Resources for Topic 1: burden of illness

What are diabetes and CVD?

These two links to information from the World Health Organisation media centre provide some background information as well as links to some of the approaches to the problem by WHO.

Cardiovascular Diseases (CVDs).

Diabetes.

What is the size of the problem?

Diabetes facts from the World Diabetes Foundation. This gives a nice overview - it starts by saying: "The prevalence of diabetes has reached epidemic proportions. WHO predicts that developing countries will bear the brunt of this epidemic in the 21st century. Currently, more than 70% of people with diabetes live in low- and middle income countries."

A paper in 2016 in the Lancet finds: "Since 1980, age-standardised diabetes prevalence in adults has increased, or at best remained unchanged, in every country. Together with population growth and ageing, this rise has led to a near quadrupling of the number of adults with diabetes worldwide. The burden of diabetes, both in terms of prevalence and number of adults affected, has increased faster in low-income and middle-income countries than in high-income countries." The team also calculated the annual cost of diabetes—which included the cost of treating and managing the disease and its complications, such as limb amputations. This was calculated in International Dollars. The global cost was 825 billion dollars per year, with the largest cost to individual countries being in China ($170 billion), the US ($105 billion), and India ($73 billion). The authors added that the calculation did not include work days lost due to diabetes, which would make the costs far greater if incorporated.

Interactive resource: Please look for information on Non-Communicable disease in your own setting in this interactive web resource from the Global Burden of Disease project http://vizhub.healthdata.org/gbd-compare/. You can explore how the burden has been changing from as far back as 1990 and compare it with the burden of other conditions. Note how the tool also allows you to look at the burden with different metrics including Disability-adjusted Life Years (DALYs) that combine information on both the fatal and non-fatal outcomes

General information on CVD from the WHO. Again, this contains much valuable and interesting information and many useful links which you  may want to follow.

The paper Looking at non-communicable diseases in Uganda through a local lens: an analysis using locally derived data makes the point that the disease burden in Uganda is substantial, but that there are few local studies other than the national databases of routine statistics. The paper also states "there have not been any published studies of NCD-related costs in Uganda. An upcoming comprehensive review of global NCD cost publications......confirms that primary prevention of CVD, stroke, and diabetes is far less expensive and has lower unit costs than treatment interventions for those conditions. Further, outpatient treatment is far less costly than inpatient treatment, so it is critical to have an effective referral system that directs patients to the proper facility"

The costs of CVD. "Non-communicable diseases (NCDs) account for two thirds of all deaths in the world. CVD alone, including heart disease and stroke, makes up nearly 50% of all NCD deaths. By 2030 the total global cost of CVD is set to rise from approximately US$863 billion in 2010 to a staggering US$1,044 billion."

A paper from the International Diabetes Federation found: "There is a large disparity in healthcare spending on diabetes between regions and countries. More than 80% of the estimated global expenditures on diabetes are made in the world’s economically richest countries, not in the low- and middle-income countries where over 70% of people with diabetes live."

HIV, cardiovascular disease, and stroke in sub-Saharan Africa. The HIV epidemic may be contributing to an increase in CVD: " Sub-Saharan Africa is facing a growing burden from non-communicable and infectious diseases including HIV infection. The therapeutic success permitting people living with HIV to live longer on combination anti retroviral therapy (ART) is being challenged by reported increases in adverse cardiovascular and metabolic disease profiles in these patients. The growing burdens of cardiovascular diseases and stroke are already beyond the capacities of most health-care systems in Africa. 7–45% of patients with HIV have metabolic syndrome and coronary heart disease."

Trends to 2018. A 2018 Lancet paper NCD Countdown 2030: worldwide trends in non-communicable disease mortality and progress towards Sustainable Development Goal target 3.4 says: "In 2016, an estimated 40·5 million (71%) of the 56·9 million worldwide deaths were from NCDs... An estimated 32·2 million NCD deaths (80%) were due to cancers, cardiovascular diseases, chronic respiratory diseases, and diabetes, and another 8·3 million (20%) were from other NCDs. Women in 164 (88%) and men in 165 (89%) of 186 countries and territories had a higher probability of dying before 70 years of age from an NCD than from communicable, maternal, perinatal, and nutritional conditions combined. Globally, the lowest risks of NCD mortality in 2016 were seen in high-income countries in Asia-Pacific, western Europe, and Australasia, and in Canada. The highest risks of dying from NCDs were observed in low-income and middle-income countries, especially in sub-Saharan Africa, and, for men, in central Asia and eastern Europe."

Let's not forget that epidemiologists were puzzled for many years by the observation of a decline in CVD rates in many high income countries which may explain these geographical differences - we will return to this in the next section on risk factors.

Data Accuracy. It is important to consider the accuracy of any data collected and presented - a paper Saving lives through certifying deaths: assessing the impact of two interventions to improve cause of death data in Perú reviews some of the literature about inaccuracy in death certification and reports on attempts to improve the accuracy.