Evaluations based only on Prevalences
Stages in Life and the Progress of Disease
There are specific stages in life during which certain diseases tend to appear and prevail. This way of interpreting disease and age resembles the teachings already out there about psychological stages in life and how conditions can progress eitehr into some sort of behavior and psychological malady, and then progress into a physiological problem with an possible neurochemistry phenomenon underlying the conditions, and/or develop more aggressively in this physical disease direction resulting in a condition which manifests itself very physiologically and in turn behaviorally and cognitively. The psychiatric interpretation of disease that manifest in such a way might state that a particular condition is completely genetic or organic and of neurophysiological, neurochemical cause, whereas a psychological interpretation might state that a condition is manifesting itself as a result of the sociocultural setting and mindset of the individual with that particular manifestation, syndrome, behavioral problem, psychiatric condition, or predefined ICD defined diagnosis, what have you.
In physical medicine, there is also this way of interpreting diseases based on behaviors that are linked to age and gender and the surrounding environment. Some of these physiological manifestations occur regardless of how we behave and act, others are in part a consequence of our behaviors and misbehaviors and the way that we live, but also biological in nature and manifestations as well. Still others are almost completely a manifestation of the fate of where and how we live, appearing as a consequence of our reactions to our environment.
[Figure: Insert Population Pyramid Figure illustrating diseases that afflict mostly <2 year old, with little to no cases after 3 yo, i.e. Respiratory Synctial Virus syndrome. ]
We can review diseases in people in a fashion that takes this varying ranges of responsibility for illness, varying from innocent to not-so-innocent reasons for pathogenesis. By this method, the following age ranges and disease types can be defined:
- Newborn diseases, due almost completely to the physical state of a person and his/her exposure to the environment
- Childhood diseases due to environmental causes, with some human-generated causes for increased risk of disease development
- Late Childhood-Early Adult age diseases due to a combination of physiological, psychological and behavioral factors
- Mid to late Adult age diseases introduced due to complex genetic, physiological, psychological and behavioral causes, along with age-linked causes beginning to appear in the scenario as well, in particular as unhealthy chronic disease manifestations
- Late to Very Late Adult (Elder) age diseases due to progressive disease complications, mostly linked to chronic disease related side effects, complications and physiopathologically induced somatic and psychiatric changes.
The above ways in which disease and the aging phenomena impact the body result in particular age-gender pyramid shapes, that make the progress of a long term disease understandable and often very predictable.
The amazing thing about this way of interpreting disease and predicting health is how recurrent these characteristics or traits related to a particular ICD type between seemingly unrelated disease phenomena. Due to the way in which we classify disease, we often define all of the baseline features for a disease, for which reason we have a hard time seeing the link between two diseases in two completely different physiological, organ systems. Is it possible for diseases that occur in midage in the gastrointestinal system could have some basic human physiological, environmental and behavioral features that overlap with a completely different organ system such as somatic pain and dermal sensitivity; for example, such a correlation if it does exist would suggest that GERD and Irritable Bowel Syndrome have some cause effect relationships directly linked to fibromyalgia.
Arm-related Fracture events versus Hip-Femur Neck events
Fractures, Dislocations, and Joint Replacement Therapy
Three ICDs that are very specific in their outcomes pertain to bones and joints. Fractures and dislocations tend to occur due to accidents. Joint Replacement Therapy tends to occur due to a combination of accidental, aging and physiological events involving the body. For all three, fractures, dislocations and joint replacement, significant age differences exist between the different subtypes of ICDs based on where the event occurs. ICDs for fracture history are grouped by appendages and torso portions affected. Joint dislocations are grouped much the same way also have skull and vertebral components, and involve different options. Joint Replacements, in which the joint tissue is replaced involve still fewer parts of the body, are more specific and are defined by the artificial joint products and materials available to the field.
The relationship between the three share anatomical features for many of the ICDs in the three groups. But causality can often be different for the same bone or joint across the three different ICD sets related to a specific part of the body Nevertheless, despite these differences, there are obvious relationships that exist between age-gender and part of the body in need of care. The types of care needed for each population can be predicted based on these fairly unique distributions of cases that are demonstrated. Kids get their fractures, dislocations and need for joint replacement for one set of reasons, adults for another, a old-age adults for yet another.
