The changing patterns of cardiovascular diseases and their risk factors in the states of India: the Global Burden of Disease Study 1990–2016
Summary: Background: The burden of cardiovascular diseases is increasing in India, but a systematic understanding of its distribution and time trends across all the states is not readily available. In this report, we present a detailed analysis of how the patterns of cardiovascular diseases and maj...
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Format: | Article |
Language: | English |
Published: |
Elsevier
2018-12-01
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Series: | The Lancet Global Health |
Online Access: | http://www.sciencedirect.com/science/article/pii/S2214109X18304078 |
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doaj-4801b4d8ec3848f2961806b6277c3bde |
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Article |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Dorairaj Prabhakaran Panniyammakal Jeemon Meenakshi Sharma Gregory A Roth Catherine Johnson Sivadasanpillai Harikrishnan Rajeev Gupta Jeyaraj D Pandian Nitish Naik Ambuj Roy R S Dhaliwal Denis Xavier Raman K Kumar Nikhil Tandon Prashant Mathur D K Shukla Ravi Mehrotra K Venugopal G Anil Kumar Chris M Varghese Melissa Furtado Pallavi Muraleedharan Rizwan S Abdulkader Tahiya Alam Ranjit M Anjana Monika Arora Anil Bhansali Deeksha Bhardwaj Eesh Bhatia Joy K Chakma Pankaj Chaturvedi Eliza Dutta Scott Glenn Prakash C Gupta Sarah C Johnson Tanvir Kaur Sanjay Kinra Anand Krishnan Michael Kutz Manu R Mathur Viswanathan Mohan Satinath Mukhopadhyay Minh Nguyen Christopher M Odell Anu M Oommen Sanghamitra Pati Martin Pletcher Kameshwar Prasad Paturi V Rao Chander Shekhar Dhirendra N Sinha P N Sylaja J S Thakur Kavumpurathu R Thankappan Nihal Thomas Simon Yadgir Chittaranjan S Yajnik Geevar Zachariah Ben Zipkin Stephen S Lim Mohsen Naghavi Rakhi Dandona Theo Vos Christopher J L Murray K Srinath Reddy Soumya Swaminathan Lalit Dandona |
spellingShingle |
Dorairaj Prabhakaran Panniyammakal Jeemon Meenakshi Sharma Gregory A Roth Catherine Johnson Sivadasanpillai Harikrishnan Rajeev Gupta Jeyaraj D Pandian Nitish Naik Ambuj Roy R S Dhaliwal Denis Xavier Raman K Kumar Nikhil Tandon Prashant Mathur D K Shukla Ravi Mehrotra K Venugopal G Anil Kumar Chris M Varghese Melissa Furtado Pallavi Muraleedharan Rizwan S Abdulkader Tahiya Alam Ranjit M Anjana Monika Arora Anil Bhansali Deeksha Bhardwaj Eesh Bhatia Joy K Chakma Pankaj Chaturvedi Eliza Dutta Scott Glenn Prakash C Gupta Sarah C Johnson Tanvir Kaur Sanjay Kinra Anand Krishnan Michael Kutz Manu R Mathur Viswanathan Mohan Satinath Mukhopadhyay Minh Nguyen Christopher M Odell Anu M Oommen Sanghamitra Pati Martin Pletcher Kameshwar Prasad Paturi V Rao Chander Shekhar Dhirendra N Sinha P N Sylaja J S Thakur Kavumpurathu R Thankappan Nihal Thomas Simon Yadgir Chittaranjan S Yajnik Geevar Zachariah Ben Zipkin Stephen S Lim Mohsen Naghavi Rakhi Dandona Theo Vos Christopher J L Murray K Srinath Reddy Soumya Swaminathan Lalit Dandona The changing patterns of cardiovascular diseases and their risk factors in the states of India: the Global Burden of Disease Study 1990–2016 The Lancet Global Health |
author_facet |
Dorairaj Prabhakaran Panniyammakal Jeemon Meenakshi Sharma Gregory A Roth Catherine Johnson Sivadasanpillai Harikrishnan Rajeev Gupta Jeyaraj D Pandian Nitish Naik Ambuj Roy R S Dhaliwal Denis Xavier Raman K Kumar Nikhil Tandon Prashant Mathur D K Shukla Ravi Mehrotra K Venugopal G Anil Kumar Chris M Varghese Melissa Furtado Pallavi Muraleedharan Rizwan S Abdulkader Tahiya Alam Ranjit M Anjana Monika Arora Anil Bhansali Deeksha Bhardwaj Eesh Bhatia Joy K Chakma Pankaj Chaturvedi Eliza Dutta Scott Glenn Prakash C Gupta Sarah C Johnson Tanvir Kaur Sanjay Kinra Anand Krishnan Michael Kutz Manu R Mathur Viswanathan Mohan Satinath Mukhopadhyay Minh Nguyen Christopher M Odell Anu M Oommen Sanghamitra Pati Martin Pletcher Kameshwar Prasad Paturi V Rao Chander Shekhar Dhirendra N Sinha P N Sylaja J S Thakur Kavumpurathu R Thankappan Nihal Thomas Simon Yadgir Chittaranjan S Yajnik Geevar Zachariah Ben Zipkin Stephen S Lim Mohsen Naghavi Rakhi Dandona Theo Vos Christopher J L Murray K Srinath Reddy Soumya Swaminathan Lalit Dandona |
author_sort |
Dorairaj Prabhakaran |
title |
The changing patterns of cardiovascular diseases and their risk factors in the states of India: the Global Burden of Disease Study 1990–2016 |
title_short |
The changing patterns of cardiovascular diseases and their risk factors in the states of India: the Global Burden of Disease Study 1990–2016 |
title_full |
