Lecture 1 - Non-infectious diseases - CVD and stroke

Question 1

What is epidemiological transition?

Answer 1

Changes in level and causes of mortality > decline of total mortality - decreasing mortality of infectious and deficiency diseases you increase the relative role of non-communicable diseases - cancer/CVD

Question 2

What is epidemiological transition affected by?

Answer 2

Socio-economic status, demographic, technological, cultural, environmental and biological changes

Question 3

What diseases have disappeared, appeared and re-emerged?

Answer 3

Smallpox -disappeared
HIV - appeared
TB - re-emerged

Question 4

What is the change in stomach cancer and lung cancer?

Answer 4

Stomach: decrease
Lung: rise and fall

Question 5

What has stroke shifted to?

Answer 5

Stroke > heart disease

Question 6

How many deaths worldwide has CVS caused in 2010?

Answer 6

15.6 million - 29.5% of all deaths in 2010

Question 7

What are the main diseases in CVD epidemiology?

Answer 7

CHD and stroke, rank 1st and 2nd amongst cause-specific mortality worldwide

Question 8

Where do most CVD deaths occur?

Answer 8

In developing world rather than developed

Question 9

Why is the burden of non-communicable disease likely to rise?

Answer 9

Demographic (aging popn) and epidemiological transitions

Question 10

Where is there low incidence of mortality from CHD?

Answer 10

Japan, UK and western countries

Question 11

Where is there high incidence of mortality from CHD?

Answer 11

Formerly socialist economies of Europe and Middle East

Question 12

In which sex are rates for CHD higher?

Answer 12

MEN> women (although gap shrinking in some countries)

Question 13

Where has there been a rise in CHD and stroke mortality?

Answer 13

Formerly socialist economies of Europe and South Asia - declining in many countries

Question 14

What factors do the epidemiological patterns indicate underlie the variation of CVD risk worldwide?

Answer 14

Environmental > genetic

Question 15

What are the 3 main risk factors for CVD?

Answer 15

High BP
Tobacco smoking
High serum cholesterol levels
Obesity
Underweight and unsafe sex

Question 16

What worldwide trends will increase the burden of non-communicable disease e.g. metabolic disorders and diabetes?

Answer 16

Overweight and obesity

Question 17

How many deaths worldwide are caused by cancer in 2010?

Answer 17

> 25% of deaths in many countries
15.1% of deaths worldwide
8 million people

Question 18

How many of these cases are more likely to occur in less developed countries?

Answer 18

60%

Question 19

Which cancers are the most commonly diagnosed?

Answer 19

Lung, breast and colorectal

Question 20

Which cancers are the most common cause of death?

Answer 20

Lung, liver and stomach

Question 21

What happens to cancer rates in migrants?

Answer 21

They converge towards local cancer rates over time - due to modifiable risk factors

Question 22

How many cancers are preventable?

Answer 22

One third - through number of lifestyle and environmental approaches

Question 23

What is the largest preventable cause of cancer in the world?

Answer 23

SMOKING

Question 24

How many years can cancer take to appear and why is this relevant?

Answer 24

20 years - so current cancer rates are affected by changes and exposures that took place in the past

Question 25

What are the major carcinogens?

Answer 25

Tobacco Alcohol Air pollution Occupational agents

Question 26

What is the concern of clinical medicine?

Answer 26

Cases of disease and disease burden for individual

Question 27

What is the concern of epidemiology?

Answer 27

Disease rates and burden of disease in populations

Question 28

What is epidemiology?

Answer 28

Study of distribution and determinants of health-related states or events in specified popn and the application of this study to control health problems

Question 29

How are epidemiological trends measured?

Answer 29

Time - rate/popn over time period Person - age (adjusted to remove effect of aging popn), gender, race Place - country

Question 30

How many strokes and HD cases are attributable to raised BP?

Answer 30

62% of all strokes | 49% of all HD

Question 31

What are the estimates for both CHD and stroke in developing countries?

Answer 31

Doubling mortality so approx. 69% and 76% of all deaths from these causes worldwide

Question 32

How have number of cancer diagnoses reduced?

Answer 32

Pap smears, cigarette smoking reduction, HPV vaccine

Question 33

What are the probabilities of cancer?

Answer 33

1 in 2 men, 1 in 3 women

Question 34

What is incidence?

Answer 34

Number of new cases

Question 35

What is prevalence?

Answer 35

Number of cases at a particular time

Question 36

What is mortality?

Answer 36

Number of deaths

Question 37

How do changes in mortality an incidence over time reflect?

Answer 37

Changes in exposure, diagnosis, screening, treatment (only mortality)

Question 38

For which cancers has mortality rate fallen?

Answer 38

Most, particularly stomach and cervical

Question 39

How many cancer deaths due to smoking?

Answer 39

1 in 4

Question 40

How many lung cancer deaths are caused by smoking?

Answer 40

90% in males | 80% in females

Question 41

By how much does smoking cessation decrease life risk for lung cancer?

Answer 41

Stopping at 30 decreases risk of lung cancer mortality by 10%

Question 42

What are the avoidable causes of cancer?

Answer 42

Tobacco, alcohol, reproductive and sexual behaviour, occupation, pollution, medicine, geophysical factors, infection, diet

Question 43

Where does arsenic cause cancer?

Answer 43

Skin, lungs urinary bladder and kidney | Also causes thickening and pigmentation change of the skin

Question 44

Infections by viruses, bacteria and parasites causes how many cancers worldwide?

Answer 44

18% of worldwide cancers | 4% of cancer in UK