The average 10-year risk of developing cardiovascular disease varies widely among India's states, ranging from 13.2% to 19.5%, with substantial variation across socio-demographic groups according to a study published this week in PLOS Medicine by Pascal Geldsetzer and Rifat Atun of Harvard University, and colleagues.
Cardiovascular disease (CVD) is the leading cause of mortality in India, yet evidence on the risk factors for CVD among India's population is limited. In the new study, researchers used two large household surveys carried out between 2012 and 2014, which sampled 797,540 adults aged 30 to 74 years across India. CVD risk was examined using established risk scores by state, rural or urban residence, age, sex, household wealth, and education.
The study identified substantial variation in CVD risk both among states and across socio-demographic groups. Overall 10-year risk of a CVD event ranged from 13.2% in Jharkhand to 19.5% in Kerala. District-level wealth and urbanization were both associated with higher CVD risk. Adults with higher household wealth tended to have a greater CVD risk. The study also determined that smoking was more prevalent in poorer households and rural areas, whereas body mass index, prevalence of high blood glucose, and systolic blood pressure were positively associated with household wealth and urban location.
"[This] information will be essential for effective targeting of resources and interventions for prevention, screening, and treatment to those most at risk and most in need," the authors say. "Such investments in targeted CVD care programs as well as relevant health policy measures are urgently needed--particularly in states with a high CVD risk."
In an accompanying Perspective, David Peiris of the University of New South Wales, Australia, and Dorairaj Prabhakaran of India's Centre for Chronic Disease Control write that the implications of the new work are different for different sectors, and could impact both clinical practice and policy making. "The risk profile heat maps generated in [the new] study could guide where the most intensive efforts are needed," they say.
PG was funded by the Harvard Graduate Student Award, which was provided by the Harvard Medical School - Center for Global Health Delivery (Dubai). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
The authors have declared that no competing interests exist.
Geldsetzer P, Manne-Goehler J, Theilmann M, Davies JI, Awasthi A, Danaei G, et al. (2018) Geographic and sociodemographic variation of cardiovascular disease risk in India: A cross-sectional study of 797,540 adults. PLoS Med 15(6): e1002581. https:/
Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
Department of Economics, University of Goettingen, Göttingen, Germany
Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany
MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
Centre for Global Health, King's College London, London, United Kingdom
Indian Institute of Public Health, Gandhinagar, Gujarat, India
Department of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
Public Health Foundation of India, Delhi, National Capital Region, India
Institute of Public Health, Heidelberg University, Heidelberg, Germany
Africa Health Research Institute, Mtubatuba, South Africa
Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, Massachusetts, United States of America
In your coverage please use this URL to provide access to the freely available paper: http://journals.