Abstract
BackgroundThe global burden of disease has shifted from communicable diseases in children to chronic diseases in adults. This epidemiologic shift varies greatly by region, but in Europe, chronic conditions account for 86% of all deaths, 77% of the disease burden, and up to 80% of health care expenditures. A number of risk factors have been implicated in chronic diseases, such as exposure to infectious agents. A number of associations have been well established while others remain uncertain.Methods and FindingsWe assessed the body of evidence regarding the infectious aetiology of chronic diseases in the peer-reviewed literature over the last decade. Causality was assessed with three different criteria: First, the total number of associations documented in the literature between each infectious agent and chronic condition; second, the epidemiologic study design (quality of the study); third, evidence for the number of Hill's criteria and Koch's postulates that linked the pathogen with the chronic condition.We identified 3136 publications, of which 148 were included in the analysis. There were a total of 75 different infectious agents and 122 chronic conditions. The evidence was strong for five pathogens, based on study type, strength and number of associations; they accounted for 60% of the associations documented in the literature. They were human immunodeficiency virus, hepatitis C virus, Helicobacter pylori, hepatitis B virus, and Chlamydia pneumoniae and were collectively implicated in the aetiology of 37 different chronic conditions. Other pathogens examined were only associated with very few chronic conditions (≤3) and when applying the three different criteria of evidence the strength of the causality was weak.ConclusionsPrevention and treatment of these five pathogens lend themselves as effective public health intervention entry points. By concentrating research efforts on these promising areas, the human, economic, and societal burden arising from chronic conditions can be reduced.
Highlights
Over the last decades, the global disease burden has continued to shift away from communicable to non-communicable diseases and from premature death to years lived with disability [1]
Prevention and treatment of these five pathogens lend themselves as effective public health intervention entry points
By concentrating research efforts on these promising areas, the human, economic, and societal burden arising from chronic conditions can be reduced
Summary
The global disease burden has continued to shift away from communicable to non-communicable diseases and from premature death to years lived with disability [1]. Chronic conditions account for almost 60% of all deaths and 43% of the global burden of disease and by 2020 their contribution is expected to rise to 73% and 60%, respectively. 79% of deaths attributed to these conditions occur in developing countries These challenges loom large on the horizon and call for prevention and early treatment of chronic diseases in order to attenuate the human, economic and societal costs [2]. A number of associations between infectious pathogens and chronic conditions have been established unequivocally. These include the associations of Helicobacter pylori with peptic ulcer and gastric cancer, hepatitis B virus or hepatitis C virus (HBV or HCV, respectively) with liver cirrhosis and cancer, and human papilloma virus (HPV) with cervical cancer [3]. A number of associations have been well established while others remain uncertain
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