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Mukherjee D, Moitra S, Gun P, Bera M, Dey-Biswas P, Mukherjee R. Comorbidity Profiling in Rural and Urban Population of West Bengal, India: Report From a Community-Based Primary Healthcare System. Cureus 2024; 16:e51436. [PMID: 38169631 PMCID: PMC10758112 DOI: 10.7759/cureus.51436] [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: 12/23/2023] [Indexed: 01/05/2024] Open
Abstract
Introduction The burden of non-communicable diseases (NCDs) is fast changing across the world, especially in the context of rapid urbanization, adoption of Western lifestyles, and an aging multi-morbid population. Over the last three decades, India has undergone a significant demographic and socioeconomic transition. For effective targeting of health system resources and services, it is essential to understand how the prevalence of NCDs varies among population groups across India. We set out to understand the distribution of NCDs and co-morbidities in urban and rural West Bengal. Methods As part of a service improvement project, data was collected from four urban and four rural community-based clinics across West Bengal, India. The reason for visiting the healthcare center was recorded as the primary diagnosis and co-morbidities were recorded per the Elixhauser comorbidity scoring criteria. Associations between all the demographic variables and NCDs were studied using the Poisson regression model and multivariate analysis. Demographic profile, co-morbidities, and Elixhauser comorbidity index were expressed as frequency (%), mean (standard deviation, SD), or median (interquartile range, IQR) as appropriate. Results We obtained data from 1244 patients of which 886 (71%) were from urban areas and 358 (29%) were from rural areas. Patients were mostly female (61%) and had a mean (SD) age of 53 (11) years. There was a positive correlation between living in an urban residence and age, body mass index (BMI), hypertension, cardiovascular disease (CVD), and respiratory disease. There was a positive correlation between CVD and age, male sex, living in an urban residence, and hypertension but did not correlate positively with diabetes. BMI positively correlated with living in an urban residence, hypertension, diabetes, and musculoskeletal disorders. We observed a significantly higher prevalence of musculoskeletal (p=0.002) and psychological diseases (p<0.001) in the rural population, while the prevalence of hypertension (p<0.001) and respiratory diseases among the participants living in urban areas was higher (p<0.001). There was no statistically significant difference in the prevalence of diabetes between urban and rural areas (p=0.38). In the multivariable analyses, we observed that increased age, being overweight, and living in urban areas were associated with hypertension (prevalence ratio (PR): 1.40, 1.30, and 1.30, respectively; all p-values <0.05). An interaction between sex and living area was associated with a lower prevalence of musculoskeletal diseases (PR: 0.34; 95%CI: 0.18-0.66), i.e., musculoskeletal diseases were less prevalent in males living in urban areas (p=0.002). Conclusion There is a rise in multimorbidity with changing demographic patterns and a narrowing of the urban-rural gap in disease distribution. More investment is required in risk factor prevention, screening, and treatment, with greater accessibility of healthcare resources for those in rural areas. Further work needs to be done to study the trends and distribution of NCDs in West Bengal to inform healthcare policy.
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Affiliation(s)
| | | | - Punyabrata Gun
- General Medicine, Swasthya Shiksha Nirman (Rational Medicine Network), Kolkata, IND
| | - Mrinmoy Bera
- General Medicine, Swasthya Shiksha Nirman (Rational Medicine Network), Kolkata, IND
| | - Piyali Dey-Biswas
- Epidemiology and Public Health, Swasthya Shiksha Nirman (Rational Medicine Network), Kolkata, IND
| | - Rahul Mukherjee
- Respiratory Medicine and Physiology, Birmingham Heartlands Hospital, Birmingham, GBR
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Datta BK, Ansa BE, Saucier A, Pandey A, Haider MR, Puranda R, Adams M, Coffin J. Child Marriage and Cardiovascular Risk: An Application of the Non-laboratory Framingham Risk Score. High Blood Press Cardiovasc Prev 2024; 31:55-63. [PMID: 38285323 DOI: 10.1007/s40292-023-00620-2] [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: 10/10/2023] [Accepted: 12/22/2023] [Indexed: 01/30/2024] Open
Abstract
INTRODUCTION Child marriage, defined as marriage before the age of 18 years, is a precocious transition from adolescence to adulthood, which may take a long-term toll on health. AIM This study aims to assess whether child marriage was associated with added risk of adverse cardiovascular outcomes in a nationally representative sample of Indian adults. METHODS Applying the non-laboratory-based Framingham algorithm to data on 336,953 women aged 30-49 years and 49,617 men aged 30-54 years, we estimated individual's predicted heart age (PHA). Comparing the PHA with chronological age (CA), we categorized individuals in four groups: (i) low PHA: PHA < CA, (ii) equal PHA: PHA = CA (reference category), (iii) high PHA: PHA > CA by at most 4 years, and (iv) very high PHA: PHA > CA by 5 + years. We estimated multivariable multinomial logistic regressions to obtain relative risks of respective categories for the child marriage indicator. RESULTS We found that women who were married in childhood had 1.06 (95% CI 1.01-1.10) and 1.22 (95% CI 1.16-1.27) times higher adjusted risks of having high and very high PHA, respectively, compared to women who were married as adults. For men, no differential risks were found between those who were married as children and as adults. These results were generally robust across various socioeconomic sub-groups. CONCLUSIONS These findings add to the relatively new and evolving strand of literature that examines the role of child marriage on later life chronic health outcomes and provide important insights for public health policies aimed at improving women's health and wellbeing.
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Affiliation(s)
- Biplab Kumar Datta
- Institute of Public and Preventive Health, Augusta University, 1120 15th St., CJ 2300, Augusta, GA, 30912, USA.
- Department of Health Management, Economics and Policy, Augusta University, Augusta, GA, USA.
| | - Benjamin E Ansa
- Institute of Public and Preventive Health, Augusta University, 1120 15th St., CJ 2300, Augusta, GA, 30912, USA
- Department of Health Management, Economics and Policy, Augusta University, Augusta, GA, USA
| | - Ashley Saucier
- Department of Family Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Ajay Pandey
- Department of Biological Sciences, Augusta University, Augusta, GA, USA
| | - Mohammad Rifat Haider
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA, USA
| | - Racquel Puranda
- Department of Family Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Malika Adams
- Department of Family Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Janis Coffin
- Department of Family Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
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Zhang C, Shen Y, Wang A, Wang D, Cao L, Yue W. Cardiovascular Disease in China: Socioeconomic Status Variation in Prevalence. Risk Manag Healthc Policy 2023; 16:2077-2084. [PMID: 37841077 PMCID: PMC10575027 DOI: 10.2147/rmhp.s429224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/03/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction Cardiovascular disease is the single largest contributor to global mortality and the leading cause of both death and premature death in China. Data on the association between cardiovascular disease and socioeconomic status are sparse, especially for Asian countries. Our study collected data to describe the socioeconomic status variation across cardiovascular disease using a large nationwide cross-sectional study. Methods We chose participants using the cluster sampling method, prepared a face-to-face questionnaire interview for the selected community residents, and collected information on health conditions, socioeconomic status, demographics, and comorbidities. All collected data were reported as frequencies and corresponding percentages. Linear regression and simple and multivariable logistic regression were performed to identify the prevalence variation. All statistical analyses were performed using SPSS version 26 software. Results Socioeconomic information was available for 394,688 participants (covering most provincial districts). The prevalence of cardiovascular disease was 7.9%. The prevalence was higher in rural areas than that in urban areas (rural, 8.4%; urban, 7.5%). There was a negative relationship between urbanization and cardiovascular disease prevalence. Furthermore, cardiovascular disease prevalence had a negative relationship with average earnings. Conclusion This cross-sectional analysis of socioeconomic status variation in the prevalence of cardiovascular disease in China showed a significant negative relationship between regional and individual socioeconomic status and cardiovascular disease. The results imply that governments would benefit communities by focusing on effective and targeted interventions for prevention, screening, and treatment in individuals who may be in the socioeconomic status with a high risk for cardiovascular disease.
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Affiliation(s)
- Chao Zhang
- Department of Neurology, Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Huanhu Hospital, Clinical College of Neurology, Neurosurgery, and Neurorehabilitation, Tianjin Medical University, Tianjin University, Tianjin, People’s Republic of China
| | - Ying Shen
- Department of Traditional Chinese Medicine, Beijing Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Anxin Wang
- Department of Epidemiology, National Clinical Research Center for Neurological Diseases, Beijing TianTan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Da Wang
- Department of Medical Administration, Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Huanhu Hospital, Tianjin, People’s Republic of China
| | - Lei Cao
- Department of Neurology, Nation Project Office of Stroke Prevention and Control, Beijing, People’s Republic of China
| | - Wei Yue
- Department of Neurology, Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Huanhu Hospital, Clinical College of Neurology, Neurosurgery, and Neurorehabilitation, Tianjin Medical University, Tianjin University, Tianjin, People’s Republic of China
- Department of Medical Administration, Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Huanhu Hospital, Tianjin, People’s Republic of China
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Guo C, Liu Z, Fan H, Wang H, Zhang X, Fan C, Li Y, Han X, Zhang T. Associations of healthy lifestyle and three latent socioeconomic status patterns with physical multimorbidity among middle-aged and older adults in China. Prev Med 2023; 175:107693. [PMID: 37660757 DOI: 10.1016/j.ypmed.2023.107693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Multimorbidity is an emerging global public health concern. However, complex associations of healthy lifestyle and socioeconomic status (SES) with multimorbidity have not been identified. METHODS This population-based prospective cohort study used data from four waves of the China Health and Retirement Longitudinal Study (CHARLS) to explore these relationships. Physical multimorbidity was measured using 12 non-communicable diseases. Latent class analysis (LCA) was conducted to determine the optimal SES patterns based on annual per-capita household expenditure, occupation, education level, and health insurance. The healthy lifestyle score (0-5) was constructed comprising information on smoking, drinking, physical activity, sleep, and body shape. RESULTS Of 17,708 participants in the CHARLS, 7776 were eligible for inclusion in our analysis (13.3% with high SES, 26.1% with medium SES, and 60.6% with low SES). Compared with high SES participants, those with low SES had higher risks of incident physical multimorbidity (OR 1.22, 95% CI 1.05, 1.42), which was competitively mediated by lifestyle (mediation proportion, -10.17%, 95% CI -19.12%, -1.23%). Significant interactions were observed between lifestyle factors and SES in patients with incident diabetes. Participants with low SES and no or one healthy lifestyle factor had a higher risk of incident physical multimorbidity than those with high SES and four to five healthy lifestyle factors (OR 2.19, 95% CI 1.57, 3.04). CONCLUSION Healthy lifestyles competitively mediate a fractional proportion of socioeconomic inequity in incident physical multimorbidity. Furthermore, healthy lifestyles were associated with lower multimorbidity risk in the SES subgroups, supporting the important role of lifestyle in reducing physical multimorbidity burden.
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Affiliation(s)
- Chengnan Guo
- Department of Epidemiology, School of Public Health, Key Laboratory of Public Health Safety (Fudan University), Ministry of Education, Fudan University, Shanghai, China; Shanghai Institute of Infectious Disease and Biosecurity, School of Public Health, Fudan University, Shanghai, China
| | - Zhenqiu Liu
- State Key Laboratory of Genetic Engineering and Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Fudan University, Shanghai, China; Fudan University Taizhou Institute of Health Sciences, Taizhou, China
| | - Hong Fan
- Department of Epidemiology, School of Public Health, Key Laboratory of Public Health Safety (Fudan University), Ministry of Education, Fudan University, Shanghai, China; Shanghai Institute of Infectious Disease and Biosecurity, School of Public Health, Fudan University, Shanghai, China; Fudan University Taizhou Institute of Health Sciences, Taizhou, China
| | - Haili Wang
- Department of Epidemiology, School of Public Health, Key Laboratory of Public Health Safety (Fudan University), Ministry of Education, Fudan University, Shanghai, China; Shanghai Institute of Infectious Disease and Biosecurity, School of Public Health, Fudan University, Shanghai, China
| | - Xin Zhang
- Department of Epidemiology, School of Public Health, Key Laboratory of Public Health Safety (Fudan University), Ministry of Education, Fudan University, Shanghai, China; Shanghai Institute of Infectious Disease and Biosecurity, School of Public Health, Fudan University, Shanghai, China
| | - Changjia Fan
- School of Public Health, Fudan University, Shanghai, China
| | - Yi Li
- Department of Epidemiology, School of Public Health, Key Laboratory of Public Health Safety (Fudan University), Ministry of Education, Fudan University, Shanghai, China; Shanghai Institute of Infectious Disease and Biosecurity, School of Public Health, Fudan University, Shanghai, China
| | - Xinyu Han
- Department of Epidemiology, School of Public Health, Key Laboratory of Public Health Safety (Fudan University), Ministry of Education, Fudan University, Shanghai, China; Shanghai Institute of Infectious Disease and Biosecurity, School of Public Health, Fudan University, Shanghai, China
| | - Tiejun Zhang
- Department of Epidemiology, School of Public Health, Key Laboratory of Public Health Safety (Fudan University), Ministry of Education, Fudan University, Shanghai, China; Shanghai Institute of Infectious Disease and Biosecurity, School of Public Health, Fudan University, Shanghai, China; State Key Laboratory of Genetic Engineering and Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Fudan University, Shanghai, China; Fudan University Taizhou Institute of Health Sciences, Taizhou, China.
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Ambade M, Kim R, Subramanian SV. Socio-economic distribution of modifiable risk factors for cardiovascular diseases: An analysis of the national longitudinal ageing study in India. Prev Med 2023; 175:107696. [PMID: 37666306 DOI: 10.1016/j.ypmed.2023.107696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 07/13/2023] [Accepted: 09/01/2023] [Indexed: 09/06/2023]
Abstract
The association of socioeconomic status (SES) with modifiable risk factors for cardiovascular diseases (CVDs) is unclear in developing nations. We studied SES variations in major risk factors and their percentage distribution for adults aged 45 years or above in India. Using individual records of 59,672 individuals aged 45 years or above from the Longitudinal Ageing Study in India Wave 1 (cross-sectional study design), 2017-18, we chart age-and-sex-adjusted prevalence of clinical risk factors such as measured high blood pressure, hypertension, overweight, obesity, central adiposity and self-reported high blood glucose; and lifestyle risk factors such as excessive use of alcohol, current use of smoking and smokeless tobacco and physical inactivity across SES variables of education, quintiles of mean per capita expenditure and social caste. Multivariable analysis was used to explore the SES gradient of risk factors. The sample used in the study is predominantly rural (69.9%), illiterate (50.7%), has more females (54.2%), and belongs to other backward classes (45.6%). Prevalence of high blood pressure, overweight, obesity, central adiposity, high blood glucose, and physical inactivity increased; and excessive alcohol consumption and current use of smoking/smokeless tobacco decreased with income, education, and social caste. However, no significant income gradient was noted for lifestyle risk factors except the use of smokeless tobacco. The income gradient was largest for central adiposity (waist-circumference) with a difference of 23.4 percentage points as it increased from 38.7% among the poorest to 62.1% among the richest. The major burden of CVDs risk factors among older adults aged 45+ years falls among high SES.
