Abstract
SummaryIntroductionIndia accounts for about a fifth of cardiovascular deaths globally, but nationally representative data on mortality trends are not yet available. In this nationwide mortality study, we aimed to assess the trends in ischaemic heart disease and stroke mortality over 15 years using the Million Death Study.MethodsWe determined national and subnational cardiovascular mortality rates and trends by sex and birth cohort using cause of death ascertained by verbal autopsy from 2001 to 2013 among 2·4 million households. We derived mortality rates for ischaemic heart disease and stroke by applying mortality proportions to UN mortality estimates for India and projected the rates from 2000 to 2015.FindingsCardiovascular disease caused more than 2·1 million deaths in India in 2015 at all ages, or more than a quarter of all deaths. At ages 30–69 years, of 1·3 million cardiovascular deaths, 0·9 million (68·4%) were caused by ischaemic heart disease and 0·4 million (28·0%) by stroke. At these ages, the probability of dying from ischaemic heart disease increased during 2000–15, from 10·4% to 13·1% in men and 4·8% to 6·6% in women. Ischaemic heart disease mortality rates in rural areas increased rapidly and surpassed those in urban areas. By contrast, the probability of dying from stroke decreased from 5·7% to 5·0% in men and 5·0% to 3·9% in women. A third of premature stroke deaths occurred in the northeastern states, inhabited by a sixth of India’s population, where rates increased significantly and were three times higher than the national average. The increased mortality rates of ischaemic heart disease nationally and stroke in the northeastern states were higher in the cohorts of adults born in the 1970s onwards, than in earlier decades. A large and growing proportion of the ischaemic heart disease nationally and stroke deaths in high-burden states reported earlier diagnosis of cardiovascular disease, but low medication use.InterpretationThe unexpectedly diverse patterns of cardiovascular mortality require investigation to identify the role of established and new cardiovascular risk factors. Secondary prevention with effective and inexpensive long-term treatment and adult smoking cessation could prevent substantial numbers of premature deaths. Without progress against the control of cardiovascular disease in India, global goals to reduce non-communicable diseases by 2030 will be difficult to achieve.FundingFogarty International Center of the US National Institutes of Health, Dalla Lana School of Public Health, University of Toronto, Indian Council of Medical Research, and the Disease Control Priorities.
Highlights
WHO estimates that India accounts for just over a fifth of these deaths1 and reduction of global cardiovascular mortality greatly depends on India, where cardiovascular disease develops a decade earlier in life compared with high-income countries
Understanding of the differ ences in cardiovascular mortality by sex, rural and urban residence, and age across India can help to plan prevent ion and treatment services and identify causes that might differ from cardiovascular risk factors documented in high-income countries
We aimed to examine the trends in ischaemic heart disease and stroke mortality using the Million Death Study, a large ongoing nationally representative mortality study
Summary
Cardiovascular disease, comprising mostly ischaemic heart disease and stroke, is the leading cause of death worldwide, accounting for 17·7 million deaths annually. Of these deaths, 6·2 million (35%) occur in middle age (30–69 years). WHO estimates that India accounts for just over a fifth of these deaths and reduction of global cardiovascular mortality greatly depends on India, where cardiovascular disease develops a decade earlier in life compared with high-income countries.2Cardiovascular mortality has not been measured directly and systematically across India, with evidence on burdens mostly drawn from small, local studies. Over the past 15 years, unequal distribution of the country’s rapid eco nomic growth and urbanisation has probably contributed to marked regional differences in the key risk factors for cardiovascular mortality. Understanding of the differ ences in cardiovascular mortality by sex, rural and urban residence, and age across India can help to plan prevent ion and treatment services and identify causes that might differ from cardiovascular risk factors documented in high-income countries. We aimed to examine the trends in ischaemic heart disease and stroke mortality using the Million Death Study, a large ongoing nationally representative mortality study.. Cardiovascular disease, comprising mostly ischaemic heart disease and stroke, is the leading cause of death worldwide, accounting for 17·7 million deaths annually.. Cardiovascular disease, comprising mostly ischaemic heart disease and stroke, is the leading cause of death worldwide, accounting for 17·7 million deaths annually.1 Of these deaths, 6·2 million (35%) occur in middle age (30–69 years).. WHO estimates that India accounts for just over a fifth of these deaths and reduction of global cardiovascular mortality greatly depends on India, where cardiovascular disease develops a decade earlier in life compared with high-income countries.. Understanding of the differ ences in cardiovascular mortality by sex, rural and urban residence, and age across India can help to plan prevent ion and treatment services and identify causes that might differ from cardiovascular risk factors documented in high-income countries..
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