1. Health Statistics and Informatics Non-communicable diseases A global overview

2. Health Statistics and Informatics Outline Definition Non-communicable disease mortality worldwide The Epidemiological Transition Global Burden of Disease Study Major risk factors Blood pressure Cholesterol Smoking Infection and non-communicable diseases 2

3. Health Statistics and Informatics What are non-communicable diseases? 3

4. Health Statistics and Informatics Classifying deaths and diseases (WHO) Communicable diseases [Group I] Those where death is directly due to the action of a communicable agent Non-communicable diseases Diseases [Group II] Cancer, diseases of various organ systems (eg respiratory, cardiovascular etc.), diabetes, mental health etc. External causes (injuries, poisonings and violence) [Group III] 4

5. Health Statistics and Informatics Importance of non- communicable diseases mortality 5

6. Health Statistics and Informatics A global problem In 2004 there were 59 million deaths world- wide Non-communicable diseases accounted for 60% of these deaths and injuries and violence 10%. By 2020 it is estimated that non- communicable disease will account for 73% of all deaths 6 GBD 2004 Update, 2008

7. Health Statistics and Informatics The epidemiologic transition (Omran, 1971) Change in the balance of disease in a population from communicable diseases to non-communicable disease 7

8. Health Statistics and Informatics Decline in proportion of total mortality due to infectious diseases England & Wales, 1911-94, by age 8 Males Females 1-14 25-44 45-64 65-74

9. Health Statistics and Informatics Different countries at different stages of the epidemiological transition 9

10. Health Statistics and Informatics Non-communicable diseases as % of all deaths by global region (all ages ) WORLDWIDE59% N.America; W Europe88% China, W Pacific, + some SE Asia75% Latin America + Caribbean67% S E Asia including India51% Sub-Saharan Africa21% 10

11. Health Statistics and Informatics Urbanisation 11

12. Health Statistics and Informatics 12 http://www.indiaimages.com/street/street_life2_large.jpg

13. Health Statistics and Informatics Urbanisation 13

14. Health Statistics and Informatics Drivers of the epidemiological transition in low and middle income countries Population ageing Major socio-economic changes (especially urbanisation) changes in risk factors such as diet, physical activity, smoking etc. 14

15. Health Statistics and Informatics Global Burden of Disease (GBD) Study 15

16. Health Statistics and Informatics Global Burden of Disease Study First GBD study started in 1992 by World Bank. Second GBD study (in collaboration with WHO) conducted 2001 Extensive synthesis of all available data to give set of mortality estimates by age, sex, region and cause worldwide – for the first time 2001 GBD study covers 135 causes of death, 17 sub-regions, based on aggregation of country- level information 16

17. Health Statistics and Informatics Global Burden of Disease 2004 Update (published 2008) http://www.who.int/healthinfo/global_ burden_disease/GBD_report_2004upda te_full.pdf 17

18. Health Statistics and Informatics Distribution of deaths in the world by sex, 2004 18 GBD report 2004 update, 2008

19. Health Statistics and Informatics Mortality rates among men and women aged 15–59 years, region and cause-of-death group, 2004 19 GBD report 2004 update, 2008

20. Health Statistics and Informatics Projected global deaths for selected causes, 2004–2030 20 GBD report 2004 update, 2008

21. Health Statistics and Informatics Smoking 21

22. Health Statistics and Informatics % of deaths aged 35-69 years attributable to smoking in 2000 MenWomen Belarus33%0% Russia33%3% Ukraine32%3% Central Asia (8)23%4% Estonia31%3% Latvia30%2% Lithuania29%0% United Kingdom25%21% Germany29%11% 22 Source : http://www.deathsfromsmoking.net/

23. Health Statistics and Informatics Risk of myocardial infarction increases with every single cigarette smoked per day 23 Odds Ratio of Myocardial Infarction Source : K. K. Teo et al Tobacco use and risk of myocardial infarction in 52 countries in the INTERHEART study Lancet 368 (9536):647-658, 2006. INTERHEART study 52 countries 12 461 cases, 14 637 controls

24. Health Statistics and Informatics Smoking causes more deaths from cardiovascular disease than cancer Deaths attributed to smoking among men (all ages) in Russia, 2000 All cancers = 77,000 Cardiovascular disease = 148,000 24 Source : http://www.deathsfromsmoking.net/

25. Health Statistics and Informatics Things are getting worse not better 25

26. Health Statistics and Informatics Smoking in men in Russia is not declining 26 Rural Urban St Petersburgh/Moscow Source : Perlman et al Tob.Control 16 (5):299-305, 2007 Russian Longitudinal Monitoring Survey

27. Health Statistics and Informatics Smoking in women in Russia is increasing 27 Rural Urban St Petersburgh/Moscow Russian Longitudinal Monitoring Survey Source : Perlman et al Tob.Control 16 (5):299-305, 2007

28. Health Statistics and Informatics Giving up smoking reduces risk 28

29. Health Statistics and Informatics 29

30. Health Statistics and Informatics Summary Non-communicable diseases are now the most common cause of death world wide Increasing rates in low and middle income countries because of change in lifestyles (urbanisation) Key risk factors have very large effects (diet, physical activity, smoking, etc…) Interventions are effective and can reduce burden The need to combine results and have large studies to continue to evaluate 30