The double burden of disease among mining workers in Papua, Indonesia: at the crossroads between Old and New health paradigms.
As the global shift toward non-communicable diseases overlaps with the unfinished agenda of confronting infectious diseases in low- and middle-income countries, epidemiological links across both burdens must be recognized. This study examined the non-communicable disease-infectious disease overlap in the specific comorbidity rates for key diseases in an occupational cohort in Papua, Indonesia.



Diagnosed cases of ischaemic heart disease, stroke, hypertension, diabetes (types 1 and 2), chronic obstructive pulmonary disease, asthma, cancer, HIV and AIDS, tuberculosis, and malaria were extracted from 22,550 patient records (21,513 men, 1037 women) stored in identical electronic health information systems from two clinic sites in Papua, Indonesia. Data were collected as International Classification of Diseases, 10th Revision, entries from records spanning January-December 2013. A novel application of Circos software was used to visualize the interconnectedness between the disease burdens as overlapping prevalence estimates representing comorbidities.



Overall, NCDs represented 38 % of all disease cases, primarily in the form of type 2 diabetes (n = 1440) and hypertension (n = 1398). Malaria cases represented the largest single portion of the disease burden with 5310 recorded cases, followed by type 2 diabetes with 1400 cases. Tuberculosis occurred most frequently alongside malaria (29 %), followed by chronic obstructive pulmonary disease (19 %), asthma (17 %), and stroke (12 %). Hypertension-tuberculosis (4 %), tuberculosis-cancer (4 %), and asthma-tuberculosis (2 %) comorbidities were also observed.



The high prevalence of multimorbidity, preponderance of non-communicable diseases, and extensive interweaving of non-communicable and infectious disease comorbidities highlighted in this cohort of mining workers in Papua, Indonesia reflect the markedly double disease burden increasingly plaguing Indonesia and other similar low- and middle-income countries - a challenge with which their over-stretched, under-resourced health systems are ill-equipped to cope. Integrated, person-centered treatment and control strategies rooted in the primary healthcare sector will be critical to reverse this trend.
Non-Communicable Diseases, International SOS, London, UK. rod.rodriguez@ncdapa.org.|NCD Asia Pacific Alliance, Tokyo, Japan. rod.rodriguez@ncdapa.org.
Rodrigo
R
Rodriguez-Fernandez
Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden.
Nawi
N
Ng
Center for Health Policy and Management, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia.
Dwidjo
D
Susilo
Center for Health Policy and Management, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia.
John
J
Prawira
Non-Communicable Diseases, International SOS, London, UK.
Michael J
MJ
Bangs
Freeport Public Health and Malaria Control, International SOS, Papua, Indonesia.|Department of Family Nursing, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.|NCD Asia Pacific Alliance, Tokyo, Japan.
Rachel M
RM
Amiya
D000293:Adolescent; D000328:Adult; D000368:Aged; D001249:Asthma / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology; D002908:Chronic Disease / Q000453:epidemiology*; D003141:Communicable Diseases / Q000453:epidemiology*; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000453:epidemiology; D006801:Humans; D007214:Indonesia / Q000453:epidemiology; D008288:Malaria / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D008906:Mining; D009369:Neoplasms / Q000453:epidemiology; D015995:Prevalence; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology; D014376:Tuberculosis / Q000453:epidemiology; D055815:Young Adult
Comorbidity; Data visualization; Indonesia; Infectious disease; Non-communicable disease; Primary health care