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Affiliation(s)
- Mayanka Ambade
- Indian Institute of Technology Mandi, Himachal Pradesh, India.
| | - Rockli Kim
- Division of Health Policy and Management, College of Health Science, Korea University, Seoul, South Korea; Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea.
| | - S V Subramanian
- Harvard Center for Population and Development Studies, 9 Bow Street, Cambridge, MA 02138, USA; Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
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Ebrahimi H, Masinaei M, Aminorroaya A, Aryan Z, Mehdipour P, Rostam-Abadi Y, Ahmadi N, Saeedi Moghaddam S, Pishgar F, Ghanbari A, Rezaei N, Takian A, Farzadfar F. Risk of incident cardiovascular diseases at national and subnational levels in Iran from 2000 to 2016 and projection through 2030: Insights from Iran STEPS surveys. PLoS One 2023; 18:e0290006. [PMID: 37611004 PMCID: PMC10446220 DOI: 10.1371/journal.pone.0290006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 07/24/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Cardiovascular Disease (CVD) is the leading cause of death in developing countries. CVD risk stratification guides the health policy to make evidence-based decisions. AIM To provide current picture and future trend of CVD risk in the adult Iranian population. METHODS Nationally representative datasets of 2005, 2006, 2007, 2008, 2009, 2011, and 2016 STEPwise approach to non-communicable diseases risk factor surveillance (STEPS) studies were used to generate the 10-year and 30-year risks of CVD based on Framingham, Globorisk, and World Health Organization (WHO) risk estimation models. Trend of CVD risk was calculated from 2000 until 2016 and projected to 2030. RESULTS In 2016, based on Framingham model, 14.0% of the Iranian, aged 30 to 74, were at great risk (≥20%) of CVD in the next 10 years (8.0% among females, 20.7% among males). Among those aged 25 to 59, 12.7% had ≥45% risk of CVD in the coming 30 years (9.2% among females, 16.6 among males). In 2016, CVD risk was higher among urban area inhabitants. Age-standardized Framingham 10-year CVD risk will increase 32.2% and 19%, from 2000 to 2030, in females and males, respectively. Eastern provinces had the lowest and northern provinces had the greatest risk. CONCLUSIONS This study projected that CVD risk has increased from 2000 to 2016 in Iran. Without further risk factor modification, this trend will continue until 2030. We have identified populations at higher risks of CVD to guide future intervention.
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Affiliation(s)
- Hedyeh Ebrahimi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Masinaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Arya Aminorroaya
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Aryan
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, United States of America
| | - Parinaz Mehdipour
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Yasna Rostam-Abadi
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
| | - Naser Ahmadi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Saeedi Moghaddam
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Kiel Institute for the World Economy, Kiel, Germany
| | - Farhad Pishgar
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, School of Medicine, Baltimore, Maryland, United States of America
| | - Ali Ghanbari
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazila Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Takian
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Department of Global Health and Public Policy, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Health Equity Research Center (HERC), Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Sasikumar M, Marconi SD, Dharmaraj A, Mehta K, Das M, Goel S. Prevalence of risk factors and estimation of 10-year risk for cardiovascular diseases among male adult population of Tamil Nadu India-an insight from the National Family Health Survey-5. Indian Heart J 2023; 75:251-257. [PMID: 37336261 PMCID: PMC10421976 DOI: 10.1016/j.ihj.2023.06.003] [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: 03/04/2023] [Revised: 05/01/2023] [Accepted: 06/12/2023] [Indexed: 06/21/2023] Open
Abstract
OBJECTIVE Cardiovascular diseases (CVD) are one of the most addressed preventable diseases of public health importance. However, the risk estimates and use of these risk scores for CVD prevention are the least explored areas. So, in this study, we explored the different categories of Framingham heart study (FHS) 10-year-CVD risk score and their associated factors among the adult male population in Tamil Nadu, India. METHODS We used the risk factor level data for male adults aged 18 years and above from the National Family Health Survey (NFHS-5) of Tamil Nadu state, India. Sociodemographic variables, behavioral factors, and physiological/biochemical factors were considered as the risk factor and were estimated using the world health organization (WHO) STEPS categories. FHS 10-year-CVD risk score was calculated using a body-mass index-based published Cox regression equation. RESULTS Out of 2289 adult males, only 1.12% of the participants had a 10-year CVD risk score greater than 30% and ∼4% of the total participants require statin treatment (FRS-CVD risk score ≥20). Educational status (aOR:14.21, 95 CI: 4.36-46.22- no formal schooling when compared to 10th and above standard), weekly fruit intake (aOR:0.51, 95 CI: 0.27-0.97 when compared to daily fruit intake) and abdominal obesity (aOR:2.43, 95 CI: 1.58-3.74) were found to be associated with higher FRS scores when adjusted for all other factors not involved in FRS calculation. CONCLUSION Widespread use of this score needs to be encouraged in clinical practices and patients with a higher risk of CVD events should be counselled for lifestyle modifications and compliance with treatment for decreasing the burden due to CVDs.
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Affiliation(s)
- Midhun Sasikumar
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College Vellore, Tamil Nadu, 632002, India
| | - Sam David Marconi
- Department of Community Health, Christian Medical College Vellore, Tamil Nadu, 632002, India
| | - Aravind Dharmaraj
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College Vellore, Tamil Nadu, 632002, India
| | - Kedar Mehta
- Department of Community Medicine, GMERS Gotri Vadodara, Gujarat, India
| | - Milan Das
- International Institute for Population Sciences, India
| | - Sonu Goel
- Honorary Professor Faculty of Human and Health Sciences Swansea University, United Kingdom; Public Health Master's Program School of Medicine, University of Limerick, Ireland.
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Singh K, Joshi A, Venkateshmurthy NS, Rahul R, Huffman MD, Tandon N, Prabhakaran D. A Delphi Study to Prioritize Evidence-Based Strategies for Cardiovascular Disease Care in India. GLOBAL IMPLEMENTATION RESEARCH AND APPLICATIONS 2023; 3:1-12. [PMID: 37363377 PMCID: PMC10240122 DOI: 10.1007/s43477-023-00087-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 04/30/2023] [Indexed: 06/28/2023]
Abstract
Providing quality cardiovascular disease (CVD) care in low resource setting requires understanding of priority and effective interventions. This study aimed to identify and prioritize evidence-based quality improvement strategies for CVD care in India using a modified two-round Delphi process in which, we asked 46 experts (clinicians, researchers, program implementers and policy makers) to rate 25 proven CVD care strategies grouped into: (1) patient support, (2) information communication technology (ICT) for health, (3) group problem solving, (4) training, and (5) multicomponent strategy on a scale of 1 (highest/best)-5 (lowest/worst) on priority, relative advantage, and feasibility. Subsequently, we convened an expert consensus panel of 32 members to deliberate and achieve consensus regarding the prioritized set of strategies for CVD care. The Delphi study found that group problem solving strategies achieved the best score for priority (1.80) but fared poorly on feasibility (2.88). Compared to others, multicomponent strategies were rated favorably across all domains (priority = 1.84, relative advantage = 1.94, and feasibility = 2.40). The ICT for health strategies achieved the worst scores for priority = 2.01, relative advantage = 2.31, and feasibility = 2.85. Training and patient support strategies scored moderately across all domains. The expert panel narrowed the selection of a multicomponent strategy consisting of (1) electronic health records with clinical decision-support system, (2) non-physician health worker facilitated care, (3) patient education materials, (4) text-message based reminders for healthy lifestyle, and (5) audit and feedback report for providers. Future research will evaluate the real-world feasibility and effectiveness of the multicomponent strategy in patients with CVD in a low- and middle-income country setting. Supplementary Information The online version contains supplementary material available at 10.1007/s43477-023-00087-2.
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Affiliation(s)
- Kavita Singh
- Public Health Foundation of India, Gurugram, Haryana 122002 India
- Centre for Chronic Disease Control, New Delhi, India
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | | | | | | | - Mark D. Huffman
- Washington University, Saint Louis, USA
- Feinberg School of Medicine, Northwestern University, Chicago, USA
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Nikhil Tandon
- All India Institute of Medical Sciences, New Delhi, India
| | - Dorairaj Prabhakaran
- Public Health Foundation of India, Gurugram, Haryana 122002 India
- Centre for Chronic Disease Control, New Delhi, India
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Brindley C, Van Ourti T, Capuno J, Kraft A, Kudymowa J, O'Donnell O. Risk factor contributions to socioeconomic inequality in cardiovascular risk in the Philippines: a cross-sectional study of nationally representative survey data. BMC Public Health 2023; 23:689. [PMID: 37046247 PMCID: PMC10092926 DOI: 10.1186/s12889-023-15517-x] [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: 10/06/2022] [Accepted: 03/24/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Primary prevention of cardiovascular diseases (CVD) increasingly relies on monitoring global CVD risk scores. Lack of evidence on socioeconomic inequality in these scores and the contributions that specific risk factors make to this inequality impedes effective targeting of CVD prevention. We aimed to address this evidence gap by measuring and decomposing socioeconomic inequality in CVD risk in the Philippines. METHODS We used data on 8462 individuals aged 40-74 years from the Philippines National Nutrition Survey and the laboratory-based Globorisk equation to predict 10-year risk of a CVD event from sex, age, systolic blood pressure, total cholesterol, high blood glucose, and smoking. We used a household wealth index to proxy socioeconomic status and measured socioeconomic inequality with a concentration index that we decomposed into contributions of the risk factors used to predict CVD risk. We measured socioeconomic inequalities in these risk factors and decomposed them into contributions of more distal risk factors: body mass index, fat share of energy intake, low physical activity, and drinking alcohol. We stratified by sex. RESULTS Wealthier individuals, particularly males, had greater exposure to all risk factors, with the exception of smoking, and had higher CVD risks. Total cholesterol and high blood glucose accounted for 58% and 34%, respectively, of the socioeconomic inequality in CVD risk among males. For females, the respective estimates were 63% and 69%. Systolic blood pressure accounted for 26% of the higher CVD risk of wealthier males but did not contribute to inequality among females. If smoking prevalence had not been higher among poorer individuals, then the inequality in CVD risk would have been 35% higher for males and 75% higher for females. Among distal risk factors, body mass index and fat intake contributed most to inequalities in total cholesterol, high blood sugar, and, for males, systolic blood pressure. CONCLUSIONS Wealthier Filipinos have higher predicted CVD risks and greater exposure to all risk factors, except smoking. There is need for a nuanced approach to CVD prevention that targets anti-smoking programmes on the poorer population while targeting diet and exercise interventions on the wealthier.
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Affiliation(s)
- Callum Brindley
- Erasmus School of Health Policy and Management, Erasmus University, 1738, Rotterdam, 3000 DR, The Netherlands.
- Erasmus Centre for Health Economics, Erasmus University Rotterdam, Rotterdam, the Netherlands.
| | - Tom Van Ourti
- Erasmus School of Health Policy and Management, Erasmus University, 1738, Rotterdam, 3000 DR, The Netherlands
- Erasmus Centre for Health Economics, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Tinbergen Institute, Amsterdam, the Netherlands
| | - Joseph Capuno
- School of Economics, University of the Philippines Diliman, Diliman, The Philippines
| | - Aleli Kraft
- School of Economics, University of the Philippines Diliman, Diliman, The Philippines
| | - Jenny Kudymowa
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Rethink Priorities, Frankfurt, Germany
| | - Owen O'Donnell
- Erasmus School of Health Policy and Management, Erasmus University, 1738, Rotterdam, 3000 DR, The Netherlands
- Erasmus Centre for Health Economics, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Tinbergen Institute, Amsterdam, the Netherlands
- Faculty of Economics and Business, University of Lausanne, Lausanne, Switzerland
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10
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Performance of the SCORE and Globorisk cardiovascular risk prediction models: a prospective cohort study in Dutch general practice. Br J Gen Pract 2022; 73:e24-e33. [PMID: 36443066 PMCID: PMC9710862 DOI: 10.3399/bjgp.2021.0726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 08/11/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND GPs frequently use 10-year-risk estimations of cardiovascular disease (CVD) to identify high- risk patients. AIM To assess the performance of four models for predicting the 10-year risk of CVD in Dutch general practice. DESIGN AND SETTING Prospective cohort study. Routine data (2009- 2019) was used from 46 Dutch general practices linked to cause of death statistics. METHOD The outcome measures were fatal CVD for SCORE and first diagnosis of fatal or non- fatal CVD for SCORE fatal and non-fatal (SCORE- FNF), Globorisk-laboratory, and Globorisk-office. Model performance was assessed by examining discrimination and calibration. RESULTS The final number of patients for risk prediction was 1981 for SCORE and SCORE-FNF, 3588 for Globorisk-laboratory, and 4399 for Globorisk- office. The observed percentage of events was 18.6% (n = 353) for SCORE- FNF, 6.9% (n = 230) for Globorisk-laboratory, 7.9% (n = 323) for Globorisk-office, and 0.3% (n = 5) for SCORE. The models showed poor discrimination and calibration. The performance of SCORE could not be examined because of the limited number of fatal CVD events. SCORE-FNF, the model that is currently used for risk prediction of fatal plus non-fatal CVD in Dutch general practice, was found to underestimate the risk in all deciles of predicted risks. CONCLUSION Wide eligibility criteria and a broad outcome measure contribute to the model applicability in daily practice. The restriction to fatal CVD outcomes of SCORE renders it less usable in routine Dutch general practice. The models seriously underestimate the 10-year risk of fatal plus non-fatal CVD in Dutch general practice. The poor model performance is possibly because of differences between patients that are eligible for risk prediction and the population that was used for model development. In addition, selection of higher-risk patients for CVD risk assessment by GPs may also contribute to the poor model performance.
