2 diseases Flashcards
types of epidemiological paradigms for disease causation (x3)
- Programming:
- critical periods of growth: exposure here leads to outcome
eg barker hypothesis: IU malnutrition leads to CVD as adult
- Adult Risk factor:
- risk factors of LIFESTYLE AND BEHAVIOUR as adult leads to outcome
eg: exercise –> outcome
- Life Course:
- programming and adult risk factor together
top causes of death High income and low income
From WHO: Global health estimates 2021
top cause of death globally is IHD
High income:
- Driver: Aging population
- conditions: IHD, covid, stroke, Alzheimer’s, lung cancer, COPD, colon ca, LRTI, Kidney, HTN
Low income:
Driver: high rates of communicable disease (8/10 communicable)
conditions: LRTI, stroke, IHD, malaria, Preterm birth, covid, diarrhoeal, TB, birth, HIV
HIV deaths decreasing
Global burden of disease
Lancet study published in 2024 for 2021 data
- Looks at DALYs
2010 -2021
KEY TAKE AWAYS
- non communicable largest burden: make up 16/25
- decrease communicable ( caveat COVID new entry at TOP )
- CMNN remain high (communicable, maternal, neonatal, nutrition)
Depression
Clinical: low mood >2 weeks, with functional disability. Physical and mental
Aetiology: genetic, biological, environmental
Public Health relevance:
World: Commonest mental health disorder no. 12 on GBD
UK: (fingertips)
13% prevalence
Time: increasing
Person:
- ethnic minority
- W>M
- increases with age
- unemployed
Place:
- South Yorkshire and North east
Prevention:
- secondary
Suicide
Clinical: intentionally causing own death. coroner’s verdict.
Aetiology: genetic, biological, environmental
Public Health: leading cause of death for young adults. Early intervention prevents suicide
UK: (ONS)
10 per 100,000 deaths per year
Time:
-decrease since 1982
- increase 08-10 (financial crash)
Person:
- Men >women
-highest >45
- Low SEC
- other MH
Place:
- North East HIGHEST
- London lowest
Prevention:
- 1: strengthen protective factors
- 2: detect those at risk, intervention
England suicide prevention strategy 2023-28
Dementia
Clinical: neurodegenerative, memory loss, confusion, speech, understanding
Aetiology: Alzheimer’s 60% (beta-amyloid, tau) + Vascular (infarcts)
PH relevance:
- aging population, cost, undiagnosed, no cure
UK:
- 12% deaths due to dementia
4.3% prevalence in England
Time:
- increasing (1.6mil by 2040)
Person:
- increase with age
- W > M
place:
- IMD high
- North West, south east, north east, East England,
Schizophrenia
Clinical: psychosis. Positive, negative, cognitive
Aetiology: unknown
PH relevance:
- high disease burden
- high physical health burden
- stigmatised and hard to reach group
UK:
- 1% prevalence
Time:
- ?falling (poor data)
Person:
- male, 25-40, black
- low SEC
- ?cannabis use
Place:
- Urban >rural
Prevention:
- Early intervention for first presentation psychosis
Parkinsons
Clinical: progressive neurological disorder that primarily affects movement. Motor + non-motor symptoms
Aetiology: loss of dopamine producing neurons in SN + lewy body
PH relevance:
- increasing with aging population
- falls, fractures and hospital admission
- social care
UK
200 per 100,000
Time:
Time: prevalence stable (Okunoye et al 2022 cohort study), but will increase as population gets older
Person: increase with age (doubles between 50-69), Male, sporadic
place: n/a
Prevention:
no routine screening
Coronary heart disease
Clinical: inadequate blood supply to heart. Angina, MI, cardiac arrest
Aetiology: atherosclerosis
PH relevance:
- one of the top causes of death in the UK
UK:
Time: fallen since 80s
Person:
- M, increasing age,
age, lifestyle, disease, family, other
Place:
North, Scotland, wales
Prevention:
1: exercise, diet
2: treatment
Stroke
Clinical: form of CVD: ischaemic or haemorrhagic
TIA
Aetiology: CVD, HTN
PH relevance:
- leading cause of death and disability
- preventable
UK
100K strokes a year
Time:
- increasing due to age (age adjusted decreasing)
Person:
male, old, low SEC
Place: n/a
Prevention:
1: lifestyle, HTN, cholestrol
2: FAST
Breast Cancer
Relevance: major cancer in women
Incidence: 173 per 100,000 (females)
5 year survival :85%
Time: survival increasing
Person: female, older, deprivation, white higher ethnic lower (start family early), genetic
breast cancer screening in place (50-71 every 3 years)
Lung Cancer
Relevance: high case fatality rate + preventable
Incidence: 66 per 100 000
5 year survival: 20%
Time: improving ( reducing smoking, stage shift)
Person: men, over 50
targeted lung cancer screening started (55-74)
Colorectal cancer
PH Relevance:
