Fewer people in India are now dying due to ailments associated with childhood undernutrition and unsafe water sources, but more are suffering health loss and death from diseases attributable to high blood pressure, high blood sugar and high cholesterol according to a new analysis of 79 risk factors in 188 countries.
In 1990, childhood undernutrition was the leading cause of deaths in India but does not figure in the top 10 causes of deaths now. Instead, alcohol use and high body mass index, which did not kill as many people in 1990, are now among the top 10 killers.
High blood pressure, high blood sugar and household air pollution from solid fuels were estimated to cause 7.8%, 5.2% and 4.7% of the total health loss in India in 2013, respectively. These three risk factors together contributed to 3.3 million premature deaths in India in 2013. The other major contributors to health loss in India are unsafe water sources, tobacco smoking, alcohol use, high blood cholesterol and air pollution. The contributions of unsafe water sources and poor sanitation as well as child and maternal undernutrition to health loss have dropped significantly since 1990, though they remain substantial contributors to health loss in India.
The risk factors examined in the study contributed to a total of 30.8 million deaths worldwide in 2013, up by a fifth from 25.1 million deaths in 1990. The top risks associated with deaths among both men and women globally are high blood pressure, smoking, high body mass index, and high fasting plasma glucose. But the greatest cumulative impact on health comes from poor diet. A combination of 14 dietary risk factors contributes to the highest number of deaths worldwide through ailments like ischemic heart disease, stroke, and diabetes.
The study, “Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries 1990-2013: a systematic analysis for the GBD 2013”, examined the extent, pattern, and trends of risk factors’ contributions to death and health loss across countries.
Published in the journal The Lancet in September, it was conducted by an international consortium of researchers working on the Global Burden of Disease (GBD) study, including from the Public Health Foundation of India (PHFI), and led by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington.
The study examines which risk factors contributed to health loss as well as death. Researchers used DALYs, or disability-adjusted life years, to measure overall health loss. One DALY equals one lost year of healthy life. DALYs are measured as the sum of years of life lost due to early death and years of healthy life lost due to disability.
“It is remarkable that the contribution of metabolic risk factors such as high blood pressure, blood sugar and cholesterol, and that of poor diet and alcohol use, to health loss has doubled in India over the past quarter of a century,” said co-author of the study Dr. Lalit Dandona, professor at the PHFI and IHME and who led the work of this study in India. “On the other hand, the contribution of unsafe water and sanitation, and child and maternal undernutrition, to health loss has halved in India but these are still significant causes of disease burden. Parallel to this, air pollution and tobacco smoking continue to be major contributors to health loss in India. The findings from this study provide useful pointers for where policy emphasis is needed to improve population health.”
“Since 1990, improvements in unsafe water sources and sanitation, and in undernutrition of children and mothers, have reduced their contribution to the disease burden in India but these risk factors continue to be significant contributors to ill health,” said Dr. Soumya Swaminathan, Director General of the Indian Council of Medical Research.
High blood pressure was the number-one individual risk factor associated with global deaths in 2013, contributing to 10.4 million deaths around the world that year. Its impact on mortality grew by 49.1% between 1990 – when it was also the number-one global risk – and 2013. While this risk heavily impacts both sexes, its increasing impact has been more dramatic for men than women.: it grew 39.9% for women and 59% for men.
India is part of a global landscape with tremendous regional variations. In much of the Middle East and Latin America, high body mass index is the number-one risk associated with health loss. In South and Southeast Asia, household air pollution is a leading risk, and India also grapples with high risks of unsafe water and childhood undernutrition. Alcohol is the number-two risk in Russia, and smoking is the number-one risk in many high-income countries, including the United Kingdom. The most marked differences are found in sub-Saharan Africa, which, unlike other regions, is dominated by a toxic combination of childhood undernutrition, unsafe water and sanitation, unsafe sex, and alcohol use.
The GBD study includes several risk factors in its analysis for the first time. One example is the factoring in of HIV into the calculation of intimate partner violence. The addition of wasting, which was associated with about one in every five deaths in children under 5 in 2013, and stunting, which contributed to 3.5% of under 5 deaths, highlights the importance of child under-nutrition as two new risk factors. Finally, but not entirely surprisingly, unsafe sex took a huge toll on global health, contributing to 82 % of HIV/AIDS deaths and 94 % of HIV/AIDS deaths among 15-19 year- olds in 2013.