The changing patterns of cardiovascular diseases and their risk factors in the states of India: the Global Burden of Disease Study 1990–2016

Abstract

SummaryBackgroundThe 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.MethodsWe 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.FindingsOverall, 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.InterpretationThe burden from the leading cardiovascular diseases in India—ischaemic heart disease and strok...

The burden of cancers and their variations across the states of India: the Global Burden of Disease Study 1990–2016

“…For breast cancer, a substantial increase in age-standardised incidence rate is consistent with changes in some risk factors over time in India, such as later age at first birth, lower parity, and increase in overweight and obesity 32, 36, 37. The substantial decrease in the age-standardised incidence rate of oesophageal cancer might be partly due to the decrease in smoking prevalence over the 26-year period and in smokeless tobacco use over the past 10 years 32, 34. The absence of change in the age-standardised incidence rate of lung cancer in India might be related to the mixed trends of its major risk factors, which include decrease in smoking and household air pollution but an increase in ambient air pollution, but also due to the patterns of other unknown risk factors 32, 34.…”

“…We highlight some of the key risk factors that are associated with the highest burden of cancers in India. The substantial decrease in the age-standardised incidence rate of stomach cancer across the country might be due to lifestyle changes such as reduced consumption of salt-preserved foods, better availability of refrigeration, and increasing fruit consumption, and to decreases in smoking prevalence 32, 33, 34. The prevalence of Helicobacter pylori remains persistently high in Indians, 35 and hence this is an unlikely factor in the decreasing incidence of stomach cancer.…”

“…The substantial decrease in the age-standardised incidence rate of oesophageal cancer might be partly due to the decrease in smoking prevalence over the 26-year period and in smokeless tobacco use over the past 10 years 32, 34. The absence of change in the age-standardised incidence rate of lung cancer in India might be related to the mixed trends of its major risk factors, which include decrease in smoking and household air pollution but an increase in ambient air pollution, but also due to the patterns of other unknown risk factors 32, 34. The small decrease in the age-standardised incidence rate of lip and oral cavity cancer in India could be related to the reduction in use of smokeless tobacco in India during the past decade 32 .…”

Women's and healthcare providers’ perceptions of long‐term complications associated with hypertension and diabetes in pregnancy: a qualitative study

“…1 Cardiovascular disease (CVD) accounts for most deaths 2 ; onset is typically early, 3 and case fatality rates are high. 1 Cardiovascular disease (CVD) accounts for most deaths 2 ; onset is typically early, 3 and case fatality rates are high.…”

“…India is undergoing a major epidemiological transition towards non-communicable diseases (NCDs). 1 Cardiovascular disease (CVD) accounts for most deaths 2 ; onset is typically early, 3 and case fatality rates are high. 4,5 CVD is the leading cause of death in women in India.…”