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Epidemiology and Demography of Cardiovascular Disease

Andrew Sargent

Learning Outcomes
At the end of this session, you will be able to: Discuss the worldwide context of CVD. Relate some of the UKs regional variations in mortality and morbidity to the concept of cardiovascular risk. Describe some of the local health needs in relation to the diverse population of London. Discuss the relationship between socio-economic, racial, cultural factors in the prevalence of CVD.

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CVD Morbidity
2.2 million people in the UK live with CHD 900,000 live with Stroke 7 million have Hypertension 2 million have diagnosed Diabetes CVD cost the health care system in the UK around 14.4 billion in 2006

CVD Mortality

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Key Risk Factors for CVD

Obesity Diabetes Hypertension Dyslipidaemia Smoking Stress* Excessive Alcohol intake Ethnicity Age Sex Genetic predisposition Social/ Environmental factors

Obese (%)

Obese (%)

Figure 1.

10 0

20

30

40

50

60

70

80

10

20

30

40

50

60

70

80

Nauru Cook Is French Polynesia Bahrain Egypt USA South Africa Turkey Kuwait Seychelles Russia Mexico Lesotho Tunisia Germany Hungary Fiji Saudi Arabia Mauritius Peru Vanuatu Uruguay Cyprus Australia Belgium Lithuania Latvia New Zealand Czech Rep Morocco Ireland Croatia Iran Canada Spain Kyrgyzstan UK Brazil Finland Netherlands Austria France Malaysia Sweden Denmark Singapore Italy Ghana Estonia Norway Pakistan Philippines Switzerland China Japan South Korea Lao India

Obesity
Males

Females

Nauru Cook Is French Polynesia Croatia Kuwait USA Bahrain Hungary Ireland Germany Uruguay Canada Cyprus Czech Rep Saudi Arabia Turkey Egypt New Zealand Spain Vanuatu Belgium Peru Lithuania Russia Estonia Finland Latvia South Africa Seychelles UK Austria Denmark Mauritius Fiji Sweden Italy Netherlands France Tunisia Switzerland Singapore Norway Iran Brazil Kyrgyzstan Morocco Malaysia Japan Philippines China South Korea Pakistan Lao Ghana India

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Estimated future NHS obesity disease related costs in cost/year; Billion, assuming obesity growth
Diabetes CHD Stroke Colorectal cancer Breast cancer NHS cost (all related diseases) 2007 2.0 3.9 4.7 0.45 0.27 17.4 2015 2.2 4.7 5.2 0.50 0.29 19.5 2025 2.6 5.5 5.6 0.53 0.32 21.5 2050 3.5 6.1 5.5 0.50 0.31 22.9

Lifecycle: the proposed causal links

Reduced capacity to care for baby

Higher mortality rate

Adult chronic diseases

Impaired mental development later

Elderly Diabetic, arthritic, Ob

Baby
High Birth Weight

Normal/high growth

Early Weaning

Untimely / inadequate

Rapid
Inadequate health care system Disordered foetal nutrition

weight gain

Frequent fast foods

Inadequate physical activity

Visceral obesity, H/T, Diabetes

Child overweight
Reduced play and social isolation

Woman
O/W - obese

Pregnancy
Glucose intolerance Diabetes

Adolescent
O/W-obese

Poor school conditions

Reduced fertility; CVD, HT Cancers

Early onset Type 2 Diabetes

Inadequate obstetric care

Reduced job opportunities

Adapted from James et al. SCN Millennium Rep. Food & Nutrition Bulletin, 2000, 21, 3S.

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UK Government Foresight obesity map (2007)

Societal influences Individual psychology

Food Production

Food Consumption

Individual activity

Activity environment

Biology

adult mortality (relative risk)

The 3 epidemiological J curve

2
BMI (body mass index: Weight (kg) over height (m)squared

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18.5

BMI

25

30

35

40

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Culturally-variant ideas of appropriate and preferable body image

Relationships between obesity and perceived attractiveness vary among communities and societies. African American women prefer body size which is larger than similar groups of Euro-American women (Flynn & Fitzgibbon 1998, Stevens et al. 1994, Becker et al. 1999, Fitzgibbon et al. 2000). Overweight and obese African-American women perceive themselves to be healthier, more attractive and more attractive to the opposite sex than white women of similar weight and age (Flynn & Fitzgibbon 1998, Stevens et al. 1994, Becker et al. 1999) European Americans experience dissatisfaction with their own body size at lower BMI than either Hispanic and African Americans (Fitzgibbon et al. 2000).

Smoking

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Diet

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Diabetes

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CVD as a Long Term Condition

Treatment

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Summary
CVD mortality is continuing to fall nationally, but morbidity continues to rise. The multifactorial aetiology of CVD has noticeable international and regional variations. Londons diverse socio-economic and ethnic population create local variations in health needs. Managing the disease requires a broad social perspective and a thorough understanding of the demography of the local population.

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