Morbidity compression or expansion? A temporal analysis of the age at onset of non-communicable diseases in India

Mohanty, Sanjay K.; Rodgers, Justin; Singh, Rajeev Ranjan; Mishra, Radhe Shyam; Kim, Rockli; Khan, Junaid; Behera, Priyamadhaba; Subramanian, S. V.

doi:10.1007/s11357-020-00296-9

Cited by 26 publications

(29 citation statements)

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“…Prevalence varied widely across Indian states and was found to be higher in wealthier groups [ 8 ]. The median age of onset of hypertension is estimated to have declined from 61 years in 2004 to 55 years by 2018 [ 9 ]. Hypertension is the main risk factor of CVD in the country [ 10 ] and accounted for 35.5% of DALYs in 2019, compared with 26.8% globally [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Awareness, treatment, and control of hypertension in adults aged 45 years and over and their spouses in India: A nationally representative cross-sectional study

et al. 2021

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Background Lack of nationwide evidence on awareness, treatment, and control (ATC) of hypertension among older adults in India impeded targeted management of this condition. We aimed to estimate rates of hypertension ATC in the older population and to assess differences in these rates across sociodemographic groups and states in India. Methods and findings We used a nationally representative survey of individuals aged 45 years and over and their spouses in all Indian states (except one) in 2017 to 2018. We identified hypertension by blood pressure (BP) measurement ≥140/90 mm Hg or self-reported diagnosis if also taking medication or observing salt/diet restriction to control BP. We distinguished those who (i) reported diagnosis (“aware”); (ii) reported taking medication or being under salt/diet restriction to control BP (“treated”); and (iii) had measured systolic BP <140 and diastolic BP <90 (“controlled”). We estimated age–sex adjusted hypertension prevalence and rates of ATC by consumption quintile, education, age, sex, urban–rural, caste, religion, marital status, living arrangement, employment status, health insurance, and state. We used concentration indices to measure socioeconomic inequalities and multivariable logistic regression to estimate fully adjusted differences in these outcomes. Study limitations included reliance on BP measurement on a single occasion, missing measurements of BP for some participants, and lack of data on nonadherence to medication. The 64,427 participants in the analysis sample had a median age of 57 years: 58% were female, and 70% were rural dwellers. We estimated hypertension prevalence to be 41.9% (95% CI 41.0 to 42.9). Among those with hypertension, we estimated that 54.4% (95% CI 53.1 to 55.7), 50.8% (95% CI 49.5 to 52.0), and 28.8% (95% CI 27.4 to 30.1) were aware, treated, and controlled, respectively. Across states, adjusted rates of ATC ranged from 27.5% (95% CI 22.2 to 32.8) to 75.9% (95% CI 70.8 to 81.1), from 23.8% (95% CI 17.6 to 30.1) to 74.9% (95% CI 69.8 to 79.9), and from 4.6% (95% CI 1.1 to 8.1) to 41.9% (95% CI 36.8 to 46.9), respectively. Age–sex adjusted rates were lower (p < 0.001) in poorer, less educated, and socially disadvantaged groups, as well as for males, rural residents, and the employed. Among individuals with hypertension, the richest fifth were 8.5 percentage points (pp) (95% CI 5.3 to 11.7; p < 0.001), 8.9 pp (95% CI 5.7 to 12.0; p < 0.001), and 7.1 pp (95% CI 4.2 to 10.1; p < 0.001) more likely to be aware, treated, and controlled, respectively, than the poorest fifth. Conclusions Hypertension prevalence was high, and ATC of the condition were low among older adults in India. Inequalities in these indicators pointed to opportunities to target hypertension management more effectively and equitably on socially disadvantaged groups.

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confidence: 99%

Awareness, treatment, and control of hypertension in adults aged 45 years and over and their spouses in India: A nationally representative cross-sectional study

et al. 2021

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“…Especially during the COVID-19 era, multimorbidity has gained attention from the medical fraternity due to its widespread repercussions on the health of the infected individuals. Despite the existing literature, which highlights critical implications of multimorbidity, like, declining functional status, poor quality of life, 3 , 4 higher mortality risks, 5 increased healthcare utilization, 6 and economic liability on the patients’ family 5 the trajectory of multimorbidity is inadequately explored in the national context.…”

Section: Introductionmentioning

confidence: 99%

“… 7 , 8 Nevertheless, a recent study conducted by Mohanty et al (2021) highlighted morbidity expansion, especially for non-communicable diseases in India. 6 Morbidity expansion refers to a situation where the life expectancy increases, and the proportion of life spent with diseases and disability also increases simultaneously. 6 , 9 Morbidity expansion occurs when medical advances are successful in reducing the case fatality and mortality rates; however, the existing burden and pattern of morbidities (diseases) remain unchanged.…”