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11
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Rajendran S, Mishra S, Madhavanpillai M, G V. Association of hemoglobin glycation index with cardiovascular risk factors in non-diabetic adults: A cross-sectional study. Diabetes Metab Syndr 2022; 16:102592. [PMID: 35998512 DOI: 10.1016/j.dsx.2022.102592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/11/2022] [Accepted: 08/05/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND AIMS The study aimed to explore the association of hemoglobin glycation index (HGI) with cardiovascular risk factors in non-diabetic adults. METHODS This cross-sectional study included 200 adults of 20-60 years of age. Predicted glycated hemoglobin (HbA1c) was calculated from linear regression equation. HGI was calculated using the formula HGI = measured HbA1c- predicted HbA1c. The study subjects were classified into three groups based on their HGI tertiles. Cardiovascular risk factors were compared between the groups and Pearson correlation test was done to correlate HGI with cardiovascular risk factors. RESULTS Serum total cholesterol, triglyceride, low density lipoprotein cholesterol (LDL-C) and very low density lipoprotein cholesterol (VLDL-C) showed significant increase with increase in HGI in non diabetic individuals. High HGI group had significantly high serum total cholesterol, triglyceride, LDL-C and VLDL-C compared to low HGI group. Serum total cholesterol, triglyceride, LDL-C and VLDL-C showed a statistically significant positive correlation with HGI. CONCLUSION We have found a statistically significant correlation of HGI with serum lipid profile, a significant cardiovascular risk factor in non-diabetic individuals. HGI, a simple derivative of HbA1c and fasting plasma glucose may be used to identify cardiovascular risk in non-diabetic individuals. Further prospective studies are required in larger sample size to confirm the clinical implications of HGI.
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Affiliation(s)
- Suryapriya Rajendran
- Department of Biochemistry, Saveetha Medical College and Hospital, SIMATS, Chennai, 602105, India.
| | - Sasmita Mishra
- Department of Biochemistry, Aarupadai Veedu Medical College and Hospital, VMRF, Puducherry, 607402, India
| | - Manju Madhavanpillai
- Department of Biochemistry, Aarupadai Veedu Medical College and Hospital, VMRF, Puducherry, 607402, India
| | - Vishnupriya G
- Aarupadai Veedu Medical College and Hospital, VMRF, Puducherry, 607402, India
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Singh P, Forthal DN, Shah M, Bruckner TA. Association between vaccine preventable diseases in children and improved sanitation following a nationwide sanitation campaign in India: an ecological analysis. BMJ Open 2022; 12:e052937. [PMID: 35443943 PMCID: PMC9021782 DOI: 10.1136/bmjopen-2021-052937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Persistent exposure to faecal pathogens due to open defecation may cause environmental enteropathy that, in turn, may lead to undernutrition and vaccine failure in under 5-year-old (u5) children. The Swachh Bharat Mission (SBM) programme in India, launched in 2014, aimed to construct toilets for every household nationwide and reduce open defecation. This programme, if successful, had the potential to reduce the burden of four vaccine preventable diseases (VPDs): diphtheria, pertussis, tetanus and measles. We examine whether increased household toilet availability in Indian districts following SBM corresponds with a reduction in diphtheria, pertussis, tetanus and measles in u5 children. DESIGN Observational, ecological study. SETTING 532 districts in 28 Indian states, from 2013 to 2016. PRIMARY OUTCOME AND EXPOSURE We retrieved data on district-level change in the annual incidence (per 1000 u5 children) of four VPDs, from 2013 (pre-SBM) to 2016 (post-SBM). We obtained data on our exposure, the change in the percentage of households with toilets (per district), from three large national surveys conducted in 2013 and 2016. We used linear regression analysis, which controlled for change over time in socioeconomic factors, health system-related covariates and pre-SBM annual incidence of VPDs. RESULTS A one percentage point increase in households with toilets corresponds with 0.33 fewer measle cases per 1000 u5 children in a district (coefficient: -0.33, 95% CI -0.0641 to -0.014; p<0.05). About 12% of this association is mediated by a reduction in u5 stunting. We observe no relation of the exposure with diphtheria, pertussis or tetanus. Findings remain robust to sensitivity analyses. CONCLUSION Rapid improvements in ambient sanitation through increased toilet availability correspond with a reduction in the annual incidence of measles in u5 children. We encourage replication of findings and further research to identify potential pathways by which SBM may reduce measle burden in u5 children.
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Affiliation(s)
- Parvati Singh
- College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Donald N Forthal
- School of Medicine, University of California, Irvine, California, USA
| | - Manisha Shah
- Luskin School of Public Affairs, University of California, Los Angeles, California, USA
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Marbaniang SP, Lhungdim H, Chungkham HS. Identifying the latent classes of modifiable risk behaviours among diabetic and hypertensive individuals in Northeastern India: a population-based cross-sectional study. BMJ Open 2022; 12:e053757. [PMID: 35210340 PMCID: PMC8883275 DOI: 10.1136/bmjopen-2021-053757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To identify the latent classes of modifiable risk factors among the patients with diabetes and hypertension based on the observed indicator variables: smoking, alcohol, aerated drinks, overweight or obesity, diabetes and hypertension. We hypothesised that the study population diagnosed with diabetes or hypertension is homogeneous with respect to the modifiable risk factors. DESIGN A cross-sectional study using a stratified random sampling method and a nationally representative large-scale survey. SETTING AND PARTICIPANTS Data come from the fourth round of the Indian National Family Health Survey, 2015-2016. Respondents aged 15-49 years who were diagnosed with either diabetes or hypertension or both were included. The total sample is 22 249, out of which 3284 were men and 18 965 were women. PRIMARY AND SECONDARY OUTCOME MEASURES The observed variables used as latent indicators are the following: smoking, alcohol, aerated drinks, overweight or obesity, diabetes and hypertension. The concomitant variables include age, gender, education, marital status and household wealth index. Latent class model was used to simultaneously identify the latent class and to determine the association between the concomitant variables and the latent classes. RESULTS Three latent classes were identified and labelled as class 1: 'diabetic with low-risk lifestyle' (21%), class 2: 'high-risk lifestyle' (8%) and class 3: 'hypertensive with low-risk lifestyle' (71%). Class 1 is characterised by those with a high probability of having diabetes and low probability of smoking and drinking alcohol. Class 2 is characterised by a high probability of smoking and drinking alcohol and class 3 by a high probability of having high blood pressure and low probability of smoking and drinking alcohol. CONCLUSIONS Co-occurrence of smoking and alcohol consumption was prevalent in men, while excess body weight and high blood pressure were prevalent in women. Policy and programmes in Northeastern India should focus on targeting multiple modifiable risk behaviours that co-occur within an individual.
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Affiliation(s)
- Strong P Marbaniang
- Public Health and Mortality Studies, International Institute for Population Sciences, Mumbai, India
| | - Hemkhothang Lhungdim
- Public Health and Mortality Studies, International Institute for Population Sciences, Mumbai, India
| | - Holendro Singh Chungkham
- Applied and Official Statistics Unit, Indian Statistical Institute, North-East Centre at Tezpur, Tezpur, India
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14
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Naidu K, Sunkaraboina S. Remote health monitoring system using heterogeneous networks. Healthc Technol Lett 2021; 9:16-24. [PMID: 35340405 PMCID: PMC8927882 DOI: 10.1049/htl2.12020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 12/04/2021] [Accepted: 12/05/2021] [Indexed: 11/19/2022] Open
Abstract
This paper presents the implementation of a remote health monitoring system by using Heterogeneous Networks (HetNet), in which remote patients' vital data can be sent to the proximate hospital with very low end‐to‐end latency. To carry out the aforementioned process, patients' statistics are delivered initially from Wireless Body Area Network (WBAN) to the patients' mobile phone by using ISM band. Then, from there, contemporary networks make use of single wireless network alone to send the patients' data to the nearest hospital (even though there are multiple networks in a terrain). But, this particular network may have so much of end‐to‐end latency as a consequence of lack of resources in the network. However, in the proposed work, all the available heterogeneous Radio Access Technology (RAT) networks carry multiple patients' statistics to the nearest hospital by using either the RAT's free channels (in licensed band) or white space channels. Further, in order to reduce the latency in the proposed system, a novel hand‐off method is suggested in this paper by exploiting SDR features. Moreover, simulation results reveal the effectiveness of the proposed system in terms of end‐to‐end latency and spectral efficiency.
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15
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Moreira NCDV, Mdala I, Hussain A, Bhowmik B, Siddiquee T, Fernandes VO, Montenegro RM, Meyer HE. Cardiovascular Risk, Obesity, and Sociodemographic Indicators in a Brazilian Population. Front Public Health 2021; 9:725009. [PMID: 34917567 PMCID: PMC8669243 DOI: 10.3389/fpubh.2021.725009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 10/26/2021] [Indexed: 01/10/2023] Open
Abstract
Background and Aims: Cardiovascular diseases (CVDs) are the leading cause of death globally and in Brazil. Evidence suggests that the risk of CVDs differs by race/ethnicity. Scarce information exists about the association between CVD risk, obesity indicators and sociodemographic characteristics in the Brazilian population. Objectives: We aimed to assess the CVD risk following the Framingham risk score in relation to the population's sociodemographic profile. Further, we examined the association between anthropometric markers and risk of CVDs. Methods: A total of 701 subjects aged ≥20 years from North-eastern Brazil were recruited randomly to participate in a population-based, cross-sectional survey. Age-adjusted data for CVD risk, sociodemographic characteristics, and anthropometric indices were assessed, and their relationships examined. Results: High CVD risk (Framingham risk score ≥10%) was observed in 18.9% of the population. Males (31.9 vs. 12.5%) and older subjects (age ≥45 years: 68.9% vs. age <45 years: 4.2%) had significantly higher risk of CVDs, whereas those employed in manual labor showed lower risk (7.6 vs. 21.7%). Central obesity measures like waist-to-hip ratio and waist-to-height ratio were more strongly associated with predicted CVD risk than body mass index. Conclusions: Our population had a high risk of CVDs using the Framingham risk score. Cost-effective strategies for screening, prevention and treatment of CVDs may likely reduce disease burden and health expenditure in Brazil. Central obesity measures were strongly associated with predicted CVD risk and might be useful in the clinical assessment of patients. Follow-up studies are warranted to validate our findings.
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Affiliation(s)
- Nayla Cristina do Vale Moreira
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo (UiO), Oslo, Norway.,Faculty of Medicine, Federal University of Ceará (FAMED-UFC), Fortaleza, Brazil.,Faculty of Health Sciences, NORD University, Bodø, Norway
| | - Ibrahimu Mdala
- Department of General Practice, Institute of Health and Society, University of Oslo (UiO), Oslo, Norway
| | - Akhtar Hussain
- Faculty of Medicine, Federal University of Ceará (FAMED-UFC), Fortaleza, Brazil.,Faculty of Health Sciences, NORD University, Bodø, Norway.,Centre for Global Health Research, Diabetic Association of Bangladesh, Dhaka, Bangladesh.,International Diabetes Federation, Brussels, Belgium
| | - Bishwajit Bhowmik
- Centre for Global Health Research, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Tasnima Siddiquee
- Centre for Global Health Research, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | | | - Renan M Montenegro
- Faculty of Medicine, Federal University of Ceará (FAMED-UFC), Fortaleza, Brazil
| | - Haakon E Meyer
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo (UiO), Oslo, Norway.,Norwegian Institute of Public Health, Oslo, Norway
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16
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Baby J, Varghese JS, Cyriac S, Narayan KMV, Kurpad AV, Thomas T, Patel S. Contribution of economic and nutritional context to overweight/obesity dynamics in Indian women from 1998 to 2016: a multilevel analysis of national survey data. BMJ Open 2021; 11:e050598. [PMID: 34887275 PMCID: PMC8663076 DOI: 10.1136/bmjopen-2021-050598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Overweight/obesity increased dramatically among Indian women since 2000. We evaluated the independent contributions of economic and nutrition context to the changing distribution of overweight/obesity among women from 1998 to 2016 across India. METHODS Individual-level data from 473 912 ever married Indian women aged 18-49 in the National Family Health Surveys (1998-1999, 2005-2006, 2015-2016) were merged with year-matched state-level economic and nutrition context indicators. Cross-classified generalised linear mixed models were estimated to quantify associations of contextual characteristics with overweight/obesity (body mass index ≥25 kg/m2) across survey rounds. RESULTS Between 1998 and 2016, age-standardised prevalence of overweight/obesity increased from 13.9% to 27.5% nationally at an annual growth rate of 0.8%. After accounting for a woman's age, parity and social class, the adjusted OR (aOR) for overweight/obesity was 2.02 times higher for every unit of state log per capita gross domestic product (GDP) (95% credible interval (CrI) 2.00 to 2.03). Yet, the association of state GDP with overweight/obesity generally decreased over survey round. Women in states with higher per capita daily oil (aOR 1.02 per gram; 95% CrI 1.01 to 1.03) and sugar (aOR 1.05 per gram; 95% CrI 1.04 to 1.05) consumption were more likely to be overweight/obese, while women in states with higher cereal consumption were less likely to be overweight/obese (aOR 0.93 per 10 gram; 95% CrI 0.93 to 0.93). CONCLUSIONS Indicators of state economic development and nutrition transition were independently associated with a woman's likelihood of being overweight/obese. The impact of state wealth waned over survey round, suggesting that risks for overweight/obesity may be increasingly shaped by individual factors as economic development expands in India.
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Affiliation(s)
- Jeswin Baby
- Division of Epidemiology and Biostatistics, St John's Research Institute, Bangalore, Karnataka, India
- Department of Statistical Sciences, Kannur University, Kannur, Kerala, India
| | - Jithin Sam Varghese
- Nutrition and Health Sciences Doctoral Program, Laney School of Graduate Studies, Emory University, Atlanta, Georgia, USA
| | - Shruthi Cyriac
- Nutrition and Health Sciences Doctoral Program, Laney School of Graduate Studies, Emory University, Atlanta, Georgia, USA
| | - K M Venkat Narayan
- Department of Global Health and Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Anura V Kurpad
- Department of Physiology, St John's Medical College, Bangalore, Karnataka, India
| | - Tinku Thomas
- Department of Biostatistics, St John's Medical College, Bangalore, Karnataka, India
| | - Shivani Patel
- Department of Global Health and Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Trends and Inequalities in the Incidence of Acute Myocardial Infarction among Beijing Townships, 2007-2018. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312276. [PMID: 34886003 PMCID: PMC8656834 DOI: 10.3390/ijerph182312276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 11/28/2022]
Abstract
Acute myocardial infarction (AMI) poses a serious disease burden in China, but studies on small-area characteristics of AMI incidence are lacking. We therefore examined temporal trends and geographic variations in AMI incidence at the township level in Beijing. In this cross-sectional analysis, 259,830 AMI events during 2007–2018 from the Beijing Cardiovascular Disease Surveillance System were included. We estimated AMI incidence for 307 consistent townships during consecutive 3-year periods with a Bayesian spatial model. From 2007 to 2018, the median AMI incidence in townships increased from 216.3 to 231.6 per 100,000, with a greater relative increase in young and middle-aged males (35–49 years: 54.2%; 50–64 years: 33.2%). The most pronounced increases in the relative inequalities was observed among young residents (2.1 to 2.8 for males and 2.8 to 3.4 for females). Townships with high rates and larger relative increases were primarily located in Beijing’s northeastern and southwestern peri-urban areas. However, large increases among young and middle-aged males were observed throughout peri-urban areas. AMI incidence and their changes over time varied substantially at the township level in Beijing, especially among young adults. Targeted mitigation strategies are required for high-risk populations and areas to reduce health disparities across Beijing.
