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Gupta R, Gaur K, Ahuja S, Anjana RM. Recent studies on hypertension prevalence and control in India 2023. Hypertens Res 2024; 47:1445-1456. [PMID: 38379011 DOI: 10.1038/s41440-024-01585-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/27/2023] [Accepted: 12/30/2023] [Indexed: 02/22/2024]
Abstract
Hypertension is the most important chronic disease risk factor in India. Recent epidemiological studies have reported that hypertension is increasing in India with a more rapid increase in rural and young populations. Fifth National Family Health Survey (NFHS-5) and Indian Council of Medical Research-INDIAB surveys have reported that there are substantial geographic variations in hypertension prevalence with greater prevalence in more developed states and districts of the country. There is a high prevalence of young-age hypertension, especially in the less developed states. The incidence of adverse events from hypertension-related cardiovascular disease is significantly greater in India than in more developed countries. A low level of hypertension awareness, treatment, and control, especially in rural and underserved urban populations is an important finding. In this narrative review, we highlight recent nationwide studies and unique features of hypertension in India and suggest strategies for better hypertension management and control.
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Affiliation(s)
- Rajeev Gupta
- Department of Preventive Cardiology & Medicine, Eternal Heart Care Centre & Research Institute, Jaipur, India.
- Research Board, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, India.
| | - Kiran Gaur
- Department of Statistics, Mathematics and Computer Science, Government SKN Agriculture University, Jobner, Jaipur, India
| | - Shiva Ahuja
- Department of Orthodontics, Jaipur Dental College, Jaipur, India
| | - Ranjit Mohan Anjana
- Madras Diabetes Research Foundation & Dr Mohan's Diabetes Research Centre, Chennai, India
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Ravindranath R, Sarma PS, Sivasankaran S, Thankappan KR, Jeemon P. Voices of care: unveiling patient journeys in primary care for hypertension and diabetes management in Kerala, India. Front Public Health 2024; 12:1375227. [PMID: 38846619 PMCID: PMC11155455 DOI: 10.3389/fpubh.2024.1375227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/06/2024] [Indexed: 06/09/2024] Open
Abstract
Background Diabetes and hypertension are leading public health problems, particularly affecting low- and middle-income countries, with considerable variations in the care continuum between different age, socio-economic, and rural and urban groups. In this qualitative study, examining the factors affecting access to healthcare in Kerala, we aim to explore the healthcare-seeking pathways of people living with diabetes and hypertension. Methods We conducted 20 semi-structured interviews and one focus group discussion (FGD) on a purposive sample of people living with diabetes and hypertension. Participants were recruited at four primary care facilities in Malappuram district of Kerala. Interviews were transcribed and analyzed deductively and inductively using thematic analysis underpinned by Levesque et al.'s framework. Results The patient journey in managing diabetes and hypertension is complex, involving multiple entry and exit points within the healthcare system. Patients did not perceive Primary Health Centres (PHCs) as their initial points of access to healthcare, despite recognizing their value for specific services. Numerous social, cultural, economic, and health system determinants underpinned access to healthcare. These included limited patient knowledge of their condition, self-medication practices, lack of trust/support, high out-of-pocket expenditure, unavailability of medicines, physical distance to health facilities, and attitude of healthcare providers. Conclusion The study underscores the need to improve access to timely diagnosis, treatment, and ongoing care for diabetes and hypertension at the lower level of the healthcare system. Currently, primary healthcare services do not align with the "felt needs" of the community. Practical recommendations to address the social, cultural, economic, and health system determinants include enabling and empowering people with diabetes and hypertension and their families to engage in self-management, improving existing health information systems, ensuring the availability of diagnostics and first-line drug therapy for diabetes and hypertension, and encouraging the use of single-pill combination (SPC) medications to reduce pill burden. Ensuring equitable access to drugs may improve hypertension and diabetes control in most disadvantaged groups. Furthermore, a more comprehensive approach to healthcare policy that recognizes the interconnectedness of non-communicable diseases (NCDs) and their social determinants is essential.
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Affiliation(s)
- Ranjana Ravindranath
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - P. Sankara Sarma
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | | | | | - Panniyammakal Jeemon
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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Varghese JS, Ghosh A, Stein AD, Narayan KMV, Patel SA. The association of hypertension among married Indian couples: a nationally representative cross-sectional study. Sci Rep 2024; 14:10411. [PMID: 38710852 PMCID: PMC11074266 DOI: 10.1038/s41598-024-61169-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 05/02/2024] [Indexed: 05/08/2024] Open
Abstract
Mounting evidence demonstrates that intimate partners sharing risk factors have similar propensities for chronic conditions such as hypertension. The objective was to study whether spousal hypertension was associated with one's own hypertension status independent of known risk factors, and stratified by socio-demographic subgroups (age, sex, wealth quintile, caste endogamy). Data were from heterosexual married couples (n = 50,023, women: 18-49 years, men: 21-54 years) who participated in the National Family Health Survey-V (2019-2021). Hypertension was defined as self-reported diagnosis of hypertension or average of three blood pressure measurements ≥ 140 systolic or 90 mmHg diastolic BP. Among married adults, the prevalence of hypertension among men (38.8 years [SD 8.3]) and women (33.9 years [SD 7.9]) were 29.1% [95% CI 28.5-29.8] and 20.6% [95% CI 20.0-21.1] respectively. The prevalence of hypertension among both partners was 8.4% [95% CI 8.0-8.8]. Women and men were more likely to have hypertension if their spouses had the condition (husband with hypertension: PR 1.37 [95% CI 1.30-1.44]; wife with hypertension: PR 1.32 [95% CI 1.26-1.38]), after adjusting for known risk factors. Spouse's hypertension status was consistently associated with own status across all socio-demographic subgroups examined. These findings present opportunities to consider married couples as a unit in efforts to diagnose and treat hypertension.
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Affiliation(s)
- Jithin Sam Varghese
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
- Emory Global Diabetes Research Center of Woodruff Health Sciences Center and Emory University, Atlanta, GA, 30322, USA.
| | | | - Aryeh D Stein
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - K M Venkat Narayan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Emory Global Diabetes Research Center of Woodruff Health Sciences Center and Emory University, Atlanta, GA, 30322, USA
| | - Shivani A Patel
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Emory Global Diabetes Research Center of Woodruff Health Sciences Center and Emory University, Atlanta, GA, 30322, USA
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Garg S, Tripathi N, Bebarta KK, Sinha N, Tiwari A. Effectiveness of the health and wellness centers in improving identification and primary care of non-communicable diseases in Chhattisgarh State of India. J Family Med Prim Care 2024; 13:2092-2098. [PMID: 38948552 PMCID: PMC11213423 DOI: 10.4103/jfmpc.jfmpc_1538_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 12/04/2023] [Accepted: 01/09/2024] [Indexed: 07/02/2024] Open
Abstract
Introduction India launched a national initiative named Health and Wellness Centres (HWCs) in 2018 to provide population-based primary care including for the non-communicable diseases (NCDs) in rural areas. The current study assesses whether operationalization of HWCs improved the detection of NCDs and increased the share of public sector facilities in providing NCD services. Methods Two rounds of household surveys were conducted in rural Chhattisgarh in 2019 and 2022. With a focus on NCDs, the household survey covered a representative sample of individuals above the age of 30 years - 2760 individuals in 2019 and 2638 in 2022. Multi-variate regression analysis was carried out to determine effects of HWCs on identification of NCDs and utilization of public sector services. Results The population covered by HWCs had 25% greater chance of being identified with NCDs as compared to the population without HWCs (AOR = 1.25, P = 0.03). The NCD patients living in areas covered by HWCs had 70% greater chance of utilizing the public healthcare facilities (AOR = 1.70, P = 0.01). In the population covered by HWCs, the share of the public sector in NCD care increased from 41.2% in 2019 to 62.1% in 2022, whereas the share of informal private providers dropped from 23.5% in 2019 to 8.4% in 2022. Conclusion The HWCs showed effectiveness in increasing detection of NCDs at the population level and bringing a larger share of NCD patients to utilize public sector services. They can prove to be a crucial architectural correction for improving primary care service delivery for NCDs and other population health needs in India.
