PREVENTION AND CONTROL OF LIFESTYLE DISEASE. Proportion of global deaths under the age 70 years, by...
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PREVENTION AND CONTROL OF LIFESTYLE DISEASE
Proportion of global deaths under the age70 years, by cause of death, comparable estimates, 2012
Age-standardized NCD death rates by WHO region
Probability of dying from the four main noncommunicable diseases between the ages of 30 and 70 yearscomparable estimates, 2012
NCD and risk factors
Cardiovascular diseases
Cardiovascular diseases
Cardiovascular diseases is the leading cause of mortality in Kerala contributing to as much as 40% of all deaths.
The age adjusted death rate due to cardiovascular in the state is 490 per lakh for men and 231 per lakh for women every year
Coronary artery diseases
State reports a higher prevalence of coronary artery diseases when compared to other states in India 7.4% in rural (in 1991) 13.5% in urban(in 1995)
The estimated prevalence of coronary artery disease in the age group 20-69 years for 2015 is 10.1 %.(31)
*Kutty VR, Balakrishnan KG, Jayasree AK, Thomas J. Prevalence of coronary heart disease in the rural population of Thiruvananthapuram district, Kerala, India. Int J Cardiol [Internet]. 1993 Apr [cited 2015 Apr 24];39(1):59–70. Available from: http://www.ncbi.nlm.nih.gov/pubmed/8407009**Begom R, Singh RB. Prevalence of coronary artery disease and its risk factors in the urban population of South and North India. Acta Cardiol [Internet]. 1995 Jan [cited 2015 May 7];50(3):227–40. Available from: http://www.ncbi.nlm.nih.gov/pubmed/7676762***National Commission on Macroeconomics and Health. NCMH Background Papers·Burden of Disease in India. New delhi; 2005. p. 1–388. Available from: http://www.who.int/macrohealth/action/NCMH_Burden of disease_(29 Sep 2005).pdf
Death due to coronary artery disease in kerala
Kerala China Japan United states
0
50
100
150
200
250
300
350
400
450
382
64 50
170
128
4115
70
malesfemales
Per
10
0,0
00
Mohanan PP, Mathew R, Harikrishnan S, Krishnan MN, Zachariah G, Joseph J, et al. Presentation, management, and outcomes of 25 748 acute coronary syndrome admissions in Kerala, India: results from the Kerala ACS Registry. Eur Heart J [Internet]. 2013 Jan 7 [cited 2015 May 8];34(2):121–9. Available from: http://eurheartj.oxfordjournals.org/content/early/2012/09/06/eurheartj.ehs219
Acute coronary event in Kerala CAD in Kerala is both premature and
malignant Average age is 60 years (56 in males and 69 in
females)
60% of CAD deaths in men and 40% of CAD deaths in women occur before the age of 65 (USA-18%)
1 month case fatality rate following STEMI- 8.5% ( around 4 in developed countries)
Soman CR, Kutty VR, Safraj S, Vijayakumar K, Rajamohanan K, Ajayan K. All-cause mortality and cardiovascular mortality in Kerala state of India: results from a 5-year follow-up of 161,942 rural community dwelling adults. Asia Pac J Public Health [Internet]. 2011 Nov [cited 2015 Apr 23];23(6):896–903. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20460280
Mohanan PP, Mathew R, Harikrishnan S, Krishnan MN, Zachariah G, Joseph J, et al. Presentation, management, and outcomes of 25 748 acute coronary syndrome admissions in Kerala, India: results from the Kerala ACS Registry. Eur Heart J [Internet]. 2013 Jan 7 [cited 2015 May 8];34(2):121–9. Available from: http://eurheartj.oxfordjournals.org/content/early/2012/09/06/eurheartj.ehs219
Stroke
Prevalence stroke among adults (>18 years ) in the state was 0.3%
