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638 Cardio Diabetes Medicine 2017

Can The Projected World Center of Chronic Disease

Be Converted to The Worlds Control Centre of

Chronic Disease?

Dr.Alexander Thomas, President,AHPI

Dr.V.C.Shanmuganandan, Joint Director,AHPI

Dr.John Tharakan, Consultant,AHPI

Introduction: heart disease (IHD) and stroke constitute the major-
The epidemiological transition in India in the past two ity of CVD mortality in India (83%), with IHD being
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decades has been dramatic; in a short timeframe, the predominant. The ratio of IHD to stroke mortality in
predominant epidemiological characteristics have India is significantly higher than the global average,
transitioned from infectious diseases, diseases of and is comparable to that of Western industrialized
under nutrition, and maternal and childhood diseases countries. Together, IHD and stroke are responsible
to non-communicable diseases (NCDs). The disease for more than one-fifth (21.1%) of all deaths and
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burden attributable to maternal disorders, measles, one-tenth of the years of life lost in India (years
protein-energy malnutrition, and diarrheal diseases of life lost is a measure that quantifies premature
decreased >50% in the past 2 decades, whereas mortality by weighting younger deaths more than
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life expectancy at birth increased from 58.3 to 65.2 older deaths). The years of life lost attributable to
years, resulting in the ageing of the population during CVD in India increased by 59% from 1990 to 2010
the same period. Consequently, the NCD burden (23.2 million to 37 million). 8
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increased rapidly in India, with a proportional rise in In the urban areas of India, the prevalence of dia-
burden attributable to CVD. Nearly two-thirds of the betes mellitus has almost doubled in the past 20
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burden of NCD mortality in India is currently years, from 9% to 17%, and in rural areas it has
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contributed by CVD-related conditions. Despite wide nearly quadrupled, from 2% to 9%. In 2013, the In-
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heterogeneity in the prevalence of risk factors across ternational Diabetes Federation estimated that
different regions (explained below), CVD is the 65.1 million people in India had diabetes mellitus,
leading cause of death in all parts of India, includ- a high proportion of whom were adults of working
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ing the poorer states and rural areas. The disease age. It is estimated that the number of individuals
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transition in India in the past 2 decades resembles with diabetes mellitus will increase to an alarming
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the accelerated epidemiological transition model with 101 million by 2030. An estimate based on the
a rapid shift to the age of delayed chronic diseases. ICMR-INDIAB study indicates that the number of
individuals in India with prediabetes (impaired fast-
According to the Global Burden of Disease study ing glucose or impaired glucose tolerance) is 77
age-standardized estimates (2010), nearly a quar- million. In addition, based on epidemiological
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ter (24.8%) of all deaths in India is attributable to data and conversion rates among control groups in
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CVD The age-standardized CVD death rate of 272 intervention studies, the conversion rate from pre-
per 100 000 population in India is higher than the diabetes to diabetes mellitus is high. 72–74 Diabetes
global average of 235 per 100 000 population . awareness and control are poor in rural regions in
It is interesting to note that the public health strategy comparison with urban regions. 69,70 Diabetes mellitus
in India is still in the process of making this transi- continues to have a positive social gradient (with a
tion of addressing NCDs. The health infrastructure higher burden among the rich and well educated), with
in the country which has focussed on communica- the exception of certain settings such as industrial
ble diseases has not been recalibrated to address worksites. 66,75,76 However, a recently concluded study
the increasing NCD burden in the country. Ischemic on risk factors of CVD in urban and rural Delhi
suggests that there is no difference in the prevalence

GCDC 2017