Increasing Chronic Diseases Stimulate Development of COVID-19

 

The Lancet: Increasing chronic diseases stimulate the development of COVID-19


The Lancet published a special issue of the 2019 Global Burden of Disease Study.

In GBD2019, important data related to China from where COVID arose are as follows:

Since 1990, the life expectancy of the Chinese population has increased by nearly 10 years, from 68.1 years to 77.6 years in 2019. The healthy life expectancy of the Chinese population has also increased significantly. 

The healthy life expectancy of the new born population in 2019 is 8 years longer than that of the population born 30 years ago.

Since 1990, the health loss of the Chinese population caused by non-communicable diseases has increased by more than 40%. 

In 2019, premature deaths and poor health caused by non-communicable diseases reached 85%.

In the past 30 years, the biggest diseases that contributed to the increase in health loss in China were ischemic heart disease, stroke, lung cancer, diabetes, age-related diseases and other hearing loss.

 In East Asia, the main risk factor for health loss in 2019 is tobacco use. Hypertension, unhealthy diets, and air pollution each account for 10-15% of China's disease burden in 2019.

In 2019, China’s five major mortality risk factors were smoking (approximately 2.7 million deaths), high blood pressure (2.6 million deaths), unhealthy diet (2.02 million deaths), air pollution (1.85 million deaths), and high blood sugar (107 Ten thousand people died).


The most comprehensive global research on COVID-19

 The analysis of 286 causes of death, 369 diseases and injuries, and 87 risk factors in 204 countries and regions reveals how prepared the world's population is in response to the COVID-19 epidemic affecting basic health.

The global crisis of chronic diseases and the failure of global public health to contain the increase in highly preventable risk factors have made the global population vulnerable to public health emergencies like the COVID-19 epidemic.

We need to take urgent action to deal with chronic diseases, social inequality, and the global syndemic that coexists with COVID-19 to ensure a healthier health system and healthier people, so that countries are more capable of responding to the threat of future epidemics.

The Global Burden of Disease Study provides a roadmap for areas with the highest demand, including data on risk factors and chronic disease burden in specific countries.

The interaction between COVID-19 and the continued global growth of chronic diseases and related risk factors (including obesity, hyperglycemia, and outdoor air pollution) has created a perfect storm over the past 30 years, stimulating the development of COVID-19.

Increasing chronic diseases stimulate the development of COVID-19, says The Lancet Published research. Infographics


The Lancet published the 2019 Global Burden of Disease Study (GBD). The latest research findings provide new insights into how countries are prepared to respond to the impact of the COVID-19 epidemic on basic health and clarify the true scale of the challenge of preventing further threats from the pandemic.

This study also shows that the increase in the number of people exposed to key risk factors (including high blood pressure, high blood sugar, body mass index [BMI] and high cholesterol), coupled with certain countries (such as the United States and Caribbean countries) due to cardiovascular disease

 The death toll is also increasing, indicating that the life expectancy growth of the global population may be approaching a turning point.

The author emphasizes that the vision of preventing disease through government actions or through incentives that enable people to develop healthier behaviors and obtain health care resources has not yet been realized around the world.

"Most risk factors can be prevented and treated, and dealing with them will bring huge social and economic benefits. We have not been able to change unhealthy behaviors, especially those related to dietary quality, caloric intake, and physical exercise. Related behaviors.

 Part of the reason is due to policy concerns, public health funding, and insufficient behavioral research.” Professor Christopher Murray, Director of the Institute for Health Metrics and Evaluation (IHME) of the University of Washington, who led this research Say.

Several risk factors highlighted in this study and non-communicable diseases (NCDs), including obesity, diabetes, and cardiovascular disease, are all related to the increased risk of serious illness and death caused by COVID-19. 

However, various diseases not only affect each other physiologically; they also interact with social factors. We need to carry out urgent actions to deal with chronic diseases, social inequality, and the global syndemic of COVID-19. 

Comprehensive concurrency refers to the mutual influence of multiple epidemics, which will increase the disease burden of people already affected by the disease and make them more vulnerable.


The Lancet Editor-in-Chief Dr Richard Horton said on COVID-19:

 "The concurrent nature of the threats we face requires us to not only deal with the symptoms, but also urgently deal with the underlying social inequalities (poverty, housing, education, and ethnic issues) that create this situation. ), these issues are powerful determinants of health."

