Public Health 150 Non-communicable Diseases

Name: Public Health 150 Non-communicable Diseases
Uploaded: 2017-09-09T18:40:48+00:00
Duration: PTM44S29
Description: Public Health 150 Non-communicable Diseases

Public Health 150 Non-communicable Diseases
PH150 Public Health 150 Non-communicable Diseases Zuo-Feng Zhang, MD, PhD Professor of Epidemiology October 31, 2011 ZuoFeng Zhang - 31 October 2011

PH150 What are NCDs? NCD is a medical condition or disease, which is not infectious NCDs are diseases or medical conditions with long duration and relatively slow progression NCDs are usually called “Chronic Diseases” ZuoFeng Zhang - 31 October 2011

Why NCDs Are Important in Public Health?
PH150 Why NCDs Are Important in Public Health? 57 million deaths that occurred globally in 2008 36 million – 63.2%, almost two thirds – were due to NCDs 9 million death that occurred among people under age 60 mainly cardiovascular diseases, cancers, diabetes and chronic lung diseases ZuoFeng Zhang - 31 October 2011

UN High-Level meeting on NCDs, September 19-20, 2011
PH150 UN High-Level meeting on NCDs, September 19-20, 2011 ZuoFeng Zhang - 31 October 2011

PH150 ZuoFeng Zhang - 31 October 2011

Number of deaths for leading causes of death in the US
PH150 Number of deaths for leading causes of death in the US Heart disease: 631,636 Cancer: 559,888 Stroke (cerebrovascular diseases): 137,119 Chronic lower respiratory diseases: 124,583 Accidents (unintentional injuries): 121,599 Diabetes: 72,449 Alzheimer's disease: 72,432 Influenza and Pneumonia: 56,326 Nephritis, nephrotic syndrome, and nephrosis: 45,344 Septicemia: 34,234 ZuoFeng Zhang - 31 October 2011

PH150 US ZuoFeng Zhang - 31 October 2011

Cardiovascular Diseases
PH150 Cardiovascular Diseases CVDs include diseases of the heart, vascular diseases of the brain and diseases of blood vessels. CVDs are responsible for over 17.3 million deaths per year and are the leading causes of death in the world WHO. Global Atlas on Cardiovascular Disease Prevention and Control. Mendis S, Puska P, Norrving B editors. World Health Organization, Geneva 2011 ZuoFeng Zhang - 31 October 2011

Heart and Brain PH150 ZuoFeng Zhang - 31 October 2011
WHO. Global Atlas on Cardiovascular Disease Prevention and Control. Mendis S, Puska P, Norrving B editors. World Health Organization, Geneva 2011 ZuoFeng Zhang - 31 October 2011

Proportion of Death caused by CVDs
PH150 Proportion of Death caused by CVDs WHO. Global Atlas on Cardiovascular Disease Prevention and Control. Mendis S, Puska P, Norrving B editors. World Health Organization, Geneva 2011 ZuoFeng Zhang - 31 October 2011

PH150 Distribution of CVDs ZuoFeng Zhang - 31 October 2011

PH150 What Is Tumor/Cancer? ZuoFeng Zhang - 31 October 2011

Tumor is a disorder of cells
PH150 Tumor is a disorder of cells A neoplasm (Greek, Neo-New, plasma, thing formed) is the autonomous growth of tissue that have escaped the normal restraints on cell proliferation and exhibit varying degrees of fidelity to their precursors. It is usually appears as a tumor ( a swelling) made of mass of cells.“Abnormal growth of cells”, “Unlimited growth of cells”. ZuoFeng Zhang - 31 October 2011

PH150 Tumors In general, neoplasms are irreversible, and their growth is for the most part, autonomous. ZuoFeng Zhang - 31 October 2011

Benign versus Malignant Tumors
PH150 Benign versus Malignant Tumors Benign tumors do not penetrate (invade) adjacent tissue borders, nor do they spread (metastasize) to distant sites. They remain localize overgrowths in the area in which they arise Benign tumors are more differentiated than malignant tumors, that is, they are more closely resemble their tissue of origin. ZuoFeng Zhang - 31 October 2011

