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HLTC27: Epidemiology > Lecture 9: Chronic Disease Epidemiology > Flashcards

Lecture 9: Chronic Disease Epidemiology Flashcards

1
Q

what is the primary focus for epidemiology?

A

Populations - how we study disease phenomenon to improve the health of a population

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2
Q

mortality patterns in the last century

A
  • beginning of the 20th century, many cause of mortality was due to infectious diseases from factors such as human settlement and colonization
  • decrease in infectious diseases due to improved sanitation, housing, nutrition, antibiotics, and immunizations
  • increase in chronic disease in the last few decades due to overconsumption
  • in 2030, we are about to see a 27% increase in chronic diseases
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3
Q

Most common types of chronic disease

A
  • heart disease
  • cancer
  • chronic lung disease
  • stroke
  • Alzheimer’s disease
  • diabetes
  • chronic kidney disease
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4
Q

multi-morbidity

A

an individual is living with multiple conditions

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5
Q

Chronic Disease in Canada

A

44% of adults 20+ have at least 1 of these 10 common conditions:
Hypertension
Osteoarthritis
Mood and anxiety disorders
Osteoporosis
Cancer
Asthma
Diabetes
Ischemic heart disease
COPD
Dementia

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6
Q

Chronic Disease in Ontario

A

74.2% of deaths are from chronic disease. Within that, most are from cancer.

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7
Q

Reason for the trend from infectious to non-infectious diseases

A

advances in medicine, demography, and quality of life

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8
Q

How do we reduce disparities in chronic disease risk and burden?

A

look at the upstream factors which are those that are beyond the control of the individual.

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9
Q

Population health

A

aims to improve the health of the overall population and reduce disparities

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10
Q

Health Impact Pyramid

A
  • Counseling and education
  • Clinical interventions
  • long-lasting protection interventions
  • changing the context to make healthy decisions the default
  • socioeconomic factors
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11
Q

Types of preventions

A

primordial, primary, secondary, tertiary

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12
Q

Phases of each of the preventions

A

primordial - underlying economic, social, and environmental conditions
primary - specific causal factors
secondary - early stages of disease
tertiary - late stage of disease

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13
Q

Primordial prevention

A

to avoid the emergence and establishment of the social, economic, and cultural patters of living that increase the risk of disease

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14
Q

primary prevention

A

limit the incidence of disease by controlling specific causes and risk factors

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15
Q

secondary prevention

A

reduce the more serious consequences of disease through early diagnosis and treatment

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16
Q

tertiary prevention

A

reduce the number and/or impact of complications

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17
Q

demographic transition

A

model to explain that population growth has been exponential and is looking to keep growing

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18
Q

explanation for the demographic transition

A

decrease in mortality rate
decrease in fertility rate (birth rate)
increase in population size
increase in age population

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19
Q

The 5 stages to the demographic transition

A

Stage 1:
high birth and death rate
natural increase: stable or slow increase

Stage 2:
high birth rate
death rate rapidly drops
natural increase: very rapid increase

Stage 3:
dropping birth rate
death rate drops slowly
natural increase: increase slows down

Stage 4:
low birth and death rate
natural increase: falling and then stable

Stage 5:
birth rate rising and low death rate
natural increase: stable or slow increase

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20
Q

Epidemiologic Transition

A

experienced high infectious disease and low non-communicable disease to low infectious disease to high non-communicable disease. Infectious diseases are lower than NCD now

21
Q

Abdel Omran

A
  • 1971, posited his theory of epidemiologic transition
  • a stage of development characterized by a shift in population growth, life expectancy, and disease patterns
22
Q

Stage 1: Pestilence and Famine

A
  • first stage of the epidemiologic transition
  • infectious and parasite disease were the main cause of death
  • also accidents and attacks by animals and other humans
  • Thomas Malthus called these deaths “natural checks”
  • The Black Plague was the most violent stage 1 epidemic
23
Q

Stage 2: Receding Pandemics

A
  • improved sanitation, nutrition, and medicine during the industrial revolution reduced the spread of infectious diseases
  • death rates did not improve universally or immediately though
  • poor people who were crowded in industrial cities had high death rates from cholera
24
Q

Stage 3: Degenerative disease

A
  • chronic disease of aging
  • physical and mental illness
25
Q

Stage 4: Delayed Degenerative disease

A
  • Life expectancy of older people
    is extended through medical
    advances.
  • Cancer medicines, bypass
    surgery, better diet, reduced use
    of tobacco, and alcohol
  • However, consumption of non-
    nutritious food and sedentary
    behavior have resulted in an
    increase in obesity in this stage
26
Q

Possible Stage 5

A
  • Infectious Diseases
  • Reemergence of infectious and
    parasitic diseases; diseases
    thought to have been eradicated
    or controlled return, and new
    ones emerge
27
Q

Reasons for why there is a possible stage 5

A
  • evolution
  • poverty
  • increased connections
  • comordities
28
Q

How does global climate change impact human health?

