Heart Disease, Stroke Among Top Killers in India

Heart disease and stroke together contributed to 28.1% of total deaths in India in 2016, compared to 15.2% in 1990.

New Delhi: India has witnessed an alarming rise in the occurrence of heart disease, stroke, diabetes and cancers in the past 25 years, a series of new studies published on Wednesday in the journal The Lancet, among others, have revealed.

Detailed estimates of cardiovascular diseases, diabetes, chronic respiratory diseases, cancer and suicide show that their prevalence has gone up in every Indian state between 1990 and 2016, but there is large variation among the states as well.

The prevalence of heart disease and stroke has increased by over 50% from 1990 to 2016 in India, with an increase observed in every state. The contribution of these diseases to total deaths and disease burden in the country has almost doubled in the last 25 years. Heart disease is now the leading individual cause of disease burden in India, and stroke is the fifth leading cause.

Heart disease and stroke together contributed to 28.1% of total deaths in India in 2016, compared to 15.2% in 1990. Heart disease alone contributed 17.8% of total deaths and stroke, to 7.1%. The proportion of deaths and disability from heart disease was significantly higher in men than in women but was similar among men and women for stroke. Deaths due to cardiovascular diseases rose from 1.3 million in 1990 to 2.8 million in 2016.

The number of prevalent cases of cardiovascular diseases has increased from 25.7 million in 1990 to 54.5 million in 2016. The prevalence was the highest in Kerala, Punjab and Tamil Nadu, followed by Andhra Pradesh, Himachal Pradesh, Maharashtra, Goa and West Bengal.

More than half of the total cardiovascular disease deaths in India in 2016 were in people younger than 70 years. “This proportion was the highest in less developed states, which is a major cause for concern with respect to the challenges posed to the health systems,” the researchers observed. “Reducing premature deaths from cardiovascular diseases in the economically productive age groups requires urgent action across all states of India.”

According to K. Srinath Reddy, president of the Public Health Foundation of India (PHFI) and one of the studies’ coauthors, “The study shows that the response has to be appropriate to the context of each state. By shining the torchlight on specific disease burdens that each state must prioritise, this study will help direct health system resources to maximise impact through early prevention and effective treatment.”

The other senior authors include Soumya Swaminathan, deputy director general of programmes at the WHO, and Lalit Dandona, a distinguished research professor at the PHFI.

“While it is known that non-communicable diseases have been increasing in India, a major finding of concern is that the highest rate of increase in heart disease and diabetes is in less developed states,” Balram Bhargava, director-general of the Indian Council of Medical Research (ICMR), pointed out. “These states already have a high burden from chronic obstructive lung disease and a range of infectious and childhood diseases.”

The increase in health loss due to diabetes since 1990 has been the highest among major non-communicable diseases. The increase has been observed in every state of the country, and the relative rate of increase is the highest in several less developed states. “Policy action must take these state-level differences into account to control this potentially explosive public health situation,” the researchers suggested.

The number of persons with diabetes in India has increased from 26 million in 1990 to 65 million in 2016. Among the risk factors contributing to diabetes in India (as of two years ago), high body mass index had the highest impact. The other risk factors included dietary risks, tobacco use, occupational exposure to secondhand smoke, low physical activity and alcohol use.

The proportional contribution of cancers to the total health loss in India has also doubled from 1990 to 2016, but the incidence of different types of cancers varies widely between the states, according to the study. Over 8% of the total deaths in India in 2016 were due to cancer, which is double the number in 1990. The estimated number of cancer cases increased from 548,000 in 1990 to 1.06 million in 2016. The leading types of cancer in 2016 were stomach (9%), breast (8.2%), lung (7.5%), lip and oral cavity (7·2%), pharynx cancer other than nasopharynx (6.8%), colon and rectum (5.8%), leukaemia (5.2%), and cervix (5.2%).

Another area of concern is the rise in suicides, which is presently the leading cause of death in the 15-39-year age group in India. Almost 37% of the total global suicide deaths among women occur in India, and suicide death rate among the elderly has also increased over the past quarter century.

The studies were conducted as part of the India State-level Disease Burden Initiative, a joint project of the ICMR, PHFI and the Institute for Health Metrics and Evaluation. Experts from over 100 Indian institutions participated in the exercise.

Dinesh C. Sharma writes at India Science Wire and tweets @dineshcsharma.