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Affiliation(s)
- Samir Garg
- State Health Resource Centre, Raipur, Chhattisgarh, India
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Rangamani S, Huliyappa D, Kulothungan V, Saravanan S, Murugan P, Mahadevan R, Rachel Packiaseeli C, Bobby E, Sunitha K, Mallick AK, Nayak SD, Swain SK, Behera M, Nath BK, Swami A, Kalwar AK, Difoesa B, Sardana V, Maheshwari D, Bhushan B, Mittal D, Chaurasia RN, Meena L, Vinay Urs KS, Koli RR, Suresh Kumar N, Mathur P. Stroke incidence, mortality, subtypes in rural and urban populations in five geographic areas of India (2018-2019): results from the National Stroke Registry Programme. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 23:100308. [PMID: 38404513 PMCID: PMC10884975 DOI: 10.1016/j.lansea.2023.100308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 09/30/2023] [Accepted: 10/11/2023] [Indexed: 02/27/2024]
Abstract
Background Increasing stroke burden in India demands a long-term stroke surveillance framework. Earlier studies in India were urban-based, short term and provided limited data on stroke incidence and its outcomes. This gap is addressed by the establishment of five population-based stroke registries (PBSRs) of the National Stroke Registry Programme, India. This paper describes stroke incidence, mortality and age, sex, and subtypes distribution in the five PBSRs with urban and rural populations. Methods First-ever incident stroke patients in age group ≥18 years, resident for at least one year in the defined geographic area, identified from health facilities were registered. Death records with stroke as the cause of death from the Civil Registration System (CRS) were included. Transient ischemic attack (TIA) was excluded. Three PBSRs (Cuttack, Tirunelveli, Cachar) included urban and rural populations. PBSRs in Kota and Varanasi were urban areas. The crude and age-standardized incidence rate (ASR) by age, sex, and residence (urban and rural), rate ratios of ASR, case fatality proportions and rates at day 28 after onset of stroke were calculated for years 2018-2019. Findings A total of 13,820 registered first-ever stroke cases that included 985 death certificate-only cases (DCOs) were analysed. The pooled crude incidence rate was 138.1 per 100,000 population with an age-standardized incidence rate (ASR) of 103.4 (both sexes), 125.7 (males) and 80.8 (females). The risk of stroke among rural residents was one in seven (Cuttack), one in nine (Tirunelveli), and one in 15 (Cachar). Ischemic stroke was the most common type in all PBSRs. Age-standardized case fatality rates (ASCFR) per 100,000 population for pooled PBSRs was 30.0 (males) and 18.8 (females), and the rate ratio (M/F) ranged from 1.2 (Cuttack) to 2.0 (Cachar). Interpretation Population-based registries have provided a comprehensive stroke surveillance platform to measure stroke burden and outcomes by age, sex, residence and subtype across India. The rural-urban pattern of stroke incidence and mortality shall guide health policy and programme planning to strengthen stroke prevention and treatment measures in India. Funding The National Stroke Registry Programme is funded through the intramural funding of the Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, India.
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Affiliation(s)
- Sukanya Rangamani
- ICMR-National Centre for Disease Informatics and Research, II Floor of Nirmal Bhawan, ICMR Complex Kannamangala Post, Bengaluru, 562 110, India
| | - Deepadarshan Huliyappa
- ICMR-National Centre for Disease Informatics and Research, II Floor of Nirmal Bhawan, ICMR Complex Kannamangala Post, Bengaluru, 562 110, India
| | - Vaitheeswaran Kulothungan
- ICMR-National Centre for Disease Informatics and Research, II Floor of Nirmal Bhawan, ICMR Complex Kannamangala Post, Bengaluru, 562 110, India
| | | | - P.K. Murugan
- Tirunelveli Medical College, Tirunelveli, 627011, India
| | | | | | - Esakki Bobby
- Tirunelveli Medical College, Tirunelveli, 627011, India
| | | | - Ashok Kumar Mallick
- SCB Medical College & Hospital, Cuttack, Behera Colony, Mangalabag, Cuttack, Odisha, 753001, India
| | - Soumya Darshan Nayak
- SCB Medical College & Hospital, Cuttack, Behera Colony, Mangalabag, Cuttack, Odisha, 753001, India
| | - Santosh Kumar Swain
- SCB Medical College & Hospital, Cuttack, Behera Colony, Mangalabag, Cuttack, Odisha, 753001, India
| | - Manoranjan Behera
- SCB Medical College & Hospital, Cuttack, Behera Colony, Mangalabag, Cuttack, Odisha, 753001, India
| | - Bhaskar Kanti Nath
- Silchar Medical College, Beside Indian Post, Ghungoor, Masimpur, Silchar, Assam, 788014, India
| | - Abhijit Swami
- Silchar Medical College, Beside Indian Post, Ghungoor, Masimpur, Silchar, Assam, 788014, India
| | - Amit Kumar Kalwar
- Silchar Medical College, Beside Indian Post, Ghungoor, Masimpur, Silchar, Assam, 788014, India
| | - Bijush Difoesa
- Silchar Medical College, Beside Indian Post, Ghungoor, Masimpur, Silchar, Assam, 788014, India
| | - Vijay Sardana
- Govt Medical College, MBS Hospital, Nayapura, Kota, Rajasthan, 324001, India
| | - Dilip Maheshwari
- Govt Medical College, MBS Hospital, Nayapura, Kota, Rajasthan, 324001, India
| | - Bharat Bhushan
- Govt Medical College, MBS Hospital, Nayapura, Kota, Rajasthan, 324001, India
| | - Deepika Mittal
- Govt Medical College, MBS Hospital, Nayapura, Kota, Rajasthan, 324001, India
| | - Rameshwar Nath Chaurasia
- Department of Neurology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, 221005, India
| | - L.P. Meena
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, 221005, India
| | - K S Vinay Urs
- ICMR-National Centre for Disease Informatics and Research, II Floor of Nirmal Bhawan, ICMR Complex Kannamangala Post, Bengaluru, 562 110, India
| | - Rahul Rajendra Koli
- ICMR-National Centre for Disease Informatics and Research, II Floor of Nirmal Bhawan, ICMR Complex Kannamangala Post, Bengaluru, 562 110, India
| | - Natesan Suresh Kumar
- ICMR-National Centre for Disease Informatics and Research, II Floor of Nirmal Bhawan, ICMR Complex Kannamangala Post, Bengaluru, 562 110, India
| | - Prashant Mathur
- ICMR-National Centre for Disease Informatics and Research, II Floor of Nirmal Bhawan, ICMR Complex Kannamangala Post, Bengaluru, 562 110, India
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Rao Guthi V, Sujith Kumar D, Kumar S, Kondagunta N, Raj S, Goel S, Ojah P. Hypertension treatment cascade among men and women of reproductive age group in India: analysis of National Family Health Survey-5 (2019-2021). THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 23:100271. [PMID: 38404520 PMCID: PMC10884964 DOI: 10.1016/j.lansea.2023.100271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 05/12/2023] [Accepted: 08/18/2023] [Indexed: 02/27/2024]
Abstract