A
  • pesticide use
  • chemical pollution
  • water contamination
  • antimicrobial resistance
  • intensive agriculture
  • biodiversity loss
29
Q

Global type 2 diabetes patterns

A

Rising rates of prediabetes and type 2 diabetes prevalence, globally

30
Q

Type 2 Diabetes among Immigrant Populations

A

Risk Factors:
- genetics
- ethnicity
- environment
- SES, age, sex
- migration

Theories and Policies
- thrifty genotype/phenotype hypothesis
- acculturation
- immigration policies
- healthy migrant effect

31
Q

Immigration trends

A

Between 2006 and 2011, recent immigrants made up 17.2% of foreign-born populations

32
Q

diabetes prevalence stats among immigrants

A

Between 1985 and 2005, about 12% of immigrants were
diagnosed with diabetes in Ontario

33
Q

Prediabetes and Conversion to Diabetes

A

There is a critical window of opportunity to prevent
diabetes, especially among high risk populations.
Intensive lifestyle, physical activity, dietary changes, decrease in fat. Prevents diabetes in nearly 60%.

34
Q

The Built Environment

A
  • population interventions
  • “Built environment”
    encompasses all the physical
    structures and elements of the
    human made environments in
    which we live, work, travel, and
    play
  • Research shown health risks
    and benefits of the built
    environment shape health
    outcomes such as obesity and
    diabetes = health impacts at a
    population level
  • compact communities are better than urban sprawl
  • low walkability among ethnic groups
35
Q

How do we address chronic diseases moving forward

A

21 Recommendations tackling (PHO and CCO report)
- tobacco use
- alcohol consumption
- physical activity
- healthy eating
- capacity-building of public health systems
- promoting health equity

36
Q

Recommendations for Smoking

A
  1. increase tobacco tax
  2. integrated tobacco
    cessation system
  3. social marketing campaign
  4. Ban smoking on bar and restaurant patios
37
Q

Recommendations for Alcohol consumption

A
  1. socially responsible pricing
  2. controls on alcohol availability
  3. control alcohol marketing and promotion
  4. access to counselling interventions
38
Q

Recommendations for Physical Activity

A
  1. Physical education credit
  2. Daily physical activity
  3. Active Transportation
  4. Workplace physical activity policy
39
Q

Recommendations for Healthy Eating

A
  1. Food and nutrition strategy
  2. Food skills in curricula
  3. Healthy eating in publicly funded institutions
  4. Mandatory menu labelling
40
Q

Recommendations for Capacity-Building

A
  1. Whole-of-government approach
  2. Improve measurement, and increase accountability
  3. Connect knowledge with practice
  4. Communications campaigns
41
Q

Recommendations for Health Equity

A
  1. Reduce health inequities
  2. Address First Nations, Inuit, and Metis Health
42
Q

Clinical Medicine Vs. Epidemiology

A

Clinical Medicine:
- patients
- diagnosis
- treatment
- prognosis

Epidemiology:
- populations/group
- prevention/health promotion
- risk assessment

43
Q

Clinical Epidemiology (Clinical Part)

A

seeks to answer questions and to guide clinical decisions making with the best available evidence

44
Q

Clinical Epidemiology (Epidemiology Part)

A

used to answer the questions have been developed
by epidemiologists

45
Q

Clinical Epidemiology

A
  • Clinical epidemiology is the application of epidemiology principles and methods to the clinical setting.
  • studying patients
  • improve patient-level outcomes
46
Q

Purpose of clinical epidemiology

A

develop and apply methods of clinical observation that will lead to valid conclusions

47
Q

Questions for clinical epidemiology

A

Abnormality - is the patient sick or well?
Diagnosis - How accurate are the diagnosis tests?
Frequency - How often does the disease occur?
Risk - What are the associated risk factors?
Prognosis - Consequences of having the disease?
Treatment - How treatment changes course of disease.
Prevention - Is the intervention effective in preventing?
Cause - what conditions lead to the disease?
Cost - How much will care for an illness cost?

48
Q

Evidence of Causality

A

RCT
Cohort
Case-Control
Cross sectional
Ecological Study

HLTC27: Epidemiology (5 decks)

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