Invasion and Metastasis
PH150 Invasion and Metastasis Malignant tumors (cancer) are capable of invasion (spread of the neoplasms into adjacent structures) and metastasis (implantation of the neoplasms into noncontiguous sites). ZuoFeng Zhang - 31 October 2011

Oral Premalignant Lesions
PH150 Oral Premalignant Lesions Oral submucous fibrosis Oral Leukoplakia Erythroplakia Second Primary Cancers following a first primary oral cancer Invasive oral cancer Esophageal Cancer Oral Cancer Lung Cancer ZuoFeng Zhang - 31 October 2011

Cancer Statistics 12.7 million new cases in 2008
PH150 Cancer Statistics 12.7 million new cases in 2008 7.6 million deaths from cancer (13.3% of overall deaths) in 2008 ZuoFeng Zhang - 31 October 2011

Incidence and Mortality, World 2008
PH150 Incidence and Mortality, World 2008 ZuoFeng Zhang - 31 October 2011

PH150 Cancer ZuoFeng Zhang - 31 October 2011

Projected demographic effects on cancer incidence and mortality
New cancers (in 1,000,000s) of all cancers Region 2008 2010 2020 2030 World 12.67 13.30 16.93 21.37 More developed regions 5.56 5.72 6.59 7.43 Less developed regions 7.11 7.52 9.92 12.88 Africa 0.68 0.72 0.95 1.28 Asia (Japan) 0.62 0.64 0.74 0.79 Asia (Other) 5.48 5.75 7.60 9.89 Europe 3.21 3.29 3.67 4.06 Latin America/Caribbean 0.91 0.96 1.69 North America 1.60 1.67 2.08 2.50 Oceania 0.14 0.18 0.23 New deaths (in 1,000,000s) of all cancers Region 2008 2010 2020 2030 World 7.57 7.96 10.22 13.16 More developed regions 2.75 2.84 3.32 3.86 Less developed regions 4.82 5.11 6.83 9.10 Africa 0.51 0.54 0.72 0.97 Asia (Japan) 0.34 0.36 0.43 0.47 Asia (Other) 3.73 3.92 5.24 6.98 Europe 1.72 1.77 1.99 2.26 Latin America/Caribbean 0.58 0.78 1.05 North America 0.64 0.66 0.84 1.06 Oceania 0.06 0.08 0.10 ZuoFeng Zhang - 31 October 2011

Projected demographic effects on cancer incidence and mortality
New cancers (in 100,000s) Cancer site 2008 2010 2020 2030 Lung 16.1 17.0 22.1 28.7 Breast 13.8 14.5 17.9 21.7 Colon/rectum 12.3 13.0 16.8 21.9 Stomach 9.9 10.4 13.5 17.4 Prostate 9.0 9.5 12.8 17.1 Liver 7.5 7.9 10.0 12.5 Cervix 5.3 5.5 6.6 7.8 Esophagus 4.8 5.1 8.4 New deaths (in 100,000s) Cancer site 2008 2010 2020 2030 Lung 13.8 14.5 19.0 24.9 Stomach 7.4 7.8 10.1 13.2 Liver 7.0 7.3 9.3 11.8 Colon/rectum 6.1 6.4 8.3 11.0 Breast 4.6 4.8 6.0 7.5 Esophagus 4.1 4.3 5.6 7.2 Cervix 2.8 2.9 3.6 Prostate 2.6 2.7 5.0 ZuoFeng Zhang - 31 October 2011

Cancer Incidence and Mortality in China and World, 2008
PH150 Cancer Incidence and Mortality in China and World, 2008 China New Cases Incidence Deaths Mortality Male 1,622,502 (24.5%) 211.0 1,222,199 (28.9%) 158.6 Female 1,194,708 (19.8%) 152.4 736,148 (22.0%) 91.6 Total 2,817,210 (22.2%) 181.0 1,958,347 (25.88%) 124.6 World 6,617,844 203.8 4,219,626 128.6 6,044,710 165.1 3,345,176 87.6 12,662,554 181.6 7,564,802 106.1 Incidence and Mortality are per 100,000 Population: China: 1,331,460,000; World: 6,775,235,700; China/World: 19.65% Globocan, 2008 ZuoFeng Zhang - 31 October 2011