Background Only a proportion of adults with hypertension are diagnosed and receive recommended prescriptions despite the availability of inexpensive and efficacious treatment. We aimed to estimate the prevalence of different stages of hypertension treatment cascade among the reproductive age groups in India at the national and state levels. We also identified the predictors of different stages of the hypertension treatment cascade. Methods We used the nationally representative data from National Family Health Survey (NFHS)-5. We included all the males (15-54 years) and females aged 15-49. Socio-demographic factors, anthropometric measurements, habits, comorbid conditions, and healthcare access stratified the stages of the hypertension treatment cascade among hypertensives. We used multinomial logistic regression to identify the determinants of the treatment cascade levels. Findings We had data from 1,267,786 individuals. The national prevalence of hypertension was 18.3% (95% CI: 18.1%-18.4%). Men (21.6%, 95% CI: 21.5%-21.7%) were found to have a higher prevalence as compared to women (14.8%, 95% CI: 14.7%-14.9%). Among hypertensive individuals, 70.5% (95% CI: 70.3%-70.7%) had ever received a BP measurement ("screened"), 34.3% (95% CI: 34.1%-34.5%) had been diagnosed prior to the survey ("aware"), 13.7% (95% CI: 13.5%-13.8%) reported taking a prescribed anti-hypertensive drug ("under treatment"), and 7.8% (95% CI: 7.7%-7.9%) had their BP under control ("controlled"). Males, illiterates, poor, never married, residents of rural areas, smokers/tobacco users, and alcoholic users were less likely to be in any of the treatment cascades. Interpretation The prevalence of hypertension in India is high. The "Rule of half" of hypertension does not apply to India as the proportion of people screened, aware of their hypertension status, treated, and controlled are lower than 50% at each stage. Program managers must improve access to hypertension diagnosis and treatment, especially among men in rural areas and populations with lower household wealth. Funding None.
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Affiliation(s)
- Visweswara Rao Guthi
- Department of Community Medicine, SVIMS-Sri Padmavathi Medical College for Women, Tirupati, Andhra Pradesh, India
| | - D.S. Sujith Kumar
- Department of Community Medicine, SVIMS-Sri Padmavathi Medical College for Women, Tirupati, Andhra Pradesh, India
| | - Sanjeev Kumar
- Department of Community and Family Medicine, AIIMS, Bhopal, India
| | - Nagaraj Kondagunta
- Department of Community Medicine, SVIMS-Sri Padmavathi Medical College for Women, Tirupati, Andhra Pradesh, India
| | - Sonika Raj
- Public Health Masters Program, School of Medicine, University of Limerick, Ireland
| | - Sonu Goel
- Public Health Masters Program, School of Medicine, University of Limerick, Ireland
| | - Pratyashee Ojah
- Biostatistics and Demography, International Institute for Population Sciences, Mumbai, India
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Seenappa K, Kulothungan V, Mohan R, Mathur P. District-Wise Heterogeneity in Blood Pressure Measurements, Prehypertension, Raised Blood Pressure, and Their Determinants Among Indians: National Family Health Survey-5. Int J Public Health 2024; 69:1606766. [PMID: 38562553 PMCID: PMC10982880 DOI: 10.3389/ijph.2024.1606766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/28/2024] [Indexed: 04/04/2024] Open
Abstract
Objective: The objective of the study was to determine the prevalence and determinants of ever-measured blood pressure, prehypertension, and raised blood pressure at national, state and district levels in India. Methods: We analysed data from the National Family Health Survey (NFHS-5), on 743,067 adults aged 18-54 years. The sample consisted of 87.6% females and 12.4% males. We estimated prevalence rates and determined adjusted odds ratios for various dependent variables related to blood pressure. Geographical variations were visualized on the map of India, and multivariate logistic regression was employed at state and district levels, with significance set at p < 0.05. Results: The prevalence of ever-measured blood pressure varied widely, from 30.3% to 98.5% across districts, with southern and northern regions showing higher rates. Prehypertension affected 33.7% of the population, with varying prevalence across districts. Raised blood pressure was there in 15.9%, with notably higher rates in southern region (16.8%). Determinants included age, gender, education, wealth, lifestyle, obesity, and blood glucose levels. Conclusion: These findings demonstrate the subnational variations in blood pressure, can guide evidence-based interventions at the state and district level, towards reducing the burden of raised blood pressure and enhancing overall population health.
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Affiliation(s)
| | | | | | - Prashant Mathur
- Indian Council of Medical Research-National Centre for Disease Informatics and Research (ICMR-NCDIR), Bengaluru, Karnataka, India
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Wang J, Tan F, Wang Z, Yu Y, Yang J, Wang Y, Shao R, Yin X. Understanding Gaps in the Hypertension and Diabetes Care Cascade: Systematic Scoping Review. JMIR Public Health Surveill 2024; 10:e51802. [PMID: 38149840 PMCID: PMC10907944 DOI: 10.2196/51802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/22/2023] [Accepted: 12/27/2023] [Indexed: 12/28/2023] Open
Abstract
BACKGROUND Hypertension and diabetes are global health challenges requiring effective management to mitigate their considerable burden. The successful management of hypertension and diabetes requires the completion of a sequence of stages, which are collectively termed the care cascade. OBJECTIVE This scoping review aimed to describe the characteristics of studies on the hypertension and diabetes care cascade and identify potential interventions as well as factors that impact each stage of the care cascade. METHODS The method of this scoping review has been guided by the framework by Arksey and O'Malley. We systematically searched MEDLINE, Embase, and Web of Science using terms pertinent to hypertension, diabetes, and specific stages of the care cascade. Articles published after 2011 were considered, and we included all studies that described the completion of at least one stage of the care cascade of hypertension and diabetes. Study selection was independently performed by 2 paired authors. Descriptive statistics were used to elucidate key patterns and trends. Inductive content analysis was performed to generate themes regarding the barriers and facilitators for improving the care cascade in hypertension and diabetes management. RESULTS A total of 128 studies were included, with 42.2% (54/128) conducted in high-income countries. Of them, 47 (36.7%) focused on hypertension care, 63 (49.2%) focused on diabetes care, and only 18 (14.1%) reported on the care of both diseases. The majority (96/128, 75.0%) were observational in design. Cascade stages documented in the literature were awareness, screening, diagnosis, linkage to care, treatment, adherence to medication, and control. Most studies focused on the stages of treatment and control, while a relative paucity of studies examined the stages before treatment initiation (76/128, 59.4% vs 52/128, 40.6%). There was a wide spectrum of interventions aimed at enhancing the hypertension and diabetes care cascade. The analysis unveiled a multitude of individual-level and system-level factors influencing the successful completion of cascade sequences in both high-income and low- and middle-income settings. CONCLUSIONS This review offers a comprehensive understanding of hypertension and diabetes management, emphasizing the pivotal factors that impact each stage of care. Future research should focus on upstream cascade stages and context-specific interventions to optimize patient retention and care outcomes.