- 4th most common cancer in the UK
- known RF
- Screening
Incidence: 56.6 pr 100 000
5 year survival: 60%
Time: survival improving,
Person: older Age, diet, smoking, gastro conditions
(increasing in younger age but 90% still >50)
Screening: 50-74: Home FIT kit (then colonoscopy)
Prostate cancer
2nd most common cause of cancer in the UK
Incidence: 88 per 100,000
5 year survival: 87% 5 year survival
Time: improving
Person: Men, old, African,
Screening: ?(prostate then MRI screening: NEJM
Cervical cancer
Common cancer in women
Incidence:
5 per 100,000
highest in females aged 30 to 34
decreasing
5 year survival: 70%
Improving
Person: gender, younger age, lower deprivation
Prevention:
Primary:
HPV vaccine (1 HPV vaccine 12/13: coverage 83% F, 65% M)
Secondary: screening
screen (25-64) uptake 72-76&
HPV first
Asthma
Clincal: chronic, inflam condition, shortness of breath
PH relevance:
Commonest chronic condition in childhood
UK:
Prevalence: 12%
Time
Person:
Boys, childhood, viral,
Place:
air pollution,
Prevention:
I: air quality
2: annual review, personalised asthma plan, medication
COPD
Clinical: Chronic bronchitis and emphysema
Public health:
- preventable (smoking)
- high mortality and morbidity
UK
- 3 million in the UK
- Common reason for ED admission and hospital readmission
Time:
- increasing
Person:
Men = women,
older age,
lower SEC,
smoking
place:
prevention:
1: stop smoking, occupational exposure
2: vaccination
sickle cell
Clinical: red blood cell disease, sickling, obstruct blood
aetiology:
Autosomal recessive (Ch 11)
Public health prevalence:
- Health inequality
- screening
UK:
Prevalence: Afro-Caribbean: 1 in 10-40 have trait 1 in 60-200 have disease
UK Prevalence: 20 per 100,000
- Screening:
1. blood test for mothers and fathers who mother is a carrier - in high prevalence areas to all women
- family origin questionnaire
- in low prevalence areas then blood test - Heel prick test
- all new-borns
1 +2 then diagnostic test (CVS and amnio)
diabetes
Clinical: multisystem characterised by hyperglycaemia
aetiology:
T1DM: autoimmune
T2DM: insulin resistance and relative insulin deficiency
Public health relevance:
- Increasing mortality and morbidity
- increasing prev.
UK:
- 4 million in the UK
- large undiagnosed
Time: increase
Person:
- deprived, LMIC, more common England
Alcohol use disorder
clinical: drink >14 units in a week, harmful drinking + dependence
Aetiology: addiction cycle
Public health:
- short and long term effects ( HTN, stroke, CHD, pancreatitis, liver disease)
- prevention
UK
21% of adults
time:
- overall decrease since 2000 with decrease in binge drinking in young adults
place: all 4 nations. worse scotland
person:
mortality: 39.5 per 100,00
prevention:
SAFER
Strengthen restriction
Advance drink driving counter measures
Facilitate screen and treatment
Enforce bans on advertising
promotion, sponsorship
Raise price
Air pollution
overview:
- household, particulate, ozone
causes:
- transport, industry, farming, energy consumption, heating
public health importance:
- increase CVD, resp infections and diseases, maternal, neonatal, cancers
UK:
28K deaths a year due to air pollution
time:
- increasing worldwide
- decrease UK
person:
- high risk groups
place:
- cities, location to road/ polluter
drug misuse
clinical: dependence leading to harm
Public health:
- preventable
- inequality
- cross-sector
UK:
- 2% drug use disorder
time:
- opioid USA, increasing UK
place:
- deprivation, Scotland
Person:
men, young
Smoking
leading cause of cancer, COPD
Why PH:
- cause of cancer
- preventable
- inequality
UK:
- 13% adults smoke
- declining
- 1 in 4 cancer deaths
cost:
- England £17 billion
- productivity
- direct (healthcare costs) and indirect
Vaping:
- increasing around 13% of youth
reasons: social, and mental health
control:
tobacco and vapes bill 2024
MPOWER
Monitor tobacco use and prevention policies
Protect people from tobacco smoke
Offer help to quit tobacco use
Warn about the dangers of tobacco
Enforce bans on tobacco advertising, promotion and sponsorship
Raise taxes on tobacco
UK Gov:
1998: smoking kills (seminal white paper)
2024: tobacco and vapes bill (smoke free generation)
Oral health
conditions: tooth decay, periodontal disease, oral cancers
Public health:
- cost £3.6billion per year
- tooth decay most common hospital admission for 5-9 year olds
UK:
- 1/4 of <5 experience tooth decay
- deprivation
time:
- better
person:
- young, elderly, LD
- homeless, prison
place:
- North West
- deprivation
prevention:
1: fluoride brush and varnish, breastfeeding, less sugar, fluoridation of drinking water