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Obesity Measures as Predictors of Type 2 Diabetes and Cardiovascular Diseases among the Jordanian Population: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212187. [PMID: 34831943 PMCID: PMC8618033 DOI: 10.3390/ijerph182212187] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/16/2021] [Accepted: 11/18/2021] [Indexed: 12/23/2022]
Abstract
Obesity is strongly associated with cardiovascular diseases (CVD) and type 2 diabetes (T2D). This study aimed to use obesity measures, body mass index (BMI) and waist circumference (WC) to predict the CVD and T2D risk and to determine the best predictor of these diseases among Jordanian adults. A cross-sectional study was conducted at the governmental and military hospitals across Jordan. The study participants were healthy or previously diagnosed with CVD or T2D. The continuous variables were compared using ANOVA, and the categorical variables were compared using the X2 test. The multivariate logistic regression was used to predict CVD and T2D risk through their association with BMI and WC. The final sample consisted of 6000 Jordanian adults with a mean age of 41.5 ± 14.7 years, 73.6% females. The BMI (OR = 1.7, CI: 1.30–2.30, p < 0.001) was associated with a higher risk of T2D compared to WC (OR = 1.3, CI: 1.04–1.52, p = 0.016). However, our results showed that BMI was not associated with CVD risk, while the WC was significantly and positively associated with CVD risk (OR = 1.9, CI: 1.47–2.47, p < 0.001). In conclusion, an elevated BMI predicts a higher risk of T2D, while WC is more efficient in predicting CVD risk. Our results can be used to construct a population-specific intervention to reduce the risk of CVD and T2D among adults in Jordan and other countries with similar backgrounds.
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Kumar R, Saini V, Kaur C, Isser HS, Tyagi N, Sahoo S. Association between PON1 rs662 gene polymorphism and serum paraoxonase1 level in coronary artery disease patients in Northern India. EGYPTIAN JOURNAL OF MEDICAL HUMAN GENETICS 2021. [DOI: 10.1186/s43042-021-00196-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Coronary artery disease (CAD) is a leading cause of morbidity and mortality, with a shifting trend towards the younger population. Paraoxonase1 (PON1) is a glycoprotein enzyme associated with high-density lipoprotein (HDL) particles in the blood. It has the ability to protect against lipid oxidation, thereby reducing the risk of atherogenesis. PON1 rs662 gene polymorphism may affect serum PON1 levels as well as its activity and may have a significant role in the pathogenesis of CAD. The present study was conducted to identify the association of PON1 rs662 gene polymorphism with serum PON1 levels in CAD patients in the North Indian population. This case–control study included 71 angiography-proven CAD patients (with > 50% luminal stenosis in one or more coronary arteries) and 71 controls (with < 50% luminal obstruction in angiography). PON1 rs662 gene polymorphism was studied using PCR and RFLP under the standardized protocol. Serum PON1 levels were estimated by ELISA.
Results
The serum PON1 level was significantly lower in the CAD group than in the controls (7.79 ± 3.16 vs. 10.79 ± 3.19 ng/mL; p < 0.0001). Logistic regression analysis showed that homozygous GG genotype of PON1 rs662 SNP has ninefold increased risk of developing CAD in an Indian population (OR = 9.0, 95%CI 2.79–29.06, p = 0.0002). A significantly higher frequency of G allele was also observed in CAD patients than in controls (OR 2.64, 95%CI 1.61–4.33, p = 0.001).
Conclusions
The reduced serum PON1 level is associated with CAD. PON1 rs662 gene polymorphism is significantly associated with CAD susceptibility in the North Indian population.
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Marbaniang SP, Lhungdim H, Chauhan S, Srivastava S. Interaction of multiple risk factors and population attributable fraction for type 2 diabetes and hypertension among adults aged 15-49 years in Northeast India. Diabetes Metab Syndr 2021; 15:102227. [PMID: 34311195 DOI: 10.1016/j.dsx.2021.102227] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 07/15/2021] [Accepted: 07/17/2021] [Indexed: 12/27/2022]
Abstract
AIMS The aim is to assess the association and population attributable fraction (PAF) of multiple risk factors combination for diabetes and hypertension among adults in the Northeast region of India. METHODS Data used is from the Indian Demographic Health Survey conducted in 2015-16. The study comprised 107, 766 respondents (95,153 females and 12, 613 males) aged 15-49 years. We examined four modifiable risk factors: smoking, alcohol consumption, aerated drinks consumption, and overweight or obesity. PAF was calculated using the relative risk from the multivariable logistic regression models. RESULTS Overweight or obesity in conjunction with smoking was associated with 43.9 % of patients with diabetes. Smoking in conjunction with alcohol and overweight or obesity contributed to 53% of patients with diabetes (PAF = 53 %). The three risk factors combination (i.e., smoking, alcohol, and overweight or obesity) is associated with the most hypertension cases (PAF = 50.7 %). Experiencing all four risk factors is associated with 50.3 % of patients with hypertension. In women, the four-risk combination contributed the most hypertension cases (PAF = 46.8 %). CONCLUSIONS Overweight or obesity was the single most significant factor leading to hypertension and diabetes among the study population. Also, smoking, alcohol, and overweight or obesity together are prominent risk factors for hypertension and diabetes.
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Affiliation(s)
- Strong P Marbaniang
- Department of Public Health and Mortality Studies, International Institute for Population Sciences, Mumbai, 400088, India.
| | - Hemkhothang Lhungdim
- Department of Public Health and Mortality Studies, International Institute for Population Sciences, Mumbai, 400088, India
| | - Shekhar Chauhan
- Department of Population Policies and Programmes, International Institute for Population Sciences, Mumbai, 400088, India
| | - Shobhit Srivastava
- Department of Mathematical Demography and Statistics, International Institute for Population Sciences, Mumbai, 400088, India
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21
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Singh P, Shah M, Bruckner TA. Child Undernutrition following the Introduction of a Large-Scale Toilet Construction Campaign in India. J Nutr 2021; 151:2455-2464. [PMID: 34143878 PMCID: PMC8436001 DOI: 10.1093/jn/nxab150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/01/2021] [Accepted: 04/26/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Lack of toilets and the widespread practice of open defecation may contribute to India's large burden of child undernutrition. OBJECTIVES We examine whether a large national sanitation campaign launched in 2014, the Swachh Bharat Mission (SBM), precedes a reduction in stunting and wasting among under 5-y-old (u5) children in India. METHODS In this observational study, we used district-level data from before (2013-2014) and after (2015-2016) SBM from 3 national surveys to derive, as our outcomes, the percentage of u5 children per district who are stunted and wasted. We defined our exposures as 1) binary indicator of SBM and 2) percentage of households with toilets per district. Our analytic sample comprised nearly all 640 Indian districts (with ∼1200 rural/urban divisions per district per time point). Linear regression analyses controlled for baseline differences in districts, linear time trends by state, and relevant covariates. RESULTS Relative to pre-SBM, u5 stunting declines by 0.06% (95% CI: -0.10, -0.01; P = 0.009) with every percentage increase in households with toilets post-SBM. Rural regions and districts with higher pre-SBM toilet availability show greater decline in u5 stunting post-SBM. CONCLUSIONS An increase in toilet availability on a national scale, precipitated by the SBM sanitation campaign, is associated with a reduction in undernutrition among u5 children in India over the early phase of the campaign.
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Affiliation(s)
- Parvati Singh
- Program in Public Health, University of
California, Irvine, Irvine, CA,
USA
| | - Manisha Shah
- Department of Public Policy, Luskin School of Public Affairs,
University of California, Los Angeles, Los
Angeles, CA, USA
| | - Tim A Bruckner
- Program in Public Health, University of
California, Irvine, Irvine, CA,
USA
- Center for Population, Inequality and Policy, University of
California, Irvine, Irvine, CA,
USA
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22
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Teufel F, Geldsetzer P, Sudharsanan N, Subramanyam M, Yapa HM, De Neve JW, Vollmer S, Bärnighausen T. The effect of bearing and rearing a child on blood pressure: a nationally representative instrumental variable analysis of 444611 mothers in India. Int J Epidemiol 2021; 50:1671-1683. [PMID: 34293139 PMCID: PMC8580275 DOI: 10.1093/ije/dyab058] [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] [Accepted: 03/04/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND At the individual level, it is well known that pregnancies have a short-term effect on a woman's cardiovascular system and blood pressure. The long-term effect of having children on maternal blood pressure, however, is unknown. We thus estimated the causal effect of having children on blood pressure among mothers in India, a country with a history of high fertility rates. METHODS We used nationally representative cross-sectional data from the 2015-16 India National Family and Health Survey (NFHS-4). The study population comprised 444 611 mothers aged 15-49 years. We used the sex of the first-born child as an instrumental variable (IV) for the total number of a woman's children. We estimated the effect of an additional child on systolic and diastolic blood pressure in IV (two-stage least squares) regressions. In additional analyses, we stratified the IV regressions by time since a mother last gave birth. Furthermore, we repeated our analyses using mothers' husbands and partners as the regression sample. RESULTS On average, mothers had 2.7 children [standard deviation (SD): 1.5], a systolic blood pressure of 116.4 mmHg (SD: 14.4) and diastolic blood pressure of 78.5 mmHg (SD: 9.4). One in seven mothers was hypertensive. In conventional ordinary least squares regression, each child was associated with 0.42 mmHg lower systolic [95% confidence interval (CI): -0.46 to -0.39, P < 0.001] and 0.13 mmHg lower diastolic (95% CI: -0.15 to -0.11, P < 0.001) blood pressure. In the IV regressions, each child decreased a mother's systolic blood pressure by an average of 1.00 mmHg (95% CI: -1.26 to -0.74, P < 0.001) and diastolic blood pressure by an average of 0.35 mmHg (95% CI: -0.52 to -0.17, P < 0.001). These decreases were sustained over more than a decade after childbirth, with effect sizes slightly declining as the time since last birth increased. Having children did not influence blood pressure in men. CONCLUSIONS Bearing and rearing a child decreases blood pressure among mothers in India.
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Affiliation(s)
- Felix Teufel
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Pascal Geldsetzer
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany.,Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Nikkil Sudharsanan
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | | | - H Manisha Yapa
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Jan-Walter De Neve
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Sebastian Vollmer
- Department of Economics, University of Goettingen, Goettingen, Germany.,Centre for Modern Indian Studies, University of Goettingen, Goettingen, Germany
| | - Till Bärnighausen
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany.,Africa Health Research Institute (AHRI), Somkhele and Durban, South Africa.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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23
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Chowdhary R, Masarkar N, Khadanga S. Polymorphism in Genes Apolipoprotein C3 (APOC3) and Fatty Acid-Binding Proteins (FABP2) in Nondiabetic Dyslipidemics: A Tertiary Care Hospital-Based Pilot Study. J Lab Physicians 2021; 14:119-124. [PMID: 35982873 PMCID: PMC9381319 DOI: 10.1055/s-0041-1731949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Context
Dyslipidemia is a multifactorial disease in which lipoproteins play an important role as one of the early markers for coronary heart disease (CHD). Mixed dyslipidemia is common in people with diabetes mellitus, but nondiabetic dyslipidemics (NDD) remain unidentified for the risk of developing dyslipidemia and eventually CHD.
Objectives
This pilot study attempts to analyze the genetic basis of lipid metabolism alterations, emphasizing the association between fatty acid-binding protein-2 (FABP2-Ala54Thr) and apolipoprotein-C3 (APOC3-rs5128) genetic polymorphism, as a risk for developing dyslipidemia and CHD in NDD.
Methods and Design
Total 90 subjects—30 DD, 30 NDD, and 30 apparently healthy subjects representing Central India—were included. Biochemical analysis and DNA genotyping were done by polymerase chain reaction restriction fragment length polymorphism.
Statistical Analysis
The biochemical parameters were reported as means ± standard deviation. One-way analysis of variance test was used to compare biochemical parameters of three groups. Chi-squared test was done to compare genotype distributions. The strength of association was assessed by odds ratios (ORs) with 95% confidence intervals (CIs). All statistical analysis was done using SPSS-PC software and Graph Pad.
Results
In NDD, maximum polymorphism was observed followed by DD and least polymorphism was observed in controls. There was a significant association of
APOC3
G allele with occurrence of hypertriglyceridemia (
p
< 0.05); however, no such association was found for FABP2 A allele (
p
> 0.05). Logistic regression analysis revealed APOC3 polymorphism to be significantly associated with dyslipidemia (OR = 2.6667, 95% CI = 1.0510–6.7663,
p
= 0.0341); no such association was found for FABP2 polymorphism (OR = 0.4643, 95% CI = 0.1641–1.3136,
p
= 0.1347). The triglyceride and cholesterol values in individuals with homozygous genotype indicate that genetic study is comparable to the biochemical findings in carriers of polymorphic allele than noncarriers, especially in NDD patients.
Conclusions
Pilot study indicates that the presence of
APOC3
gene polymorphism is associated with pro-atherogenic dyslipidemia in nondiabetic patients and may raise risk of CHD. This information could be used for preventive strategies in NDD group that may otherwise go unnoticed.
