2B Epidemiology of specific diseases Flashcards
Descriptive aspects of diseases that are most important to public health specialists
CAPPTPPP
1. Clinical features
2. Aetiology
3. Public health relevance
4. Prevalence
5. Time
6. Place
7. Person
8. Prevention
Depression
- CLINICAL FEATURES
mood disorder characterised by low mood that exceeds normal sadness/grief in intensity or duration and is accompanied by functional disability.
Symptoms include low mood, lack of positive emotions and changes in bodily function such as reduced appetite
- AETIOLOGY
The aetiology is debated. There appears to be a contribution of neurochemical abnormalities and hormonal imbalances. It is influenced by genetics and may be triggered by adverse life events.
3.PUBLIC HEALTH RELEVANCE
commonest psychiatric condition
second highest cause of disability globally as measure by years lost to disability in 2010
- PREVALANCE IN UK
1/2 of all women and 1/4 of all men will have a depressive episode in their lifetime - TIME
Increasing incidence worldwide - PLACE
People living in industrial areas are more likely to be treated for depression - PERSON (SLAG FED)
-socioeconomic circumstances: unemployed twice as likely to have depression as employed
-Life events: can be triggered by adverse life events
- Age: incidence increases with age
-Gender: women>men
- Family: increased risk if FHx
-Ethnicity: sometimes seen as a western construct. LIkely under detected in some countries
- Disease: can occur following serious disease, during chronic disease or following pregnacy
PREVENTION: effective treatments are available
Suicide/ parasuicide
CLINICAL FEATURES:
suicide: the act of intentionally taking ones own life
Parasuicide: failed suicide attempt
Over half the people who commit suicide have a history of parasuicide
PUBLIC HEALTH RELAVANCE
Leading cause of death in young adults
PREVALANCE IN UK
10 per 100 000 per year
TIME
marked decrease in the 1960s attributed to switch from coal gas to safer natural gas
PLACE
Within the UK London has higher than average suicide rates
In the EU, in 2020 Lithuania had the highest suicide rates
PERSON
socioeconomic circumstances: Highest amongst low income groups particularly unemployed and homeless
Age: Rates higher in over 50s
Gender: men>women
Family: more common in single, divorced or widowed
Disease: associated with mental illness, however, there is frequently no history of mental illness
PREVENTION
Primary: address risk factors such as employment and housing
Secondary: good treatment of mental illness in those with parasucide
Dementia
CLINICAL FEATURES
Neurodegenerative conditions marked by memory loss, confusion and problems with speech and understanding.
Most common forms are alzhiemers and vascular (but lewy body disease and CJD also occur)
AETIOLOGY
Alzheimer’s: genetics and environment play a role. Amyloid plaques are seen alongside neuronal atrophy
Vascular: can be single infarct or multi infarct (stokes)
PUBLIC HEALTH RELEVANCE
Increasing prevalence
Leading cause of death in UK in 2022
High financial cost in terms of unpaid care, social care and healthcare
No cures, only treatment for mil-mod dementia with limited efficacy
PREVALANCE IN UK
1 in 20 people > 65 years develop dementia. 1in 5 people over 80 years develop dementia
TIME
prevalence rising as population ages
PLACE
Highest in countries with an ageing population
PERSON
Lifestyle: risks include smoking, high fat/salt diet, sedentary lifestyle, excessive alcohol
Age: risk increases with age
Gender: slightly more women than men
Family: there are genetic forms of early onset alzheimers disease
Disease: associated with hypertension, hypercholesteraemia, obesity, down syndrome
PREVENTION:
secondary: those with memory loss are encouraged to use their memory and cognitive skills to preserve them
schizophrenia
CLINICAL FEATURES
- psychotic, chronic, often lifelong condition associated with symptoms in 3 groups:
Positive: hallucinations, delusions
