindividuals per 100,000 population. Deaths
from COPD and related conditions constitutedfrom COPD and related conditions constituted
3.6% of all deaths in the United States.3.6% of all deaths in the United States.
 b. Approximately 60,000 deaths per year in theb. Approximately 60,000 deaths per year in the
United States are due to bronchitis, emphy-United States are due to bronchitis, emphy-
sema, or asthma; these diseases aresema, or asthma; these diseases are
contributory causes to another 60,000 deaths.contributory causes to another 60,000 deaths.

 a. II has teen estimated that 16 milliona. II has teen estimated that 16 million
Americans have chronic bronchitis,Americans have chronic bronchitis,
asthma, or em-physemaasthma, or em-physema
 b. Approximately 14% of adult men andb. Approximately 14% of adult men and
8% of adult women have chronic8% of adult women have chronic
bronchitis, obstructive airways disease, orbronchitis, obstructive airways disease, or
both.both.

Time trends.Time trends.
 Deaths attributed to COPD areDeaths attributed to COPD are
increasing; the age-adjusted death rateincreasing; the age-adjusted death rate
rose 28% between 1968 and 1978, duringrose 28% between 1968 and 1978, during
which time the overall death rate declinedwhich time the overall death rate declined
by 22%.by 22%.

Causal and risk factorsCausal and risk factors
 1.1. Smoking.Smoking. It has been demonstrated repeatedly during the past 20It has been demonstrated repeatedly during the past 20
years that smoking, particularly cigarette smoking, is the mostyears that smoking, particularly cigarette smoking, is the most
important cause of COPD. The risk is related to the number ofimportant cause of COPD. The risk is related to the number of
cigarettes smoked daily and to the duration of the smoking.cigarettes smoked daily and to the duration of the smoking.
 2.2. Occupational exposure,Occupational exposure, especially among tin, copper, and coalespecially among tin, copper, and coal
miners; chemical workers; foundry workers; cotton textile workers;miners; chemical workers; foundry workers; cotton textile workers;
and others engaged in certain heavy industry, in-creases the risk ofand others engaged in certain heavy industry, in-creases the risk of
COPD. This is especially true for smokers. The effect is usuallyCOPD. This is especially true for smokers. The effect is usually
considered additive but is considered by some to be multiplicative.considered additive but is considered by some to be multiplicative.
 3.3. Air pollution, including indoor pollutants,Air pollution, including indoor pollutants, has been demonstratedhas been demonstrated
to be harmful at high levels; whether or not exposure to low levels ofto be harmful at high levels; whether or not exposure to low levels of
pollutants has a significant health effect has not yet been determined.pollutants has a significant health effect has not yet been determined.

 4.4. Chronic exposure to ETS in healthy nonsmokersChronic exposure to ETS in healthy nonsmokers leadsleads
to a reduction of small airway lung function resembling thatto a reduction of small airway lung function resembling that
of light smokers.of light smokers.
 5. Sex.5. Sex. Men are at a higher risk than women of developingMen are at a higher risk than women of developing
emphysema and COPD, but not chronic bronchitis; riskemphysema and COPD, but not chronic bronchitis; risk
differences between the sexes increase with age. Older mendifferences between the sexes increase with age. Older men
are at much greater risk than older women, possibly becauseare at much greater risk than older women, possibly because
of occupational exposures.of occupational exposures.
 6.6. Socioeconomic factors.Socioeconomic factors. Morbidity and mortality fromMorbidity and mortality from
COPD generally are higher in blue-collar workers than inCOPD generally are higher in blue-collar workers than in
white-collar workers and in people with few years of formalwhite-collar workers and in people with few years of formal
education. These associations likely are related to smokingeducation. These associations likely are related to smoking
and occupational exposure.and occupational exposure.
 7.7. Family history.Family history. Offspring of affected parents andOffspring of affected parents and
brothers and sisters of affected siblings are more likely tobrothers and sisters of affected siblings are more likely to
develop COPD.develop COPD.