The age adjusted annual incidence of stroke in Kerala in 2010 was 135 per 100,000 were more in males (143 )compared to females (128)
Ischemic stroke was the most common type of stroke ( 73 per 100000)
#Menon J, Joseph J, Thachil A, Attacheril T V, Banerjee A. Surveillance of noncommunicable diseases by community health workers in Kerala: the epidemiology of noncommunicable diseases in rural areas (ENDIRA) study. Glob Heart [Internet]. 2014 Dec [cited 2015 Apr 1];9(4):409–17. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25592794
##Soman CR, Kutty VR, Safraj S, Vijayakumar K, Rajamohanan K, Ajayan K. All-cause mortality and cardiovascular mortality in Kerala state of India: results from a 5-year follow-up of 161,942 rural community dwelling adults. Asia Pac J Public Health [Internet]. 2011 Nov [cited 2015 Apr 23];23(6):896–903. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20460280
Stroke
No urban rural difference in incidence
average age of stroke patients was 67 years stroke in the young( <40 years,)only 4%
case fatality rate within one month was 24.5% for urban and 37.1% for rural populations which is comparable to national figuresSridharan SE, Unnikrishnan JP, Sukumaran S, Sylaja PN, Nayak SD, Sarma PS, et al. Incidence,
types, risk factors, and outcome of stroke in a developing country: the Trivandrum Stroke Registry. Stroke [Internet]. 2009 Apr 1 [cited 2015 May 5];40(4):1212–8. Available from: http://stroke.ahajournals.org/content/40/4/1212.full
Cancer
Incidence of cancer in Kerala
Kerala (1) India (2) World (2)0
50
100
150
200
250
132
97
204
123
92
167
malesfemales
Per
10
0,0
00
1.Three Year Report of PBCR 2009-2011 [Internet]. [cited 2015 Apr 28]. Available from: http://www.ncrpindia.org/ALL_NCRP_REPORTS/PBCR_REPORT_2009_2011/ALL_CONTENT/Printed_Version.htm2 GLOBOCAN :Fact Sheets by Population [Internet]. [cited 2015 Apr 27]. Available from: http://globocan.iarc.fr/Pages/fact_sheets_population.aspx
Trend in incidence of cancer in Kerala
1991-92
1993-97
1998-02
2005-07
2009-11
0
20
40
60
80
100
120
140
109.2
87.896.6
132.3 132.6
87.181.1 80
114.9123.2
Thiruvananthapuram
males females
In 1
00
,00
0
1991-92
1993-97
1998-02
2005-07
2009-11
0
20
40
60
80
100
120
140
115.9 116.6
99.4 102.6
118.5
80.4 80.4 76 76.3
91.6
Kollam
Males Females
In 1
00
,00
0
*CI5 - Home [Internet]. [cited 2015 Apr 27]. Available from: http://ci5.iarc.fr/Default.aspx**Three Year Report of PBCR 2009-2011 [Internet]. [cited 2015 Apr 28]. Available from: http://www.ncrpindia.org/ALL_NCRP_REPORTS/PBCR_REPORT_2009_2011/ALL_CONTENT/Printed_Version.htm
Among males lung cancer (14.5%) was the leading site followed by cancer of oral cavity (14.2%).
Among females cancer of breast (29.8%) was the leading site of cancer followed by cancer of thyroid( 12.5%)
Children (0-14years) constituted 4.8% of all cancers and leukemia was the predominant cancer among them in both genders ( males 57.5% and females 47.5%).
-100
0
100
200
300
400
500
600
Change in cancer incidence in males from 1991-92 to 2009-11
%
Mul
tiple
mye
lom
a
Corpu
s ut
eri
Gallb
ladd
er e
tc.
Mel
anom
a of
skin
Lung
Brea
st
Ovary
etc
.
Panc
reas
Live
r
Conne
ctive
tissu
e
Stom
ach
Oesop
hagu
s
Nose
sinu
ses et
c.
geni
tal o
rgan
s
-100
-50
0
50
100
150
200
250
300
350
Change in cancer incidence in females from 1991-92 to 2009-11
%
Chronic Lung diseases
Chronic lung diseases
Chronic obstructive pulmonary diseases (COPD) accounted for 5.2% of the total NCD burden and 12.2% of the NCD related mortality.
