Prevention of non-communicable diseases as a prerequisite for reducing mortality in the country

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1 Prevention of non-communicable diseases as a prerequisite for reducing mortality in the country Boytsov S.A. National Research Center for Preventive Medicine, Moscow

2 СVD mortality rate in Russia, Finland, France, Poland, Norway and Germany Финляндия Finland Франция France Германия Germany Норвегия Norway Польша Poland РФ RF

3 Birthrate and mortality in Russian Federation 25,0 (per 1 000) 20,0 15,0 10,0 23,2 15,7 15,0 15,7 15,7 15,9 16,6 14,5 14,7 15,3 15,6 16,2 16,4 15,9 16,1 15,1 14,2 14,6 14,5 13,7 14,1 14,2 13,6 13,5 13,3 13,9 13,4 14,6 11,0 11,3 13,4 11,2 11,4 12,2 13,3 12,1 11,3 12,0 12,3 12,5 12,6 12,7 12,8 9,8 8,7 10,7 9,4 9,6 9,3 8,9 8,6 8,8 8,3 8,7 9,0 9,7 10,2 10,4 10,2 10,3 7,4 7,6 5,0 0,0 рождаемость Birth rate смертность Mortality Federal State Statistics Service,

4 Trends in mortality rates of the main causes in Russian Federation (per ) 4 Federal State Statistics Service, 2013

2013, depending on age (per 100 000) 25-64

5 Death rates due to circulatory diseases among adult population of the Russian Federation in 2013, depending on age (per ) older 64 Federal State Statistics Service, 2013

6 Mortality among men and women aged years in 83 regions of the Смертность Russian Federation, в РФ (2012г; 2012 на 1000) (regions are listed in ascending order of mortality on abscissa left) Per 100 thous Novosibirsk (31) Chukotka (83) Moscow (2) Arkhangelsk (40) of the region Boytsov SA, Somorodskaya IV,Tretyakov VV, 2014, in print 23 of the 24 regions with the highest mortality rates( 60-83) are in the European part of Russia, to the north of Moscow, in Siberia and in the Russian Far East

7 Cause of death structure in the Russian Federation Federal State Statistics Service, 2013

8 Prevalence of cardiovascular health indicators in relation to gender in the ESSE-RF research participating regions 60 % Женщины, N=11386 Women, N=11386 Men, N=6919 Мужчины, N=6919 Total, N=18305 Всего, N= Smoking Курение НФА ИПС НПОФ Повышенное Повышенный Ожирение Повышенная Smoking LFA ECS IIFL High BP High CS Obesity High glucose A АД ХС глюкоза BP - blood pressure; CS - total cholesterol; LPA - low physical activity; ECS - excessive consumption of salt; IIFV - inadequate intake of fruits and vegetable ESSE-RF, 2014

9 The prevalence of hypertension in the ESSE-RF research participating regions % ESSE-RF, 2014

of treatment ОШ Poor control of hypertension in the

10 ОШ Factors determining the low treatment efficiency and control of hypertension in the RF (p <0,05) Low efficiency of treatment ОШ Poor control of hypertension in the population (60% men and 40% women not taking medications ESSE-RF, 2014

11 The prevalence of TCH> 5 mmol / l in the ESSE-RF research participating regions Male 58,4%, Female 56,3%, Total 57,6% ESSE-RF, 2014

12 High-risk frequency (SCORE> 5%) in patients without CVD In regions participating in the study (%) Male 40,6%, Female 7,1%, Total 18,6% % ESSE-RF, 2014

13 Factors independently associated with high cardiovascular risk in the RF (p <0.001) ОR Male ОR Female ESSE-RF, 2014

14 Risk factors contribution in CVD mortality over 10 years in the Russian population among men and women Men Women % Shalnova SA, Deev AD. 2012