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Affiliation(s)
- Jie Wang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Fangqin Tan
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zhenzhong Wang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yiwen Yu
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jingsong Yang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yueqing Wang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ruitai Shao
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xuejun Yin
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
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Varghese JS, Ghosh A, Stein A, Narayan KV, Patel S. The association of hypertension among married Indian couples: a nationally representative cross-sectional study. RESEARCH SQUARE 2024:rs.3.rs-3865512. [PMID: 38352475 PMCID: PMC10862969 DOI: 10.21203/rs.3.rs-3865512/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
Mounting evidence demonstrates that intimate partners sharing risk factors have similar propensities for chronic conditions such as hypertension. The objective was to study whether spousal hypertension was associated with one's own hypertension status independent of known risk factors, and stratified by socio-demographic subgroups (age, sex, wealth quintile, caste endogamy). Data were from heterosexual married couples (n = 50,023, women: 18-49y, men: 21-54y) who participated in the National Family Health Survey-V (2019-21). Hypertension was defined as self-reported diagnosis of hypertension or average of three blood pressure measurements ≥ 140 systolic or 90 mmHg diastolic BP. Among married adults, the prevalence of hypertension among men (38.8 years [SD: 8.3]) and women (33.9 years [SD: 7.9]) were 29.1% [95%CI: 28.5-29.8] and 20.6% [95%CI: 20.0-21.1] respectively. The prevalence of hypertension among both partners was 8.4% [95%CI: 8.0-8.8]. Women and men were more likely to have hypertension if their spouses had the condition (husband with hypertension: PR = 1.37 [95%CI: 1.30-1.44]; wife with hypertension: PR = 1.32 [95%CI: 1.26-1.38]), after adjusting for known risk factors. Spouse's hypertension status was consistently associated with own status across all socio-demographic subgroups examined. These findings present opportunities to consider married couples as a unit in efforts to diagnose and treat hypertension.
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Sivanantham P, Anandraj J, Mathan Kumar S, Essakky S, Gola A, Kar SS. Predictors of Control Status of Hypertension in India: A Systematic Review and Meta-analysis. JOURNAL OF PREVENTION (2022) 2024; 45:27-45. [PMID: 38087106 DOI: 10.1007/s10935-023-00756-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/08/2023] [Indexed: 02/06/2024]
Abstract
Predictors of hypertension (HTN) control status have not been well understood in India. This information is crucial for policymakers and program managers to devise newer HTN control strategies and implement relevant policies and programs. Therefore, we undertook this meta-analysis to estimate the effect of various factors on the control status of HTN in India. We systematically searched PubMed and Embase for observational studies and community-based trials published between April 2013 and March 2021 conducted among people (≥ 15 years) with hypertension in India. Quality of studies was assessed using Newcastle Ottawa (NO) scale. Meta-analysis was performed using random effects model. We reported the effect of various factors on the prevalence of controlled HTN using pooled odds ratio (OR) with 95% confidence interval (CI). Of the 842 studies screened, we analyzed nine studies that included 2,441 individuals. Based on the NO scale, majority (90%) of studies had a low risk of bias. The odds of having controlled HTN were significantly higher among women (OR 1.78, 95% CI 1.62-1.95), those aged > 45 years (OR 1.69, 95% CI 1.44-1.97), and those residing in urban parts of India (OR 1.74; 95% CI 1.48-2.03). These measures varied considerably across different regions of the country. Very few studies reported data on the relationship between behavioural risk factors of non-communicable diseases (NCDs) and HTN control status. We did not find any statistically significant differences between behavioural risk factors of NCDs and HTN control status. To improve HTN control in India, the ongoing/newer HTN control programs need to target men, those aged 15-45, and rural residents. Future studies on HTN control determinants should report disaggregated data and use standardized definitions for behavioral risk factors to enhance reliability and comprehensiveness of findings on the determinants of HTN control in future reviews.
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Affiliation(s)
- Parthibane Sivanantham
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Jeyanthi Anandraj
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - S Mathan Kumar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Saravanan Essakky
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Anurag Gola
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Sitanshu Sekhar Kar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.
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Sehgal R, Srinivasapura Venkateshmurthy N, Khatkar R, Konkati SP, Jarhyan P, Sharma M, Ide N, Prabhakaran D, Mohan S. Awareness and Availability of Low Sodium Iodized Salt: Results from Formative Research of Promoting Uptake of Low SodiUm Iodized Salt by Rural and Urban HousehoLds in India-The PLURAL Study. Nutrients 2023; 16:130. [PMID: 38201960 PMCID: PMC10781031 DOI: 10.3390/nu16010130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/21/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024] Open
Abstract
Dietary sodium intake is high among adults in India. Use of low sodium iodized salt (LSIS) can help reduce sodium intake. However, contextually relevant and culturally appropriate interventions to promote LSIS uptake in India have not been developed and implemented. We carried out formative research to inform an intervention to promote uptake of LSIS among rural and urban households in north (Sonipat district) and south (Visakhapatnam and Anakapalli districts) India. Sixty-two in-depth interviews of six focus groups were held with a range of stakeholders-consumers, retailers and influencers. Participant views on availability, affordability, taste and safety of LSIS, along with views on hypertension, its risk factors and potential intervention design and delivery strategies were elicited. Thematic analysis of the data was carried out. While the awareness of hypertension and its risk factors was high among the participants, awareness of LSIS was low. There was also low demand for, and availability of, LSIS. Since cost of LSIS was higher than regular salt, participants preferred that a subsidy be provided to offset the cost. Based on these findings, an intervention to promote the uptake of LSIS was implemented by project staff using various educational materials such as posters, pamphlets and short videos.
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Affiliation(s)
- Reena Sehgal
- Public Health Foundation of India, New Delhi 110030, India; (R.S.); (R.K.); (P.J.); (D.P.); (S.M.)
| | - Nikhil Srinivasapura Venkateshmurthy
- Public Health Foundation of India, New Delhi 110030, India; (R.S.); (R.K.); (P.J.); (D.P.); (S.M.)
- Centre for Chronic Disease Control, New Delhi 110016, India;
| | - Rajesh Khatkar
- Public Health Foundation of India, New Delhi 110030, India; (R.S.); (R.K.); (P.J.); (D.P.); (S.M.)
| | | | - Prashant Jarhyan
- Public Health Foundation of India, New Delhi 110030, India; (R.S.); (R.K.); (P.J.); (D.P.); (S.M.)
| | - Manika Sharma
- Resolve to Save Lives, New York, NY 10004, USA; (M.S.); (N.I.)
| | - Nicole Ide
- Resolve to Save Lives, New York, NY 10004, USA; (M.S.); (N.I.)
| | - Dorairaj Prabhakaran
- Public Health Foundation of India, New Delhi 110030, India; (R.S.); (R.K.); (P.J.); (D.P.); (S.M.)
