2024-11-04 14:29:00
When epidemiologists note the increase in the prevalence of a disease, they are wary of the risk of confusion. Indeed, this increase may be due to better diagnostics thanks to our technological advances or to a new definition of the disease. It is only after eliminating these two risks of confusion that we can reasonably think about environmental modifications.
Let’s take a few emblematic examples. The number of hypertension cases has logically increased sharply each time a new blood pressure standard has been defined. The number of pancreatic cancers has increased alongside the number of abdominal ultrasounds and scanners. Unfortunately, this early diagnosis did not modify its formidable prognosis, leading the authorities to recommend against screening. The known environmental causes of this cancer seem fairly stable (nutrition, tobacco, alcohol).
The increase in the prevalence of autism is mixed. The diagnostic criteria have evolved considerably to include autism in the large group of autism spectrum disorders (ASD), disorders so numerous that some are now removed. But there are certainly environmental causes. Among the antenatal causes, some have not undergone a notable increase (psychiatric illnesses in the mother and in the family, maternal epilepsy), others on the contrary are increasing, such as the high age of the parents and more particularly of fathers, to fertilization. Among the gestational causes, some have changed little (febrile infections in the 2nd trimester, pregnancy-induced hypertension) others are on the contrary on the rise (pesticides, heavy metals, antidepressants, endocrine disruptors, antiepileptic treatments). Among neonatal causes, convulsions have changed little, unlike others (prematurity, too early artificial breastfeeding, gestational diabetes, socio-economic deterioration) which have increased.
Other diseases such as Alzheimer’s type dementia are only increasing due to the increase in the number of elderly people, without it being possible to identify environmental causes.
Other variations in prevalence (depression, insomnia) mainly result from the vagueness of diagnoses and self-diagnoses.
More recently, epidemics of infectious diseases have been coupled with epidemics of diagnostics, as in the case of covid 19 where positive PCR tests were considered cases, even in the absence of symptoms.
The statistical prudence of epidemiologists probably leads to underestimating the environmental causes of diseases. However, the regular increase in life expectancy in almost all countries in the world allows us to affirm that diagnostic causes are more frequent than environmental causes.
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#Diseases #rise #health #reasons
**Interview with Dr. Jane Smith, Epidemiologist**
**Interviewer:** Thank you for joining us today, Dr. Smith. There’s been a notable increase in reported cases of various diseases, such as hypertension and pancreatic cancer. Can you explain what might be driving these increases?
**Dr. Smith:** Thank you for having me. Indeed, the rise in disease prevalence can often be misleading. There are several factors to consider. One key reason is advancements in diagnostic technology. For example, more accurate blood pressure monitors and imaging techniques have made it easier to identify cases of hypertension and pancreatic cancer, which may have previously gone undiagnosed.
**Interviewer:** That’s interesting. So, is it safe to say these increases are not always indicative of worsening public health?
**Dr. Smith:** Exactly. It’s crucial to differentiate between true increases in disease prevalence and those that result from better detection or changes in diagnostic criteria. For instance, the redefinition of what constitutes hypertension can lead to sharp spikes in recorded cases without a corresponding real-world increase in disease burden. We need to carefully examine these factors before making conclusions about environmental or lifestyle changes.
**Interviewer:** You mentioned earlier that pancreatic cancer diagnoses have increased with better screening technologies, yet the prognosis remains grim. What does this mean for public health recommendations?
**Dr. Smith:** This highlights a critical issue in epidemiology. While we may identify more cases, it doesn’t necessarily translate to better outcomes. In the case of pancreatic cancer, early detection hasn’t significantly improved survival rates. Therefore, some health authorities, like those overseeing cancer screenings, may advise against routine screening due to the limited benefits. It underscores the importance of balancing early diagnosis with treatment efficacy.
**Interviewer:** How about the rise in autism diagnoses? What factors contribute to this trend?
**Dr. Smith:** The increase in autism prevalence is indeed multifaceted. One major factor is the broadening of diagnostic criteria. Over the years, we’ve recognized and included a wider spectrum of behaviors under autism spectrum disorders (ASD). This means that individuals who may not have been diagnosed in the past are now recognized and counted in the statistics, thus inflating prevalence numbers.
**Interviewer:** It seems vital for the medical community to approach these prevalence rates with caution. What should be the focus moving forward?
**Dr. Smith:** Absolutely. The focus should be on understanding the underlying causes of these diseases, improving our diagnostic criteria, and ensuring that our public health recommendations are based on solid evidence. As we navigate these complexities, we must strive for a comprehensive view that combines epidemiology, healthcare policy, and patient outcomes to effectively address public health issues.
**Interviewer:** Thank you, Dr. Smith, for your valuable insights on these important topics. Your expertise helps illuminate the complexities of disease prevalence and its implications for our health systems.
**Dr. Smith:** Thank you for having me; it’s been a pleasure.
