India's no.1 killer: Heart disease
Largest-ever study of deaths shows heart ailments have replaced
communicable diseases as the biggest killer in rural & urban India.
Heart diseases have emerged as the number one killer in both urban and rural areas of the country.
Top 10 causes of death in India
The results are surprising because they indicate a reversal in
disease patterns in the country from communicable diseases to non-
communicable or lifestyle diseases.
About 25 per cent of deaths in the age group of 25- 69 years occur
because of heart diseases. In urban areas, 32.8 per cent deaths occur
because of heart ailments, while this percentage in rural areas is 22.9.
If all age groups are included, heart diseases account for about 19
per cent of all deaths. It is the leading cause of death among males as
well as females. It is also the leading cause of death in all regions
though the numbers vary. The proportion of deaths caused by heart
disease is the highest in south India (25 per cent) and lowest - 12 per
cent - in the central region.
"What we have found is quite provocative. If you look at rural areas
of poorer states like Uttar Pradesh and Bihar, the leading cause of
death among middleaged males is cardiovascular disease.
Heart attacks are killing people not just in urban areas," said Dr
Prabhat Jha, director of the Centre for Global Health Research at the
University of Toronto and lead researcher of the study. The study is
being carried out in collaboration with the Registrar General of India (
RGI) and the Indian Council of Medical Research (ICMR).
The data forms part of the first set of results from the study,
dubbed the 'Million Deaths Study' because it aims to investigate one
million deaths by 2014.
The preliminary results relate to an analysis of 1,30,000 deaths that
occurred between 2001 and 2003. Data relating to another 270,000 deaths
is being analysed currently.
The study is based on the existing system of tracking the health
status of 6 million people across 1.1 million households in all the
states and union territories through the units of Sample Registration
System (SRS) which the RGI uses to track birth and mortality data in the
country.
Members of SRS units have been trained in 'verbal autopsy' technique -
a method of prospective investigation of deaths - while the actual
cause of death is determined by physicians.
Verbal autopsy is an investigation of a "train of events,
circumstances, symptoms and signs of illness leading to death through an
interview of relatives or associates of the deceased." This technique
was first tested in Tamil Nadu where 35,000 deaths were investigated in
2006 to find out the exact cause of death. Overall, 42 per cent of
deaths in
India are accounted for by noncommunicable diseases, while
communicable diseases and those associated with child birth and
nutritional disorders account for 38 per cent of deaths.
Other causes of deaths in the 25- 69 years age group - urban and
rural areas taken together - are respiratory diseases such as asthma
(10.2 per cent), tuberculosis (10.1 per cent), malignant tumours ( 9 per
cent), digestive diseases (5.1 per cent) and diarrhoeal disease (5 per
cent).
Malaria, which had been a leading cause of death, now accounts for only 2.8 per cent deaths.
The study is claimed to be the largest exercise of its kind in the
world and is expected to throw up new insights into disease patterns as
well as underlying risk factors. It is not a mere academic exercise.
Findings from the study could help the government design interventions
and new policies in the health sector.
Currently, India lacks authentic data on the causes of deaths.
About 9.5 million deaths, which is about one in six deaths worldwide,
occur in the country every year. Over three- quarters of these deaths
take place in the home and more than half of these do not have a
certified cause.
The law on 'Medically Certified Causes of Death' has not been
effective in providing any useful inputs as just about 0.4 million
deaths are registered under this and that too in some cities.
Earlier, only smaller studies conducted in villages in coastal Andhra
Pradesh had indicated that cardiovascular diseases had replaced
communicable diseases as the top killer in rural areas. But, no large-
scale studies have been done so far.
Unlike deaths from communicable diseases or injuries having known
causes, most non- communicable diseases can have multiple causes. For
example, heart attack could be caused by smoking, high blood pressure,
high cholesterol and other factors.
Jha observed: " Heart disease is not an emerging problem anymore. It
has already emerged as a major cause of death in rural areas. We haven't
recognised this and don't have adequate programmes to deal with it. For
tuberculosis you have TB clinics. For malaria, you have the malaria
control programme.
For cardiovascular diseases in rural areas, we have nothing so far."
Regarding acute heart attacks - not chronic heart disease - that are a
major cause of death in urban India, he said it was mainly killing young
people in their productive years. A large percentage of these heart
attacks are attributed to smoking.
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