Non-Communicable Diseases: Risk Factors and other Health Problems 031 Conclusion The burden of diabetes has increased substantially over the years. Information from the Global Burden of Disease Study suggests that the biggest contributor amongst the modifiable behavioural risk factors is unhealthy eating. The exposure to unhealthy diet occurs throughout the lifespan of an individual and accumulates over his/her lifetime. With the increasing prevalence of diabetes and high prevalences of hypertension and hypercholesterolaemia, it is unlikely that Malaysia will able to achieve target 3.4 of the United Nations Sustainable Development Goals (of reducing premature mortality due to NCDs). At the current trajectory, it is also unlikely for Malaysia to reach the nine voluntary global targets for the prevention and control of NCDs. In view of the increasing and high burden of NCD risk factors, it is expected that the costs of treating patients with NCDs and their related complications will continue to increase. NCDs will continue to dominate health services provision at all levels of care, particularly at secondary and tertiary levels. This will also add to the increasing need for rehabilitation and palliative care services, which are currently of limited availability and accessibility in Malaysia. Recommendations There is an urgent need to reduce the exposure to NCD risk factors amongst Malaysians. Firstly, we must address and acknowledge that NCDs are a development issue. The underlying wider determinants of these NCD risk factors include poverty, income disparity, rapid urbanisation, a rapidly ageing society, food security and low health literacy. There is an urgent need to operationalise the “whole-of- government” approach. The challenge remains that ministries and agencies outside of health, view NCDs as a “health issue” and as such, there is no systematic transfer of responsibility and accountability for policy actions in addressing the wider determinants of NCDs. Table 4.1: Non-Communicable Diseases Trend in Malaysia Non-Communicable Diseases 2011 2015 2019 Diabetes Overall Raised Blood Glucose 11.2 13.4 18.3 Known Diabetes 7.2 8.3 9.4 Raised Blood Glucose Among Those Not Known to Have Diabetes 4.0 5.1 8.9 Hypertension Overall Raised Blood Pressure 32.7 30.3 30.0 Known Hypertension 12.8 13.1 15.9 Raised Blood Pressure Among Those Not Known to Have Hypertension 19.8 17.2 14.1 Hypercholesterolaemia Overall Raised Blood Cholesterol 35.1 47.7 38.1 Known Hypercholesterolaemia 8.4 9.1 13.5 Raised Total Cholesterol Among Those Not Known to Have Hypercholesterolaemia 26.6 38.6 24.6 The solutions for those who are at risk and unknown needs to be cost-efficient to drive awareness at a national scale. Whereas for those who are known, NCD care needs to be efficient and effective at a lower cost. Digital health is potentially a powerful enabler to address the growing burden of NCDs and achieve UHC – whether supporting prevention, management and control. The World Health Organisation (WHO) has published a list of “best buys” and “good buys”, interventions with evidence of cost-effectiveness. MOH has also published “Policy Options to Combat Obesity in Malaysia” in 2017, developed by an expert working group, that lists the potential policy options for interventions. Despite a convincing body of evidence and strong global support, there are still many policy interventions that have been politically difficult for the Malaysian Government to adopt. The Government now must be ready to make these difficult decisions if we are to effectively address this high burden of NCDs. References 1. World Health Organization, Global Health Observatory (GHO) data, NCD mortality and morbidity, https://www.who.int/gho/ncd/mortality_ morbidity/en/ Access Date 18 November 2019 2. Institute of Public Health (IPH) 2017. Malaysian Burden of Disease and Injury Study 2009- 2014 3. Institute for Public Health (IPH). National Health and Morbidity Survey 2011 (NHMS 2011). Vol. II: Non-Communicable Diseases. Kuala Lumpur: Ministry of Health Malaysia; 2011. ISBN 978-967-3887-68-2 4. Institute of Public Health (IPH) 2015. National Health and Morbidity Survey 2015 (NHMS 2015). Vol II: Non-Communicable Diseases, Risk Factors & Other Health Problems;2015. 5. Classification of diabetes mellitus. Geneva: World Health Organization; 2019. Licence: CC BY-NC-SA 3.0 IGO 6. Working Group on Hypertension CPG (2018). Clinical Practice Guidelines
- Management Of Hypertension, 5TH Edition.
National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report Circulation, 106 (2002)3143–421.