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Affiliation(s)
- Rashmi Chowdhary
- Department of Biochemistry, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Neha Masarkar
- Department of Biochemistry, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Sagar Khadanga
- Department of Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
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24
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Cisse K, Samadoulougou S, Ouedraogo M, Bonnechère B, Degryse JM, Kouanda S, Kirakoya-Samadoulougou F. Geographic and Sociodemographic Disparities in Cardiovascular Risk in Burkina Faso: Findings from a Nationwide Cross-Sectional Survey. Risk Manag Healthc Policy 2021; 14:2863-2876. [PMID: 34262373 PMCID: PMC8274528 DOI: 10.2147/rmhp.s301049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 06/02/2021] [Indexed: 12/04/2022] Open
Abstract
Background Cardiovascular disease (CVD) risk assessment is a critical step in the current approach to the primary prevention of CVD, particularly in low-income countries such as Burkina Faso. In this study, we aimed to assess the geographic and sociodemographic disparities of the ten-year cardiovascular risk in Burkina Faso. Methods We conducted a secondary analysis of the data from the first nationwide survey using the World Health Organization (WHO) STEPwise approach. Ten-year cardiovascular risk was determined using the WHO 2019 updated risk chart (WHO risk) as main outcome, and the Framingham risk score (FRS) and the Globorisk chart for secondary outcomes. We performed a modified Poisson regression model using a generalized estimating equation to examine the association between CVD risk and sociodemographic characteristics. Results A total of 3081 participants aged 30 to 64 years were included in this analysis. The overall age and sex-standardized mean of absolute ten-year cardiovascular risk assessed using the WHO risk chart was 2.5% (95% CI: 2.4–2.6), ranging from 2.3% (95% CI: 2.2–2.4) in Centre Est to 3.0% (95% CI: 2.8–3.2) in the Centre region. It was 4.6% (95% CI: 4.4–4.8) for FRS and 4.0% (95% CI: 3.8–4.1) for Globorisk. Regarding categorized CVD risk (absolute risk ≥10%), we found out that the age and sex-standardized prevalence of elevated risk was 1.7% (95% CI: 1.3–2.1) for WHO risk, 10.4% (95% CI: 9.6–11.2) for FRS, and 5.9% (95% CI: 5.1–6.6) for Globorisk. For all of the three risk scores, elevated CVD risk was associated with increasing age, men, higher education, urban residence, and health region (Centre). Conclusion We found sociodemographic and geographic inequalities in the ten-year CVD risk in Burkina Faso regardless of risk score used. Therefore, population-wide interventions are needed to improve detection and management of adult in the higher CVD risk groups in Burkina Faso.
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Affiliation(s)
- Kadari Cisse
- Centre de Recherche en Epidémiologie, Biostatistiques et Recherche Clinique, Ecole de Santé Publique, Université libre de Bruxelles, Brussels, Belgium.,Departement Biomédical et Santé Publique, Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso
| | - Sekou Samadoulougou
- Evaluation Platform on Obesity Prevention, Quebec Heart and Lung Institute Research Centre, Quebec, G1V 4G5, Canada
| | - Mady Ouedraogo
- Institut National de la Statistique et de la Démographique, Ouagadougou, Burkina Faso
| | - Bruno Bonnechère
- Department of Psychiatry, University of Cambridge, Cambridge, United-Kingdom
| | - Jean-Marie Degryse
- Institut de Recherche Santé et Société, UCLouvain, Bruxelles, Belgium.,Department of Public Health and Primary Care, KULeuven, Leuven, Belgium
| | - Seni Kouanda
- Departement Biomédical et Santé Publique, Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso.,Institut Africain de Santé Publique, Ouagadougou, Burkina Faso
| | - Fati Kirakoya-Samadoulougou
- Centre de Recherche en Epidémiologie, Biostatistiques et Recherche Clinique, Ecole de Santé Publique, Université libre de Bruxelles, Brussels, Belgium
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25
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Wagner RG, Crowther NJ, Micklesfield LK, Boua PR, Nonterah EA, Mashinya F, Mohamed SF, Asiki G, Tollman S, Ramsay M, Davies JI. Estimating the burden of cardiovascular risk in community dwellers over 40 years old in South Africa, Kenya, Burkina Faso and Ghana. BMJ Glob Health 2021; 6:bmjgh-2020-003499. [PMID: 33479017 PMCID: PMC7825268 DOI: 10.1136/bmjgh-2020-003499] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 11/26/2020] [Accepted: 12/25/2020] [Indexed: 12/20/2022] Open
Abstract
Introduction Cardiovascular disease (CVD) risk factors are increasing in sub-Saharan Africa. The impact of these risk factors on future CVD outcomes and burden is poorly understood. We examined the magnitude of modifiable risk factors, estimated future CVD risk and compared results between three commonly used 10-year CVD risk factor algorithms and their variants in four African countries. Methods In the Africa-Wits-INDEPTH partnership for Genomic studies (the AWI-Gen Study), 10 349 randomly sampled individuals aged 40–60 years from six sites participated in a survey, with blood pressure, blood glucose and lipid levels measured. Using these data, 10-year CVD risk estimates using Framingham, Globorisk and WHO-CVD and their office-based variants were generated. Differences in future CVD risk and results by algorithm are described using kappa and coefficients to examine agreement and correlations, respectively. Results The 10-year CVD risk across all participants in all sites varied from 2.6% (95% CI: 1.6% to 4.1%) using the WHO-CVD lab algorithm to 6.5% (95% CI: 3.7% to 11.4%) using the Framingham office algorithm, with substantial differences in risk between sites. The highest risk was in South African settings (in urban Soweto: 8.9% (IQR: 5.3–15.3)). Agreement between algorithms was low to moderate (kappa from 0.03 to 0.55) and correlations ranged between 0.28 and 0.70. Depending on the algorithm used, those at high risk (defined as risk of 10-year CVD event >20%) who were under treatment for a modifiable risk factor ranged from 19.2% to 33.9%, with substantial variation by both sex and site. Conclusion The African sites in this study are at different stages of an ongoing epidemiological transition as evidenced by both risk factor levels and estimated 10-year CVD risk. There is low correlation and disparate levels of population risk, predicted by different risk algorithms, within sites. Validating existing risk algorithms or designing context-specific 10-year CVD risk algorithms is essential for accurately defining population risk and targeting national policies and individual CVD treatment on the African continent.
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Affiliation(s)
- Ryan G Wagner
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Nigel J Crowther
- Department of Chemical Pathology, National Health Laboratory Service, Johannesburg, Gauteng, South Africa.,Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Lisa K Micklesfield
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Palwende Romauld Boua
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Sante, Ouagadougou, Centre, Burkina Faso
| | - Engelbert A Nonterah
- Navrongo Health Research Centre, Ghana Health Service, Accra, Greater Accra, Ghana
| | - Felistas Mashinya
- Department of Pathology and Medical Sciences, Faculty of Health Sciences, University of Limpopo, Sovenga, Limpopo, South Africa
| | - Shukri F Mohamed
- Health and Systems for Health, African Population and Health Research Center, Nairobi, Kenya
| | - Gershim Asiki
- Health and Systems for Health, African Population and Health Research Center, Nairobi, Kenya
| | - Stephen Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa.,Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden.,International Network for the Demographic Evaluation of People and Their Health, INDEPTH Network, Accra, Ghana
| | - Michèle Ramsay
- Sydney Brenner Institute for Molecular Bioscience and Division of Human Genetics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Justine I Davies
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa.,Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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26
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Obesity and dyslipidemia among Bhil tribal population: A cross-sectional study from India. Int J Diabetes Dev Ctries 2021. [DOI: 10.1007/s13410-021-00962-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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27
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Lugun J, Ghosh D, Anand A, Chakraborty B, Ghosh S. Prevalence of CVD risk factors among some tribal and nontribal populations of Jharkhand - A comparative survey. Spat Spatiotemporal Epidemiol 2021; 37:100419. [PMID: 33980408 DOI: 10.1016/j.sste.2021.100419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 03/14/2021] [Accepted: 03/15/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND World especially India had been witnessing a sharp increase of death and disability due to cardiovascular disease (CVD). Prevention, cure and management of cardiovascular diseases (CVD) necessitate true picture of the spread of CVD risk factors throughout the country. Among few surveys in India, very little reports were from state Jharkhand. This study aimed to report the status of CVD risk factors among tribal and nontribal population of Jharkhand. METHODS Comparative study was conducted on rural tribals and urban nontribals with no apparent CVD related symptoms. Informed consents, filled up CVD risk questionnaire were collected. Anthropometric and behavioral data with measured Blood pressure (BP), blood sugar and body mass index (BMI) were analyzed by multivariate logistic regression to find out the association of inappropriate features related to CVD, if any with age, gender and ethnicity. RESULTS Almost 2 fold more susceptibility to develop hypertension, pre-hypertension and obesity was found in nontribals over 8.0%, 15.6% and 22.1% of respective affected tribals. This trend increased up to 3 fold in > 40 years age group. This >40 when compared with < 40 years age group nearly 16 fold and 11 fold significantly increased hypertension risk was reported in nontribals and tribals respectively We report 14.8% diabetic in tribals, highest so far in India. CONCLUSION With age above 40 years, susceptibility to different CVD risk factors like hypertension, pre-hypertension, obesity, high MAP reported to increase severely in urban nontribals than rural tribals.
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Affiliation(s)
- Jyoti Lugun
- Department of Zoology, DSPMU, Ranchi, Jharkhand, India
| | - Deepra Ghosh
- Department of Statistics, University of Calcutta, Kolkata, WB, India
| | - Anushil Anand
- Department of Zoology, DSPMU, Ranchi, Jharkhand, India
| | - Balarko Chakraborty
- Department of Oncogene Regulation, Chittaranjan National Cancer Institute, Kolkata, WB, India
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28
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Cardiovascular disease risk profile and management practices in 45 low-income and middle-income countries: A cross-sectional study of nationally representative individual-level survey data. PLoS Med 2021; 18:e1003485. [PMID: 33661979 PMCID: PMC7932723 DOI: 10.1371/journal.pmed.1003485] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 02/01/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Global cardiovascular disease (CVD) burden is high and rising, especially in low-income and middle-income countries (LMICs). Focussing on 45 LMICs, we aimed to determine (1) the adult population's median 10-year predicted CVD risk, including its variation within countries by socio-demographic characteristics, and (2) the prevalence of self-reported blood pressure (BP) medication use among those with and without an indication for such medication as per World Health Organization (WHO) guidelines. METHODS AND FINDINGS We conducted a cross-sectional analysis of nationally representative household surveys from 45 LMICs carried out between 2005 and 2017, with 32 surveys being WHO Stepwise Approach to Surveillance (STEPS) surveys. Country-specific median 10-year CVD risk was calculated using the 2019 WHO CVD Risk Chart Working Group non-laboratory-based equations. BP medication indications were based on the WHO Package of Essential Noncommunicable Disease Interventions guidelines. Regression models examined associations between CVD risk, BP medication use, and socio-demographic characteristics. Our complete case analysis included 600,484 adults from 45 countries. Median 10-year CVD risk (interquartile range [IQR]) for males and females was 2.7% (2.3%-4.2%) and 1.6% (1.3%-2.1%), respectively, with estimates indicating the lowest risk in sub-Saharan Africa and highest in Europe and the Eastern Mediterranean. Higher educational attainment and current employment were associated with lower CVD risk in most countries. Of those indicated for BP medication, the median (IQR) percentage taking medication was 24.2% (15.4%-37.2%) for males and 41.6% (23.9%-53.8%) for females. Conversely, a median (IQR) 47.1% (36.1%-58.6%) of all people taking a BP medication were not indicated for such based on CVD risk status. There was no association between BP medication use and socio-demographic characteristics in most of the 45 study countries. Study limitations include variation in country survey methods, most notably the sample age range and year of data collection, insufficient data to use the laboratory-based CVD risk equations, and an inability to determine past history of a CVD diagnosis. CONCLUSIONS This study found underuse of guideline-indicated BP medication in people with elevated CVD risk and overuse by people with lower CVD risk. Country-specific targeted policies are needed to help improve the identification and management of those at highest CVD risk.
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29
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Abstract
In India, increasing lifespan and decreasing fertility rates have resulted in a growing number of older persons. By 2050, people over 60 years of age are predicted to constitute 19.1% of the total population. This ageing of the population is expected to be accompanied by a dramatic increase in the prevalence of dementia. The aetiopathogenesis of dementia has been the subject of a number of prospective longitudinal studies in North America and Europe; however, the findings from these studies cannot simply be translated to the Indian population. The population of India is extremely diverse in terms of socio-economic, cultural, linguistic, geographical, lifestyle-related and genetic factors. Indeed, preliminary data from recently initiated longitudinal studies in India indicate that the prevalence of vascular and metabolic risk factors, as well as white matter hyperintensities, differs between urban and rural cohorts. More information on the complex role of vascular risk factors, gender and genetic influences on dementia prevalence and progression in Indian populations is urgently needed. Low-cost, culturally appropriate and scalable interventions need to be developed expeditiously and implemented through public health measures to reduce the growing burden of dementia. Here, we review the literature concerning dementia epidemiology and risk factors in the Indian population and discuss the future work that needs to be performed to put in place public health interventions to mitigate the burden of dementia.
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30
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Kokane AM, Joshi R, Kotnis A, Chatterjee A, Yadav K, Revadi G, Joshi A, Pakhare AP. Determinants of behavioural and biological risk factors for cardiovascular diseases from state level STEPS survey (2017-19) in Madhya Pradesh. PeerJ 2020; 8:e10476. [PMID: 33354427 PMCID: PMC7733649 DOI: 10.7717/peerj.10476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/11/2020] [Indexed: 11/20/2022] Open
Abstract
Background National and statewide assessment of cardiovascular risk factors needs to be conducted periodically in order to inform public health policy and prioritise allocation of funds, especially in LMICs. Although there have been studies from India which have explored the determinants of cardiovascular risk factors, they have mostly been from high epidemiological transition states. The present study assessed the determinants of cardiovascular (CVD) risk factors in a low epidemiological transition state (Madhya Pradesh) using the WHO STEPwise approach to surveillance (STEPS). Methods A total of 5,680 persons aged 18–69 years were selected from the state of Madhya Pradesh through multi-stage cluster random sampling. Key CVD risk factors we sought to evaluate were from behavioural (tobacco, alcohol, physical activity, diet) and biological domains (overweight or obese, Hypertension, Diabetes, and Raised serum cholesterol). Key socio-demographic factors of interest were the caste and tribe groups, and rural vs urban location, in addition to known influencers of CVD risk such as age, gender and education level Results Those belonging to the scheduled tribes were more at risk of consuming tobacco (OR 2.13 (95% CI [1.52–2.98]), and a diet with less than five servings of fruits and vegetables (OR 2.78 (95% CI [1.06–7.24]), but had had the least risk of physical inactivity (OR 0.31 (95% CI [0.02–0.54]). Residence in a rural area also reduced the odds of physical inactivity (OR 0.65 (95% CI [0.46–0.92])). Lack of formal education was a risk factor for both tobacco consumption and alcohol intake (OR 1.40 (95% CI [1.08–1.82]) for tobacco use; 1.68 (95% CI [1.14–2.49]) for alcohol intake). Those belonging to schedules tribes had much lower risk of being obese (OR 0.25; 95% CI [0.17–0.37]), but were at similar risk of all other clinical CVD risk factors as compared to other caste groups. Conclusion In the current study we explored socio-demographic determinants of behavioural and biological CVD risks, and found that in Madhya Pradesh, belonging to a scheduled tribe or living in a rural location, protects against being physically inactive or being overweight or obese. Increasing age confers a greater CVD-risk in all domains. Being a male, and lack of formal education confers a greater risk for behavioural domains, but not for most clinical risk domains. Future efforts at curbing CVDs should be therefore two pronged –a population-based strategy targeting biological risk factors, and a more focussed approach directed at those displaying risky behaviour.