CIRRHOSISCIRRHOSIS
Primary preventionPrimary prevention
a. Health protection measuresa. Health protection measures are recommended byare recommended by
alcoholism researchers and, thus, are not specific foralcoholism researchers and, thus, are not specific for
cirrhosis. Those measures, which are not of provencirrhosis. Those measures, which are not of proven
value, include legislative and regulatory controls on:value, include legislative and regulatory controls on:
 (1) Prices of alcoholic beverages(1) Prices of alcoholic beverages
 (2) Types and locations of liquor outlets(2) Types and locations of liquor outlets
 (3) Hours and days of liquor sales ;(3) Hours and days of liquor sales ;
 (4) Drinking age(4) Drinking age
 (5) Alcohol content of beverages(5) Alcohol content of beverages
 (6) Differential taxation of various beverages(6) Differential taxation of various beverages
 (7) Alcohol distribution systems(7) Alcohol distribution systems

CIRRHOSISCIRRHOSIS
Primary preventionPrimary prevention
b. Health promotion measuresb. Health promotion measures include:include:
 (1) Public education programs(1) Public education programs
 (2) Specifically targeted preventive programs(2) Specifically targeted preventive programs
 (3) Beverage substitution initiatives(3) Beverage substitution initiatives
 (4) Anti-alcohol promotion and marketing(4) Anti-alcohol promotion and marketing
measuresmeasures

DIABETESDIABETES
 a. The 1986 death rate for diabetes was 15.4a. The 1986 death rate for diabetes was 15.4
individuals per 100,000 population. Theseindividuals per 100,000 population. These
deaths (38,000) comprise 1.8% of all deaths indeaths (38,000) comprise 1.8% of all deaths in
the United States.the United States.
 b. Of those diagnosed with diabetes before theb. Of those diagnosed with diabetes before the
age of 30, median survival age is 10-15 yearsage of 30, median survival age is 10-15 years
less then that of the general population; end-less then that of the general population; end-
stage renal disease (VIII) develops in 40 % ofstage renal disease (VIII) develops in 40 % of
these patients, and in remainder, early deaththese patients, and in remainder, early death
usually results from CHD.usually results from CHD.

DIABETESDIABETES
MorbidityMorbidity
 a.a. BlindnessBlindness (approximately 6000 new cases every(approximately 6000 new cases every
year) due to retinopathy. Diabetes is the leading causeyear) due to retinopathy. Diabetes is the leading cause
of blindness in the USA.of blindness in the USA.
 b.b. Cardiovascular disease.Cardiovascular disease. Diabetes is an importantDiabetes is an important
risk factor for CHD and peripheral vascular disease.risk factor for CHD and peripheral vascular disease.
Diabetic vascular disease is the major cause ofDiabetic vascular disease is the major cause of
amputation (50 000 per year).amputation (50 000 per year).
 c.c. Nephropathy.Nephropathy. Diabetic nephropathy occurs inDiabetic nephropathy occurs in
approximately 10% of diabetic and accounts for 25%approximately 10% of diabetic and accounts for 25%
of dialysis patients. Hypertensive nephropathy is alsoof dialysis patients. Hypertensive nephropathy is also
a risk.a risk.

DIABETESDIABETES
 1. Deficiency in the action of the hormone insulin1. Deficiency in the action of the hormone insulin
-which may result from aquantative deficiency of-which may result from aquantative deficiency of
insulin, an abnormal insulin resistance to its action, orinsulin, an abnormal insulin resistance to its action, or
a combination of deficit — is believed to be the causea combination of deficit — is believed to be the cause
of diabetes.of diabetes.
 2. Obesity.2. Obesity. Although etiology of both IDDM andAlthough etiology of both IDDM and
NIDD Mis poorly understood, studies have shownNIDD Mis poorly understood, studies have shown
that approximately 80% of people with NIDDM arethat approximately 80% of people with NIDDM are
obese.obese.
 3. Family history.3. Family history. A family history predisposesA family history predisposes
individuals to diabetes. This predisposition is relatedindividuals to diabetes. This predisposition is related
to the gene loci HLA DR3/DR4.to the gene loci HLA DR3/DR4.