Negative: Flat affect, low mood, social withdrawal
Cognitive: poor memory, difficulty concentrating
- Symptoms develop gradually. Drugs can help control symptoms but are associated with significant side effects: tiredness, weight gain, hormonal imbalances, tardive dyskinesia
AETIOLOGY
-Unknown
- genetic component shown by twin studies
- can be triggered by stressful life events
PUBLIC HEALTH RELEVANCE
- high burden of disease as chronic condition
-stigmatised
- treatment often requires use of the mental health act
- Associated with a higher mortality from physical illness, injury, suicide
PREVELANCE
-1% lifetime prevalence in UK
TIME
- Prevalence increasing over time globally
PLACE
- incidence similar world wide
- more common in urban areas than rural areas
PERSON
Socioeconomic conditions: more common in lower SE groups, particularly in homeless and prisoners but note social drifty influence
Lifestyle: associated with cannabis use
Age: usually occurs in later adolescence, rare in <10 years and >40 years
Gender: men> women
Family: more common in FHx
Ethnicity: more common in Afro-carribeans but unclear whether this is due to over diagnosis
Disease: associated with other forms of psychosis (ie post partum and drug induced)
PREVENTION
Secondary: drugs to help reduce symptoms, psychosocial therapies
Parkinsons disease
CLINICAL FEATURES
- progressive, neurodegenerative condition characterised by loss of dopamine containing neurons in the substantia nigra
- symptoms include a slow, shuffling gait, a pill rolling tremor, lack of facial expression, difficulty swallowing and writing
AETIOLOGY
- unknown
- most cases are idiopathic
- increased risk if repeated head trauma (ie boxing)
- several candidate genes have been identified
PUBLIC HEALTH RELEVANCE
-common cause of falls, fractures and hospital admission
- high cost to healthcare and to social care
-no lab test so early diagnosis difficult (clinical diagnosis)
PREVELANCE IN UK
- approx 200 per 100 000
TIME
- prevalence stable
PLACE
- no marked geographical variation
PERSON
Socioeconomic circumstances: -
Lifestyle: -
Age: prevalence increases with age (up to 2% of the population over 80years)
Gender: slightly more men than women
Family: most cases sporadic
Ethnicity: -
Disease:-
Coronary heart diease
CLINICAL FEATURES
-Angina: stable (chest pain on exertion), unstable (chest pain at rest)
-Myocardial infarction: cardiac ischaemia leading to chest pain, arm pain, SOB, sweatiness, pale, nausea
- Stroke: ischaemic, symptoms depend on brain location
Peripheral artery disease: intermittent claudication, ischameia
Heart failure: secondary to myocardial ischaemia, leading to SOB, oedema, orthopnoea
Cardiac arrest: CHD is the number one cause of cardiac arrest in UK
AETIOLOGY
- atherosclerosis leading to blockage of blood vessels
PUBLIC HEALTH RELEVANCE
- 2nd highest cause of UK mortality in 2022
- potentially preventable
- inequalities: incidence higher in deprived areas
PREVELANCE IN UK (incidence)
-200 myocardial infarctions per 100 000 population per year
TIME
- mortality was falling from CHD but has been climbing since 2020
PLACE
- Deprived areas have higher incidence than affluent areas
PERSON
Socioeconomic conditions: higher mortality in those in deprived areas
Lifestyle: smoking, sedentary lifestyle, high fat/salt diet, excessive alcohol all increase risk
Age: risk increases with age
Gender: men> women (but risk for women increases after the menopause)
Family: higher risk if FHx, also rare genetic risk factors (ie familial hypercholesterolaemia)
Ethnicity: higher mortality for south Asians living in UK
Disease: associated with hypercholesterolaemia, hypertension, obesity diabetes
PREVENTION
primary: encourage stop smoking, physical activity
Secodnary: treatment for high risk ie post MI to reduce risk of recurrance
Stroke
CLINICAL FEATURES
- vascular disorder effecting the brain
- two main types: ischaemic and haemorrhagic
- TIAs occur when there is temporary interruption to brain blood supply, symptoms resolve withing 24 hours