He continued: "COVID-19 is an urgent and long-term public health emergency. The long-term neglect of the current crisis puts the future at risk. So far, COVID-19 has caused more than one million deaths and is non-communicable. 

Disease plays an important role in this process, and it will continue to affect the health of various countries after the epidemic subsides. This global burden of disease study provides a method for how to rebuild the health system after the COVID-19 epidemic. Focus on the regions with the highest demand and the differences between different countries.

The health system is ill-prepared for the rapid growth of non-communicable diseases and disability issues

Although the global healthy life expectancy (the number of years that people can expect to be in good health) has increased steadily between 1990 and 2019 (over 6.5 years), the healthy life expectancy in 198 of the 204 countries we assessed It has not yet reached the same number of years as the overall life expectancy, which shows that people have longer years of unhealthy health.

Disability, rather than premature death, has become an increasingly large part of the global burden of disease, from approximately one-fifth (21%) of the total burden in 1990 to more than one-third of the total burden in 2019 (34 %).


What is disability-adjusted life years or DALYs?

 In 11 countries (including Singapore, Iceland, Norway, Ireland, Australia, New Zealand, and Qatar), more than half of the health loss (measured by disability-adjusted life years DALYs) is caused by non-communicable diseases and injuries. Caused by the resulting disability.

In the past few decades, global efforts have been made to deal with infectious diseases and antenatal care, and have successfully improved the health of children under 10 years of age (the overall disease burden has been reduced by about 55%). However, health work for the elderly is still not enough. In contrast to this.

In the past three decades, the top ten causes of global health loss (measured by the absolute value added of DALYs), including six major causes affecting the elderly population: Ischemic heart disease (between 1990 and 2019 Related DALYs increased by 50%), diabetes (148% increase), stroke (32%), chronic kidney disease (93%), lung cancer (69%), and age-related hearing loss (83%). 

In addition, the other four causes are common from adolescence to old age: human immunodeficiency virus/AIDS (HIV/AIDS) (128%), musculoskeletal disease (129%), low back pain (47%), and depression (61%). For example, between 1990 and 2019, DALYs caused by ischemic heart disease in the Philippines increased by more than 400%, while DALYs caused by diabetes in the UAE increased by more than 1,000%. 

The growth of such ill-health conditions poses a threat to some health care systems, which are generally overwhelmed and unable to cope with chronic diseases related to population growth and aging.

The main factors of health loss in 2019 vary greatly depending on the age group. Road traffic injuries, headaches, HIV/AIDS, low back pain, and depression are the main health problems for younger people aged 10 to 49. In contrast, ischemic heart disease, stroke, and diabetes are the main causes of health loss for people aged 50 and over.

In the past ten years, global progress in health has been uneven. Low- and middle-income countries (LMICs) have made impressive progress in health, mainly due to successful treatments for infectious diseases, maternal and neonatal diseases. For example, in Ethiopia, Sudan, and Bangladesh, age-standardized health loss rates (DALYs) have decreased by 2% or more per year.

However, the author warns that the health systems of low- and middle-income countries are not adequate to cope with the increasing disease burden caused by non-communicable diseases. 

The proportion of the disease burden caused by these non-communicable diseases in the total disease burden in low- and middle-income countries varies from About one-third in 1990 increased to nearly two-thirds in 2019.

 In addition, although the number of deaths due to infectious diseases in low- and middle-income countries has generally decreased, the number of deaths due to non-communicable diseases is increasing. 

For example, in Uzbekistan, diabetes has risen from the 21st cause of death to the fifth leading cause of death (a 600% increase in deaths). 

Similarly, in the Philippines, ischemic heart disease has risen from the fifth cause of death to the leading cause of death (increased by more than 350%).


In contrast, in some high-income countries, health improvements have begun to stagnate, and have even reversed in several countries, especially in the United States, where the age-standardized death rate has increased by nearly 3 in the past decade. %. 

The author believes that the reasons for the lack of progress may include the increase in obesity, and the decreasing possibility of reducing smoking and the possibility of further improving the coverage of hypertension and high cholesterol treatment, reducing smoking and further improving hypertension and treatment coverage for high cholesterol is necessary to maintain a reduction in deaths from cardiovascular diseases.