For example, in the case of upper limb versus lower limb related ICDs, we find youth- and mid-age related events involving fractures and dislocations tend to focus on the upper limbs, and later mid-age to old-age related events involving lower limbs. The body parts most susceptible to aging are the legs and hip or pelvis, which demonstrate increased events due to calcium loss. The body parts most susceptible to youth-related activities are the arms, but especially those parts most engaged in the different types of outdoor or sports related events responsible for dislocations and fractures in the upper arm and forearm, phalanges, carpals, tarsals, metacarpals and metatarsals. One very unique dislocation ICD for the elbow is only related to very young children, and due to its two types of etiology (accident and child mishandling), is a possible indicator of young child mistreatment or even abuse.
Elbow Dislocations
Age-related Abuse, Dependency and Addiction Behaviors
The abuse, dependency and addiction to Alcohol, Tobacco products, Cannabis, and several street drugs are specifically identified using the ICDs. The differentiation between dependency and non-dependency defines a major subcategory used for the definition of an ICD. The differences between dependency and non-dependency are somewhat subjective in nature, resulting in some flexibility and fluidity in how a PCP or other care giver differentiates patients that may be linked to these two sets of ICDs.
Tobacco (305.1), Alcohol (305.0), and Cannabis (305.2) Users Prevalence
There are three major behaviors noted with these classes of ICDs. The three best examples of behavior relate to abuse and dependency of alcohol, tobacco products, and cannabis. All three are very common events and in general, except for some minor age-related differences in outcomes, cannabis behavior pretty much resembles the behaviors seen for other more experiment street drugs such as LSD, amphetamines, opiates, and mood stabilizers or anti-depressants.
The alcohol use curve resembles the tobacco use and cannabis use curves combined into a single form. This is a very interesting outcome that suggests two distinct sets of behavioral and psychological events are at play in regard to abuse and addiction.
The age-gender incidence-prevalence curves for cannabis depicts two teenage to mid twenty-year old groups (male versus female) primarily engaged in this activity, apparently a result of experimental behaviors. The male engagement process precedes female peaks on involvement by about one or two years. Once these experimental activities have ceased, we find the prevalence of cannabis use and entry in the ICD diagnoses columns reduced significantly, almost to zero.
This contrasts with the alcohol abuse behaviors, which demonstrate this teenage to twenty year old experimental stage, followed by a reduction and then slow but progressive increase in ICD claims entered, with females reaching their peak age at a much older point in mid-life than males.
Tobacco abuse is a combination of the two, with a significant peak in use/abuse noted for the teen age years, a potential cause for which is availability and ease of purchasing tobacco products versus alcohol products.
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Heart Valve Replacements: Mitral, Aortic and Tricuspid valves (Adulthood), versus just Pulmonary Valve (Childhood + Adulthood)
Heart Valve Replacement
Two age groups are represented with heart valve replacement ICD studies–children under 17 (perhaps 15) years of age, and adults during their retirement years.
The heart has four valves–mitral, aortic, tricuspid, and pulmonary. One of these four valves differs in that it is replaced in substantially larger numbers in very young patient population–children under 17 years of age, with a peak in incidence/prevalence around 14-15 years of age. This unique valve replacement procedure involving children pertains to the pulmonary valve.
These replacements demonstrate no preferance for either gender. The heart valve demonstrating the least distribution across age in terms of replacement is the aortic valve, which predominates in retirement groups due to the survival rates for any related comorbidities these patients experience. The two atrioventricular valves demonstrate similar age-gender distributions in terms of Incidence-Prevalence curves. Frequency of pulmonary valve replacement in children is about 65-75% as prevalent as the same event for retirement population groups.
Trichomonas vaginalis, Pediculus capitis (head lice), P. corporus (body lice), Phthiris publis (pubic lice), and Toxoplasmosis
Hygiene and ICDs
Hygiene related disorders may be interpreted as those pertaining mostly to the living environment and those pertaining to personal hygiene related behaviors. Environmental onset disorders also include most of the basic diseases for which immunization protocols have been established.
Some diseases are early onset and demonstrate very high prevalence rates in the earliest childhood years. Others require social interactions to ensue and as a result are transmitted to new patients by way of typical social interactions, or in the case of sexually transmitted diseases, by way of interpersonal interactions. Some communicable diseases may be due to very small changes in environmental state and human behavior, such as the toxoplasmosis induced in numerous ways, ranging from a poor surrounding environment to circumstantial poor personal sanitation states, be they due to personal hygiene practice or not (i.e the development of toxoplasmosis due to specific brands of feminine sanitation products).
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Related Pages
Brian Altonen, MPH, MS 
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