India makes progress against some health risk factors, but lifestyle disease burden rises

High BP, blood sugar and household air pollution from solid fuels were estimated to cause 7.8%, 5.2% and 4.7% of total health loss in India in 2013, respectively


New Delhi: More Indians are suffering from diseases connected with high blood pressure, blood sugar and cholesterol, responsible for 3.3 million premature deaths in 2013, said a study published in The Lancet journal on Friday.

But the loss to human health from ailments associated with childhoood undernutrition and unsafe water sources has lessened, found the study led by the Institute for Health Metrics and Evaluation (IHME), an independent global health research centre at the University of Washington. The Public Health Foundation of India (PHFI) took part in the study.

The study analysed of 79 health risk factors in 188 countries. The study examined which risk factors contribute to loss of health as well as death. Researchers used DALYs, or disability-adjusted life years, to measure overall health loss. One DALY equals one lost year of healthy life. DALYs are measured as the sum of years of life lost due to early death and years of healthy life lost due to disability.

High blood pressure, high blood sugar and household air pollution from solid fuels were estimated to cause 7.8%, 5.2% and 4.7% of the total health loss in India in 2013, respectively. These three risk factors together contributed to 3.3 million premature deaths in India in 2013.

The other major contributors to health loss in India are unsafe water sources, tobacco smoking, alcohol use, high blood cholesterol and outside air pollution. The contribution of unsafe water sources and poor sanitation, as well as child and maternal undernutrition, to health loss have dropped significantly since 1990, but these are still substantial contributors to health loss in India.

The risk factors examined in the study contributed to a total of 30.8 million deaths worldwide in 2013, up by one-fifth from 25.1 million deaths in 1990. The top risks associated with death among both men and women globally are high blood pressure, smoking, high body mass index, and high fasting plasma glucose.

But the greatest cumulative impact on health comes from a poor diet. A combination of 14 dietary risk factors contributed to the highest number of deaths worldwide through ailments like ischemic heart disease, stroke and diabetes.

“It is remarkable that the contribution of metabolic risk factors such as high blood pressure, blood sugar and cholesterol, and that of poor diet and alcohol use, to health loss has doubled in India over the past quarter of a century,” said Lalit Dandona, professor at PHFI and IHME, who led the work of this study in India.

“On the other hand, the contribution of unsafe water and sanitation, and child and maternal undernutrition, to health loss has halved in India but these are still significant causes of disease burden. Parallel to this, air pollution and tobacco smoking continue to be major contributors to health loss in India. The findings from this study provide useful pointers for where policy emphasis is needed to improve population health in India.”

“Metabolic risk factors that include high blood pressure, blood sugar and cholesterol, along with unhealthy dietary habits and smoking are responsible for about 5.2 million premature deaths in India every year,” said D.K. Srinath Reddy, who is president of PHFI and member of the GBD Scientific Council. “This trend will continue to increase unless effective prevention strategies to address these risk factors are implemented in India rapidly.”

India is part of a global landscape with tremendous regional variations. In much of the Middle East and Latin America, high body mass index is the No. 1 risk associated with health loss. In South and South-East Asia, household air pollution is a leading risk, and India also grapples with high risks of unsafe water and childhood undernutrition.

The study includes several risk factors—wasting, stunting, unsafe sex, no hand-washing with soap—in its analysis for the first time. Another first is the factoring in of HIV into the calculation of intimate partner violence.

The addition of wasting, which was associated with about one out of every five deaths in children under five in 2013, and stunting, which contributed to 3.5% of under-five deaths, highlights the importance of child undernutrition as a risk factor.

Unsafe sex took a huge toll on global health, contributing to 82% of HIV/AIDS deaths and 94% of HIV/AIDS deaths among 15- to 19-year-olds in 2013.

“There’s great potential to improve health by avoiding certain risks like smoking and poor diet as well as tackling environmental risks like air pollution,” said IHME director Christopher Murray, who led the study globally. “The challenge for policy-makers will be to use what we know to guide prevention efforts and health policies.”

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