1. Chapter 7: Epidemiology of Chronic Diseases

2. “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

3. “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

4. “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.

5. 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.

6. Risk Factors for Chronic Diseases Obesity High cholesterol Tobacco smoking Lack of physical activity Alcohol use Emotional disorders Poor diet and nutrition

7. 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

8. 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.

9. 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.

10. Disability-Adjusted Life Year Indication of health outcomes Measures the time lived with disability Also measures the time lost due to premature death

11. Quality Adjusted Life Year Frequently used outcome measure in cost utility analysis Incorporates: – Quality or desirability of a health state – Duration of survival

12. 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

13. 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, self- management support, delivery system design, decision support, clinical information system

14. 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.

15. 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