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Affiliation(s)
- Arun M Kokane
- Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, Madhya Pradesh, India
| | - Rajnish Joshi
- General Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, Madhya Pradesh, India
| | - Ashwin Kotnis
- Biochemistry, All India Institute of Medical Sciences, Bhopal, Bhopal, Madhya Pradesh, India
| | - Anirban Chatterjee
- Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, Madhya Pradesh, India
| | - Kriti Yadav
- Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, Madhya Pradesh, India
| | - G Revadi
- Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, Madhya Pradesh, India
| | - Ankur Joshi
- Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, Madhya Pradesh, India
| | - Abhijit P Pakhare
- Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, Madhya Pradesh, India
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31
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Nambiar D, Bhaumik S, Pal A, Ved R. Assessing cardiovascular disease risk factor screening inequalities in India using Lot Quality Assurance Sampling. BMC Health Serv Res 2020; 20:1077. [PMID: 33238995 PMCID: PMC7687829 DOI: 10.1186/s12913-020-05914-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 11/10/2020] [Indexed: 02/07/2023] Open
Abstract
Background Cardiovascular diseases (CVDs) are the leading cause of mortality in India. India has rolled out Comprehensive Primary Health Care (CPHC) reforms including population based screening for hypertension and diabetes, facilitated by frontline health workers. Our study assessed blood pressure and blood sugar coverage achieved by frontline workers using Lot Quality Assurance Sampling (LQAS). Methods LQAS Supervision Areas were defined as catchments covered by frontline workers in primary health centres in two districts each of Uttar Pradesh and Delhi. In each Area, 19 households for each of four sampling universes (males, females, Above Poverty Line (APL) and Below Poverty Line (BPL)) were visited using probability proportional to size sampling. Following written informed consent procedures, a short questionnaire was administered to individuals aged 30 or older using tablets related to screening for diabetes and hypertension. Using the LQAS hand tally method, coverage across Supervision Areas was determined. Results A sample of 2052 individuals was surveyed, median ages ranging from 42 to 45 years. Caste affiliation, education levels, and occupation varied by location; the sample was largely married and Hindu. Awareness of and interaction with frontline health workers was reported in Uttar Pradesh and mixed in Delhi. Greater coverage of CVD risk factor screening (especially blood pressure) was seen among females, as compared to males. No clear pattern of inequality was seen by poverty status; some SAs did not have adequate BPL samples. Overall, blood pressure and blood sugar screening coverage by frontline health workers fell short of targeted coverage levels at the aggregate level, but in all sites, at least one area was crossing this threshold level. Conclusion CVD screening coverage levels at this early stage are low. More emphasis may be needed on reaching males. Sex and poverty related inequalities must be addressed by more closely studying the local context and models of service delivery where the threshold of screening is being met. LQAS is a pragmatic method for measuring program inequalities, in resource-constrained settings, although possibly not for spatially segregated population sub-groups. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-020-05914-y.
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Affiliation(s)
- Devaki Nambiar
- George Institute for Global Health, 311-312, Third Floor, Elegance Tower, Plot No. 8, Jasola District Centre, New Delhi, 110025, India. .,Faculty of Medicine, University of New South Wales, Sydney, Australia. .,Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India. .,Bernard Lown Scholars for Cardiovascular Health Program, Harvard T. H. Chan School of Public Health, Boston, USA.
| | - Soumyadeep Bhaumik
- George Institute for Global Health, 311-312, Third Floor, Elegance Tower, Plot No. 8, Jasola District Centre, New Delhi, 110025, India.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Anita Pal
- Department of Education and Education Technology, University of Hyderabad, Hyderabad, India
| | - Rajani Ved
- Bernard Lown Scholars for Cardiovascular Health Program, Harvard T. H. Chan School of Public Health, Boston, USA.,National Health Systems Resource Centre, New Delhi, India
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Satheesh G, Sharma A, Puthean S, Ansil T P M, E J, Raj Mishra S, Unnikrishnan MK. Availability, price and affordability of essential medicines for managing cardiovascular diseases and diabetes: a statewide survey in Kerala, India. Trop Med Int Health 2020; 25:1467-1479. [PMID: 32959441 DOI: 10.1111/tmi.13494] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Limited access to essential medicines (EMs) for cardiovascular disease (CVD) and diabetes is a major concern in low- and middle-income countries. We aimed to generate data on availability, price and affordability of EMs for CVD and diabetes in India. METHODS Using WHO/HAI survey methodology, we evaluated availability and prices of 23 EMs in 30 public sector facilities (government hospitals and semi-public/government-subsidised-discount-pharmacies (GSDPs)) and 60 private retail pharmacies across six districts in Kerala state, India (November 2018 - May 2019). Median Price Ratios (MPRs) were calculated by comparing consumer prices with international reference prices. We also analysed data (collected in July 2020) on six anti-hypertensive fixed-dose-combinations (FDCs) that were designated as 'essential' by the WHO in 2019. RESULTS Mean availability of surveyed generic EMs was 45.7% in government hospitals, 64.7% in GSDPs and 72.0% in private retail pharmacies. On average, the most-sold and highest-priced generics, respectively, were 6.6% and 8.9% costlier than the lowest-priced generics (LPG). Median MPR for LPG was 2.71 in private retail and 2.25 in GSDPs. Monthly supply of LPG would cost the lowest-paid worker 1.11 and 0.79 days' wages in private retail and GSDPs, respectively. Mean availability of the surveyed FDCs was poor (private retail: 15-85%; GSDPs: 8.3-66.7%), and the private retail prices of FDCs were comparable to the sum of corresponding constituent monotherapies. CONCLUSION Availability of CVD and diabetes EMs fall short of WHO's 80% target in both sectors. Although availability in the private retail pharmacies was near-optimal, prices appear unaffordable compared to GSDPs. Initiatives such as mandating generic prescribing, adding the WHO-approved FDCs in local EM lists, improving price transparency, and streamlining medicine supply to ensure equitable access to EMs, especially in the public sector, are crucial in tackling Kerala's ever-increasing CVD burden.
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Affiliation(s)
- Gautam Satheesh
- Department of Pharmacy Practice, National College of Pharmacy, Kozhikode, India.,The George Institute for Global Health, Hyderabad, India
| | - Abhishek Sharma
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA.,PRECISIONheor, Precision Value & Health, Boston, MA, USA.,World Heart Federation, Salim Yusuf Emerging Leaders Programme, Geneva, Switzerland
| | - Sandra Puthean
- Department of Pharmacy Practice, National College of Pharmacy, Kozhikode, India
| | - Muhammed Ansil T P
- Department of Pharmacy Practice, National College of Pharmacy, Kozhikode, India
| | - Jereena E
- Department of Pharmacy Practice, National College of Pharmacy, Kozhikode, India
| | - Shiva Raj Mishra
- World Heart Federation, Salim Yusuf Emerging Leaders Programme, Geneva, Switzerland.,Nepal Development Society, Bharatpur, Nepal
| | - M K Unnikrishnan
- Department of Pharmacy Practice, National College of Pharmacy, Kozhikode, India
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Jayakumari C, Jabbar PK, Soumya S, Jayakumar R, Das DV, Girivishnu G, Gopi A, Gomez R, Sreenath R, Nair A. Lipid Profile in Indian Patients With Type 2 Diabetes: The Scope for Atherosclerotic Cardiovascular Disease Risk Reduction. Diabetes Spectr 2020; 33:299-306. [PMID: 33223767 PMCID: PMC7666608 DOI: 10.2337/ds19-0046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Reduction of atherosclerotic cardiovascular disease (ASCVD) risk in patients with diabetes requires proper management of lipid parameters. This study aimed to find the pattern of dyslipidemia and scope of ASCVD risk reduction in patients with diabetes by lipid management. METHODS Clinical, biochemical, and medication profiles of all patients with diabetes attending a tertiary diabetes care hospital over a 2-year period were collected. The prevalence of various lipid abnormalities was determined after excluding patients with thyroid dysfunction and those on lipid-lowering medications. Patients were stratified according to LDL cholesterol, HDL cholesterol, and triglyceride levels, and other clinical parameters were compared among the groups. The adequacy of statin treatment was assessed based on American Diabetes Association guidelines. RESULTS Nine hundred and seventy-one patients were included. The prevalence of hyperlipidemia was 40.0%, of whom 14.6% were newly diagnosed. The most common lipid abnormality was elevated LDL cholesterol. Higher A1C and fasting blood glucose values were found to be associated with higher LDL cholesterol levels. Twenty-seven percent of patients with indications for treatment with statins were receiving them. Of those being treated with statins, 42.6% had an LDL cholesterol level ≥100 mg/dL. CONCLUSION In South Indian patients with type 2 diabetes and fair glycemic control, high LDL cholesterol is the predominant lipid abnormality. There remains a huge potential for ASCVD risk reduction in this population if the knowledge practice gap is addressed.
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Affiliation(s)
- Chellamma Jayakumari
- Department of Endocrinology and Metabolism, Government Medical College, Thiruvananthapuram, India
| | | | - Sarayu Soumya
- Department of Endocrinology and Metabolism, Government Medical College, Thiruvananthapuram, India
| | | | - Darvin Vamadevan Das
- Department of Endocrinology and Metabolism, Government Medical College, Thiruvananthapuram, India
| | - Gopi Girivishnu
- Department of Endocrinology and Metabolism, Government Medical College, Thiruvananthapuram, India
| | - Anjana Gopi
- Department of Pediatrics, ESIC Model and Superspecialty Hospital, Kollam, India
| | - Ramesh Gomez
- Department of Endocrinology and Metabolism, Government Medical College, Thiruvananthapuram, India
| | - Ravindranath Sreenath
- Department of Endocrinology and Metabolism, Government Medical College, Thiruvananthapuram, India
| | - Abilash Nair
- Department of Endocrinology and Metabolism, Government Medical College, Thiruvananthapuram, India
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Gopalakrishnan A, Sivadasanpillai H, Ganapathi S, Mohanan Nair KK, Sivasubramonian S, Valaparambil A. Clinical profile & long-term natural history of symptomatic coronary artery disease in young patients (<30 yr). Indian J Med Res 2020; 152:263-272. [PMID: 33107486 PMCID: PMC7881811 DOI: 10.4103/ijmr.ijmr_1090_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background & objectives: Several studies have shown a high prevalence of cardiovascular risk factors in patients in the age group of 30-74 yr, but there is a paucity of data in young patients below 30 yr. We analyzed the clinical and coronary angiographic profile of patients <30 yr of age with symptomatic coronary artery disease (CAD) and also assessed their intermediate and long-term outcomes. Methods: All patients less than 30 yr of age who presented with symptomatic CAD from 1978 to 2017 in the department of Cardiology of a tertiary care hospital in south India, were studied for coronary risk factors and angiographic and treatment patterns, and the follow up data were collected. Results: The mean age of the 159 patients <30 yr of age was 26.7±3.29 yr. Male preponderance was observed (91.8%), 63.5 per cent patients were smokers and 88.3 per cent were dyslipidaemic. Acute myocardial infarction was the most common mode of presentation. Forty one per cent patients were non-adherent to medications. Risk factor control was inadequate with respect to smoking cessation, alcoholism, physical activity and dietary regulation. The predictors of long-term mortality were multivessel CAD [hazard ratio (HR): 1.927, 95% confidence interval (CI): 1.003-3.701] and reduction in ejection fraction (EF) (10% decrease in EF; HR: 1.349, 95% CI: 1.096-1.662). Overall mortality was 30 per cent at 10 yr and 48 per cent at 20 yr. Interpretation & conclusions: Decreasing EF and multivessel involvement were found to be the strong correlates for long-term mortality in young patients below 30 yr of age with CAD. High long-term mortality rates and poor risk factor control suggest the vast scope for the improvement of outcomes in these patients with aggressive risk factor control.
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Affiliation(s)
- Arun Gopalakrishnan
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Thiruvananthapuram, Kerala, India
| | - Harikrishnan Sivadasanpillai
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Thiruvananthapuram, Kerala, India
| | - Sanjay Ganapathi
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Thiruvananthapuram, Kerala, India
| | - Krishna Kumar Mohanan Nair
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Thiruvananthapuram, Kerala, India
| | - Sivasankaran Sivasubramonian
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Thiruvananthapuram, Kerala, India
| | - Ajitkumar Valaparambil
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Thiruvananthapuram, Kerala, India
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Zhao Y, Atun R, Oldenburg B, McPake B, Tang S, Mercer SW, Cowling TE, Sum G, Qin VM, Lee JT. Physical multimorbidity, health service use, and catastrophic health expenditure by socioeconomic groups in China: an analysis of population-based panel data. LANCET GLOBAL HEALTH 2020; 8:e840-e849. [PMID: 32446349 PMCID: PMC7241981 DOI: 10.1016/s2214-109x(20)30127-3] [Citation(s) in RCA: 169] [Impact Index Per Article: 42.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 03/24/2020] [Accepted: 03/30/2020] [Indexed: 01/28/2023]
Abstract
Background Multimorbidity, the presence of two or more mental or physical chronic non-communicable diseases, is a major challenge for the health system in China, which faces unprecedented ageing of its population. Here we examined the distribution of physical multimorbidity in relation to socioeconomic status; the association between physical multimorbidity, health-care service use, and catastrophic health expenditures; and whether these associations varied by socioeconomic group and social health insurance schemes. Methods In this population-based, panel data analysis, we used data from three waves of the nationally representative China Health and Retirement Longitudinal Study (CHARLS) for 2011, 2013, and 2015. We included participants aged 50 years and older in 2015, who had complete follow-up for the three waves. We used 11 physical non-communicable diseases to measure physical multimorbidity and annual per-capita household consumption spending as a proxy for socioeconomic status. Findings Of 17 708 participants in CHARLS, 11 817 were eligible for inclusion in our analysis. The median age of participants was 62 years (IQR 56–69) in 2015, and 5766 (48·8%) participants were male. 7320 (61·9%) eligible participants had physical multimorbidity in China in 2015. The prevalence of physical multimorbidity was increased with older age (odds ratio 2·93, 95% CI 2·71–3·15), among women (2·70, 2·04–3·57), within a higher socioeconomic group (for quartile 4 [highest group] 1·50, 1·24–1·82), and higher educational level (5·17, 3·02–8·83); however, physical multimorbidity was more common in poorer regions than in the more affluent regions. An additional chronic non-communicable disease was associated with an increase in the number of outpatient visits (incidence rate ratio 1·29, 95% CI 1·27–1·31), and number of days spent in hospital as an inpatient (1·38, 1·35–1·41). We saw similar effects in health service use of an additional chronic non-communicable disease in different socioeconomic groups and among those covered by different social health insurance programmes. Overall, physical multimorbidity was associated with a significantly increased likelihood of catastrophic health expenditure (for the overall population: odds ratio 1·29, 95% CI 1·26–1·32, adjusted for sociodemographic variables). The effect of physical multimorbidity on catastrophic health expenditures persisted even among the higher socioeconomic groups and across all health insurance programmes. Interpretation Concerted efforts are needed to reduce health inequalities that are due to physical multimorbidity, and its adverse economic effect in population groups in China. Social health insurance reforms must place emphasis on reducing out-of-pocket spending for patients with multimorbidity to provide greater financial risk protection. Funding None.