- unilateral weakness, slurred speech/ no speech, difficulty swallowing, confusion
PUBLIC HEALTH RELEVANCE
-4th biggest cause of death in UK in 2022
- high burden on unpaid care and social care
-potentially preventable with lifestyle modification or medical intervention
INCIDENCE
- around 200 per 100 000 population per year
TIME
- age adjusted incidence decreasing in western Europe but overall incidence increasing due to aging population
PLACE
N/A
PERSON
socioeconomic circumstances: higher mortality (jn under 75 years) for those on lower incomes
Lifestyle: higher risk if sedentary, high fat/salt diet, excessive alcohol, smoking
Age: risk increases with age
Gender: men> women (but risk for women increases after the menopause)
Family: higher risk if family history
Ethnicity: higher risk for south Asian, african and afro-carribean
Disease: higher risk if hypertension, hypercholesterolaemia, obesity, CAD, TIA, prev stroke
PREVENTION
Primary (before stroke): hypertension screening and management, cholesterol screening and management, smoking cessation, diet and exercise modification, anticoagulant for AF
Secondary (after stroke): FAST knowledge, thrombolysis availability, hypertension management, rehab on stroke ward
Asthma
CLINICAL FEATURES
- chronic disease characterised by episodic reversible airway obstruction and excessive mucous production
- causes SOB and wheeze
PUBLIC HEALTH RELEVANCE
- most common chronic disease in children. Prevalence is increasing
- acute admissions often preventable by appropriate community and primary care management
PREVELANCE IN UK
- 1 in 9 lifetime prevalence
TIME
- lifetime prevalence is increasing but incidence is decreasing
PLACE
- no clear geographical variation within UK but global variation in prevalence is marked (1%-18%)
PERSON
socioeconomic circumstances: -
Lifestyle: -
Age: higher prevalence in children than adults
Gender: boys>girls
Family: increased risk if atopic family history
Ethnicity:-
Disease: triggers include viral illness, smoking or second hand smoke exposure, exercise, air pollution, pollen, stress, house dust mite
PREVENTION
secondary: air pollution management, preventer inhalers, annual influenza vaccine
COPD
CLINCAL FEATURES
- chronic disease combining bronchitis and emphysema
- limited reversibility of airway obstruction
PUBLIC HEALTH REVELANCE
- many cases are preventable by lifestyle modification
- most cases are linked to smoking (80%) or occupational exposures
-up to 1 in 8 emergency hospital admissions may be COPD related
-High burden or morbidity and mortality
PREVELANCE IN UK
- around 1300 per 100 000 people in UK have been diagnosed with COPD
- that’s around a 1 in 60 lifetime incidence
- many more cases are undiagnosed
TIME
- Incidence seems to have peak but prevalence still increasing (increasing survival)
PERSON
socioeconomic circumstances: increased prevalence in lower income groups
Lifestyle:: smoking/occupational exposure
Age: prevelance increases with age
Gender: -
Family: rare cause is genetic alpha 1 antitrypisin deficiency
Ethnicity: -
Disease: -
PREVENTION
primary: stop smoking initiatives and reducing occupational exposure (gases, dusts and fumes)
Secondary: medical management, influenza and pneumococcal vaccination
Sickle cell anaemia
CLINICAL FEATURES:
-genetic condition causing abnormal haemoglobin leading to abnormal shaped red blood cells
- abnormal red blood cells do not carry o2 well and break down easily (anaemia), can block blood vessels (vaso-occlusive crises) and can progressively damage the spleen (immunocompromise)
- carriers of the gene have a degree of resistance to malaria
AETIOLOGY
- autosomal recessive inheritance
PUBLIC HEALTH RELEVANCE
-health inequalities: in the UK vast majority of cases are in the afro-Caribbean community
- antenatal and newborn screening is recommended
PREVELANCE IN UK
- UK prevalence is around 20 per 100 000 population
- prevalence in Afro-Caribbean community 1 in 60-200 population