- Centre for Chronic Disease Control, New Delhi 110016, India;
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Sailesh Mohan
- Public Health Foundation of India, New Delhi 110030, India; (R.S.); (R.K.); (P.J.); (D.P.); (S.M.)
- Centre for Chronic Disease Control, New Delhi 110016, India;
- School of Nursing & Midwifery, Deakin University, Burwood, VIC 3125, Australia
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Anjana RM, Unnikrishnan R, Pradeepa R, Deepa M, Mohan V. Metabolic non-communicable diseases in India: time to act - Authors' reply. Lancet Diabetes Endocrinol 2023; 11:898-899. [PMID: 37996198 DOI: 10.1016/s2213-8587(23)00296-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 10/11/2023] [Indexed: 11/25/2023]
Affiliation(s)
- Ranjit Mohan Anjana
- Department of Diabetology, Madras Diabetes Research Foundation and Dr Mohan's Diabetes Specialities Centre, Chennai, India.
| | - Ranjit Unnikrishnan
- Department of Diabetology, Madras Diabetes Research Foundation and Dr Mohan's Diabetes Specialities Centre, Chennai, India
| | - Rajendra Pradeepa
- Department of Research Operations & Diabetes Complications, Madras Diabetes Research Foundation, Chennai, India
| | - Mohan Deepa
- Department of Epidemiology, Madras Diabetes Research Foundation, Chennai, India
| | - Viswanathan Mohan
- Department of Diabetology, Madras Diabetes Research Foundation and Dr Mohan's Diabetes Specialities Centre, Chennai, India
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13
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Habeeb S, Thankappan KR. Metabolic non-communicable diseases in India: time to act. Lancet Diabetes Endocrinol 2023; 11:897-898. [PMID: 37996197 DOI: 10.1016/s2213-8587(23)00298-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 10/11/2023] [Indexed: 11/25/2023]
Affiliation(s)
- Shifa Habeeb
- Department of Community Medicine, Amrita Institute of Medical Sciences, Kochi 682041, India.
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Singh MM, Basu S, Lalwani H, Rao S, Maheshwari V, Garg S, Sharma N. Hypertension care cascade in an urban resettlement colony and slum in Delhi, India: a cross-sectional survey. BMC Public Health 2023; 23:2116. [PMID: 37891517 PMCID: PMC10612386 DOI: 10.1186/s12889-023-17021-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/19/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Hypertension care cascade in resource-limited settings is compromised with a majority of patients with hypertension remaining undiagnosed, untreated, non-adherent, and poorly controlled at every stage. However, there is paucity of information on care and management of hypertensive patients in community-based settings of low-income urban neighbourhoods in India. METHODS This was a community-based cross-sectional study conducted in an urban resettlement colony and slum area in the Northeast District of Delhi. The adult population was screened for hypertension using standardized methods, and adherence to medications was assessed using the Morisky Green Levine scale. Binary logistic regression analysis was conducted to ascertain the sociodemographic predictors of the outcome (presence of hypertension, adherence to antihypertensive medication, blood pressure control). A p-value < 0.05 was considered statistically significant. RESULTS We included 8850 adult participants including 5295 females and 3555 males in this study. Nearly 29% of the participants were hypertensive, of which 61.77% were newly diagnosed cases. Furthermore, nearly 81% of the previously diagnosed cases had been initiated on antihypertensive medication, of which 57.54% were adherent to their medications while 36.12% attained controlled blood pressure levels. The odds of having hypertension were significantly higher among males (AOR = 1.87, 95% CI: 1.63 to 2.15), age ≥ 60 years (AOR = 9.15, 95% CI: 7.82 to 10.70), high waist circumference (AOR = 2.24, 95% CI: 1.86 to 2.70) and Body Mass Index of ≥ 25.00 (AOR = 2.55, 95% CI: 2.00 to 3.26). Furthermore, on adjusted analysis, patients of hypertension having diabetes (DM) comorbidity had significantly higher odds of being adherent to anti-hypertensive medications (AOR = 1.81, 95% CI: 1.31 to 2.51) compared to those without DM comorbidity, while tobacco users had significantly lower odds of being adherent to antihypertensive medication (AOR = 0.50, 95% CI: 0.31 to 0.82). CONCLUSIONS Hypertension care cascade in urban slum-resettlement colony setting revealed a high burden of undiagnosed hypertension, low rates of medication adherence, and poor blood pressure control. Strengthening community screening and primary care continuum of care is necessary to improve the hypertension care cascade from early diagnosis to effective management with optimal health outcomes to reduce patient complications and increase longevity.
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Affiliation(s)
| | - Saurav Basu
- Indian Institute of Public Health - Delhi, Public Health Foundation of India, New Delhi, India.
| | - Heena Lalwani
- Department of Community Medicine, Maulana Azad Medical College, New Delhi, India.
| | - Shivani Rao
- Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
| | - Vansh Maheshwari
- Indian Institute of Public Health - Delhi, Public Health Foundation of India, New Delhi, India
| | - Sandeep Garg
- Department of Internal Medicine, Maulana Azad Medical College, New Delhi, India
| | - Nandini Sharma
- Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
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15
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Lamloum D, Fassio F, Osetinsky B, Tediosi F. Care Cascades for Hypertension in Low-Income Settings: A Systematic Review and Meta-Analysis. Int J Public Health 2023; 68:1606428. [PMID: 37901590 PMCID: PMC10600349 DOI: 10.3389/ijph.2023.1606428] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/28/2023] [Indexed: 10/31/2023] Open
Abstract
Objective: High blood pressure is the leading risk factor for cardiovascular disease. The hypertension care cascade (HCC) is increasingly being used to evaluate the effectiveness of interventions. This systematic review aims to examine HCC in low-income settings. Methods: The search strategy included articles published between January 2010 and April 2023. We excluded studies with incomplete HCC, on fragile patients or aged <18 years, reviews. We used the MOOSE guideline. Five researchers retrieved data on the survey year, country, population, HCC and diagnostic methods for hypertension. We used JBI Critical Appraisal Tools for quality assessment. Results: Ninety-five articles were analyzed. Average hypertension prevalence was 33% (95% CI: 31%-34%), lower in LICs than in LMICs (25% vs. 34%). The overall mean awareness of hypertension was 48% (95% CI: 45%-51%), its treatment was 35% (95% IC: 32%-38%) and its control 16% (95% CI: 14%-18%). In almost all steps, percentages were lower in LICs and in Sub-Saharan Africa. Conclusion: Trends in HCC vary between countries, with poorer performance in LICs. This review highlights the need for interventions tailored to low-income settings in order to improve hypertension care.