 4. Sex.4. Sex. Males and females have about the same risk for developingMales and females have about the same risk for developing
IDDM.IDDM.
 5. Racial and ethnic factors5. Racial and ethnic factors
a. The incidence rate for IDDM among whites is about 1.5a. The incidence rate for IDDM among whites is about 1.5
times the rate for black.times the rate for black.
b. The incidence of NIDDM is very high among Nativeb. The incidence of NIDDM is very high among Native
Americans, black women, Mexican americanus.Americans, black women, Mexican americanus.
 6. Socioeconomic factors.6. Socioeconomic factors. Changes in socioeconomic status haveChanges in socioeconomic status have
been shown to lead to a marked and rapid increase in the incidencebeen shown to lead to a marked and rapid increase in the incidence
of NIDDM. The reasons for this interesting phenomenon areof NIDDM. The reasons for this interesting phenomenon are
speculated to be:speculated to be:
a.a. More plentiful food sourcesMore plentiful food sources may lead to rapid rise in bodymay lead to rapid rise in body
weight and corresponding increased risk for developing NIDDMweight and corresponding increased risk for developing NIDDM
bb. Increase in socioeconomic status is generally associated. Increase in socioeconomic status is generally associated
with awith a decline in the overall level of physical activity.decline in the overall level of physical activity.
c. Prevention.c. Prevention. Currently, there is noCurrently, there is no primary prevention.primary prevention.
d. Secondary preventiond. Secondary prevention is possible and may be cost-is possible and may be cost-
effective in high-risk groups.effective in high-risk groups.

RENAL DISEASERENAL DISEASE
 1.1. Immune injury,Immune injury, predominantly as a resultpredominantly as a result
of previous streptococcal infection, is the mostof previous streptococcal infection, is the most
frequent cause of glomerulonephritis.frequent cause of glomerulonephritis.
 2.2. Occupational exposure.Occupational exposure. Exposure toExposure to
industrial solvents and gasoline by certainindustrial solvents and gasoline by certain
occupational groups (e.g., painters) is a muchoccupational groups (e.g., painters) is a much
less frequent cause of renal disease.less frequent cause of renal disease.
 3.3. Race.Race. Black adults are more likely toBlack adults are more likely to
develop renal diseases, in particulardevelop renal diseases, in particular
hypertensive nephropathy.hypertensive nephropathy.

 4. Sex.4. Sex. Men are 20 %-30 % more likelyMen are 20 %-30 % more likely
then women to develop renal disease.then women to develop renal disease.
 5. Age.5. Age. Individuals over 45 years of ageIndividuals over 45 years of age
are more likely to develop renal diseaseare more likely to develop renal disease
then those under age 45 years.then those under age 45 years.
 6.6. Diabetes.Diabetes. Diabetic nephropathy andDiabetic nephropathy and
hypertensive nephropathy are majorhypertensive nephropathy are major
causes of morbidity and mortality amongcauses of morbidity and mortality among
diabetics.diabetics.

PEPTIC ULCER DISEASEPEPTIC ULCER DISEASE
Incidence and prevalenceIncidence and prevalence
 a. An annual incidence ratea. An annual incidence rate of 3 per 1000of 3 per 1000
population leads to approximately 350,000population leads to approximately 350,000
new cases per year.new cases per year.
 b. The lifetime prevalence of peptic ulcerb. The lifetime prevalence of peptic ulcer
disease is 5 %-l0 %. The 1-year prevalence ofdisease is 5 %-l0 %. The 1-year prevalence of
self-reported peptic ulcer disease in the Unitedself-reported peptic ulcer disease in the United
States was about l.7 %-9 % between 1961 andStates was about l.7 %-9 % between 1961 and
1981. About 4 million Americans suffer from1981. About 4 million Americans suffer from
active peptic ulcers during any given year.active peptic ulcers during any given year.