15 Pearson correlation coefficient Смертность between в РФ (2012г; socio-economic на 1000) indicators and overall mortality indicators in the Russian regions Socio-economic indicators Pearson correlation coefficient Р Sales of vodka, liqueurs and spirits per capita of the population of working age and older, lit per person. 0,568* <0,0001 Proportion of population with incomes below the subsistence level,% 0,265* 0,016 Density of public hard surface roads, km of roads per 1,000 square kilometers of territory -0,483** <0,0001 Density of public railways, km of track per 10,000 sq km area -0,273* 0,012 Level of development of the territory, proportion of the area of human settlements in the total land area,% -0,332** 0,002 GRP per capita, thous. per capita -0,226* 0,04 Unemployment rate,% -0,296** 0,007 Average living area per person except for old and dilapidated fund sq.m per person 0,292** 0,007 Median salary (average salary worker) 0,223* 0,043 Urban population% 0,245* 0,026 Sales of beer per capita of the population of working age and older, lit per person. 0,156 0,16 The ratio of cash income to the cost of a fixed basket of consumer goods and services -0,118 0,287 The ratio of the median wage to the cost of a fixed basket of consumer goods and services 0,141 0,204 The volume of deposits (deposits) of individuals in banks per capita, thous. per capita -0,04 0,723 Share of profitable enterprises,% -0,21 0,057 Coefficient of inequality of wages (Gini) -0,179 0,105 Boytsov SA, Somorodskaya IV, Tretyakov VV, 2014, in print

16 Contribution of risk factors dynamics in CVD mortality reduction in in Russia Totally 59,6% Shalnova SA, Deev AD. 2012

17 CVD mortality correlation with the sales of statins and ACE inhibitors in Russia Packs per year ACE inhib sales Packs per year Statin sales r=-1,0 p=0,0001 r=-1,0 p=0,0001 Spearman rank correlation coefficient

Concurrent implementation of the three strategies - keystone to success in mortality reduction from NCDs Decline in mortality from coronary heart disease by 20-80% in 10-20 years (experience of 15

18 Concurrent implementation of the three strategies - keystone to success in mortality reduction from NCDs Decline in mortality from coronary heart disease by 20-80% in years (experience of 15 countries): Population strategy (healthy lifestyle formation ) 30-40% contribution to the reduction of mortality % -> 0 in direct health costs Effect in 5-10 years High-risk strategy (screening) 20-30% contribution to the reduction of mortality 1.3% of total direct health care costs, or 3% of FCMIF Effect in 3-4 years Treatment, secondary prevention 40% contribution to the mortality reduction 98.7% of all direct healthcare costs Effect in 3-4 years

19 Five main elements of a healthy lifestyle and prevention of non-communicable diseases Strategy 1 Informing and motivating people to healthy lifestyles (media, education, culture, public organizations, volunteers) 1 st Elemen Providing conditions for a healthy lifestyle 2 nd Element Periodic health examination (Dispensary observation), preventive examinations, health centers 3 rd Element Public health authorities of the subject of the Russian Federation Center of Medical Prevention Dispensary observation 4 th Element Strategy 2 Hospitals & Resorts 5 th Element Strategy 3 Boytsov S.A, 2013

20 Intersectional cooperation in healthy lifestyle Commission on Public Health Protection Programs Mass media Education Culture Sport Envirome nt Industry, trade Allocation, correction and addition of activities related to motivating the population to healthy lifestyles and ensuring conditions for HLS United roadmap Ministry of Health Public Health Centre

21 Group criteria "Roadmap for Healthy Lifestyles and Non-communicable Disease in the territorial subject of the Russian Federation", implemented on the basis of interagency cooperation Birth rates, mortality and morbidity among the population of the subject of the Russian Federation (basic criteria for total assessment of the public health services in the subject of the Russian Federation) Prevalence of NCD risk factors among the population of the RF subject (criteria for assessment of the total public health services in the subject of the Russian Federation in the part concerning the formation of healthy lifestyles and NCD prevention) Informing population about risk factors of NCDs and motivation to healthy lifestyle Providing conditions for healthy diet Providing conditions for adequate physical activity Providing of favorable environmental conditions Providing social conditions, working conditions, access to education and culture Activities of regional government agencies of healthcare in the of the subject of the Russian Federation in the prevention of NCDs and healthy lifestyle formation