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Affiliation(s)
- Yang Zhao
- The Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia; WHO Collaborating Centre on Implementation Research for Prevention and Control of Noncommunicable Diseases, Melbourne, VIC, Australia; The George Institute for Global Health at Peking University Health Science Center, Beijing, China.
| | - Rifat Atun
- Department of Global Health and Population, Harvard T H Chan School of Public Health and Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Brian Oldenburg
- The Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia; WHO Collaborating Centre on Implementation Research for Prevention and Control of Noncommunicable Diseases, Melbourne, VIC, Australia
| | - Barbara McPake
- The Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Shenglan Tang
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Stewart W Mercer
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Thomas E Cowling
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Grace Sum
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Vicky Mengqi Qin
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - John Tayu Lee
- The Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia; Public Health Policy Evaluation Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
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Milà C, Ranzani O, Sanchez M, Ambrós A, Bhogadi S, Kinra S, Kogevinas M, Dadvand P, Tonne C. Land-Use Change and Cardiometabolic Risk Factors in an Urbanizing Area of South India: A Population-Based Cohort Study. ENVIRONMENTAL HEALTH PERSPECTIVES 2020; 128:47003. [PMID: 32243204 PMCID: PMC7228094 DOI: 10.1289/ehp5445] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
BACKGROUND Land-use changes in city fringes due to urbanization can lead to a reduction of greenspace that may reduce its associated health benefits. OBJECTIVES We evaluated the association between changes in residential surrounding built-up land use and cardiometabolic risk factors in an urbanizing peri-urban area of south India and explored the mediating roles of air pollution, physical activity, and stress in these associations. METHODS We analyzed data on 6,039 adults from the third follow-up of the Andhra Pradesh Children and Parent Study (APCAPS) cohort (2010-2012). We generated trajectories of change in residential surrounding built-up land use (buffer areas) from 1995-2009 (stable, slow increase, fast increase) using remote sensing data and image classification methods. We estimated associations between built-up land use trajectories and natural log-transformed blood pressure, waist circumference, triglycerides, fasting glucose, and non-high-density lipoprotein (non-HDL) cholesterol using linear mixed models. We accounted for multiple mediators and the multilevel structure of the data in mediation analyses. RESULTS We observed positive associations between a fast increase in built-up land use within 300m of the home and all cardiometabolic risk factors. Compared with participants with stable trajectories, those with the largest increase in built-up land use had 1.5% (95% CI: 0.1, 2.9) higher systolic blood pressure, 2.4% (95% CI: 0.6, 4.3) higher diastolic blood pressure, 2.1% (95% CI: 0.5, 3.8) higher waist circumference, and 1.6% (95% CI: -0.6, 3.8) higher fasting glucose in fully adjusted models. Associations were positive, but not statistically significant, for triglycerides, fasting glucose, and non-HDL cholesterol. Physical activity and ambient particulate matter ≤2.5μm in aerodynamic diameter (PM2.5) partially mediated the estimated associations. Associations between fast build-up and all cardiometabolic risk factors except non-HDL cholesterol were stronger in women than men. DISCUSSION Increases in built-up land use surrounding residences were consistently associated with higher levels of cardiometabolic risk factors. Our findings support the need for better integration of health considerations in urban planning in rapidly urbanizing settings. https://doi.org/10.1289/EHP5445.
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Affiliation(s)
- Carles Milà
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Otavio Ranzani
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Margaux Sanchez
- Vieillissement et Maladies chroniques, Institut national de la santé et de la recherche médicale, Paris, France
| | - Albert Ambrós
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Madrid, Spain
| | | | - Sanjay Kinra
- London School of Hygiene and Tropical Medicine, London, UK
| | - Manolis Kogevinas
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Payam Dadvand
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Cathryn Tonne
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Madrid, Spain
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Babatunde OA, Olarewaju SO, Adeomi AA, Akande JO, Bashorun A, Umeokonkwo CD, Bamidele JO. 10-year risk for cardiovascular diseases using WHO prediction chart: findings from the civil servants in South-western Nigeria. BMC Cardiovasc Disord 2020; 20:154. [PMID: 32234017 PMCID: PMC7110661 DOI: 10.1186/s12872-020-01438-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 03/16/2020] [Indexed: 01/11/2023] Open
Abstract
Background Globally, cardiovascular diseases (CVDs) have continued to ravage the human existence through the premature deaths of its workforce. Despite this burden, many studies in Nigeria have focused on determining the prevalence of risk factors which alone are insufficient to assess the risk of future cardiovascular events. Therefore, we determined the pattern and predictors of 10-year risk for CVDs in South-western Nigeria. Methods We conducted a cross-sectional study among workers at the local government areas (LGAs) of Oyo State. Using a multi-stage sampling technique, we recruited 260 respondents from the LGA secretariats. A pre-tested, interviewer-administered questionnaire was administered to obtain information on the socio-demographics and behavioural attributes. Lipid analysis, anthropometric, blood pressure, fasting blood glucose measurements were done using standard protocols. The respondents’ CVD risk was assessed using WHO prediction chart. Data were analyzed using IBM SPSS version 25; bivariate analysis was done using Chi-square and binary logistic regression was used to identify the predictors of 10-year risk for CVDs at 5% level of significance. Results The mean age of respondents was 46.0 + 6.7 years. The proportion of respondents with good knowledge of risk factors was 57.7%. The prevalence of CVD risk factors were as follows: systolic hypertension (29.6%), visceral obesity (35.8%), diabetes mellitus (18.8%), smoking (5.8%), elevated total cholesterol (55.4%) and physical inactivity (84.6%). The proportion of respondents with low, moderate and high risk of developing CVDs within 10 years was 76.9, 8.5 and 14.6% respectively. Respondents with age ≥ 40 years (aOR = 2.6, 95% CI = 1.3–8.5), management cadre (aOR = 3.8, 95% CI = 1.6–9.6), obesity (aOR = 4.8, 95% CI = 1.2–120), abnormal waist circumference (aOR = 2.8, 95% CI = 1.3–5.2) and physical inactivity (aOR = 2.4, 95% CI = 1.2–4.7) were associated with the higher likelihood of developing CVDs. Conclusion About one-sixth of the respondents had high risk of developing CVDs within the next 10 years and it is likely that it will reduce the productivity of the State. Lifestyle modification and early detection of risk factors through regular screening programmes for those with high CVD risk is therefore recommended.
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Affiliation(s)
- Olaniyan Akintunde Babatunde
- Department of Community Medicine, Ladoke Akintola University of Technology, Ogbomoso, Oyo State, Nigeria. .,Nigeria Field Epidemiology and Laboratory Training Program, Abuja, Nigeria. .,Oyo State Primary Healthcare Board, Agodi, Ibadan, Oyo State, Nigeria.
| | | | - Adeleye Abiodun Adeomi
- Department of Community Medicine, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Joel Olufunminiyi Akande
- Department of Chemical Pathology, BOWEN University Teaching Hospital, Ogbomoso, Oyo State, Nigeria
| | | | - Chukwuma David Umeokonkwo
- Nigeria Field Epidemiology and Laboratory Training Program, Abuja, Nigeria.,Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
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Ghosal S, Sinha B, Ved J, Biswas M. Quantitative measure of asymptomatic cardiovascular disease risk in Type 2 diabetes: Evidence from Indian outpatient setting. Indian Heart J 2020; 72:119-122. [PMID: 32534684 PMCID: PMC7296234 DOI: 10.1016/j.ihj.2020.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/28/2020] [Accepted: 03/28/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The cardiovascular (CV) risk of patients with Type 2 diabetes (T2D) of Indo-Asian descent has never been objectively assessed, although it is documented that they have a higher prevalence of CV disease (CVD). AIMS To identify groups of Indian patients with asymptomatic T2D who are at high risk of CVD as per the QRISK calculator. METHOD After an adequate power calculation, a nation-wide study of patients with asymptomatic T2D was conducted. The QRISK3 scores of these patients were used to derive a 10-year risk of CV events. High CVD risk was defined as ≥20% risk of CV event in 10 years. RESULTS For a total of 1538 patients across 154 outpatient departments, the QRISK3 scores were collated. Median 10-year CVD risk was 22.2%. Mean 10-year CVD risk was 28.4% (standard deviation 22.1%), representing a 5.7-fold increase vs. controls (i.e., matched healthy adults). Absolute CVD risk increased linearly with age. Over 50% of T2D males aged above 45 years had a high (>20%) CVD risk. Women aged more than 55 years had a high risk of CVD. More than 50% of patients with a T2D duration of more than 5 years had a high risk of CVD as per the QRISK3 calculator.
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Abstract
To an extent the question posed in the title of this paper can simply be answered in the affirmative. Based on the extensive data available from the National Family Health Survey-1 (NFHS-1) conducted in 1992-93 and NFHS-4 in 2015-16 there has been a significant overall decline of some 19% in the prevalence of consanguineous marriage in India. However, when examined at state level the picture is more complex, with large reductions in consanguinity in southern states where intra-familial marriage previously has been strongly favoured, whereas in some northern states in which close kin unions traditionally have been proscribed small increases were recorded. In a country such as India, comprising an estimated 18% of the current world population and with multiple ethnic, religious, geographical and social sub-divisions, apparently contrary findings of this nature are not unexpected - especially given the major shifts that are underway in family sizes, in education and employment, and with rapid urbanization. The changing health profile of the population also is an important factor, with non-communicable diseases now responsible for a majority of morbidity and premature mortality in adulthood. The degree to which future alterations in the prevalence and profile of consanguineous marriage occur, and at what rate, is difficult to predict - the more so given the markedly diverse cultural identities that remain extant across the Sub-Continent, and ongoing intra-community endogamy.
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Joseph LM, Lekha TR, Boban D, Jose P, Jeemon P. Perceived facilitators and barriers of enrolment, participation and adherence to a family based structured lifestyle modification interventions in Kerala, India: A qualitative study. Wellcome Open Res 2019; 4:131. [PMID: 31828226 PMCID: PMC6896244 DOI: 10.12688/wellcomeopenres.15415.2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2019] [Indexed: 02/03/2023] Open
Abstract
Background: The objective of the study was to describe participants’ and providers’ perspectives of barriers and facilitators of enrolment, participation and adherence to a structured lifestyle modification (SLM) interventions as part of the PROLIFIC trial in Kerala, India. Methods: Family members who had been enrolled for 12-months or more in a family-based cardiovascular risk reduction intervention study (PROLIFIC Trial) were purposively sampled and interviewed using a semi-structured guide. The non-physician health workers (NPHWs) delivering the intervention were also interviewed or included in focus groups (FGDs). Thematic analysis was used for data analysis. Results: In total, 56 in-depth interviews and three FGDs were conducted. The descriptive themes emerged were categorised as (a) motivation for enrolment and engagement in the SLM interventions, (b) facilitators of adherence, and (c) reasons for non-adherence. A prior knowledge of familial cardiovascular risk, preventive nature of the programme, and a reputed organisation conducting the intervention study were appealing to the participants. Simple suggestions of healthier alternatives based on existing dietary practices, involvement of the whole family, and the free annual blood tests amplified the adherence. Participants highlighted regular monitoring of risk factors and provision of home-based care by NPHWs as facilitators for adherence. Furthermore, external motivation by NPHWs in setting and tracking short terms goals were perceived as enablers of adherence. Nonetheless, home makers expressed difficulty in dealing with varied food choices of family members. Young adults in the programme noted that dietary changes were affected by eating out as they wanted to fit in with peers. Conclusions: The findings suggest that a family-based, trained healthcare worker led SLM interventions are desirable and feasible in Kerala. Increasing the number of visits by NPHWs, regular monitoring and tracking of lifestyle goals, and targeting young adults and children for dietary changes may further improve adherence to SLM interventions.
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Affiliation(s)
- Linju M Joseph
- Centre for Chronic Disease Control, New Delhi, New Delhi, 110016, India
| | - T R Lekha
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - Dona Boban
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - Prinu Jose
- Centre for Chronic Disease Control, New Delhi, New Delhi, 110016, India
| | - Panniyammakal Jeemon
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
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Sudharsanan N, Deshmukh M, Kalkonde Y. Direct estimates of disability-adjusted life years lost due to stroke : a cross-sectional observational study in a demographic surveillance site in rural Gadchiroli, India. BMJ Open 2019; 9:e028695. [PMID: 31699719 PMCID: PMC6858195 DOI: 10.1136/bmjopen-2018-028695] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To directly estimate disability-adjusted life years (DALYs) lost due to stroke in rural Gadchiroli, India and measure the contribution of mortality and disability to total DALYs lost. DESIGN Cross-sectional descriptive study using population census, vital registration and stroke prevalence data. SETTING A demographic surveillance site of 86 villages in Gadchiroli, a rural district in Maharashtra, India. PARTICIPANTS Population counts and mortality information were drawn from a census and vital registration system covering a population of approximately 94 154 individuals; stroke prevalence information was based on a door-to-door evaluation of all 45 053 individuals from 39 of the 86 villages in the surveillance site. PRIMARY OUTCOME MEASURES Years of life lost (YLL), years lived with disability (YLD) and DALYs lost due to stroke. RESULTS There were 229 stroke deaths among the total population of 94 154 individuals and 175 stroke survivors among the subpopulation of 45 053 individuals. An estimated 2984 DALYs were lost due to stroke per 100 000 person-years with a higher burden among men compared with women (3142 vs 2821 DALYs). Over three-fourths (80%) of the total DALYs lost due to stroke were between ages 30 and 70 years. YLL accounted for 98.9% of total DALYs lost. CONCLUSIONS There was a high burden of stroke in rural Gadchiroli with a significant burden at premature ages. These results reveal a substantial need for surveillance and improved preventive and curative services for stroke in rural India.