The changing patterns of cardiovascular diseases and their risk factors in the states of India: the Global Burden of Disease Study 1990–2016 |
title_fullStr |
The changing patterns of cardiovascular diseases and their risk factors in the states of India: the Global Burden of Disease Study 1990–2016 |
title_full_unstemmed |
The changing patterns of cardiovascular diseases and their risk factors in the states of India: the Global Burden of Disease Study 1990–2016 |
title_sort |
changing patterns of cardiovascular diseases and their risk factors in the states of india: the global burden of disease study 1990–2016 |
publisher |
Elsevier |
series |
The Lancet Global Health |
issn |
2214-109X |
publishDate |
2018-12-01 |
description |
Summary: Background: The burden of cardiovascular diseases is increasing in India, but a systematic understanding of its distribution and time trends across all the states is not readily available. In this report, we present a detailed analysis of how the patterns of cardiovascular diseases and major risk factors have changed across the states of India between 1990 and 2016. Methods: We analysed the prevalence and disability-adjusted life-years (DALYs) due to cardiovascular diseases and the major component causes in the states of India from 1990 to 2016, using all accessible data sources as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2016. We placed states into four groups based on epidemiological transition level (ETL), defined using the ratio of DALYs from communicable diseases to those from non-communicable diseases and injuries combined, with a low ratio denoting high ETL and vice versa. We assessed heterogeneity in the burden of major cardiovascular diseases across the states of India, and the contribution of risk factors to cardiovascular diseases. We calculated 95% uncertainty intervals (UIs) for the point estimates. Findings: Overall, cardiovascular diseases contributed 28·1% (95% UI 26·5–29·1) of the total deaths and 14·1% (12·9–15·3) of the total DALYs in India in 2016, compared with 15·2% (13·7–16·2) and 6·9% (6·3–7·4), respectively, in 1990. In 2016, there was a nine times difference between states in the DALY rate for ischaemic heart disease, a six times difference for stroke, and a four times difference for rheumatic heart disease. 23·8 million (95% UI 22·6–25·0) prevalent cases of ischaemic heart disease were estimated in India in 2016, and 6·5 million (6·3–6·8) prevalent cases of stroke, a 2·3 times increase in both disorders from 1990. The age-standardised prevalence of both ischaemic heart disease and stroke increased in all ETL state groups between 1990 and 2016, whereas that of rheumatic heart disease decreased; the increase for ischaemic heart disease was highest in the low ETL state group. 53·4% (95% UI 52·6–54·6) of crude deaths due to cardiovascular diseases in India in 2016 were among people younger than 70 years, with a higher proportion in the low ETL state group. The leading overlapping risk factors for cardiovascular diseases in 2016 included dietary risks (56·4% [95% CI 48·5–63·9] of cardiovascular disease DALYs), high systolic blood pressure (54·6% [49·0–59·8]), air pollution (31·1% [29·0–33·4]), high total cholesterol (29·4% [24·3–34·8]), tobacco use (18·9% [16·6–21·3]), high fasting plasma glucose (16·7% [11·4–23·5]), and high body-mass index (14·7% [8·3–22·0]). The prevalence of high systolic blood pressure, high total cholesterol, and high fasting plasma glucose increased generally across all ETL state groups from 1990 to 2016, but this increase was variable across the states; the prevalence of smoking decreased during this period in all ETL state groups. Interpretation: The burden from the leading cardiovascular diseases in India—ischaemic heart disease and stroke—varies widely between the states. Their increasing prevalence and that of several major risk factors in every part of India, especially the highest increase in the prevalence of ischaemic heart disease in the less developed low ETL states, indicates the need for urgent policy and health system response appropriate for the situation in each state. Funding: Bill & Melinda Gates Foundation; and Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India. |
url |
http://www.sciencedirect.com/science/article/pii/S2214109X18304078 |
