The Epidemiology of Non-infectious Disease (14-15) Flashcards
What famous association did Sir Richard Doll discover?
The association between smoking and lung disease
→ shocking as smoking was considered ‘normal’ in the 1940s/50s
→ questioning if the increase in lung cancer deaths caused or by chance
What is a retrospective study?
(looks backwards)
→ examines exposures to risk/protection factors in relation to an outcome that is established at the start of the study
→ often criticised: error and bias are more common in retrospective studies
What is a prospective study?
(looks forward)
→ examines outcomes during the study period and relates this to other factors such as suspected rick or protection factors
→ fewer potential sources of bias
→ designed your study to track exactly the data you need
→ takes a lot of time
What were the findings of the prospective study of the effects of smoking on british doctors?
→ confirmed connection of smoking with lung cancer
→ showed how risk related directly to the extent of smoking
→ showed chronic bronchitis and coronary disease also linked to smoking
What was the UK public health response to the confirmed connection between smoking and lung cancer?
Huge public health burden + disease people don’t contribute to economy
→ 25 years before tobacco taxed on health grounds
→ Doll disappointed by failure of other governments to follow tax and by a failure to ban tobacco advertising
→ UK smoking ban 2007
How do lung cancer rates differ spatially/geographically in England?
North has higher rates e.g. North East 112.2/100,000
South has lower rates e.g. South East 66/100,000
What is the risk factor for prostate cancer?
Age
→ incidence peaks at around 65yo
→ reduces after as people are dying of other things/reduced diagnosis due to general ill health
How is prostate cancer diagnosed?
Prostate specific antigen (PSA)
→ a protein produced by normal and cancerous prostate cells
→ levels raise with age as prostate gets larger
→ levels above 3ng/mL are associated with an indication of prostate cancer
What are the advantages of PSA testing?
Prostate specific antigen (PSA) testing
→ can detect prostate cancer before symptoms arise
→ possibly detecting fast-growing cancer at an early stage, where intervention could halt spread/prevent health problems
→ detection could indicate that an individual is high risk
What are the disadvantages of PSA testing?
Prostate specific antigen (PSA) testing
→ raised PSA doesn’t always mean prostate cancer
→ low PSA doesn’t always mean no prostate cancer
→ raised PSA may lead to more tests - biopsy = pain, infection, blood in urine/semen
→ diagnosis with a slow-growing cancer which may have never caused problems/shortened life = unnecessary worry and treatment
→ treatments have side effects that affect daily life, invasive - is it worth while?
→ currently no screening for prostate cancer
Was prostate cancer screening found to be beneficial?
No
→ there were increased diagnoses that would have otherwise been missed
→ mortality rates weren’t affected - no significant difference (confidence levels overlapped)
→ screening comes with: cost, repercussion of false positives/negatives, worry, ‘unnecessary diagnosis’
is it worth it?
What are the risk factors for testicular cancer?
→ having testes
→ age (association with pubertal hormones?)
→ ethnicity
→ crypto-orchidism (undescended testes)
→ previous testicular cancer
→ inguinal hernia
→ HIV/AIDS
→ family history
→ height
Why is cervical caner 100% preventable?
→ all girls can get the HPV vaccine free from NHS from age 12-18 (year 8 school, 2nd dose year 9)
→ HPV vaccine effective at stopping girls getting the types of HPV that cause most cervical cancers
→ as of 2019/2020 boys vaccinated too - to prevent spread
What is non-communicable disease?
Disease of long duration and generally slow progression that are not passed from person to person
→ NCD are leading cause of death in the world (63% of annual deaths)
→ 80% of NCD deaths occur in low-middle income countries (spacial risk)
What are risk factors of disease?
An aspect of behaviour or lifestyle, environment or genetic profile that is associated with an increase in the occurrence of a particular disease
→ characterised by modifiable and non-modifiable
What are modifiable risk factors?
A factor that can be controlled or reduced, reducing the probability of disease
WHO prioritises:
→ physical activity
→ tobacco use
→ alcohol use/abuse
→ unhealthy diet
at an individual level can choose to change
+ how can government intervene at a population level (saves public health money)
What are non-modifiable risk factors?
A risk factor that cannot be controlled
→ age
→ sex
→ race
→ family history (genetics)
What is epidemiology?
The study of disease in a population
from such study you can estimate:
→ the prevalence of disease
→ the incidence of disease
→ factors associated with disease
→ factors likely to be causally associated
then hopefully do something about it
What is diabetes?
A chronic illness that occurs either when the pancreas doesn’t produce enough insulin or when the body cannot effectively use insulin
→ insulin is a hormone that regulated blood sugar
→ hyperglycaemia (raised blood sugar) is a common effect of uncontrolled diabetes - over time leads to damage of body systems especially nerves and blood vessels
→ important public health concern - premature morbidity, mortality, reduced life expectancy and financial costs
What are some complications with diabetes?
→ cardiovascular disease
→ kidney disease
→ retinopathy
→ neuropathy
→ amputation
→ sexual dysfunction
→ pregnancy complications
→ dementia
What is type 2 diabetes?
Results from the body’s ineffective use of insulin (non-insulin dependent diabetes)
→ largely due to access body weight and physically inactivity
→ 1 in 10 people globally by 2045
→ 4.5mil people in UK living with diabetes
→ 1.1mil undiagnosed
What is the cost of diabetes in the UK?
£23.7 billon (direct and indirect care)
→ 1 in 7 hospital beds occupied by someone with diabetes
→ sick people cannot work = cannot contribute to economy
Why have high income countered had the lowest increase in diabetes prevalence?
High income = low change
→ not as big of a lifestyle changes
where as middle income have had a huge change to access