PEPTIC ULCER DISEASEPEPTIC ULCER DISEASE
Time trendsTime trends
 a. Although overall prevalence has remaineda. Although overall prevalence has remained
stable, rates for men and women showstable, rates for men and women show
opposite patterns; rates for men haveopposite patterns; rates for men have
decreased from 2.3% to 1.8%, while rates fordecreased from 2.3% to 1.8%, while rates for
women have increased from 1.1 % to 1.7%.women have increased from 1.1 % to 1.7%.
The reason is not established but may be dueThe reason is not established but may be due
to changed smoking habits and stressto changed smoking habits and stress
associated with increased involvement in theassociated with increased involvement in the
workplace.workplace.
 b. The death rate for peptic ulcer disease hasb. The death rate for peptic ulcer disease has

ANEMIAANEMIA
Anemias were the thirteenth leading cause ofAnemias were the thirteenth leading cause of
death of children under the age of 15 in the United Statesdeath of children under the age of 15 in the United States
in 1983, accounting for 0.8 % of all deaths in that age-in 1983, accounting for 0.8 % of all deaths in that age-
group, with a mortality rate of 0.3 per 100,000group, with a mortality rate of 0.3 per 100,000
population of individuals age 1-14 years. Death often re-population of individuals age 1-14 years. Death often re-
sults due to compromised oxygen delivery to tissues,sults due to compromised oxygen delivery to tissues,
especially in cases of compromised cardiac output, suchespecially in cases of compromised cardiac output, such
as underlying vascular and cardiac disease states.as underlying vascular and cardiac disease states.
Anemia accounts for less, than 0.05% of deaths overall,Anemia accounts for less, than 0.05% of deaths overall,
with a mortality rate of 0.1 per 100,000 population.with a mortality rate of 0.1 per 100,000 population.

ANEMIAANEMIA
 a.a. Prevalence rates in children ranged from 5.7 % inPrevalence rates in children ranged from 5.7 % in
infants 1-2 years of age to 2.8 % in children 9-11 years ofinfants 1-2 years of age to 2.8 % in children 9-11 years of
age, including girls and boys of all races.age, including girls and boys of all races.
 bb. Children 6-8 years of age and boys and men 12—44. Children 6-8 years of age and boys and men 12—44
years of age had the lowest prevalencyears of age had the lowest prevalencee rates (2.3 % andrates (2.3 % and
2.9 % respectively).2.9 % respectively).
 c.c. The highest prevalenceThe highest prevalence rates, aside from infants, wererates, aside from infants, were
experienced by girls 15-17 years of age (5.9 %), youngexperienced by girls 15-17 years of age (5.9 %), young
women (4.5 %), and elderly men (4.8 %).women (4.5 %), and elderly men (4.8 %).


The important social - medicalThe important social - medical
problem are accidents, poisoningsproblem are accidents, poisonings
and traumas.and traumas.
 They occupy the III place among theThey occupy the III place among the
reasons of mortality reasons and thereasons of mortality reasons and the
same place among the reasons ofsame place among the reasons of
constant disability (9-10 %).constant disability (9-10 %).

The bases social reasons of theThe bases social reasons of the
accidents and traumas areaccidents and traumas are
alchogolism, social and economicalchogolism, social and economic
disorders, the insufficientdisorders, the insufficient
organization of the safety precautionsorganization of the safety precautions
at production.at production.

From all diseases as it has alreadyFrom all diseases as it has already
been said, certain groups of diseasesbeen said, certain groups of diseases
are allocated which have specialare allocated which have special
influence on public health andinfluence on public health and
demand purposeful medico-socialdemand purposeful medico-social
measures.measures.

Social-medical aspects of Major chronic diseases

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