In Kerala, 15.3% of the death were due to respiratory causes of which COPD was the main culprit
Prevalence of chronic respiratory disease in Kerala
Kerala India0
2
4
6
8
10
12
10.1
3.53.1
1.9
Chronic bronchitisAsthma%
Jindal SK. Indian Study on Epidemiology of Asthma , Respiratory Symptoms and Chronic Bronchitis ( INSEARCH ) A Multi ‐ Centre Study ( 2006 ‐ 2009 ) Department of Pulmonary Medicine [Internet]. 2010. Available from: http://icmr.nic.in/final/INSEARCH_Full _Report.pdf
urban rural0
2
4
6
8
10
12
14
16
5
13.5
4.5
1.9
Chronic bronchitisAsthma
Males Females0
2
4
6
8
10
12 11
9
2.53.7
Chronic bronchitisAsthma
Prevalence of chronic bronchitis
35-44 45-54 55-64 65-74 75-84 >840.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
6.29.4
14.618.7
27.0
37.5
Kerala
Kerala
Chronic Kidney disease
Age-adjusted incidence rate of ESRD in India to be 22.9 per lakh population. 7500 new chronic kidney diseases every year
in Kerala Prevalence in hospitalized patients is 17 %
33 % in Kerala Main causes are diabetes nephropathy
and hypertensive nephrosclerosis*Modi GK, Jha V. The incidence of end-stage renal disease in India: a population-based study. Kidney Int [Internet]. 2006 Dec 25 [cited 2015 May 2];70(12):2131–3. Available from: http://dx.doi.org/10.1038/sj.ki.5001958**Singh AK, Farag YMK, Mittal B V, Subramanian KK, Reddy SRK, Acharya VN, et al. Epidemiology and risk factors of chronic kidney disease in India - results from the SEEK (Screening and Early Evaluation of Kidney Disease) study. BMC Nephrol [Internet]. 2013 Jan [cited 2015 Apr 22];14(1):114. Available from: http://www.biomedcentral.com/1471-2369/14/114***Rajapurkar MM, John GT, Kirpalani AL, Abraham G, Agarwal SK, Almeida AF, et al. What do we know about chronic kidney disease in India: first report of the Indian CKD registry. BMC Nephrol [Internet]. 2012 Jan [cited 2015 Apr 17];13:10. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3350459&tool=pmcentrez&rendertype=abstract
Diabetes
Age-standardized prevalence of diabetes, 2014
Comparison of current age standardized prevalence of diabetes in above 18 years
Kerala India world0
2
4
6
8
10
12
14
16 14.8
9.5 9
Age standardized prevalence of di-abetes among >18 years
Thankappan KR, Shah B, Mathur P, Sarma PS, Srinivas G, Mini GK, et al. Risk factor profile for chronic non-communicable diseases: Results of a community-based study in Kerala, India. Indian J Med Res. 2010;131(1):53–63.
World Health Organization. Global Status Report On Noncommunicable Diseases 2014. 2014.
Diabetes in Kerala over last 25 year
27.3
16.214.6
19.6
5.9
16.3
4
y = 1.0179x - 2023.9R² = 0.6882
0
5
10
15
20
25
30
1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012
%
Year
Prevalence of diabetes
Urban Rural0
5
10
15
20
25
14.8
20.6
Prevalence of di-abetes (%)
Males Females0
5
10
15
20
25
14.3
17.8
Prevalence of di-abetes (%)
Thankappan KR, Shah B, Mathur P, Sarma PS, Srinivas G, Mini GK, et al. Risk factor profile for chronic non-communicable diseases: Results of a community-based study in Kerala, India. Indian J Med Res. 2010;131(1):53–63.
1999 20100
2
4
6
8
10
12
14
3.4
13.1
Prevalence of diabetes in age group 30-40 years
Kutty VR, Soman CR, Joseph A, Pisharody R, Vijayakumar K. Type 2 diabetes in southern Kerala: variation in prevalence among geographic divisions within a region. Natl Med J India [Internet]. Jan [cited 2015 Apr 23];13(6):287–92
Jose R, Manojan KK, Augustine P, Nujum ZT, Althaf A, Haran JC, et al. Prevalence of Type 2 Diabetes and Prediabetes in Neyyattinkara Taluk of South Kerala [Internet]. Academic Medical Journal of India. 2013 [cited 2015 Apr 23]. Available from: http://medicaljournal.in/prevalence-of-type-2-diabetes-prediabetes
Detection , treatment and control of diabetes in Kerala
Aware Treated Controled0
10
20
30
40
50
60
70
8072
68
22
73
65
31
71 70
15
Allmalesfemales
Hypertension
Age standardized prevalence of hypertension in above 18 years
Kerala India World0
5
10
15
20
25
30 28
23 22
%
Thankappan KR, Shah B, Mathur P, Sarma PS, Srinivas G, Mini GK, et al. Risk factor profile for chronic non-communicable diseases: Results of a community-based study in Kerala, India. Indian J Med Res. 2010;131(1):53–63.
