1. Group 7 Burden of disease in Brazil

2. KEY HEALTH INDICATORS Years of life lost (YLLs): Years of life lost due to premature mortality. Years lived with disability (YLDs): Years of life lived with any short-term or long-term health loss, adjusted for severity. Disability-adjusted life years (DALYs): The sum of years lost due to premature death (YLLs) and years lived with disability (YLDs). DALYs are also defined as years of healthy life lost. Healthy life expectancy, or health-adjusted life expectancy (HALE): The number of years that a person at a given age can expect to live in good health, taking into account mortality and disability.

3. INTRODUCTION Diabetes mellitus is a worldwide public health problem and one of the main chronic syndromes currently affecting humankind, regardless of socioeconomic status and geographic location. The syndrome has a multiple etiology, resulting from lack of insulin and/or the inability of insulin to adequately exert its effects. Diabetes mellitus is characterized by chronic hyperglycemia, frequently accompanied by dyslipidemia, arterial hypertension, and endothelial dysfunction 1.

4. INTRODUCTION A diabetes epidemic is underway. An estimated 30 million people world-wide had diabetes in 1985. By 1995, this number had shot up to 135 million. The latest WHO estimate (for the number of people with diabetes, world- wide, in 2000) is 177 million. This will increase to at least 300 million by 2025.

5. The number of deaths attributed to diabetes was previously estimated at just over 800,000. However, it has long been known that the number of deaths related to diabetes is considerably underestimated. A more plausible figure is likely to be around 4 million deaths per year related to the presence of the disorder. This is about 9% of the global total.

6. Diabetes Mellitus in Brazil The indicator used was disability-adjusted life years (DALY), using a discount rate of 3%. In Brazil, ischemic heart disease, stroke, and diabetes accounted for 14.7% of total lost DALYs. Brazil showed a higher proportion of years lived with disability (YLDs) among total DALYs for diabetes as compared to other countries.

7. Diabetes Mellitus in Brazil In Brazil, the most comprehensive study on diabetes mellitus prevalence was conducted in 1988, in nine State capitals. Estimated prevalence was 7.5% in individuals 30-69 years of age, with the highest prevalence (17.4%) in the 60-69-year age group

9. In 2007, the incident rate in Brazil was estimated to be 7.7 per 100,000 children per year.

14. The burden associated with the disease is documented in the data of the more than 1·6 million cases of diabetes registered: 4·3% of those registered had a diabetic foot disorder and 2·2% a previous amputation, 7·8% had renal disease, 7·8% had a previous myocardial infarction, and 8·0% had a previous stroke.

15. Linking these data with the mortality registry shows the mortality burden attributable to diabetes: Age and gender standardized mortality in people with diabetes was 57% greater than that of the general population. Of all deaths, 38% were due to cardiovascular disease, 6% to renal disease, and 17% were coded as multiple or other chronic complications of diabetes. Only 2% were due to the acute complications of diabetes.

16. Key NCDs and their shared risk factors The WHO 2008 action a plan for NCDs focuses on four NCDs (cardiovascular diseases, diabetes, cancer, and chronic respiratory disease) and their four shared their risk factors which are tobacco use physical inactivity, unhealthy diets harmful use of alcohol

17. Key NCDs and their shared risk factors These four NCDs accounted for 58% of all deaths in Brazil in 2007 and are, along with neuropsychiatric disorders, the main causes of disease burden.

18. Its cost so much and it is affect all things the hospital the govermint the persons to to mange it or prevent it and its cost about (US$ 3.9 billion) in Brazil

19. As the number of people with diabetes grows worldwide, the disease takes an ever-increasing proportion of national health care budgets. Without primary prevention, the diabetes epidemic will continue to grow. Even worse, diabetes is projected to become one of the world’s main disablers and killers within the next twenty-five years. Immediate action is needed to stem the tide of diabetes and to introduce cost-effective treatment strategies to reverse this trend.

20. What are the costs of diabetes? Direct costs to the healthcare sector include hospital services, physician services, lab tests and the daily management of diabetes – which includes availability of products such as insulin, syringes, oral hypoglycemic agents and blood-testing equipment. Costs range from relatively low-cost items, such as primary-care consultations and hospital outpatient episodes, to very high-cost items, such as long hospital inpatient stays for the treatment of complications. US$ 3.9 billion

21. A number of diabetes patients may not be able to continue working or work as effectively as they could before the onset of their condition. Sickness, absence, disability, premature retirement or premature mortality can cause loss of productivity. costs of lost production may be as much as five times the direct health care cost. This may be because there is limited access to high quality care with, consequently, a high incidence of complications, disability and premature mortality. Families too, of course, suffer loss of earnings as a result of diabetes and its consequences.

22. Primary prevention protects susceptible individuals from developing diabetes. It has an impact by reducing or delaying both the need for diabetes care and the need to treat diabetes complications. Lifestyle modifications (appropriate diet and increased physical activity and a consequent reduction of weight), supported by a continuous education programme, were used to achieve a reduction of almost two-thirds in the progression to diabetes over a six-year period. Prevention and diabetes:

23. Secondary Prevention Secondary prevention includes early detection, prevention and treatment. Appropriate action taken at the right time is beneficial in terms of quality of life, and is cost-effective, especially if it can prevent hospital admission.

24. 1- http://www.ncbi.nlm.nih.gov/pubmed/19503954http://www.ncbi.nlm.nih.gov/pubmed/19503954 2- http://www.scielo.br/scielo.php?pid=S0102- 311X2009000600006&script=sci_arttexthttp://www.scielo.br/scielo.php?pid=S0102- 311X2009000600006&script=sci_arttext 3- http://www.who.int/mediacentre/factsheets/fs236/en/http://www.who.int/mediacentre/factsheets/fs236/en/