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YR1 Epidemiology in Practice > Lectures 5&6 - Global patterns of disease part 2 > Flashcards

Lectures 5&6 - Global patterns of disease part 2 Flashcards

1
Q

what is epidemiological transition?

A

changing patterns of population age distributions, mortality, fertility, life expectancy, and causes of death

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2
Q

explain the concept of epidemiological transition

A

Changes in levels and causes of mortality:

  • decline in total mortality
  • reduction in infectious diseases
  • declined death rate in all age groups (however this increases the role of chronic non-communicable diseases due to ageing population)
  • chronic diseases also due to lifestyle factors
  • advances in clinical medicine and epidemiology
  • disappearance/re-emergence of diseases
  • emergence of new infectious disease (e.g. AIDS)
  • increase in previously controlled infections (e.g. TB, dengue fever)
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3
Q

what are the classifications of diseases and injuries?

A
  • communicable, maternal, perinatal and nutritional
  • non-communicable
  • injuries = intentional and unintentional
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4
Q

give examples of communicable, maternal, perinatal and nutritional diseases

A
  • HIV and STDs
  • malaria
  • maternal conditions
  • neonatal conditions
  • nutritional deficiencies
  • respiratory and intestinal infections
  • TB
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5
Q

give examples of non-communicable diseases

A
  • cancers
  • CVDs
  • chronic respiratory diseases
  • cirrhosis
  • congenital abnormalities
  • diabetes mellitus
  • neurological conditions and mental/behavioural disorders
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6
Q

give examples of intentional injuries

A
  • homicide
  • suicide
  • war
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7
Q

give an example of a non-intentional injury

A
  • road traffic injuries
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8
Q

what is the difference between a communicable disease and a non-communicable disease?

A

a communicable disease is caused by an infectious agent which can be transmitted by direct contact between individuals, bodily discharges or via a vector

Non-communicable diseases are non-infectious and non-transmissible

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9
Q

compare the observed demographic transition with epidemiological transition

A

demographic transition: high birth and death rates to low birth and death rates

epidemiological transition: infectious diseases replaced by degenerative and man-made diseases

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10
Q

what % of deaths worldwide did cancer cause in 2010?

A

15.1% (8m people)

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11
Q

what are the most commonly diagnosed cancers?

A

lung, breast and colorectal cancer

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12
Q

what are the most common causes of cancer death?

A

lung, liver, stomach and colon cancers

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13
Q

what do cancer rates in migrants tend to do?

A

converge towards local cancer rates over time, suggesting a role for modifiable risk factors

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14
Q

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

A

smoking

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15
Q

why have age-specific cancer incidence and mortality rates fallen for some cancers but risen for others?

A

due to changes in relevant exposures, diagnosis, treatment and screening

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16
Q

name 4 major carcinogens

A
  • tobacco
  • alcohol
  • air pollution
  • occupational agents (e.g. asbestos)
17
Q

describe the epidemiology of cancer in men

A
  • leading incidence and mortality of cancer in men is lung cancer in every country, regardless of income
  • more prostate cancers in HICs
  • very low incidence of colorectal cancers in LICs
  • liver cancer is the most frequent cause of premature cancer death
  • men in sub-saharan Africa are at a major risk of liver cancer due to hepatitis prevalence
18
Q

describe the epidemiology of cancer in women

A
  • leading cancer incidence is breast cancer in every country regardless of income
  • second is cervical cancer in most countries
  • leading cancer mortality is breast cancer in all countries except China
  • leading cancer mortality in China is lung cancer
  • lung cancer is the most frequent cause of premature cancer death in women in North America
19
Q

why is there a low incidence of colorectal cancers in LICs?

A

LICs cannot afford the high meat diets that MICs and HICs can afford

20
Q

why is there a high incidence and mortality of cervical cancer in LICs?

A

LICs don’t have effective screening processes that are available in MICs and HICs

21
Q

what are the 9 major behavioural and environmental risk factors for cancer?

A
  • smoking
  • low intake of fruit/veg
  • alcohol use
  • unsafe sex
  • overweight/obesity
  • physical inactivity
  • contaminated injections in healthcare
  • urban air pollution
  • indoor smoke from household solid fuel use
22
Q

which cancers can be due to infections?

A

liver - hepatitis viruses B/C
stomach - H. pylori
cervical - HPV

23
Q

what % of cancer deaths are due to infections in LICs compared to HICs?

A

LICs - 26.9%

HICs - 8.1%

24
Q

what % of deaths did CVDs account for worldwide in 2010?

A

29.5% (15.6m people)

25
Q

what are the 1st and 2nd highest mortality-causing CVDs?

A

1) CHD

2) strokes

26
Q

what is likely to happen to the burden of disease from non-communicable diseases in LICs?

A

burden is likely to rise with an estimated doubling of mortality from CHD and stroke due to demographic (ageing and population) and epidemiological transitions

27
Q

describe the discrepancies in incidence and mortality from CHD between different countries

A
  • low rates in japan
  • increased rates in UK and other western countries
  • high rates in formerly socialist economies of Europe
  • high rates in middle east
  • rates are higher in men than in women, at all ages
28
Q

what do variations in CVD rates worldwide suggest?

A

the epidemiological patterns suggest that environmental factors provide a greater risk for CVD than genetic factors

29
Q

what is the relationship between age and CVDs?

A

number of deaths from CHD increases with age but decreases after 80 years old (because there are less people in these age groups as they have died)

30
Q

what is the relationship between ethnicity and CVDs?

A

there are higher death rates from CHD in black males than white males in the US

31
Q

which characteristics of a person, other than age and ethnicity, influence risk of CVDs?

A
  • sex
  • socioeconomic status
  • religion
  • marital status
  • occupation
32
Q

what are established, modifiable risk factors for CHD?

A
  • hypertension
  • tobacco and smoking
  • blood/serum cholesterol levels
  • body weight
  • physical activity
33
Q

describe the role of serum cholesterol in determining the risk of CHD

A
  • good predictive marker
  • well-measured with a single measurement taken
  • prognostic validity
  • HOWEVER poor ability to discriminate between cases and non-cases of CHD
34
Q

describe the role of BP in determining the risk of CHD

A
  • lifestyle factors (especially diet) are key in explaining differences between populations and the rise in BP with age (e.g. lower BP in Kenya than UK due to different diet)
  • BP also varies with ethnicity and gender
35
Q

describe the role of smoking in determining the risk of CHD

A
  • smokers have a cardiovascular age that is 10 years older than non-smokers
  • smoking worldwide is decreasing
  • proportion of smokers in LICs is increasing
36
Q

describe the role of obesity in determining the risk of CHD

A
  • obesity rates increasing in many countries (especially USA)
  • obesity promotes diabetes
37
Q

describe the role of physical inactivity in determining the risk of CHD

A
  • increasing worldwide
  • due to lifestyle (e.g. cars and technology)
  • physical activity can prevent CHD
38
Q

what happens to CHD as blood pressure/cholesterol increase? what is the best method of intervention?

A
  • risk of CHD increases
  • intervention based on BP of the whole population has proven more successful than interventions only focussed on high-risk individuals

YR1 Epidemiology in Practice (11 decks)

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