Transcript Chapter 7: Epidemiology of Chronic Diseases

Chapter 7: Epidemiology of
Chronic Diseases
“The Change You Like to See….”
(1 of 3)
• Chronic diseases result from prolongation of
acute illness.
– With periods of remission and exacerbation of
signs and symptoms
• Lead to disability
• Demand attention throughout the life span
• Globally, referred to as noncommunicable
diseases
“The Change You Like to See….”
(2 of 3)
• Examples are arthritis, heart disease, stroke,
cancer, COPD, hypertension, and diabetes.
• Risk factors for chronic disease
– Low socioeconomic status
– Inadequate access to health care
– Poor lifestyle
– Abnormal genetics
“The Change You Like to See….”
(3 of 3)
• Risk factors for chronic disease (cont’d)
– Poor environment
– Decreased emotional strength
• Not all acute illnesses progress to chronic
states.
• Chronic diseases are the leading cause of
death in the United States.
Chronic Disease Mortality and
Morbidity
• Measures of mortality include:
– Defined population (denominator)
– Time period
– Number of deaths occurring in a location/place
(numerator)
• Age-adjusted rates should be used.
• Gender, race, ethnicity, and socioeconomic
status should be considered.
Risk Factors for Chronic Diseases
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Obesity
High cholesterol
Tobacco smoking
Lack of physical activity
• Alcohol use
• Emotional disorders
• Poor diet and nutrition
Some of the Chronic Diseases
(1 of 2)
• Cystic fibrosis
– 1,000 new U.S. cases annually
– Treatment: support, medications, nutritious food
• Cardiovascular disease
– Account for 29% of deaths worldwide
– Usually preventable
– Risk factors include physical inactivity, smoking,
diabetes, high cholesterol, high blood pressure.
• Can be managed or controlled
Some of the Chronic Diseases
(2 of 2)
Figure 7-9 Percentage of the civilian,
noninstitutionalized population with diagnosed
diabetes by age, United States, 1980–2007.
Source: From CDC. Diabetes mellitus. Retrieved September 21, 2010, from
http://www.cdc.gov/diabetes/statistics/prev/national/figbyage.htm
• Diabetes mellitus
– Prevalence is increasing
in all age groups.
• Figure shows U.S.
increases from 1990
to 2007.
– Good nutrition, good
blood glucose control,
use of insulin or
antidiabetic drugs, and
regular check-ups are
advised.
Chronic Disease Surveillance
• Morbidity data provide information about
persons who have a disease.
• CDC and its partners conduct surveillance
across the country.
– Cover various population groups.
– Results can be used to monitor disease trends,
develop prevention programs, monitor prevention
efforts.
Disability-Adjusted Life Year
• Indication of health outcomes
• Measures the time lived with disability
• Also measures the time lost due to premature
death
Quality Adjusted Life Year
• Frequently used outcome measure in cost
utility analysis
• Incorporates:
– Quality or desirability of a health state
– Duration of survival
Implications for Clinical Practice
(1 of 4)
• Surveillance of own practice
– Document patient risk factors for chronic diseases.
• Software helps in this.
– Treat patients and offer education.
• Knowledge of risk factors, populations at risk
– Example: prescribing folic acid and iron for all
pregnant women
Implications for Clinical Practice
(2 of 4)
• Interdisciplinary care teams
– Most public health problems are
multidimensional.
– Require experts from different specialties to
formulate strategies
• Chronic care model
– Addresses concerns about the increase in chronic
diseases
– Components: community resources, selfmanagement support, delivery system design,
decision support, clinical information system
Implications for Clinical Practice
(3 of 4)
• Ecological and social determinants of health
– Disparities in healthcare delivery exist.
• Caused by factors ranging from poverty to corruption
• Impact on people with chronic diseases is far reaching.
– Environmental risks are also challenging.
• Examples: nuclear reactors, coal mines
– We are aware of the risk, and safety strategies are
usually in place.
• Yet cases are still reported.
Implications for Clinical Practice
(4 of 4)
• Risk factor versus population approaches
– Population-based prevention applies interventions
to an entire population.
– Focus is shifting from the search for risk factors to
the population-based perspective.
• Some disagree, and like to target interventions to
individuals in whom risk factor is detected.
– Clinicians treat individuals.
• While understanding the global picture