Section: Introductionmentioning

confidence: 99%

“… 6 Morbidity expansion refers to a situation where the life expectancy increases, and the proportion of life spent with diseases and disability also increases simultaneously. 6 , 9 Morbidity expansion occurs when medical advances are successful in reducing the case fatality and mortality rates; however, the existing burden and pattern of morbidities (diseases) remain unchanged. This in turn, increases the life expectancy of the individuals (due to reduced mortality) but they continue to live with morbidity.…”

Section: Introductionmentioning

confidence: 99%

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Temporal dynamics, patterns and correlates of single and multimorbidity in India, 1994–2018

Puri

Singh

2021

Journal of Multimorbidity and Comorbidity

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Objective As a consequence of the epidemiological transition, multimorbidity has been identified as a critical public health challenge in India. The majority of the studies in the domain are grounded on hospital-based data or are based on small sample size, findings from which can only be generalized to a specific sub-group. These studies recommend exploring multimorbidity holistically at a national level to ensure adequate healthcare management in the country. Therefore, the present study examines the pattern and correlates of single and multimorbidity over the past two decades in India. Methods The study utilized data on 397901, 257519, and 399705 individuals from 52nd (1994–1995), 60th (2004–2005), and 75th (2018) rounds of cross-sectional data from the National Sample Survey (NSS). Univariate, bivariate, and multivariable statistical methods were applied to draw inferences from the data. The findings depict an increase in single and multimorbidity burden over individuals’ age and NSS rounds. Results Hypertension and diabetes were the fastest-growing morbidities over time. Higher education, urban residence, and belonging to an affluent class were significantly associated with both single and multimorbidity occurrence over time. Conclusion The burden of single and multimorbidity increases over time among India’s older adults. Therefore, there is an urgent need to recuperate chronic disease management strategies for older adults in the Indian healthcare infrastructure.

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“…India is experiencing the rising burden of NCDs, with limited access to health care and social security [18,19]. The World Health Organisation (WHO) estimates that NCDs account for 63% of all deaths, out of which 27% of the deaths are from cardiovascular disease, 9% from cancer, 3% from diabetes, and 11% from chronic respiratory disease in India [20].…”

Section: Introductionmentioning

confidence: 99%

Uneven economic burden of non-communicable diseases among Indian households: A comparative analysis

Behera

Pradhan

2021

PLoS ONE

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Background Non-communicable diseases (NCDs) are the leading global cause of death and disproportionately concentrate among those living in low-income and middle-income countries. However, its economic impact on households remains less well known in the Indian context. This study aims to assess the economic impact of NCDs in terms of out-of-pocket expenditure (OOPE) and its catastrophic impact on NCDs affected households in India. Materials and methods Data were collected from the 75th round of the National Sample Survey Office, Government of India, conducted in the year 2017–18. This is the latest round of data available on health, which constitutes a sample of 113,823 households. The collection of data is based on a stratified multi-stage sampling method. Generalised Linear Regression model was employed to identify the socio-economic covariates associated with the catastrophic health expenditure (CHE) on hospitalisation. Results The result shows a higher burden of OOPE on NCDs affected households. The mean expenditure by NCDs households in public hospitals is INR 13,170 which is more than twice as compared to the non-NCDs households INR 6,245. Particularly, the proportion of total medical expenditure incurred on medicines (0.39) and diagnostics (0.15) is troublesome for households with NCDs, treated in public hospitals. Moreover, results from the generalised linear regression model confirm the significant relationship between CHE with residence, caste, religion, household size, and economic status of households. The intensity of CHE is more for the households who are poor, drinking unsafe water, using firewood as cooking fuel, and household size of 1–5 members. Conclusion Therefore, an urgent need for a prevention strategy should be made by the government to protect households from the economic burden of NCDs. Specifically, to reduce the burden of CHE associated with NCDs, a customised disease-specific health insurance package should be introduced by the government of India in both public and private facilities.

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Morbidity compression or expansion? A temporal analysis of the age at onset of non-communicable diseases in India

Cited by 26 publications

References 28 publications

Awareness, treatment, and control of hypertension in adults aged 45 years and over and their spouses in India: A nationally representative cross-sectional study

Awareness, treatment, and control of hypertension in adults aged 45 years and over and their spouses in India: A nationally representative cross-sectional study

Temporal dynamics, patterns and correlates of single and multimorbidity in India, 1994–2018

Uneven economic burden of non-communicable diseases among Indian households: A comparative analysis

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