PREVALENCE OF NONCOMMUNICABLE DISEASES IN INDIADr. Sujay IyerI year PG, General Medicine

TABLE OF CONTENT Introduction Burden of Noncommunicable Disease The ICMR- INDIAB Study Results from the ICMR- INDIAB Study

Diabetes and Prediabetes Obesity Hypertension Dyslipidemia

Summary

INTRODUCTION Noncommunicable diseases (NCDs), also

known as chronic diseases, are not passed from person to person. They are of long duration and generally slow progression.

The 4 main types of noncommunicable diseases are cardiovascular diseases (like heart attacks and stroke), cancers, chronic respiratory diseases (such as chronic obstructive pulmonary disease and asthma) and diabetes.

BURDEN OF NONCOMMUNICABLE DISEASES NCDs kill 38 million people each year. Almost three quarters of NCD deaths - 28 million - occur

in low- and middle-income countries. Sixteen million NCD deaths occur before the age of 70;

82% of these "premature" deaths occurred in low- and middle-income countries.

Cardiovascular diseases account for most NCD deaths, or 17.5 million people annually, followed by cancers (8.2 million), respiratory diseases (4 million), and diabetes (1.5 million).

These 4 groups of diseases account for 82% of all NCD deaths.

Tobacco use, physical inactivity, the harmful use of alcohol and unhealthy diets all increase the risk of dying from an NCD.

ICMR- INDIAB STUDY The ICMR- INDIAB Study is a nationwide cross-

sectional, door to door survey conducted in individuals 20 years and above.

The need for a large representative population-based study which could provide state-wise and rural-urban estimates of NCDs in India was found to be necessary as earlier studies suffered from several limitations.

The total sample size for the INDIAB study was 124000 individuals.

The primary objectives of the study are to determine the prevalence of Diabetes Mellitus and Prediabetes in the Indian population.

ICMR- INDIAB STUDY The additional objectives are to determine

the prevalence of Hypertension, Dyslipidemia, Obesity and Coronary Artery Disease amount the subjects.

The first phase of the study has been completed in four regions: Tamil Nadu, Maharashtra, Jharkhand and Chandigarh. (Phase I: Nov. 2008 to April 2010)

The phase II of the study is ongoing.

RESULTS OF PHASE I OF ICMR-INDIAB STUDY: DIABETES & PREDIABETES Of the 16607 individuals selected, 13055

gave blood samples. Fasting CBG and PP CBG were used for the diagnosis of Diabetes.

The definition of Diabetes was based on fasting CBG of more than 126 mg% or a 2-hour post glucose CBG of more than 220mg%.

The prevalence of Diabetes was: 10.4% in Tamil Nadu (U: 13.7%/ R: 7.8%) 8.4% in Maharashtra (U: 10.9%/ R: 6.5%) 5.3% in Jharkhand (U: 13.5%/ R: 3%) 13.6% in Chandigarh (U: 14.2%/ R: 8.3%)

DIABETES & PREDIABETES Based on these results, it was estimated that

there were 62.4 million people with Diabetes and 77.2 million people with Prediabetes in India as of 2011.

It was also found that the take-off point in prevalence of Diabetes was 25-34 years, which is a decade or two earlier than reported for Western population.

Prevalence of Diabetes was higher in urban areas.

DIABETES & PREDIABETES Age, male gender, family history, urban

residence, abdominal and generalized obesity, hypertension and income status were significant risk factors associated with Diabetes.

Good glycemic control (HbA1C < 7%) was seen on only 31.1% of urban and 30.8% of rural subjects. Mean HbA1C levels were higher than 8% in all regions.

Awareness and knowledge about Diabetes were also assessed. Only 43.2% of the study population had heard about a condition called Diabetes.

DIABETES & PREDIABETES

CORONARY ARTERY DISEASE The prevalence of Coronary Artery Disease in

subjects with or without Diabetes was assessed in the study.

Predictably, prevalence of CAD was found to be higher in patients with Diabetes.

Maharashtra had the highest prevalence of CAD among the four regions.

CORONARY ARTERY DISEASE

OBESITY Obesity, in addition to being an important

NCD in itself, acts as a major risk factor for other NCDs.

Abdominal obesity (AO), as measured by waist circumference, is considered to be a more significant predictor of morbidity and mortality as compared to generalized obesity (GO), as measured by body mass index.

The prevalence of GO was highest in Chandigarh (31.3%) followed by Tamil Nadu (24.6%), Maharashtra (16.6%) and Jharkhand (11.8%).

OBESITY The prevalence of AO, GO and CO (Combined

Obesity) was significantly higher among urban residents compared to rural residents.

HYPERTENSION High blood pressure is ranked as the third most

important risk factor for attributable burden of disease in South Asia.

The prevalence of Hypertension was highest in Tamil Nadu (27.6%), followed by Chandigarh (25.8%), Maharashtra (25%) and Jharkhand (23.8%).

Prevalence was higher in urban areas. Salt intake more than 6.5g/day conferred 1.4

times higher risk for Hypertension. The ratio of newly diagnosed to self-reported

hypertension was 3.8:1 suggesting that the ‘rule of halves’ for hypertension is still valid in India.

HYPERTENSION

DYSLIPIDEMIA Asian Indians are known to have a unique

pattern of dyslipidemia characterized by low HDL cholesterol, high triglyceride levels and high proportion of small dense LDL.

Overall, the prevalence of Dyslipidemia was found to be 79%.

Highest rates were found in Chandigarh (82.9%), followed by Jharkhand (80%), Maharashtra (77%) and Tamil Nadu (76.9%).

Hypercholesterolemia was observed in 13.9%, hypertriglyceridemia in 29.5% and low HDL-C in 72.3%.

DYSLIPIDEMIA

RISK FACTORS The rising trend of NCDs can be attributed, at

least in part, to two of the most modifiable risk factors: Physical inactivity Unhealthy diets.

The study assessed the levels of physical inactivity. Overall, 54.4% of the population were inactive.

Subjects were more inactive in urban regions.

SUMMARY The Phase I results of the ICMR- INDIAB study

shows that the prevalence of NCDs is are higher in both urban and rural areas of India compared to earlier studies.

Less than a third of individuals in India exhibit a good glycemic control.

Knowledge and awareness about Diabetes is still low.

Nearly half the population is physically inactive.

The survey lays the foundation for effective NCD prevention and control.

“THE PREVENTION OF DISEASE TODAY IS ONE OF THE MOST IMPORTANT FACTORS IN LINE OF HUMAN ENDEAVOUR” – CHARLES MAYOTHANK YOU