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

被引：254

作者：

Prabhakaran, Dorairaj ^{[1
]}

Jeemon, Panniyammakal ^{[2
]}

Sharma, Meenakshi ^{[5
]}

Roth, Gregory A. ^{[6
]}

Johnson, Catherine ^{[6
]}

Harikrishnan, Sivadasanpillai ^{[3
]}

Gupta, Rajeev ^{[7
]}

Pandian, Jeyaraj D. ^{[8
]}

Naik, Nitish ^{[9
]}

Roy, Ambuj ^{[9
]}

Dhaliwal, R. S. ^{[5
]}

Xavier, Denis ^{[13
,14
]}

Kumar, Raman K. ^{[15
,16
]}

Tandon, Nikhil ^{[10
]}

Mathur, Prashant ^{[17
]}

Shukla, D. K. ^{[5
]}

Mehrotra, Ravi ^{[18
]}

Venugopal, K. ^{[19
]}

Kumar, G. Anil ^{[1
]}

Varghese, Chris M. ^{[1
]}

Furtado, Melissa ^{[1
]}

Muraleedharan, Pallavi ^{[1
]}

Abdulkader, Rizwan S. ^{[20
]}

Alam, Tahiya ^{[6
]}

Anjana, Ranjit M. ^{[21
,22
]}

Arora, Monika ^{[1
]}

Bhansali, Anil ^{[23
]}

Bhardwaj, Deeksha ^{[1
]}

Bhatia, Eesh ^{[25
]}

Chakma, Joy K. ^{[5
]}

Chaturvedi, Pankaj ^{[26
]}

Dutta, Eliza ^{[1
]}

Glenn, Scott ^{[6
]}

Gupta, Prakash C. ^{[27
]}

Johnson, Sarah C. ^{[6
]}

Kaur, Tanvir ^{[5
]}

Kinra, Sanjay ^{[28
]}

Krishnan, Anand ^{[11
]}

Kutz, Michael ^{[6
]}

Mathur, Manu R. ^{[1
]}

Mohan, Viswanathan ^{[21
,22
]}

Mukhopadhyay, Satinath ^{[29
]}

Minh Nguyen ^{[6
]}

Odell, Christopher M. ^{[6
]}

Oommen, Anu M. ^{[30
]}

Pati, Sanghamitra ^{[32
]}

Pletcher, Martin ^{[6
]}

Prasad, Kameshwar ^{[12
]}

Rao, Paturi, V ^{[33
]}

Shekhar, Chander ^{[5
]}

机构：

[1] Publ Hlth Fdn India, Gurugram 122002, National Capita, India

[2] Achutha Menon Ctr Hlth Sci Studies, Trivandrum, Kerala, India

[3] Sree Chitra Tirunal Inst Med Sci & Technol, Dept Cardiol, Trivandrum, Kerala, India

[4] Sree Chitra Tirunal Inst Med Sci & Technol, Dept Neurol, Trivandrum, Kerala, India

[5] Indian Council Med Res, New Delhi, India

[6] Univ Washington, Inst Hlth Metr & Evaluat, Seattle, WA 98195 USA

[7] Rajasthan Univ Hlth Sci, Jaipur, Rajasthan, India

[8] Christian Med Coll & Hosp, Dept Neurol, Ludhiana, Punjab, India

[9] All India Inst Med Sci, Dept Cardiol, New Delhi, India

[10] All India Inst Med Sci, Dept Endocrinol & Metab, New Delhi, India

[11] All India Inst Med Sci, Ctr Community Med, New Delhi, India

[12] All India Inst Med Sci, Dept Neurol, New Delhi, India

[13] St Johns Med Coll, Dept Pharmacol, Bengaluru, India

[14] St Johns Res Inst, Div Clin Res & Training, Bengaluru, India

[15] Amrita Univ, Amrita Inst Med Sci, Dept Paediat Cardiol, Cochin, Kerala, India

