Prevalence of Ischemic Heart Diseases (IHD) and stroke has increased by over 50 per cent between 1990 and 2016 in India, leading to doubling of deaths caused by them, according to a global study. The Global Burden of Disease Study 1990-2016, published Wednesday, noted that diabetes prevalence in India has more than doubled in the period.
Punjab has been ranked at the top for the burden of IHDs, followed by Tamil Nadu, and vice-versa for diabetes. West Bengal was at the top position for the burden of stroke, followed by Odisha, according to the comprehensive analysis of several major non-communicable diseases (NCDs). It was conducted by the Indian Council of Medical Research (ICMR), Public Health Foundation of India (PHFI), and Institute for Health Metrics and Evaluation (IHME) in collaboration with the Ministry of Health.
The analysis stated the number of chronic obstructive lung disease cases in India has increased from 28 million to 55 million from 1990 to 2016, and death rate among these cases is twice as high in the less developed states than in the more developed states. The proportional contribution of cancers to the total health loss in India has doubled from 1990 to 2016, but the incidence of different types of cancers varies widely between the states. Kerala was ranked at the top for the burden of cancer, followed by Assam.
According to the study, the contribution of air pollution to chronic obstructive pulmonary disease (COPD) and disability-adjusted life years (DALYs) was found to be higher than that of smoking in India. “Smoking is decreasing in India and even the household air pollution is decreasing, but ambient (outdoor) air pollution is increasing in most parts of India,” it stated. Commenting on the findings, Director General of ICMR Balram Bharagava stated that one striking finding is that the age-standardised increase in the prevalence of ischaemic heart disease and diabetes, as well as their DALYs, has generally been highest in the less developed states of India, where the burden of another major NCD, chronic obstructive pulmonary disease (COPD), and communicable diseases is already high.
Among the major risk factors for ischaemic heart disease, stroke, and diabetes, the prevalence of high blood pressure, high cholesterol, high fasting plasma glucose, and overweight has increased in all parts of India. The study showed an increase in the prevalence of all the major cardiovascular diseases risk factors in all state groups, except smoking.
The high exposure to ambient and household air pollution in the less developed northern states is contributing to the high burden of COPD in these states, in which the case-fatality rate of COPD is twice as high as in the more developed states. Also, overweight, the major risk factor for diabetes doubled in every state of India from 1990 to 2016.
India had 38 adults with diabetes for every 100 overweight adults versus a global average of 19 in 2016. Increase in overweight, unhealthy diet and physical inactivity contribute to the high burden of diabetes in India, the paper on diabetes pointed. Additionally, ageing of the population is adding to the increasing burden of NCDs.
“These findings emphasise the need for the prevention and management of major NCDs to receive as much policy attention in these states as the reduction of the still high burden of communicable and childhood diseases,” Bhargava said. Bhargava said the government’s plans of establishing 1,50,000 health and wellness centres across India to provide comprehensive primary health care services would help deal with NCDs and injuries along with communicable diseases, as part of the ambitious Ayushman Bharat.
The ICMR Director-General stressed the need to invest in suitable surveillance systems to monitor the changing trends in NCDs and injuries, and their related risk factors, across the country. On the release of these new estimates, NITI Aayog member Vinod Paul said the insights provided by these findings are very timely for the planning of Ayushman Bharat, the National Health Protection Mission announced recently by the Prime Minister.
The findings in these papers demonstrate that major NCDs or suicide do not necessarily follow the same trend in the less developed states, or in the more developed states, indicating the importance of planning health improvements based on specific evidence for each state, “The detailed analysis of the changes in the major NCDs and their risk factors reported in these papers are therefore quite useful for titrating the Ayushman Bharat effort according to the need of each state,” Paul said.