ReviewCorrelation of regional cardiovascular disease mortality in India with lifestyle and nutritional factors
Introduction
Non-communicable diseases such as cardiovascular disease and cancer are emerging as major causes of death in India [1]. According to the World Health Report (2004) non-communicable diseases caused 6.08 million deaths of which cardiovascular diseases caused 3.31 million deaths in high-child high-adult mortality region of South-East Asia in the year 2002 [2]. In India non-communicable diseases caused 5.10 million deaths, of which cardiovascular diseases were responsible for 2.78 million deaths and cancer 0.75 million [2], [3]. Of the cardiovascular diseases, ischaemic heart disease caused 1.51 million deaths and others deaths were attributed to cerebrovascular disease (0.75 million), rheumatic heart disease (0.10 million), hypertensive heart disease (0.08), and inflammatory heart disease (0.05 million). Assessment of disease burden using the disability adjusted life years (DALYs) methodology revealed that non-communicable diseases resulted in 125.5 million DALYs lost as compared to 139.4 million due to communicable diseases and 39.7 million due to injuries in India [4]. Cardiovascular diseases contributed to 30.5 million DALYs of which the major share was ischaemic heart disease (15.1) and cerebrovascular diseases (7.3). It is apparent that cardiovascular diseases, especially coronary heart disease, are major cause of death in India and absolute mortality due to coronary heart disease shall increase from 1.59 million/year in the year 2000 to 2.03 million in 2010 and 2.58 million by the year 2020 [1].
While it is useful to have global data from a single country for international comparisons, diversities within a country must be recognized. India is a vastly heterogeneous country with large number of genetically, ethnically, socially and geographically separated groups. It is well known that all these factors are important in pathogenesis of cardiovascular diseases and it is difficult to extrapolate data from a single study or even multiple small studies to the country as a whole [4], [5], [6], [7], [8], [9], [10]. Cross-sectional epidemiological studies of prevalence of hypertension [5], [6], diabetes[7], [8], [10] and coronary heart disease [9] in India have shown widely disparate findings. Coronary heart disease prevalence has been reported to be higher in South India as compared to North India in recent studies [9] although a study of railway-workers reported that it was more common among the North Indians [11].
There is a wide disparity in cardiovascular disease (CVD) mortality in different Indian states as reported by the Registrar General of India [12]. To determine significance of various lifestyle variables and nutritional factors in explaining this difference in CVD mortality we performed this study. Data from the second National Family Health Survey (NFHS-2) [13] for lifestyle parameters and India Nutrition Profile study (INP) [14] focusing on nutrition intake in India were used to correlate various lifestyle and nutritional factors with cardiovascular mortality.
Section snippets
Methods
The Office of the Registrar General of India obtains statistics on causes of death from different states and union territories under the aegis of Registration of Births and Deaths Act of 1969. This system of medical certification provides cause-specific mortality profiles and the Office of Registrar General of India publishes annual report on Medical Certification of Causes of Death based on data reported by all states implementing this scheme. In the year 1998 a total of 14.9% deaths in India
Results
The latest causes of death statistics in India are available for 1998 from the Registrar General of India [12]. These causes contribute to 76–93% of all deaths in the states that report these statistics. Cardiovascular diseases form a significant proportion of these causes of deaths and vary from 10% to 42% in different states with the lowest proportion in Meghalaya (10.0%) in eastern India and the highest in Goa (41.2%) in western India (Table 1). Absolute cardiovascular mortality rates per
Discussion
This study shows that there are wide differences in cardiovascular disease mortality in different parts of India. The mortality is the lowest in sub-Himalayan states of Himachal Pradesh, Sikkim, Meghalaya and Nagaland and high in states of Tamil Nadu, Andhra Pradesh, Punjab and Goa. High mortality is not confined to a particular region. The variation in cardiovascular disease mortality can be explained by difference in dietary consumption of fats, sugars, and green-leafy vegetables and the
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