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Affiliation(s)
- Demetrio Lamloum
- Department of Preventive, Restorative and Pediatric Dentistry, University of Bern, Bern, Switzerland
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Federico Fassio
- Department of Public Health, Experimental and Forensic Medicine, Section of Biostatistics and Clinical Epidemiology, University of Pavia, Pavia, Italy
| | - Brianna Osetinsky
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Fabrizio Tediosi
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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16
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Varghese JS, Venkateshmurthy NS, Sudharsanan N, Jeemon P, Patel SA, Thirumurthy H, Roy A, Tandon N, Narayan KMV, Prabhakaran D, Ali MK. Hypertension Diagnosis, Treatment, and Control in India. JAMA Netw Open 2023; 6:e2339098. [PMID: 37870834 PMCID: PMC10594142 DOI: 10.1001/jamanetworkopen.2023.39098] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 09/10/2023] [Indexed: 10/24/2023] Open
Abstract
Importance Hypertension is a major cause of morbidity and mortality worldwide. Previous efforts to characterize gaps in the hypertension care continuum-including diagnosis, treatment, and control-in India did not assess district-level variation. Local data are critical for planning, implementation, and monitoring efforts to curb the burden of hypertension. Objective To examine the hypertension care continuum in India among individuals aged 18 to 98 years. Design, Setting, and Participants The nationally representative Fifth National Family Health Survey study was conducted in 2 phases from June 17, 2019, to March 21, 2020, and from November 21, 2020, to April 30, 2021, among 1 895 297 individuals in 28 states, 8 union territories, and 707 districts of India. Exposures District and state of residence, urban classification, age (18-39, 40-64, and ≥65 years), sex, and household wealth quintile. Main Outcomes and Measures Hypertension was defined as a self-reported diagnosis or a newly measured blood pressure of 140/90 mm Hg or more. The proportion of individuals diagnosed (self-reported), the proportion of individuals treated among those diagnosed (self-reported medication use), and the proportion of individuals with blood pressure control among those treated (blood pressure <140/90 mm Hg [aged 18-79 years] or <150/90 mm Hg [aged ≥80 years]) were calculated based on national guidelines. Age-standardized estimates of treatment and control were also provided among the total with hypertension. To assess differences in the care continuum between or within states (ie, between districts), the variance was partitioned using generalized linear mixed models. Results Of the 1 691 036 adult respondents (52.6% women; mean [SD] age, 41.6 [16.5] years), 28.1% (95% CI, 27.9%-28.3%) had hypertension, of whom 36.9% (95% CI, 36.4%-37.3%) received a diagnosis. Among those who received a diagnosis, 44.7% (95% CI, 44.1%-45.3%) reported taking medication (corresponding to 17.7% [95% CI, 17.5%-17.9%] of the total with hypertension). Among those treated, 52.5% (95% CI, 51.7%-53.4%) had blood pressure control (corresponding to 8.5% [95% CI, 8.3%-8.6%] of the total with hypertension). There were substantial variations across districts in blood pressure diagnosis (range, 6.3%-77.5%), treatment (range, 8.7%-97.1%), and control (range, 2.7%-76.6%). Large proportions of the variation in hypertension diagnosis (94.7%), treatment (93.6%), and control (97.3%) were within states, not just between states. Conclusions and Relevance In this cross-sectional survey study of Indian adults, more than 1 in 4 people had hypertension, and of these, only 1 in 3 received a diagnosis, less than 1 in 5 were treated, and only 1 in 12 had blood pressure control. National mean values hide considerable state-level and district-level variation in the care continuum, suggesting the need for targeted, decentralized solutions to improve the hypertension care continuum in India.
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Affiliation(s)
- Jithin Sam Varghese
- Emory Global Diabetes Research Center, Woodruff Health Sciences Center, Emory University, Atlanta, Georgia
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | | | - Nikkil Sudharsanan
- Professorship of Behavioral Science for Disease Prevention and Health Care, Technical University of Munich, Munich, Germany
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Panniyammakal Jeemon
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Shivani A. Patel
- Emory Global Diabetes Research Center, Woodruff Health Sciences Center, Emory University, Atlanta, Georgia
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Harsha Thirumurthy
- Leonard Davis Institute of Health Economics and Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Ambuj Roy
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - K. M. Venkat Narayan
- Emory Global Diabetes Research Center, Woodruff Health Sciences Center, Emory University, Atlanta, Georgia
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Dorairaj Prabhakaran
- Public Health Foundation of India, New Delhi, India
- Center for Chronic Disease Control, New Delhi, India
| | - Mohammed K. Ali
- Emory Global Diabetes Research Center, Woodruff Health Sciences Center, Emory University, Atlanta, Georgia
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia
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Kalkonde YV, Rangamani S, Suwanwela NC, Mathur P, Injety RJ, Sebastian IA, Vijayanand PJ, Chawla NS, Sylaja P, Sharma M, Pandian JD. Surveillance of stroke: a South-East Asia Region (SEAR) perspective. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 17:100286. [PMID: 37849929 PMCID: PMC10577148 DOI: 10.1016/j.lansea.2023.100286] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/13/2023] [Accepted: 09/16/2023] [Indexed: 10/19/2023]
Abstract
Surveillance of stroke is critical to track its burden and assess progress in prevention and treatment. We reviewed the literature to evaluate stroke surveillance efforts in the South-East Asia Region (SEAR) countries, identify progress and assess gaps. Epidemiological data on all the major parameters such as the incidence, prevalence and mortality of stroke were available for India and Thailand but for none of the other SEAR countries. Most of the epidemiological data came from investigator-initiated studies. National stroke surveillance was present only in India in the form of a National Stroke Registry Programme and Thailand has a national database that was used to obtain epidemiological data for stroke. Research on novel methods for stroke registration, such as using information technology, was absent. This review identified serious gaps in the monitoring and surveillance of stroke in SEAR countries. Systematic efforts are needed to fill those gaps.
