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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
Stage 4: Delayed Degenerative disease
* 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
Possible Stage 5
- Infectious Diseases - Reemergence of infectious and parasitic diseases; diseases thought to have been eradicated or controlled return, and new ones emerge
27
Reasons for why there is a possible stage 5
- evolution - poverty - increased connections - comordities
28
How does global climate change impact human health?
- pesticide use - chemical pollution - water contamination - antimicrobial resistance - intensive agriculture - biodiversity loss
29
Global type 2 diabetes patterns
Rising rates of prediabetes and type 2 diabetes prevalence, globally
30
Type 2 Diabetes among Immigrant Populations
Risk Factors: - genetics - ethnicity - environment - SES, age, sex - migration Theories and Policies - thrifty genotype/phenotype hypothesis - acculturation - immigration policies - healthy migrant effect
31
Immigration trends
Between 2006 and 2011, recent immigrants made up 17.2% of foreign-born populations
32
diabetes prevalence stats among immigrants
Between 1985 and 2005, about 12% of immigrants were diagnosed with diabetes in Ontario
33
Prediabetes and Conversion to Diabetes
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
The Built Environment
- 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
How do we address chronic diseases moving forward
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
Recommendations for Smoking
1. increase tobacco tax 2. integrated tobacco cessation system 3. social marketing campaign 4. Ban smoking on bar and restaurant patios
37
Recommendations for Alcohol consumption
5. socially responsible pricing 6. controls on alcohol availability 7. control alcohol marketing and promotion 8. access to counselling interventions
38
Recommendations for Physical Activity
9. Physical education credit 10. Daily physical activity 11. Active Transportation 12. Workplace physical activity policy
39
Recommendations for Healthy Eating
13. Food and nutrition strategy 14. Food skills in curricula 15. Healthy eating in publicly funded institutions 16. Mandatory menu labelling
40
Recommendations for Capacity-Building
17. Whole-of-government approach 18. Improve measurement, and increase accountability 19. Connect knowledge with practice 20. Communications campaigns
41
Recommendations for Health Equity
21. Reduce health inequities 22. Address First Nations, Inuit, and Metis Health
42
Clinical Medicine Vs. Epidemiology
Clinical Medicine: - patients - diagnosis - treatment - prognosis Epidemiology: - populations/group - prevention/health promotion - risk assessment
43
Clinical Epidemiology (Clinical Part)
seeks to answer questions and to guide clinical decisions making with the best available evidence
44
Clinical Epidemiology (Epidemiology Part)
used to answer the questions have been developed by epidemiologists
45
Clinical Epidemiology
- Clinical epidemiology is the application of epidemiology principles and methods to the clinical setting. - studying patients - improve patient-level outcomes
46
Purpose of clinical epidemiology
develop and apply methods of clinical observation that will lead to valid conclusions
47
Questions for clinical epidemiology
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
Evidence of Causality
RCT Cohort Case-Control Cross sectional Ecological Study

HLTC27: Epidemiology (5 decks)

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