EPIDEMIOLOGY OF NONCOMMUNICABLE
DISEASES
Dr Alaa Hassan El Anwar
Lecturer of public Health and community
medicine
Definition
• Non-communicable diseases (NCDs), also known as chronic diseases, are
diseases which are non-infectious or non-transmissible from person to
person.
• They tend to be of long duration and slow progression.
• They are the result of a combination of genetic, physiological,
environmental and behavioral factors.
The 4 main types of NCDs are cardiovascular diseases (e.g., hypertension,
coronary heart disease and stroke), cancers, chronic respiratory diseases (e.g.,
chronic obstructive pulmonary disease and asthma) and diabetes.
Communicable Vs. NCDs
[Link] infectious diseases are communicable, which means that these diseases can
be transmitted from person to person, either directly, for example, via droplet
for influenza, or indirectly, for example, via mosquito bites for malaria.
[Link] risk of getting a communicable disease increases with the number of
people who have the disease in the population, a feature that is absent for non-
infectious diseases.
[Link] some infectious diseases such as measles, a recovered person gains long-
lasting immunity against re-infection by the same pathogen.
Burden of NCDs and their key risk factors
worldwide and in Egypt
Burden :
• Disease burden is the impact of a health problem on a given
population, and can be measured using a variety of indicators
such as
• mortality (number of deaths),
• morbidity (prevalence and incidence of disease) or
• financial cost.
Burden of NCDs and their key risk factors worldwide
• NCDs is one of the leading causes of diseases and deaths
globally and the health care costs of NCDs are enormous.
• Globally
• Noncommunicable diseases (NCDs) kill 41 million people each
year, equivalent to 74% of all deaths globally.
• Each year, 17 million people die from a NCD before age 70; 86%
of these premature deaths occur in low- and middle-income
countries.
• Cardiovascular diseases account for most NCD deaths, followed
by cancers, chronic respiratory diseases, and diabetes.
Burden of NCDs in Egypt
• In Egypt
• NCDs are estimated to account for 86% of all deaths in 2019
• Similarly in Egypt, cardiovascular diseases account for most NCD
deaths, followed by cancers, chronic respiratory diseases, and diabetes.
• Egypt latest figures reported in 2017 STEPwise survey
revealed that:
• Percentage who currently smoke tobacco: 23%
• Percentage with insufficient physical activity: 25%
• Percentage who are overweight: 63%
• Percentage who are obese: 36%
• Percentage with raised BP: 30%
• Percentage with raised fasting blood glucose: 16%
• Percentage with raised total cholesterol : 19%
Reasons of the increasing prevalence of NCDs
1. The demographic transition:
The decrease in mortality resulted in increase in life expectancy with subsequent increase
in the proportion of the elderly populations. NCDs are usually associated with aging.
2. The epidemiologic transition:
There is shift from mortality from communicable diseases (due to the use immunizations
and antibiotics etc.) to mortality from NCDs which have chronic nature.
3. Nutrition Transition:
There is a shift in the pattern of nutrition to a diet high in total fat, sugar and other refined
carbohydrates and low in polyunsaturated fatty acids and fibers.
4. The multi-factorial nature of the risk factors for NCDs:
• Unlike communicable disease, it is difficult to identify the specific cause-effect
relationship in NCDs.
• The multiplicity of the risk factors associated with a specific NCD limits the
opportunities to have specific intervention for prevention and control.
• The risk factors are related to genetic, environment, culture and behavior, which
represent a challenging issue to public health programs.
5. Migration of population across different cultures:
• The individuals who migrate from low–risk culture (e.g. rural areas) to high-risk culture
(e.g. urban areas) follow the life-style of the new culture and demonstrate increased risk
for NCDs.
6. International communication:
• International communication, multinational business and new food technologies have
resulted in new life-styles and new food products favoring the occurrence of NCDs.
• Communication through the mass media/satellites/internet, overseas travel, and
international food marketing introduce dietary patterns which predispose to NCDs.
• Adolescents and youth are exposed to modernization in concepts and behavior. Their
exposure to the risks of NCDs early in the life cycle results in the development of a large
cohort with health problems during adulthood and older age.
7. Environmental changes:
• The increase in the level of physical and chemical air pollution is associated with high
prevalence of NCDs.
8. Limited use of scientific progress in management of NCDs:
• There are rapid and successful achievements in the science of risk detection, use of
medication and technologies to prevent and control NCDs.
• However, in developing countries high cost of NCDs prevention and control programs is
challenging.
What are risk factors of NCD?
Non-modifiable risk factors Modifiable behavioral risk
• Age factors
• Sex Most NCDs are strongly associate
• Genetics •Unhealthy diet
•Tobacco use
• Ethnicity
•Physical inactivity
• Personality type •Harmful use of alcohol
Metabolic/biological risk factors
The four key metabolic/physiological changes that increase the risk of NCDs:
• Raised blood pressure,
• Overweight/obesity,
• Hyperglycemia (high blood glucose levels)
• Hyperlipidemia (high levels of fat in the blood).
General outlines for prevention and control of the
NCDs:
• The concept of prevention is best defined in terms of levels of
prevention. Traditionally, there are 5 levels:
• Primordial prevention
• Primary prevention
• Secondary prevention
• Tertiary prevention
• Quaternary prevention
Quaternary prevention:
• Quaternary prevention is the set of health activities to mitigate or avoid the consequences of
unnecessary or excessive intervention of the health system.
• Healthcare professionals must be aware of the consequences of their decisions, and include
quaternary prevention interventions in their daily clinical practice with each patient:
• To avoid unnecessary examinations.
• To avoid the unnecessary use of antibiotics, with the subsequent increase of bacterial resistances.