[16] Amrita Univ, Res Ctr, Cochin, Kerala, India

[17] Indian Council Med Res, Natl Ctr Dis Informat & Res, Bengaluru, India

[18] Indian Council Med Res, Natl Inst Canc Prevent & Res, Noida, India

[19] Pushpagiri Inst Med Sci, Dept Cardiol, Tiruvalla, India

[20] Manonmaniam Sundaranar Univ, Dept Stat, Tirunelveli, India

[21] Madras Diabet Res Fdn, Madras, Tamil Nadu, India

[22] Dr Mohans Diabet Special Ctr, Madras, Tamil Nadu, India

[23] Postgrad Inst Med Educ & Res, Dept Endocrinol, Chandigarh, India

[24] Postgrad Inst Med Educ & Res, Sch Publ Hlth, Chandigarh, India

[25] Sanjay Gandhi Postgrad Inst Med Sci, Dept Endocrinol, Lucknow, Uttar Pradesh, India

[26] Tata Mem Hosp, Dept Head & Neck Oncol, Bombay, Maharashtra, India

[27] Healis Sekhsaria Inst Publ Hlth, Bombay, Maharashtra, India

[28] London Sch Hyg & Trop Med, Dept Noncommunicable Dis Epidemiol, London, England

[29] Inst Postgrad Med Educ & Res, Dept Endocrinol & Metab, Kolkata, India

[30] Christian Med Coll & Hosp, Community Hlth Dept, Vellore, Tamil Nadu, India

[31] Christian Med Coll & Hosp, Dept Endocrinol Diabet & Metab, Vellore, Tamil Nadu, India

[32] Indian Council Med Res, Reg Med Res Ctr, Bhubaneswar, India

[33] Ramdevrao Hosp, Kumudini Devi Diabet Res Ctr, Hyderabad, Andhra Pradesh, India

[34] Sch Prevent Oncol, Patna, Bihar, India

[35] King Edward Mem Hosp Res Ctr, Kamalnayan Bajaj Diabetol Res Ctr, Pune, Maharashtra, India

[36] Mother Hosp, Dept Cardiol, Trichur, India

来源：

LANCET GLOBAL HEALTH | 2018年 / 6卷 / 12期

基金：

比尔及梅琳达.盖茨基金会;

关键词：

HEART-DISEASE; EPIDEMIOLOGY; HYPERTENSION; STROKE; HEALTH;

D O I：

10.1016/S2214-109X(18)30407-8

中图分类号：

R1 [预防医学、卫生学];

学科分类号：

1004 ; 120402 ;

摘要：

Background The 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. Methods We 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. Findings Overall, 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 Ell 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. Interpretation The burden from the leading cardiovascular diseases in India-ischaemic heart disease and stroke- varies widely between the states. Their increasing prevalence and that of several major risk factors in every part of India, especially the highest increase in the prevalence of ischaemic heart disease in the less developed low ETL states, indicates the need for urgent policy and health system response appropriate for the situation in each state. Copyright (C) 2018 The Author(s). Published by Elsevier Ltd.

引用

页码：E1339 / E1351

页数：13

共 46 条

[1] Hypertension in India: a systematic review and meta-analysis of prevalence, awareness, and control of hypertension
Anchala, Raghupathy
Kannuri, Nanda K.
Pant, Hira
Khan, Hassan
Franco, Oscar H.
Di Angelantonio, Emanuele
Prabhakaran, Dorairaj
[J]. JOURNAL OF HYPERTENSION, 2014, 32 (06) : 1170 - 1177
[2] [Anonymous], NAT HLTH ACC EST IND
[3] [Anonymous], NAT TOB CONTR PROGR
[4] [Anonymous], REP EXP GROUP CONS F
[5] [Anonymous], NAT PROGR PREV CONTR
[6] [Anonymous], NAT TOB CONTR PROGR
[7] [Anonymous], 2017, India: health of the nation's states-the India state-level disease burden initiative
[8] [Anonymous], SUMM BUDG 2018 19
[9] [Anonymous], GBD IND COMP DAT VIS
[10] [Anonymous], 2017, LANCET, DOI DOI 10.1016/S0140-6736(17)32152-9

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