NEW DELHI: Death rates from chronic diseases such as cancer, heart disease, and stroke increased in India in the decade leading up to the Covid-19 pandemic, according to a new paper published in The Lancet on Tuesday, even as they fell in four out of five countries covered by the study.
The increase was larger for Indian females than for Indian males, for whom the probability of dying from non-communicable diseases (NCD) between birth and age 80 years increased by only 0.1 percentage points. The increase in the probability of dying from an NCD between birth and age 80 years was driven by an increase in mortality above age 40 years for females and above age 55 years for males, according to the paper.
The authors attributed the increase in mortality to particularly large contributions to an increase in overall NCD mortality from ischaemic heart disease and diabetes (including chronic kidney disease due to diabetes) for both sexes. There was, however, a decline in mortality from cirrhosis of the liver and the residual category of all other NCDs for both sexes, with additional improvements for males in stomach cancer, COPD, stroke, and the residual category of all other circulatory diseases.
The 2010-19 change, the authors said, was a deterioration (ie, going from a decrease to an increase) compared with the preceding decade for females, but an improvement (ie, smaller increase) compared with the preceding decade for males. For females, this occurred as a result of deterioration in the direction or size of change for all causes of death except cirrhosis of the liver, COPD, and the residual category of all other NCDs. For males, it was a result of an improvement in the direction or size of change for eight of the 20 NCD causes of death analysed, including COPD, ischaemic heart disease, and cirrhosis of the liver, countered by less favourable (but smaller) changes in some other causes of death (eg, upper aerodigestive tract cancers and stroke).
The authors also noted that these results are subject to substantial uncertainty because mortality data are limited with quality evaluated as very low.
According to the Indian Council of Medical Research’s NCDs data, it is estimated that the proportion of deaths due to NCDs in India increased from 37.9% in 1990 to 61.8% in 2016. The four major NCDs are cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes that share four behavioral risk factors -unhealthy diet, lack of physical activity, and use of tobacco and alcohol.
Dr RR Kasliwal, chairman, clinical and preventive cardiology, Medanta- The Medicity, said, “India is definitely seeing an increase in cases of NCDs as people here have adopted the kind of lifestyle– smoking, alcohol consumption, sedentary life, high junk in-take etc.– that did damage in the western countries earlier. They have improved and we are deteriorating. We are seeing a rise in CRM, which is cardiac, renal, and metabolic syndrome, and this is hugely concerning.”
To be sure, most countries covered by the study did show a slowing in the decline of mortality by 2019.
“The analysis suggests deaths from chronic diseases has fallen in nearly 80% of countries in the last decade. However almost two thirds of all countries – including nearly all high-income countries in Europe, north America, Australasia and the Pacific – experienced a slowdown in the rate of decline for mortality in 2010 to 2019 compared to the previous decade…,” the paper, titled ‘Benchmarking progress in non-communicable diseases: a global analysis of cause-specific mortality from 2001 to 2019’ said.
And, to be sure, Covid-19 is likely to have served as a disruptor, given its lingering after effects.
The analysis was led by researchers at the Imperial College London.
This study is likely the first global analysis to not only track changes in Non-Communicable Diseases mortality at the national level but also benchmark progress against historical performance and the regional best-performers, they added.
Majid Ezzati, the study’s senior author, from the School of Public Health at Imperial College London and Imperial Global Ghana, said: “Our latest report shows that while the majority of countries around the world are making progress to reduce the risk of dying from chronic disease, compared to the previous decade, progress has slowed, stalled or even reversed in some nations.”
“In many countries, effective healthcare programmes like medications for diabetes, hypertension and cholesterol as well as timely cancer screening and heart attack treatment may not be reaching the people who need them, and they are being left out of the health system.”
Ezzati added: “If we are to get back to the rapid improvements we saw early in the millennium, we need investment in the types of healthcare programmes and tobacco and alcohol control policies that have been shown to be effective in reducing deaths in many countries. This means not only more resources but also more focus on evidence-based policies with a proven track record.”
Leanne Riley, unit head of surveillance, monitoring and reporting at the World Health Organization (WHO) and co-author of the study, said: “These data reveal a complex global picture of non-communicable diseases. Encouraging progress is evident in some areas, such as declining mortality from certain cancers and cardiovascular diseases. Yet the overall burden remains unacceptably high. To change course, we must regain momentum and accelerate efforts through effective policies and equitable access to care.”