Age Standardized Incidence Rates (/100,000)
PH150 Age Standardized Incidence Rates (/100,000) US China World Site Males Females Stomach 7.2 3.3 41.4 19.2 22.0 10.3 Lung 61.9 36.1 42.4 19.0 35.5 12.1 Liver 5.5 2.0 37.9 14.2 15.7 5.8 Esophagus 4.9 1.3 27.4 12.0 11.5 4.7 Colon/Rectum 44.6 33.1 13.6 9.2 20.1 14.6 Breast ─ 101.1 18.7 37.5 Leukemia 11.2 7.4 5.7 4.1 5.9 Pancreas 8.3 6.3 3.9 2.6 4.6 Cervix 7.7 6.8 16.2 Brain 6.5 4.5 2.8 3.7 Prostate 124.8 1.6 25.3 Source: GLOBOCAN 2002 ZuoFeng Zhang - 31 October 2011

ZuoFeng Zhang - 31 October 2011
PH150 Now we will turn our attention to the number of new cancers anticipated in the US this year. It is estimated that almost 1.6 million new cases of cancer will be diagnosed in The most common cancers are prostate in men and breast in women; lung and colorectal cancers are the second and third most common cancers in both men and in women. ZuoFeng Zhang - 31 October 2011

ZuoFeng Zhang - 31 October 2011
PH150 Lung cancer is by far the most common fatal cancer in men (28%), followed by prostate (11%), and colon & rectum (9%). In women, lung (26%), breast (15%), and colon & rectum (9%) are the leading sites of cancer death. ZuoFeng Zhang - 31 October 2011

ZuoFeng Zhang - 31 October 2011 40
PH150 The next four slides look at the lifetime probability of developing cancer and relative survival rates of cancer. Presently, the risk of an American man developing cancer over his lifetime is one in two. ZuoFeng Zhang - 31 October 2011 40

PH150 The risk of an American woman developing cancer over her lifetime is one in three. ZuoFeng Zhang - 31 October 2011 41

PH150 COPD Chronic obstructive pulmonary disease (COPD) is a life-threatening lung disease that interferes with normal breathing – it is more than a “smoker’s cough”. An estimated 64 million people have COPD worldwide in More than 3 million people died of COPD in 2005, which is equal to 5% of all deaths globally that year. Almost 90% of COPD deaths occur in low- and middle-income countries. The primary cause of COPD is tobacco smoke (through tobacco use or second-hand smoke). The disease now affects men and women almost equally, due in part to increased tobacco use among women in high-income countries. COPD is not curable, but treatment can slow the progress of the disease. Total deaths from COPD are projected to increase by more than 30% in the next 10 years without interventions to cut risks, particularly exposure to tobacco smoke. ZuoFeng Zhang - 31 October 2011

PH150 COPD ZuoFeng Zhang - 31 October 2011

PH150 Diabetes ZuoFeng Zhang - 31 October 2011

Diabetes More than 346 million people worldwide have diabetes.
PH150 Diabetes More than 346 million people worldwide have diabetes. There is an emerging global epidemic of diabetes that can be traced back to rapid increases in overweight, obesity and physical inactivity. ZuoFeng Zhang - 31 October 2011

PH150 Diabetes Diabetes is predicted to become the seventh leading cause of death in the world by the year 2030. Total deaths from diabetes are projected to rise by more than 50% in the next 10 years. ZuoFeng Zhang - 31 October 2011

Diabetes There are two major forms of diabetes.
PH150 Diabetes There are two major forms of diabetes. Type 1 diabetes is characterized by a lack of insulin production and type 2 diabetes results from the body's ineffective use of insulin. A third type of diabetes is gestational diabetes. This type is characterized by hyperglycaemia, or raised blood sugar, which has first appeared or been recognized during pregnancy. ZuoFeng Zhang - 31 October 2011