World Health Organization. Global Status Report On Noncommunicable Diseases 2014. 2014.
Trend in prevalence of hypertension in Kerala (above 30 year of age)
Burden of hypertension
The prevalence was almost same in both genders as well as in urban and rural areas.
The burden of hypertension increases with age studies reports that 60-80% of people
above age of 60 were hypertensive
proportion of people in pre-hypertension stage is also very high (upto 40%).
Detection , treatment and control of hypertension in Kerala
Aware Treated Controlled0
5
10
15
20
25
30
35
40
45
50
37
27
9
30
21
6
44
33
11
Allmalesfemales
Status of risk factors in Kerala
Tobacco use in Kerala
Tobacco Smoked Smokeless0
5
10
15
20
25
30
35
40
21
1311
34
14
26
KeralaIndia
International Institute for Population Sciences.Ministry of Health and Family Welfare. Government of India. Global adult tobacco survey India 2009 2010. Global adult tobacco survey India 2009-10. Mumbai: International Institute for Population Sciences; 2010.
Tobacco use in Kerala
Tobacco Smoked Smokeless0
5
10
15
20
25
30
35
4035
28
13
8.5
0
8.5
MalesFemales
International Institute for Population Sciences.Ministry of Health and Family Welfare. Government of India. Global adult tobacco survey India 2009 2010. Global adult tobacco survey India 2009-10. Mumbai: International Institute for Population Sciences; 2010.
Smoking in Kerala over past 30 years
1990 2000 2010 20200
5
10
15
20
25
17.8
21.9
13.3
13
17.8f(x) = − 0.528616 x + 1075.156R² = 0.974845412181281
Current smoking
year
%
1980 1990 2000 2010 20200
10
20
30
40
50
60
38.7
50
2828
4338.7
f(x) = − 0.905341 x + 1848.265R² = 0.79586682387627
Current smoking in males
Year
%
Alcohol use in Kerala
Current use of alcohol ( within one month ) was seen in 20-23% of males aged above 15 years in Kerala.
Annual Per capita alcohol consumption was 10.2 L which is comparable to national average (11.4 L)
ICMR. NON-COMMUNICABLE DISEASE RISK FACTORS SURVEY India Phase - I 2008-09. 2007.
Obesity
The prevalence of overweight and obese (BMI>=25) in the state was estimated to around 30 % and is showing an upward trend.
Central obesity (based on waste circumference, WC) is more prevalent affecting as much as 40% of the population.
Obesity/overweight was more common in females (BMI-38%, WC-52%) when compared to males (BMI-24%,WC-26%).
Hyper-cholestrolemia
Thankappan et al
Vijayakumar etal
INDIAB study0
10
20
30
40
50
60
70
57
37
13.9
51
30
62
41
allmalesfemales
Dietary practice in Kerala
0
30
60
9087.9
9.9 3.5
Major cooking oil
Dietary practice in Kerala
Physical inactivity
Low level of physical activity was seen in 75% of the population as per the STEPS survey report.
Lack of physical activity was more common in women when compared to men.
The low level of physical activity was same in both urban and rural areas as well as across different age groups
Is there a solution?
Prevention oriented health care
Levels of prevention
Levels of prevention
Primodial prevention
Primary prevention
Secondary and tertiary prevention
prevention
Primary prevention
Promoting healthy diet Promoting recreational physical activity Avoiding tobacco , alcohol Stress management
Primary prevention
Health promotion Health education Environmental modification Lifestyle and behavioral changes
Specific protection Legislation and its proper implementation Immunization
Secondary prevention
Early diagnosis Screening
Proper treatment