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Affiliation(s)
| | - Sukanya Rangamani
- National Centre for Disease Informatics and Research, Indian Council of Medical Research, Bangalore, Karnataka, India
| | - Nijasri C. Suwanwela
- Division of Neurology, Department of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Prashant Mathur
- National Centre for Disease Informatics and Research, Indian Council of Medical Research, Bangalore, Karnataka, India
| | - Ranjit J. Injety
- Department of Neurology, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - Ivy A. Sebastian
- Consultant Neurologist, St. Stephen's Hospital, New Delhi, India
| | - Pranay J. Vijayanand
- Department of Neurology, Christian Medical College & Hospital, Ludhiana, Punjab, India
| | - Nistara S. Chawla
- Department of Neurology, Christian Medical College & Hospital, Ludhiana, Punjab, India
| | - P.N. Sylaja
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Meenakshi Sharma
- Division of Non-Communicable Diseases, Indian Council of Medical Research, New Delhi, India
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Anjana RM, Unnikrishnan R, Deepa M, Pradeepa R, Tandon N, Das AK, Joshi S, Bajaj S, Jabbar PK, Das HK, Kumar A, Dhandhania VK, Bhansali A, Rao PV, Desai A, Kalra S, Gupta A, Lakshmy R, Madhu SV, Elangovan N, Chowdhury S, Venkatesan U, Subashini R, Kaur T, Dhaliwal RS, Mohan V. Metabolic non-communicable disease health report of India: the ICMR-INDIAB national cross-sectional study (ICMR-INDIAB-17). Lancet Diabetes Endocrinol 2023; 11:474-489. [PMID: 37301218 DOI: 10.1016/s2213-8587(23)00119-5] [Citation(s) in RCA: 70] [Impact Index Per Article: 70.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 04/10/2023] [Accepted: 04/12/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Non-communicable disease (NCD) rates are rapidly increasing in India with wide regional variations. We aimed to quantify the prevalence of metabolic NCDs in India and analyse interstate and inter-regional variations. METHODS The Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study, a cross-sectional population-based survey, assessed a representative sample of individuals aged 20 years and older drawn from urban and rural areas of 31 states, union territories, and the National Capital Territory of India. We conducted the survey in multiple phases with a stratified multistage sampling design, using three-level stratification based on geography, population size, and socioeconomic status of each state. Diabetes and prediabetes were diagnosed using the WHO criteria, hypertension using the Eighth Joint National Committee guidelines, obesity (generalised and abdominal) using the WHO Asia Pacific guidelines, and dyslipidaemia using the National Cholesterol Education Program-Adult Treatment Panel III guidelines. FINDINGS A total of 113 043 individuals (79 506 from rural areas and 33 537 from urban areas) participated in the ICMR-INDIAB study between Oct 18, 2008 and Dec 17, 2020. The overall weighted prevalence of diabetes was 11·4% (95% CI 10·2-12·5; 10 151 of 107 119 individuals), prediabetes 15·3% (13·9-16·6; 15 496 of 107 119 individuals), hypertension 35·5% (33·8-37·3; 35 172 of 111 439 individuals), generalised obesity 28·6% (26·9-30·3; 29 861 of 110 368 individuals), abdominal obesity 39·5% (37·7-41·4; 40 121 of 108 665 individuals), and dyslipidaemia 81·2% (77·9-84·5; 14 895 of 18 492 of 25 647). All metabolic NCDs except prediabetes were more frequent in urban than rural areas. In many states with a lower human development index, the ratio of diabetes to prediabetes was less than 1. INTERPRETATION The prevalence of diabetes and other metabolic NCDs in India is considerably higher than previously estimated. While the diabetes epidemic is stabilising in the more developed states of the country, it is still increasing in most other states. Thus, there are serious implications for the nation, warranting urgent state-specific policies and interventions to arrest the rapidly rising epidemic of metabolic NCDs in India. FUNDING Indian Council of Medical Research and Department of Health Research, Ministry of Health and Family Welfare, Government of India.
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Affiliation(s)
- Ranjit Mohan Anjana
- Department of Diabetology, Madras Diabetes Research Foundation and Dr Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India.
| | - Ranjit Unnikrishnan
- Department of Diabetology, Madras Diabetes Research Foundation and Dr Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India
| | - Mohan Deepa
- Department of Epidemiology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Rajendra Pradeepa
- Department of Research Operations & Diabetes Complications, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Nikhil Tandon
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Ashok Kumar Das
- Department of General Medicine & Endocrinology, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Shashank Joshi
- Department of Diabetology & Endocrinology, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Sarita Bajaj
- Department of Medicine, Moti Lal Nehru Medical College, Prayagraj, Uttar Pradesh, India
| | | | | | - Ajay Kumar
- Department of Diabetology, Diabetes Care and Research Centre, Patna, Bihar, India
| | | | - Anil Bhansali
- Department of Endocrinology, Gini Health, Mohali, Punjab, India
| | - Paturi Vishnupriya Rao
- Department of Endocrinology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Ankush Desai
- Department of Endocrinology, Goa Medical College, Bambolim, Goa, India
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India
| | - Arvind Gupta
- Department of Diabetology, Jaipur Diabetes Research Centre, Jaipur, Rajasthan, India
| | - Ramakrishnan Lakshmy
- Department of Cardiac Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - Sri Venkata Madhu
- Department of Endocrinology, University College of Medical Sciences and GTB Hospital, New Delhi, India
| | - Nirmal Elangovan
- Department of Research Operations & Diabetes Complications, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Subhankar Chowdhury
- Department of Endocrinology & Metabolism, Institute of Post Graduate Medical Education & Research (IPGMER) & SSKM Hospital, Kolkata, West Bengal, India
| | | | - Radhakrishnan Subashini
- Department of Biostatistics, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Tanvir Kaur
- Non-Communicable Disease Division, Indian Council of Medical Research, New Delhi, India
| | | | - Viswanathan Mohan
- Department of Diabetology, Madras Diabetes Research Foundation and Dr Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India
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19
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Longkumer I, Yadav S, Rajkumari S, Saraswathy KN. Trends in hypertension prevalence, awareness, treatment, and control: an 8-year follow-up study from rural North India. Sci Rep 2023; 13:9910. [PMID: 37337044 DOI: 10.1038/s41598-023-37082-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 06/15/2023] [Indexed: 06/21/2023] Open
Abstract
Hypertension is a major contributor to global CVD burden. LMICs including India is challenged with rising hypertension prevalence, yet limited studies are available on temporal change and incidence among community-cohorts. This study aimed to describe trends in hypertension prevalence, awareness, treatment, and control over 8 years among a rural community-cohort from Haryana, India. The study also lends towards an analysis of incidence. Adults ≥ 30 years (N = 1542) recruited during baseline cross-sectional study between 2011 and 2014 were followed up after a median 8.1 years. At endline, demographic/lifestyle characteristics and blood pressure were re-examined. Overall median SBP significantly increased from 120 mmHg at baseline to 125.5 mmHg at endline (p < 0.001), while hypertension prevalence increased from 34.4% (95% CI 32.0-36.9) to 40.4% (95% CI 37.5-43.4) (p = 0.002). Age-standardized hypertension incidence was 30.2% (95% CI 26.7-35.2) over 8 years. Among hypertensive group, awareness, treatment, and control increased from 9.6, 8.8 and 5.0% to 31.8, 27.3 and 9.6% (p < 0.05), respectively. Increasing trend in SBP and hypertension prevalence was observed as the cohort ages. This increase is supported by the high incidence of hypertension. Nevertheless, our study highlights positive trends in hypertension care cascade but poor control, suggesting that this trend may not be adequately impactful to reduce hypertension burden.
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Affiliation(s)
- Imnameren Longkumer
- Laboratory of Biochemical and Molecular Anthropology, Department of Anthropology, University of Delhi, Delhi, 110007, India
| | - Suniti Yadav
- Laboratory of Biochemical and Molecular Anthropology, Department of Anthropology, University of Delhi, Delhi, 110007, India
| | - Sunanda Rajkumari
- Laboratory of Biochemical and Molecular Anthropology, Department of Anthropology, University of Delhi, Delhi, 110007, India
| | - Kallur Nava Saraswathy
- Laboratory of Biochemical and Molecular Anthropology, Department of Anthropology, University of Delhi, Delhi, 110007, India.