Diabetes Type 2 diabetes is much more common than type 1 diabetes.
PH150 Diabetes Type 2 diabetes is much more common than type 1 diabetes. Type 2 accounts for around 90% of all diabetes worldwide. Reports of type 2 diabetes in children – previously rare – have increased worldwide. In some countries, it accounts for almost half of newly diagnosed cases in children and adolescents. ZuoFeng Zhang - 31 October 2011

PH150 Diabetes Cardiovascular disease is responsible for between 50% and 80% of deaths in people with diabetes. Diabetes has become one of the major causes of premature illness and death in most countries, mainly through the increased risk of cardiovascular disease (CVD). ZuoFeng Zhang - 31 October 2011

PH150 Diabetes Diabetes is a leading cause of blindness, amputation and kidney failure. Lack of awareness about diabetes, combined with insufficient access to health services and essential medicines, can lead to complications such as blindness, amputation and kidney failure. ZuoFeng Zhang - 31 October 2011

Diabetes Type 2 diabetes can be prevented.
PH150 Diabetes Type 2 diabetes can be prevented. Thirty minutes of moderate-intensity physical activity on most days and a healthy diet can drastically reduce the risk of developing type 2 diabetes. Type 1 diabetes cannot be prevented. ZuoFeng Zhang - 31 October 2011

Reproductive & Sexual Behavior: 7% (1%-13%) Occupation: 4% (<2%-8%)
PH150 Percentage of Cancer Deaths Attributed to Various Factors (Doll R and Peto R, JNCI, 1981) Tobacco Use: 30% (25%-40%) Diet:35% (10%-70%) Infection: 10%? (1%-?) Reproductive & Sexual Behavior: 7% (1%-13%) Occupation: 4% (<2%-8%) Alcohol: 3% (2%-4%) Geophysical factors (natural radiation): 3% (2-4%) Pollution: 2% (<1% – 5%) Food additive: <1% (-5% – 2%) Medicines and Medical Procedures: 1% (0.5%-3%) Industrial consumer products <1% (<1%-2%) Unknown: ?, ? ZuoFeng Zhang - 31 October 2011

PH150 Lichtenstein P, Holm NV, Verkasalo PK, Iliadou A, Kaprio J, Koskenvuo M, Pukkala E, Skytthe A, Hemminki K. NEJM, 2000 ZuoFeng Zhang - 31 October 2011

Study Design in GWA Studies
PH150 Study Design in GWA Studies Multistage approach to reduce the amount of genotyping required, without sacrificing power. In stage 1, a full set of SNPs is genotyped, and a p-value threshold is used to identify a subset of SNPs with putative associations. Joel N. Hirschhorn & Mark J. Daly Nature Reviews Genetics 6, 95-108, 2005 ZuoFeng Zhang - 31 October 2011

Published Genome-Wide Associations through 06/2011,
PH150 Published Genome-Wide Associations through 06/2011, 1,449 published GWA at p≤5x10-8 for 237 traits National Human Genome Research Institute (NHGRI) GWA Catalog ZuoFeng Zhang - 31 October 2011

Tobacco causes 10% of CVD death
PH150 Tobacco causes 10% of CVD death ZuoFeng Zhang - 31 October 2011

PH150 Tobacco use is a major preventable cause of death, particularly from lung cancer. The year 2004 marks the anniversary of the release of the first Surgeon General’s report on Tobacco and Health, which initiated a decline in per capita cigarette consumption in the United States. As a result of the cigarette smoking epidemic, lung cancer death rates showed a steady increase through 1990, then began to decline among men. The lung cancer death rate among US women, who began regular cigarette smoking later than men, has begun to plateau after increasing for many decades. ZuoFeng Zhang - 31 October 2011 69