22 The main features of modern preventive medical examination of the adult population Order of the Ministry of Health of Russian Federation December 3, n "Procedures for preventive periodical medical examination of certain groups of adult population" Purpose - early detection NCD and their risk factors Broad population coverage, starting from 21 y.o. 1 time every 3 years (up to 24 million pers. / year) The district - territorial principle of organization Two-stage mechanism Differentiated approach to the survey by gender and age Medical and economic assessment methods Motivation to HLS and correction of risk factors in the preventive medical examination Payment by Compulsory Health Insurance Boytsov S.A, 2013

First identified CVD as part of the current activities of the local doctor and the medical examination of 2013 and the first half of 2014 (100 thousand) % 5000

23 First identified CVD as part of the current activities of the local doctor and the medical examination of 2013 and the first half of 2014 (100 thousand) % Rosstat CVD AH CHD CerVD Boytsov S,

24 Main results of periodic health examination 20.5 million people were examined Order of the Ministry of Health of Russian Federation from December 3, n "Procedures for preventive periodical medical examination of certain groups of adult population" 5-6 times increase in the number of the target population in comparison with additional periodic health examination of the working population in In 3-10 times increased detection of CVD and for cancer in 5-6 times about 3.6 million people underwent advanced preventive counseling number of the people under periodic health examination increased 2-fold

Approximate volume of periodic health examination on the scale of therapeutic district (1800 people) Official paper of MH of the Russian Federation from December 21, 2012 number 1344n Arrangement of

25 Approximate volume of periodic health examination on the scale of therapeutic district (1800 people) Official paper of MH of the Russian Federation from December 21, 2012 number 1344n Arrangement of the periodic health examination " In the therapeutic district about 800 people are currently under follow-up monitoring AH patients - about 700 people CHD patients - about 230 people Diabetic patients is about 50 COPD patients - about 100 people Patients with malignant tumors should be supervised by oncologists. Сitizens with high and very high cardiovascular risk (about 400 people) should be supervised in follow-up monitoring by DMP/OMP Following two years of periodic health examination about people with different combinations of NCD will be under follow-up monitoring

26 Years of life in working and economically active age saved within 10 following years due to prevented mortality from cardiovascular disease and cancer Kontsevaya A.V., Kalinina A.M., Boytsov S.A., 2014

27 Correlation Per capita GDP and full costs of one year of saved life (including the costs of medical examinations, follow-up examination and treatment within 10 years) RUR Kontsevaya A.V., Kalinina A.M., Boytsov S.A., 2014

Share and structure diagnoses CVD patients under supervision at home.

28 Who are really under the supervision of the local therapist Share and structure of diagnoses of patients under supervision at home. Share and structure diagnoses CVD patients under supervision at home. Monitoring of prophylactic medical examination, data NRCPM MH RF Tulsckaya region, n=1055, Gromova ТА, Kalinina АМ

Practical aspects of regular medical follow-up monitoring Ministry of Health of the Russian Federation National Research Center for Preventive Medicine of the Ministry of Healthcare of the Russian

noncommunicable disease and patients with a high risk of their development Guidelines edited by Boytsov SA, Chuchalin AG contents I.