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Krishna A, Murali S, Moran AE, Saxena A, Gill SS, Hering D, Kaur P. Understanding the Role of Staff Nurses in Hypertension Management in Primary Care Facilities in India: A Time-Motion Study. Prev Chronic Dis 2023; 20:E39. [PMID: 37200503 DOI: 10.5888/pcd20.220232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
INTRODUCTION India is facing a shortage of staff nurses; thus, a better understanding of nurses' workloads is essential for improving and implementing noncommunicable disease (NCD) control strategies. We estimated the proportion of time spent by staff nurses on hypertension and other NCD activities in primary care facilities in 2 states in India. METHODS We conducted a cross-sectional study in 6 purposively selected primary care facilities in Punjab and Madhya Pradesh during July through September 2021. We used a standardized stopwatch to collect data for time spent on direct hypertension activities (measuring blood pressure, counseling, recording blood pressure measurement, and other NCD-related activities), indirect hypertension activities (data management, patient follow-up calls), and non-NCD activities. We used the Mann-Whitney U test to compare the median time spent on activities between facilities using paper-based records and the Simple mobile device-based app (open-source software). RESULTS Six staff nurses were observed for 213 person-hours. Nurses spent 111 person-hours (52%; 95% CI, 45%-59%) on direct hypertension activities and 30 person-hours (14%; 95% CI, 10%-19%) on indirect hypertension activities. The time spent on blood pressure measurement (34 minutes) and documentation (35 minutes) was the maximum time on any given day. Facilities that used paper records spent more median time (39 [IQR, 26-62] minutes) for indirect hypertension activities than those using the Simple app (15 [IQR, 11-19] minutes; P < .001). CONCLUSION Our study found that hypertension activities required more than half of nurses' time in India's primary care facilities. Digital systems can help to reduce the time spent on indirect hypertension activities.
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Affiliation(s)
- Ashish Krishna
- Indian Council of Medical Research - National Institute of Epidemiology, Chennai, Tamil Nadu Housing Board, Ayapakkam, Chennai - 600077
- Resolve to Save Lives, New Delhi, India
| | - Sharan Murali
- Indian Council of Medical Research - National Institute of Epidemiology, Chennai, India
| | - Andrew E Moran
- Resolve to Save Lives, New York, New York
- Columbia University Irving Medical Center, New York, New York
| | - Ashish Saxena
- Directorate of Health Services, Government of Madhya Pradesh, Bhopal, India
| | - Sandeep Singh Gill
- Department of Health and Family Welfare Punjab, Chandigarh, Punjab, India
| | - Dagmara Hering
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| | - Prabhdeep Kaur
- Indian Council of Medical Research - National Institute of Epidemiology, Chennai, India
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21
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Mohanty SK, Mishra RS, Upadhyay AK, O'Donnell O, Maurer J. Sociodemographic and geographic inequalities in diagnosis and treatment of older adults' chronic conditions in India: a nationally representative population-based study. BMC Health Serv Res 2023; 23:332. [PMID: 37013518 PMCID: PMC10069025 DOI: 10.1186/s12913-023-09318-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 03/21/2023] [Indexed: 04/05/2023] Open
Abstract
CONTEXT Expeditious diagnosis and treatment of chronic conditions are critical to control the burden of non-communicable disease in low- and middle-income countries. We aimed to estimate sociodemographic and geographic inequalities in diagnosis and treatment of chronic conditions among adults aged 45 + in India. METHODS We used 2017-18 nationally representative data to estimate prevalence of chronic conditions (hypertension, diabetes, lung disease, heart disease, stroke, arthritis, cholesterol, and neurological) reported as diagnosed and percentages of diagnosed conditions that were untreated by sociodemographic characteristics and state. We used concentration indices to measure socioeconomic inequalities in diagnosis and lack of treatment. Fully adjusted inequalities were estimated with multivariable probit and fractional regression models. FINDINGS About 46.1% (95% CI: 44.9 to 47.3) of adults aged 45 + reported a diagnosis of at least one chronic condition and 27.5% (95% CI: 26.2 to 28.7) of the reported conditions were untreated. The percentage untreated was highest for neurological conditions (53.2%; 95% CI: 50.1 to 59.6) and lowest for diabetes (10.1%; 95% CI: 8.4 to 11.5). Age- and sex-adjusted prevalence of any diagnosed condition was highest in the richest quartile (55.3%; 95% CI: 53.3 to 57.3) and lowest in the poorest (37.7%: 95% CI: 36.1 to 39.3). Conditional on reported diagnosis, the percentage of conditions untreated was highest in the poorest quartile (34.4%: 95% CI: 32.3 to 36.5) and lowest in the richest (21.1%: 95% CI: 19.2 to 23.1). Concentration indices confirmed these patterns. Multivariable models showed that the percentage of untreated conditions was 6.0 points higher (95% CI: 3.3 to 8.6) in the poorest quartile than in the richest. Between state variations in the prevalence of diagnosed conditions and their treatment were large. CONCLUSIONS Ensuring more equitable treatment of chronic conditions in India requires improved access for poorer, less educated, and rural older people who often remain untreated even once diagnosed.
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Affiliation(s)
- Sanjay K Mohanty
- Department of Population and Development, International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, India.
| | - Radhe Shyam Mishra
- International Institute for Population Science, R4D India Project, Mumbai, India
| | - Ashish Kumar Upadhyay
- International Institute for Population Science, Research Coordinator, R4D India Project, Mumbai, India
| | - Owen O'Donnell
- Professor of Applied Economics, Erasmus School of Economics, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Jürgen Maurer
- Department of Economics, Institute of Health Economics and management, University of Lausanne, Lausanne, Switzerland
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Seth AK, Kansal S, Salve HR, Gupta S, Kumar R, Misra P. The Role of Noncommunicable Disease Clinics in Improving Control of Hypertension and Diabetes Among Adults Residing in Rural Ballabgarh, Haryana. Cureus 2023; 15:e37283. [PMID: 37038380 PMCID: PMC10082560 DOI: 10.7759/cureus.37283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2023] [Indexed: 04/12/2023] Open
Abstract
Introduction High systolic blood pressure (SBP) and raised plasma glucose are major attributable and preventable causes of death worldwide. The objective of this study was to estimate the control rates and identify determinants of control of hypertension and diabetes among adults. Methods A longitudinal follow-up study was conducted among all the adults registered at the noncommunicable disease (NCD) clinics under the national program at two primary health centers in Faridabad, Haryana. Data were collected every month from the individual booklet generated for registered adults. Two monthly visits in three months and four in six months were considered adequate follow-ups at the NCD clinic. Results In the study, 495 (82.2%) adults had hypertension, and 242 (40.2%) had diabetes. The control rates at the third and sixth months were 37.1% (95% confidence interval (CI): 31.4-42.7) and 53.6% (95% CI: 43.4-59.8) among hypertensives and 28.7% (95% CI: 21.7-35.7) and 35.9% (95% CI: 27.5-44.4) among diabetics. Among hypertensives, six-month control status was associated with adequate follow-up at the NCD clinic (adjusted odds ratio (AOR) 2.3; 95% CI: 1.4-4.0; p-value: 0.002), male sex (AOR 0.5; 95% CI: 0.3-0.9; p-value: 0.02) and high SBP (AOR 0.5; 95% CI: 0.3-0.9; p-value: 0.017). Conclusions Control status was achieved in half of the adults with hypertension and one-third of adults with diabetes after six months of regular follow-up. Adequate follow-up at the NCD clinic, male sex, and raised SBP emerged as determinants of control among hypertensives.
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Affiliation(s)
- Aswani K Seth
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Subham Kansal
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Harshal R Salve
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Surbhi Gupta
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Rakesh Kumar
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Puneet Misra
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, IND
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23
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The risk of hypertension among child brides and adolescent mothers at age 20 s, 30 s, and 40 s: Evidence from India. J Hum Hypertens 2022:10.1038/s41371-022-00730-9. [DOI: 10.1038/s41371-022-00730-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/07/2022] [Accepted: 07/13/2022] [Indexed: 11/09/2022]
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