Diseases Caused by Tobacco Use
PH150 Diseases Caused by Tobacco Use Cigarette smoking increases the risk of:  Coronary heart disease  Atherosclerotic peripheral vascular disease  Cerebrovascular disease  Cancers of the lung, larynx, mouth, esophagus, bladder, pancreas, kidney, and cervix  Chronic obstructive pulmonary disease  Intrauterine growth retardation, premature rupture of membranes  Low-birthweight babies, perinatal mortality  Cataract, macular degeneration; hip fracture  Peptic ulcer disease  Possibly liver, stomach, and colorectal cancers and acute myelocytic leukemia ZuoFeng Zhang - 31 October 2011

Disease Caused by Tobacco Use
PH150 Disease Caused by Tobacco Use Involuntary smoking (environmental tobacco smoke) is a cause of:  Lung cancer and coronary heart disease in nonsmokers  Respiratory infections and symptoms in the children of parents who smoke Smokeless tobacco causes:  Oral Cancer  Oral leukoplakia  Dental caries (possibly) Cigars cause:  Cancers of the mouth, larynx, and lung  Coronary heart disease  COPD ZuoFeng Zhang - 31 October 2011

PH150 Physical Activities ZuoFeng Zhang - 31 October 2011

PH150 The Benefits of Physical Activity Regular physical activity is one of the most important things you can do for your health. Control your weight Reduce your risk of cardiovascular disease Reduce your risk for type 2 diabetes and metabolic syndrome Reduce your risk of some cancers (colon, breast, endomentrial and lung cancers) Strengthen your bones and muscles Improve your mental health and mood Improve your ability to do daily activities and prevent falls, if you're an older adult Increase your chances of living longer CDC, 2011 ZuoFeng Zhang - 31 October 2011

PH150 Harmful Use of Alcohol ZuoFeng Zhang - 31 October 2011

PH150 Obesity ZuoFeng Zhang - 31 October 2011

Key facts Worldwide obesity has more than doubled since 1980.
PH150 Key facts Worldwide obesity has more than doubled since 1980. In 2008, 1.5 billion adults, 20 and older, were overweight. Of these over 200 million men and nearly 300 million women were obese. 65% of the world's population live in countries where overweight and obesity kills more people than underweight. Nearly 43 million children under the age of five were overweight in 2010. Obesity is preventable. ZuoFeng Zhang - 31 October 2011

PH150 Obesity Globally, 44% of diabetes, 23% of ischaemic heart disease and 7–41% of certain cancers are attributable to overweight and obesity. ZuoFeng Zhang - 31 October 2011

PH150 Obesity Body Mass Index (BMI) is a number calculated from a person's weight and height. BMI provides a reliable indicator of body fatness for most people and is used to screen for weight categories that may lead to health problems. ZuoFeng Zhang - 31 October 2011

PH150 BMI Classification Body Mass Index (BMI) is a simple index of weight-for-height that is commonly used to classify underweight, overweight and obesity in adults. It is defined as the weight in kilograms divided by the square of the height in metres (kg/m2). For example, an adult who weighs 70kg and whose height is 1.75m will have a BMI of 22.9. BMI = 70 kg / (1.75 m2) = 70 / 3.06 = 22.9 ZuoFeng Zhang - 31 October 2011

PH150 The International Classification of adult underweight, overweight and obesity according to BMI ZuoFeng Zhang - 31 October 2011

Fattest Countries in the World
PH150 Fattest Countries in the World ZuoFeng Zhang - 31 October 2011

PH150 Obesity has reached epidemic proportions in the United States. The percentage of adults age 20 to 74 who are obese increased from the late 1970s to 2000, with the largest increases occurring in the 1990s. Similar trends were observed among men and women. In the past decade, obesity trends in women have remained relatively stable, from 34% in to 36% in ; among men, prevalence increased from 28% to 33% during this period. ZuoFeng Zhang - 31 October 2011 89

PH150 This slide highlights the obesity epidemic as mentioned in the previous slide. In 2009, over 55% of adults in all states, except District of Columbia, were overweight or obese, compared to none in 1992. ZuoFeng Zhang - 31 October 2011 90

PH150 Diet ZuoFeng Zhang - 31 October 2011

Public Health 150 Non-communicable Diseases

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