National Health and Morbidity Survey 2019 Technical Report − Volume I 032 Table 4.2: Prevalence of Overall Raised Blood Glucose Among Adults Aged 18 Years and Above in Malaysia by Socio-Demographic Characteristics (n=10,464) Sociodemographic Characteristics Overall Raised Blood Glucose Male Count Estimated Population Prevalence (%) 95% CI Count Estimated Population Prevalence (%) 95% CI Lower Upper Lower Upper MALAYSIA 2,629 3,891,965 18.3 17.08 19.58 1,191 1,991,247 18.2 16.63 19.90 State Johor 217 477,575 19.7 15.92 24.16 95 259,559 20.5 15.12 27.28 Kedah 159 319,229 24.9 20.71 29.58 79 163,414 24.9 19.50 31.25 Kelantan 147 219,012 19.5 15.37 24.54 59 94,306 17.1 12.41 23.15 Melaka 151 101,214 17.0 12.48 22.64 67 46,708 16.4 9.96 25.92 Negeri Sembilan 235 234,203 33.2 25.06 42.54 108 124,986 35.1 25.54 46.06 Pahang 196 262,249 25.7 21.11 30.99 95 131,636 24.7 19.03 31.37 Pulau Pinang 178 228,349 18.2 12.48 25.76 84 131,655 20.5 13.33 30.29 Perak 128 272,611 17.6 14.14 21.77 59 163,927 20.8 15.18 27.79 Perlis 221 52,184 32.6 25.97 40.09 84 20,453 26.4 19.36 34.80 Selangor 264 824,168 18.0 14.81 21.67 115 407,918 17.0 13.50 21.19 Terengganu 178 152,036 20.5 16.99 24.60 77 69,322 18.6 13.82 24.52 Sabah 121 252,422 9.8 7.40 12.91 58 131,803 9.7 6.57 14.10 Sarawak 124 242,395 13.1 10.58 16.13 57 124,646 13.2 9.77 17.60 WP Kuala Lumpur 120 233,230 18.0 13.88 22.91 54 110,225 16.9 11.75 23.69 WP Labuan 69 7,992 12.6 8.57 18.19 33 4,147 13.2 8.88 19.11 WP Putrajaya 121 13,095 22.9 18.80 27.54 67 6,544 25.8 19.22 33.77 Location Urban 1,519 3,036,491 18.3 16.83 19.84 698 1,572,736 18.5 16.57 20.52 Rural 1,110 855,474 18.3 16.48 20.36 493 418,511 17.3 14.89 20.02 Age Group 18-19 24 38,232 4.3 2.48 7.42 13 19,181 3.9* 1.85 8.06 20-24 50 155,085 5.4 3.66 7.91 25 97,686 6.5 3.59 11.57 25-29 71 203,573 6.8 4.80 9.53 38 119,216 7.5 4.75 11.70 30-34 132 300,307 11.3 8.55 14.76 61 146,749 10.4 7.21 14.76 35-39 161 288,418 12.2 9.73 15.11 79 168,417 13.8 10.15 18.47 40-44 186 316,161 17.3 14.28 20.69 89 154,943 16.1 12.18 20.86 45-49 248 410,130 24.7 20.81 29.00 100 199,236 24.2 18.54 30.87 50-54 330 467,184 30.4 26.41 34.78 154 235,039 31.0 25.27 37.34 55-59 365 418,253 31.3 26.88 36.04 167 218,454 32.5 26.20 39.46 60-64 359 468,937 42.4 37.18 47.78 143 222,537 40.5 33.16 48.30 65-69 289 349,022 43.4 37.37 49.65 124 182,846 46.5 37.71 55.54 70-74 204 223,736 40.6 34.99 46.57 97 113,076 43.7 35.77 52.01 75 & above 210 252,927 38.4 33.15 44.02 101 113,868 37.0 29.12 45.61 Ethnicity Malaya 1,868 2,346,041 21.6 20.02 23.17 817 1,120,888 20.7 18.67 22.82 Chinese 276 689,024 15.1 12.52 18.08 154 421,065 17.9 14.22 22.39 Indian 250 389,730 31.4 25.85 37.53 117 196,881 33.1 26.17 40.86 Bumiputera Sabah 90 153,066 11.2 7.90 15.54 38 69,427 10.2 6.26 16.15 Bumiputera Sarawak 70 116,887 12.3 8.88 16.68 30 55,497 11.4 7.37 17.35 Others 75 197,216 8.8 6.21 12.21 35 127,490 9.1 5.53 14.55
Non-Communicable Diseases: Risk Factors and other Health Problems 033 Sociodemographic Characteristics Female Count Estimated Population Prevalence (%) 95% CI Lower Upper MALAYSIA 1,438 1,900,718 18.4 16.99 19.89 State Johor 122 218,017 18.8 15.11 23.18 Kedah 80 155,815 24.8 20.33 29.99 Kelantan 88 124,706 21.9 17.08 27.61 Melaka 84 54,506 17.4 12.53 23.76 Negeri Sembilan 127 109,217 31.3 22.88 41.16 Pahang 101 130,613 26.9 20.70 34.18 Pulau Pinang 94 96,695 15.8 9.92 24.09 Perak 69 108,683 14.3 10.12 19.94 Perlis 137 31,732 38.6 29.15 48.92 Selangor 149 416,250 19.1 15.25 23.58 Terengganu 101 82,714 22.5 17.38 28.66 Sabah 63 120,619 9.9 7.32 13.37 Sarawak 67 117,749 13.0 10.26 16.39 WP Kuala Lumpur 66 123,005 19.0 13.63 25.94 WP Labuan 36 3,846 12.1 6.67 20.82 WP Putrajaya 54 6,551 20.5 15.74 26.34 Location Urban 821 1,463,755 18.1 16.42 19.91 Rural 617 436,963 19.5 17.34 21.76 Age Group 18-19 11 19,051 4.8* 2.48 9.18 20-24 25 57,400 4.2 2.57 6.71 25-29 33 84,357 6.0 3.82 9.24 30-34 71 153,558 12.3 8.69 17.14 35-39 82 120,001 10.4 7.78 13.86 40-44 97 161,218 18.6 14.92 22.93 45-49 148 210,893 25.2 20.12 31.01 50-54 176 232,145 29.9 24.59 35.79 55-59 198 199,799 30.1 25.08 35.56 60-64 216 246,399 44.3 37.88 50.84 65-69 165 166,176 40.4 32.99 48.37 70-74 107 110,661 37.9 30.43 46.04 75 & above 109 139,059 39.7 31.82 48.20 Ethnicity Malaya 817 1,120,888 20.7 18.67 22.82 Chinese 154 421,065 17.9 14.22 22.39 Indian 117 196,881 33.1 26.17 40.86 Bumiputera Sabah 38 69,427 10.2 6.26 16.15 Bumiputera Sarawak 30 55,497 11.4 7.37 17.35 Others 35 127,490 9.1 5.53 14.55