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Affiliation(s)
- Nikkil Sudharsanan
- Center for Population and Development Studies, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- Population Studies Center, University of Pennsylvania, Philadelphia, PA, United States
| | - Mahesh Deshmukh
- Society for Education Action and Research in Community Health, Gadchiroli, Maharashtra, India
| | - Yogeshwar Kalkonde
- Society for Education Action and Research in Community Health, Gadchiroli, Maharashtra, India
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Mishra S, Perkins JM, Khan PK, Kim R, Mohanty SK, Subramanian SV. Variation in Chronic Diseases Across Households, Communities, Districts, and States in India. Am J Prev Med 2019; 57:721-731. [PMID: 31630764 DOI: 10.1016/j.amepre.2019.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 06/04/2019] [Accepted: 06/05/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Globally, chronic noncommunicable diseases are the leading cause of death and accounted for 6 million deaths in India in 2016. However, the extent to which variation in chronic disease can be attributed to different population levels in India is unknown, as is whether variation in individual-level factors explains outcome variation at different population levels. METHODS Cross-sectional data from the District Level Household and Facility Survey 2012-2013 conducted across 21 states, 275 districts, 14,235 villages, 378,487 households, and 1,098,940 individuals aged ≥18 years in India were analyzed in 2018‒2019. Multilevel logistic models were used to partition variation in outcomes and attribute it to individual, household, village, district and state population levels. Outcomes included experiencing respiratory, cardiovascular, musculoskeletal, or eye symptoms; reporting a positive diagnosis by a doctor for chronic heart disease, hypertension, diabetes, or vision problems; and objectively assessed real-time measures of hypertension and diabetes. RESULTS For reported diagnosis of hypertension or diabetes, a much larger percentage of variation in these outcomes was attributed to differences among households as compared to differences among units within other population levels. However, for objectively measured hypertension and diabetes, variation in these outcomes was important at the village level, followed by variation at the household level. Wealth status was positively associated with respiratory and cardiovascular symptoms, as well as all reported diagnoses and real-time measurements except for vision problems. Inclusion of individual-level sociodemographic variables explained 0%-30% of variation attributed to the household level for most chronic disease symptoms and diagnoses, but almost none at the higher levels. CONCLUSIONS These findings imply that household- and village-level factors explain substantial variation in the prevalence of chronic disease symptoms and reported diagnoses in India.
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Affiliation(s)
- Suyash Mishra
- Department of Fertility Studies, International Institute for Population Sciences, Mumbai, India
| | - Jessica M Perkins
- Department of Human and Organizational Development, Peabody College, Vanderbilt University, Nashville, Tennessee; Vanderbilt Institute of Global Health, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Pijush Kanti Khan
- Department of Fertility Studies, International Institute for Population Sciences, Mumbai, India
| | - Rockli Kim
- Harvard Center for Population and Development Studies, Cambridge, Massachusetts
| | - Sanjay K Mohanty
- Department of Fertility Studies, International Institute for Population Sciences, Mumbai, India
| | - S V Subramanian
- Harvard Center for Population and Development Studies, Cambridge, Massachusetts; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Prabhakaran D, Jaacks LM. Reflections From India on Scaling Up Risk Factor Control for Cardiovascular Diseases to Reach 1 Billion Adults. Circulation 2019; 139:4-6. [PMID: 30592651 DOI: 10.1161/circulationaha.118.035975] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Dorairaj Prabhakaran
- Public Health Foundation of India, Gurgaon, Haryana (D.P., L.M.J.).,Centre for Chronic Disease Control, New Delhi, India (D.P.)
| | - Lindsay M Jaacks
- Public Health Foundation of India, Gurgaon, Haryana (D.P., L.M.J.).,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA (L.M.J.)
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Dubey M, Rastogi S, Awasthi A. Hypertension prevalence as a function of different guidelines, India. Bull World Health Organ 2019; 97:799-809. [PMID: 31819288 PMCID: PMC6883270 DOI: 10.2471/blt.19.234500] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 08/23/2019] [Accepted: 08/23/2019] [Indexed: 12/16/2022] Open
Abstract
Objective To determine the effect of different hypertension management guidelines and of basing diagnosis on a single reading of blood pressure on the hypertension prevalence in the Indian population. Methods We performed a secondary analysis of data acquired as part of the Fourth national family health survey, 2015 to 2016, over all districts in India. We calculated the proportion of the population within three different age groups (18 to 34, 35 to 49 and 18 to 49 years of age) with raised blood pressure according to six different guidelines, and how prevalence changed if diagnoses were based on a single blood pressure measurement. Findings We observed that the Government of India and the American College of Cardiology/American Heart Association guidelines consistently yielded the lowest and highest prevalence of raised blood pressure; in the combined age group, we calculated the proportion of the population categorized as having raised blood pressure as 7.5% (95% confidence interval (CI): 7.4 to 7.7) and 40.1% (95% CI: 39.7 to 40.7), respectively. When basing diagnosis on a single reading of blood pressure only, a total of 56 million individuals would be erroneously categorized as hypertensive following the Government of India guidelines. We also showed that prevalence of hypertension in India varies with guidelines adhered to; in the combined age group, the national hypertension prevalence was three times higher when following the American College of Cardiology/American Heart Association compared with the Government of India guidelines. Conclusion To optimize current clinical practice, health-care providers need to follow universally agreed, evidence-based methods of diagnosing hypertension.
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Affiliation(s)
| | | | - Ashish Awasthi
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Plot No. 47, Sector 44, Institutional Area, Gurugram, 122002, India
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Jung L, De Neve JW, Chen S, Manne-Goehler J, Jaacks LM, Corsi DJ, Awasthi A, Subramanian S, Vollmer S, Bärnighausen T, Geldsetzer P. Nationally representative household survey data for studying the interaction between district-level development and individual-level socioeconomic gradients of cardiovascular disease risk factors in India. Data Brief 2019; 27:104486. [PMID: 31720318 PMCID: PMC6838398 DOI: 10.1016/j.dib.2019.104486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 08/29/2019] [Indexed: 01/23/2023] Open
Abstract
In this article, we describe the dataset used in our study entitled “The interaction between district-level development and individual-level socioeconomic gradients of cardiovascular disease risk factors in India: A cross-sectional study of 2.4 million adults”, recently published in Social Science & Medicine, and present supplementary analyses. We used data from three different household surveys in India, which are representative at the district level. Specifically, we analyzed pooled data from the District-Level Household Survey 4 (DLHS-4) and the second update of the Annual Health Survey (AHS), and separately analyzed data from the National Family Health Survey (NFHS-4). The DLHS-4 and AHS sampled adults aged 18 years or older between 2012 and 2014, while the NFHS-4 sampled women aged 15–49 years and - in a subsample of 15% of households - men aged 15–54 years in 2015 and 2016. The measures of individual-level socio-economic status that we used in both datasets were educational attainment and household wealth quintiles. The measures of district-level development, which we calculated from these data, were i) the percentage of participants living in an urban area, ii) female literacy rate, and iii) the district-level median of the continuous household wealth index. An additional measure of district-level development that we used was Gross Domestic Product per capita, which we obtained from the Planning Commission of the Government of India for 2004/2005. Our outcome variables were diabetes, hypertension, obesity, and current smoking. The data were analyzed using both district-level regressions and multilevel modelling.
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Affiliation(s)
- Lara Jung
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Jan-Walter De Neve
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Simiao Chen
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Jennifer Manne-Goehler
- Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Lindsay M. Jaacks
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Public Health Foundation of India, New Delhi, Delhi NCR, India
| | - Daniel J. Corsi
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Ashish Awasthi
- Public Health Foundation of India, New Delhi, Delhi NCR, India
| | - S.V. Subramanian
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Sebastian Vollmer
- Department of Economics & Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Africa Health Research Institute, Somkhele, KwaZulu-Natal, South Africa
| | - Pascal Geldsetzer
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Corresponding author.
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The interaction between district-level development and individual-level socioeconomic gradients of cardiovascular disease risk factors in India: A cross-sectional study of 2.4 million adults. Soc Sci Med 2019; 239:112514. [PMID: 31541939 DOI: 10.1016/j.socscimed.2019.112514] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 07/07/2019] [Accepted: 08/21/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Diabetes, hypertension, and obesity tend to be positively associated with socio-economic status in low- and middle-income countries (LMICs). It has been hypothesized that these positive socio-economic gradients will reverse as LMICs continue to undergo economic development. We use population-based cross-sectional data in India to examine how a district's economic development is associated with socio-economic differences in cardiovascular disease (CVD) risk factor prevalence between individuals. METHODS We separately analyzed two nationally representative household survey datasets - the NFHS-4 and the DLHS-4/AHS - that are representative at the district level in India. Diabetes was defined based on a capillary blood glucose measurement, hypertension on blood pressure measurements, obesity on measurements of height and weight, and current smoking on self-report. Five different measures of a district's economic development were used. We analyzed the data using district-level regressions (plotting the coefficient comparing high to low socio-economic status against district-level economic development) and multilevel modeling. RESULTS 757,655 and 1,618,844 adults participated in the NFHS-4 and DLHS-4/AHS, respectively. Higher education and household wealth were associated with a higher probability of having diabetes, hypertension, and obesity, and a lower probability of being a current smoker. For diabetes, hypertension, and obesity, we found that a higher economic development of a district was associated with a less positive (or even negative) association between the CVD risk factor and education. For smoking, the association with education tended to become less negative as districts had a higher level of economic development. In general, these associations did not show clear trends when household wealth quintile was used as the measure of socio-economic status instead of education. CONCLUSIONS While this study provides some evidence for the "reversal hypothesis", large-scale longitudinal studies are needed to determine whether LMICs should expect a likely reversal of current positive socioeconomic gradients in diabetes, hypertension, and obesity as their countries continue to develop economically.
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Prenissl J, Jaacks LM, Mohan V, Manne-Goehler J, Davies JI, Awasthi A, Bischops AC, Atun R, Bärnighausen T, Vollmer S, Geldsetzer P. Variation in health system performance for managing diabetes among states in India: a cross-sectional study of individuals aged 15 to 49 years. BMC Med 2019; 17:92. [PMID: 31084606 PMCID: PMC6515628 DOI: 10.1186/s12916-019-1325-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 04/15/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Understanding where adults with diabetes in India are lost in the diabetes care cascade is essential for the design of targeted health interventions and to monitor progress in health system performance for managing diabetes over time. This study aimed to determine (i) the proportion of adults with diabetes in India who have reached each step of the care cascade and (ii) the variation of these cascade indicators among states and socio-demographic groups. METHODS We used data from a population-based household survey carried out in 2015 and 2016 among women and men aged 15-49 years in all states of India. Diabetes was defined as a random blood glucose (RBG) ≥ 200 mg/dL or reporting to have diabetes. The care cascade-constructed among those with diabetes-consisted of the proportion who (i) reported having diabetes ("aware"), (ii) had sought treatment ("treated"), and (iii) had sought treatment and had a RBG < 200 mg/dL ("controlled"). The care cascade was disaggregated by state, rural-urban location, age, sex, household wealth quintile, education, and marital status. RESULTS This analysis included 729,829 participants. Among those with diabetes (19,453 participants), 52.5% (95% CI, 50.6-54.4%) were "aware", 40.5% (95% CI, 38.6-42.3%) "treated", and 24.8% (95% CI, 23.1-26.4%) "controlled". Living in a rural area, male sex, less household wealth, and lower education were associated with worse care cascade indicators. Adults with untreated diabetes constituted the highest percentage of the adult population (irrespective of diabetes status) aged 15 to 49 years in Goa (4.2%; 95% CI, 3.2-5.2%) and Tamil Nadu (3.8%; 95% CI, 3.4-4.1%). The highest absolute number of adults with untreated diabetes lived in Tamil Nadu (1,670,035; 95% CI, 1,519,130-1,812,278) and Uttar Pradesh (1,506,638; 95% CI, 1,419,466-1,589,832). CONCLUSIONS There are large losses to diabetes care at each step of the care cascade in India, with the greatest loss occurring at the awareness stage. While health system performance for managing diabetes varies greatly among India's states, improvements are particularly needed for rural areas, those with less household wealth and education, and men. Although such improvements will likely have the greatest benefits for population health in Goa and Tamil Nadu, large states with a low diabetes prevalence but a high absolute number of adults with untreated diabetes, such as Uttar Pradesh, should not be neglected.
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Affiliation(s)
- Jonas Prenissl
- Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 130/3, 69120, Heidelberg, Germany. .,Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - Lindsay M Jaacks
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Public Health Foundation of India, New Delhi, Delhi NCR, India
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India
| | - Jennifer Manne-Goehler
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Justine I Davies
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Education Campus, University of Witwatersrand, Johannesburg, Gauteng, South Africa.,Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Ashish Awasthi
- Indian Institute of Public Health, Gandhinagar, Gujarat, India
| | - Anne Christine Bischops
- Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 130/3, 69120, Heidelberg, Germany
| | - Rifat Atun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Harvard Medical School, Harvard University, Boston, MA, USA
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 130/3, 69120, Heidelberg, Germany.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
| | - Sebastian Vollmer
- Department of Economics and Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany
| | - Pascal Geldsetzer
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Kaur S, Bhatti G, Vijayvergiya R, Singh P, Mastana S, Tewari R, Bhatti J. Paraoxonase 1 Gene Polymorphisms (Q192R and L55M) Are Associated with Coronary Artery Disease Susceptibility in Asian Indians. ACTA ACUST UNITED AC 2018. [DOI: 10.1159/000494508] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2022]
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Abstract
In a Perspective, David Peiris and Dorairaj Prabhakaran discuss implications and challenges of cardiovascular disease risk assessments in the population of India.
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Affiliation(s)
- David Peiris
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia
| | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, New Delhi, India
- Public Health Foundation of India, New Delhi, India
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