PLACE
- common in sub-saharan Africa and Caribbean
- also Asia and middle east
PERSON
socioeconomic circumstances: -
Lifestyle: -
Age: occurs from birth
Gender: -
Family: AR genetic inheritance
Ethnicity: Incidence highest in Afro-carribean population in UK
Disease: -
PREVENTION
secondary: newborn screening
Diabetes
CLINICAL FEATURES
-disease characterised by hyperglycaemia
- 2 main types- type 1 generally affects children and requires insulin due to insulin deficiency. Type 2 predominantly affects adults and requires diet modification/ drugs/ insulin due to insulin resistance
- hyperglycaemia can lead to: acute effects (DKA), chronic effects ( retinopathy, peripheral neuropathy, CAD, peripheral arterial disease)
AETIOLOGY
- type 1 is autoimmune with islet cell destruction
- type 2 arises due to insulin resistance
PUBLIC HEALTH RELEVANCE
- 10% of NHS budget spent yearly on managing diabetes and its complications
- incidence increasing esp type 2 in children
PREVELANCE IN UK
- 8.6% of England >16 year olds had diabetes in 2016
- high rate on undiagnosed
TIME
- incidence increasing globally
PLACE
- incidence higher in some communities in UK ie South Asian
PERSON
socioeconomic circumstances: higher prevalence in those with low incomes
Lifestyle: higher risk if sedentary or high fat diet
Age: type 1 diabetes tends to occur in children. Type 2 diabetes occurs mostly in >40years
Gender: -
Family: type 1 diabetes higher risk if FHx
Ethnicity: higher incidence in some UK communities ie south Asian
Disease: risk higher if obesity. Gestational diabetes can occur in pregnancy
PREVENTION
primary: weight management
Secondary: lifestyle modifications and good glucose control will help mitigate complications. diabetic retinopathy screening.
Breast cancer
PUBLIC HEALTH RELEVANCE
- high cause of mortality in women
- better prognosis with early treatment
- screening benefits are controversial
INCIDENCE IN UK
80 per 100 000 per year in 2010
5 YEAR SURVIVAL
85%
TIME/ PLACE
- survival improving in the UK
PERSON
socioeconomic circumstances: higher incidence in affluent communities
Lifestyle: breastfeeding and exercise are protective
Age: risk increases with age
Gender: women> men
Family: about 5% of cases are genetic, mainly associated with BRCA1 and BRCA2
Ethnicity: lower incidence in community start start families early ie bangladeshi
Disease: -
PREVENTION
secondary: screening for 50-70year olds
Lung cancer
PUBLIC HEALTH RELEVANCE
- very high mortality which has only recently shown signs of improving
- many cases are preventable
INCIDENCE IN UK
- 67 cases per 100 000 population per year in 2010
5 YEAR SURVIVAL
-20% in 2020
TIME/PLACE
- survival shown signs of improvement in recent years after long time of little improvement
PERSON
socioeconomic circumstances: death rates higher in deprived communities
Lifestyle: smoking associated with 90% of cases. Asbestos exposure and radon exposure also associated
Age: 95% occurs in those over 50 years
Gender: Men>women but increasing numbers of women affected
Family: -
Ethnicity: -
Disease: -
PREVENTION
-Primary: reduce smoking and asbestos exposure
- secondary: no screening available routinely nationally yet but trials ongoing
Bowel cancer
PUBLIC HEALTH RELEVANCE
- prognosis better with early treatment
INCIDENCE IN THE UK
66 cases per 100 000 population per year in the UK in 2010
5 YEAR SURVIVAL
55%
TIME/PLACE
- higher incidence in western countries
- survival increasing over time
PERSON
socioeconomic circumstances: -
Lifestyle: increased risk if diet high fat, high meat, low fibre. sedentary lifestyle
Age: 90% of cases in those >50 years old
Gender: nearly equal split
Family: increased risk of first degree relative affected
Ethnicity: -
Disease: associated with bowel polyps, inflammatory bowel disease, familial adenomatous polyposis
PREVENTION
primary: diet modifications (increase fibre, reduce meat/fat), increase exercise
Secondary: FOB screening 60-74 years