29 Practical aspects of regular medical follow-up monitoring Ministry of Health of the Russian Federation National Research Center for Preventive Medicine of the Ministry of Healthcare of the Russian Federation Scientific Research Institute of Pulmonology FMBA Russian Society for the prevention of noncommunicable disease Project Follow-up medical examination of patients with chronic noncommunicable disease and patients with a high risk of their development Guidelines edited by Boytsov SA, Chuchalin AG contents I. General issues of organization and carrying out the follow-up medical examination of patients with chronic non-communicable diseases and patients with a high risk of development of non-communicable diseases on the regular basis 5 II. SPECIFIC ISSUES of follow-up medical examination of patients with various infectious diseases and patients with high total cardiovascular risk Follow-up medical examination of patients with hypertension Follow-up medical examination of patients with chronic ischemic heart disease and angina pectoris. Follow-up medical examination of CHD patients after surgical and endovascular interventions (operations) on the heart and vessels Follow-up medical examination of coronary heart disease patients with postinfarction cardiosclerosis Follow-up medical examination of patients after acute ischemic stroke Follow-up medical examination of patients with heart rhythm disorders Follow-up medical examination of patients with chronic heart failure Follow-up medical examination of patients with diabetes mellitus Follow-up medical examination of patients with high and very high total cardiovascular risk Follow-up medical examination of patients with chronic respiratory diseases and after acute pulmonary diseases Follow-up medical examination of patients with chronic kidney disease 99

30 The purpose of regular medical follow-up monitoring: decrease of exacerbations, calls for ambulance, hospitalizations, reducing preventable mortality Meeting a goal objective of regular medical follow-up monitoring: achieve the targeted values of blood pressure, cholesterol, glucose, INR

31 Achievement of target BP level in patients with CVD in a year after the cycle of clinical discussions. Main training objectives - to achieve the target values of blood pressure, cholesterol, glucose, INR

Organization of assistance at smoking cessation FL 323 Fl 15 The procedure for the prevention of noncommunicable disease Modalities of assistance in Tobacco Withdrawal, Tobacco Use Disorder treatment

32 Organization of assistance at smoking cessation FL 323 Fl 15 The procedure for the prevention of noncommunicable disease Modalities of assistance in Tobacco Withdrawal, Tobacco Use Disorder treatment and consequences of tobacco consumption Light and medium Dependence (80%) consultation in the department / office of medical prevention in out-patient clinic, health center, in-patient clinic - hospital Severe Tobacco addiction (20%) treatment according to standard smoking cessation programme in office of medical prevention in out-patient clinic, narcological dispensary Boytsov S.A, 2013

33 Periodic health examination and follow-up monitoring as a change of the content and results of the GP work Primary healthcare provide 60% r of the total health care sevice Visits by exacerbations and new diseases Prevention Periodic health examination, Preventive examination, follow-up monitoring Prevention Visits by exacerbations and new diseases prevention of exacerbations reducing the number of appeals, ambulance calls and hospitalizations improving quality of life reduce the number of preventable deaths Reducing of the mortality rate in the country could only be done by reducing it on therapeutic districts

34 Prevention of non-communicable diseases in hospitals and health resorts (fifth element of the model) High prevalence of risk factors in patients after MI, coronary artery bypass surgery and stenting % ,1 28,2 28,2 19,8 30,8 80,7 76,8 49,6 36, Effectiveness of drug therapy and correction of risk factors to reduce the risk of death in patients with coronary artery disease % statins antihypertensive therapy Smoking cessationpa + Balanced diet

35 Prevention of non-communicable diseases in hospitals and health resorts (fifth element of the model) High prevalence of risk factors in patients after MI, coronary artery bypass surgery and stenting % ,7 76,8 49,6-15 Branchs / offices of medical prevention cessation) Effectiveness of drug therapy and correction of risk factors to reduce the risk of death in patients with coronary artery disease % statins antihypertensive therapy Short preventive counseling in the practice of all physicians Smoking cessationpa + Balanced diet ,5 28,2 28,2 30, (depth individual counselling, the health care schools, 20- assistance in smoking 20,1 19,

36 Thank you for attention!

Some good practices in an interagency approach to the prevention of NCDs in Russia

Some good practices in an interagency approach to the prevention of NCDs in Russia National Research Center for Preventive Medicine of the Russian Federation WHO Collaborating Center on Development and Implementation of Non-communicable Disease Prevention Policy and Programs Collaborating