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doaj-4801b4d8ec3848f2961806b6277c3bde2020-11-25T01:50:53ZengElsevierThe Lancet Global Health2214-109X2018-12-01612e1339e1351The changing patterns of cardiovascular diseases and their risk factors in the states of India: the Global Burden of Disease Study 1990–2016Dorairaj PrabhakaranPanniyammakal JeemonMeenakshi SharmaGregory A RothCatherine JohnsonSivadasanpillai HarikrishnanRajeev GuptaJeyaraj D PandianNitish NaikAmbuj RoyR S DhaliwalDenis XavierRaman K KumarNikhil TandonPrashant MathurD K ShuklaRavi MehrotraK VenugopalG Anil KumarChris M VargheseMelissa FurtadoPallavi MuraleedharanRizwan S AbdulkaderTahiya AlamRanjit M AnjanaMonika AroraAnil BhansaliDeeksha BhardwajEesh BhatiaJoy K ChakmaPankaj ChaturvediEliza DuttaScott GlennPrakash C GuptaSarah C JohnsonTanvir KaurSanjay KinraAnand KrishnanMichael KutzManu R MathurViswanathan MohanSatinath MukhopadhyayMinh NguyenChristopher M OdellAnu M OommenSanghamitra PatiMartin PletcherKameshwar PrasadPaturi V RaoChander ShekharDhirendra N SinhaP N SylajaJ S ThakurKavumpurathu R ThankappanNihal ThomasSimon YadgirChittaranjan S YajnikGeevar ZachariahBen ZipkinStephen S LimMohsen NaghaviRakhi DandonaTheo VosChristopher J L MurrayK Srinath ReddySoumya SwaminathanLalit Dandona0Correspondence to: Prof Lalit Dandona, Public Health Foundation of India, Gurugram 122002, National Capital Region, IndiaSummary: Background: The burden of cardiovascular diseases is increasing in India, but a systematic understanding of its distribution and time trends across all the states is not readily available. In this report, we present a detailed analysis of how the patterns of cardiovascular diseases and major risk factors have changed across the states of India between 1990 and 2016. Methods: We analysed the prevalence and disability-adjusted life-years (DALYs) due to cardiovascular diseases and the major component causes in the states of India from 1990 to 2016, using all accessible data sources as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2016. We placed states into four groups based on epidemiological transition level (ETL), defined using the ratio of DALYs from communicable diseases to those from non-communicable diseases and injuries combined, with a low ratio denoting high ETL and vice versa. We assessed heterogeneity in the burden of major cardiovascular diseases across the states of India, and the contribution of risk factors to cardiovascular diseases. We calculated 95% uncertainty intervals (UIs) for the point estimates. Findings: Overall, cardiovascular diseases contributed 28·1% (95% UI 26·5–29·1) of the total deaths and 14·1% (12·9–15·3) of the total DALYs in India in 2016, compared with 15·2% (13·7–16·2) and 6·9% (6·3–7·4), respectively, in 1990. In 2016, there was a nine times difference between states in the DALY rate for ischaemic heart disease, a six times difference for stroke, and a four times difference for rheumatic heart disease. 23·8 million (95% UI 22·6–25·0) prevalent cases of ischaemic heart disease were estimated in India in 2016, and 6·5 million (6·3–6·8) prevalent cases of stroke, a 2·3 times increase in both disorders from 1990. The age-standardised prevalence of both ischaemic heart disease and stroke increased in all ETL state groups between 1990 and 2016, whereas that of rheumatic heart disease decreased; the increase for ischaemic heart disease was highest in the low ETL state group. 53·4% (95% UI 52·6–54·6) of crude deaths due to cardiovascular diseases in India in 2016 were among people younger than 70 years, with a higher proportion in the low ETL state group. The leading overlapping risk factors for cardiovascular diseases in 2016 included dietary risks (56·4% [95% CI 48·5–63·9] of cardiovascular disease DALYs), high systolic blood pressure (54·6% [49·0–59·8]), air pollution (31·1% [29·0–33·4]), high total cholesterol (29·4% [24·3–34·8]), tobacco use (18·9% [16·6–21·3]), high fasting plasma glucose (16·7% [11·4–23·5]), and high body-mass index (14·7% [8·3–22·0]). The prevalence of high systolic blood pressure, high total cholesterol, and high fasting plasma glucose increased generally across all ETL state groups from 1990 to 2016, but this increase was variable across the states; the prevalence of smoking decreased during this period in all ETL state groups. Interpretation: The burden from the leading cardiovascular diseases in India—ischaemic heart disease and stroke—varies widely between the states. Their increasing prevalence and that of several major risk factors in every part of India, especially the highest increase in the prevalence of ischaemic heart disease in the less developed low ETL states, indicates the need for urgent policy and health system response appropriate for the situation in each state. Funding: Bill & Melinda Gates Foundation; and Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India.http://www.sciencedirect.com/science/article/pii/S2214109X18304078 |