Increasing Burden of High Blood Pressure, Heart Diseases and Diabetes - PDF document

Increasing Burden of High Blood Pressure, Heart Diseases and Diabetes in India: Evidence from a panel study Sayantani Chatterjee & Laxmi Kant Dwivedi International Institute for Population Sciences, Mumbai Background For centuries communicable diseases have been the major life-taking causes around the world. Many premature deaths had occurred by uncontrolled epidemics and pandemics. However, with the advancement of the medical facilities in terms of vaccinations, antibiotics along with improved living conditions such as better access to safe drinking water, using proper toilets could trickle down the odds of having communicable diseases. Following such advancements in medical research which could raise the average life expectancies quite as much, the industrialized or the developed countries had to fight against the vices of non-communicable diseases. Such a paradigm shift in the disease pattern is often termed as health/epidemiological transition (Omran, 1971). Earlier, these non-communicable diseases were mostly associated with economic development and thus were considered as the diseases of the rich. But, by the inception of the third millennium, non-communicable diseases appear to sweep the entire globe. Moreover, the increasing trends of NCDs in the developing countries along with the persistent communicable diseases have made the situation worse whereby the developing countries have to bear the dual burden of infective and non-infective diseases in a poor environment backed by not-so-developed health systems. Non-communicable diseases are by far the leading cause of death in the world, representing 63% of all annual deaths. The leading causes of NCD deaths in 2012 were cardiovascular diseases (17.5 million deaths, or 46.2% of NCD deaths or 31% of all global deaths), cancers (8.2 million, or 21.7% of NCD deaths), respiratory diseases, including asthma and chronic obstructive pulmonary disease (4.0 million, or 10.7% of NCD deaths) and diabetes (1.5 million, or 4% of NCD deaths). Thus, these four major NCDs were responsible for 82% of NCD deaths. With that being said, around three quarters of these deaths occur in the low and middle income countries. These countries which are severely affected by the persistence of communicable diseases, the emergence of non-communicable diseases worsens the situation. Deaths from non-communicable diseases under age 70 years create a havoc as 82% of the 16 million deaths are in less economically developing countries out of which 37% of the deaths are claimed by heart disease (WHO, 2015). Murray and Lopez (1996) estimated deaths from non- communicable diseases to climb from 28.1 million deaths in 1990 to 49 .7 million in 2020 globally. With the onset of the new millennium, chronic diseases accounted for 60% of all deaths worldwide, with 80% of those taking place in developing countries where they have taken a disproportionate toll during the ages of prime productivity (Narayan et al., 2010). Raised blood pressure is one of the leading risk factors for global mortality (Bromfield and Muntner, 2013) and is estimated to have caused 9.4 million deaths and 7% of disease burden – as measured in disability-adjusted life years − in 2010. Globally, the overall prevalence of raised blood pressure in adults aged 25+ years was around 40%. In absolute numbers, the number of people with uncontrolled hypertension rose from 600 million in 1980 to 1 billion in 1

2008.The leading NCD risk factor globally is raised blood pressure to which 13% of global deaths are attributed to (WHO, 2015). It forms to be one of the leading risk factors for morbidity and mortality across the globe (Boutayeb and Boutayeb, 2005; Llyod-Sherlock, 2010). It is a major risk factor for cardiovascular disease along with diabetes (World Health Statistics, 2015). Li and Kelly (2014) observed that the prevalence of high blood pressure is at a higher side among the economically advanced countries (about 333 million in developed countries) and is emerging in the developing countries as well (around 639 million). Diabetes was prevalent among 8.5% of the adults (18+ years) in 2014. In fact, in 2015 it was the direct cause of 1.6 million deaths. The number of people suffering from diabetes increased almost four fold between 1980 to 2014 across the globe (108 million in 1980 to 422 million in 2014). In 2003, 194 million people (aged 20 to 79 years) had diabetes mellitus, almost three quarters of them belong to the developing world. Almost one million people die because of diabetes each year with two-thirds in developing countries (Buowari, 2013). Like most of the developing countries, India too bears the dual burden of communicable and non-communicable disease. Even though India is showing declining morality and changing morbidity pattern, it still has the “unfinished agenda” to combat the infectious diseases. Besides, India has to deal with the “emerging agenda” which includes chronic and newer diseases kindled by changing age structure, changing lifestyle and environment pollution (Nongkynrih et al., 2004). The three leading chronic diseases in India, as measured by their prevalence, are in descending order: cardiovascular diseases (CVDs), diabetes mellitus, and chronic obstructive pulmonary disease (COPD) (Saikia and Ram, 2010; Upadhyay, 2012; Sharma, 2013). All of these diseases are projected to continue to increase in prevalence in the near future given the demographic trends and lifestyle changes underway in India (Shetty, 2002). India is currently experiencing an epidemic of Type 2 diabetes mellitus (T2DM) and has the largest number of diabetic patients in the world. Hence, it is often referred to as the ‘diabetes capital’ of the world. Diabetes is growing alarmingly in India, home to more than 65.1 million people with the disease, compared to 50.8 million in 2010 (International Diabetes Federation, 2015; Kaveeshwar and Cornwall, 2014; Akhtar and Dhillon, 2016). Modal age at death is increasing which ensures a shift in pattern of diseases mainly from acute to chronic ones. People are now living longer but are marked by chronic diseases and increasing disability (Yadav and Arokiasamy, 2012). Many studies/reports give us definite ideas on how the levels of these diseases are increasing. Yet the plaucity of any large scale panel survey made it impossible to understand how these diseases behave in a larger scale of population. At least, it can provide a broader overview of how the diseases are distributed across the population. With that being said, the main objective of this paper is to examine the disease pattern of high blood pressure, heart disease and diabetes across the population in a panel group. We would also endeavour to throw some light on factors influencing the onset and persistence of these diseases in a larger population. Also, there will be a brief overview of the treatment seeking behaviour and expenditure associated with these diseases. Sources of Data Data were taken from India Human Development Survey-I (IHDS-I) (2004-05) and India Human Development Survey-II (IHDS-II) (2011-12). The unit of analysis is individual-level. For the analysis, we have taken 15+ years population in IHDS I under consideration. The total sample size is 99,620 individuals. 2