"With the increasing proportion of disability in the global burden of disease and the increasing proportion of healthcare expenditures, there is an urgent need to identify a new and more effective intervention."

 Professor Murray said. "As the global population is aging, the demand for medical services for disability and chronic diseases that increase with age will also increase, which will require more funds, strong political commitment, and accountability backed by better data. System and global concerted efforts to prioritize the most vulnerable people" 

The public health system failed to prevent the increase in key risk factors

In the past decade, exposure to several highly preventable risk factors (obesity, hyperglycemia, alcohol use, and drug use) has been particularly serious and worrying (a global increase of 0.5% per year). 

The above-mentioned risk factors have increased the burden of non-communicable diseases and emphasized the urgent need to strengthen public health efforts.

The largest cumulative impact on health comes from a significant increase in metabolic risk factors, which have increased by 1.5% per year since 2010. Overall, metabolic risk factors (ie, high BMI, high blood sugar, high blood pressure, and high cholesterol) accounted for nearly 20% of the total global health loss in 2019, which is 50% higher than in 1990 (10.4%). 

They have also caused a large number of deaths worldwide: in 2019, high blood pressure caused one-fifth of deaths (about 11 million people), and high blood sugar, high BMI, and high cholesterol caused 6.5 million and 5 million deaths respectively. People and 4.4 million.

Among the major noncommunicable disease risk factors, only smoking has been significantly reduced. 

The huge efforts to implement international tobacco control policies have reduced the global impact of smoking by approximately 10% since 2010, although tobacco use (smoking tobacco, second-hand smoke and chewing tobacco) in 2019 has been in many high-income countries (including the United States, Canada, and Japan). 

Belgium, and Denmark) remain the main cause of death, and has claimed nearly 9 million lives worldwide.

The impact of risk factors also varies from region to region. In many parts of Latin America, Asia and Europe, high blood pressure, high blood sugar, high BMI, and tobacco use are key factors that lead to unhealthy health.

 In Oceania, malnutrition and air pollution are the main risk factors. The most noticeable difference is in sub-Saharan Africa. Unlike other regions, the main risk factors affecting health here are malnutrition, unsafe water sources, clean conditions and hand washing, air pollution, and dangerous sexual behavior.


Countries should collaborate globally and take actions to make everyone behave healthier as possible

"It is not enough to provide information about the hazards of these risk factors," said Professor Emmanuela Gakidou, a co-author from IHME. "Considering that personal choices are affected by financial status, education, and other choices available, countries should collaborate globally and take actions to make everyone behave healthier as possible. 

At the same time, since decades of exposure to tobacco Lessons are learned from the control. When a major risk to population health (such as obesity) arises, the government may need to take coordinated actions through regulations, taxes, and subsidies."


The Lancet Research conclusion emphasizes: Need to deal with broader determinants of health

Since 2000, underdeveloped countries have made more progress than highly developed countries increasing income, extending the number of years of education, and supporting family planning to extend life expectancy and healthy life expectancy.

The author emphasizes that it should be recognized long ago: the importance of social and economic development to overall health, and the need to take a more comprehensive approach to pay more attention to all factors affecting population health.

"Considering the tremendous impact of social and economic development on healthy development, redouble our efforts in formulating to stimulate economic development, expand educational opportunities, and improve women's status should be the priority of our joint work." Professor Murray said.


The Lancet pointed out that although attention should be paid to controlling the spread of SARS-CoV-2 in the community and protecting those most vulnerable to it

The editorial published in this issue of The Lancet pointed out that although attention should be paid to controlling the spread of SARS-CoV-2 in the community and protecting those most vulnerable to it, a greater strategy is needed to succeed.

COVID-19 is a comprehensive concurrent situation of coronavirus infection and non-communicable disease epidemic, both of which affect the poor and unequal bottom of society. 


Conclusion

The message of the GBD Institute is that unless the deep-rooted structural inequalities in society are addressed, unless a more liberal immigration policy is adopted, the community will not be able to avoid the impact of future outbreaks of infectious diseases, and population health will not achieve the pursuit of global health advocates. The results. It is time for the global health community to change the direction of its efforts.


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