Two large surveys covering nearly 8 lakh adults between 2012 and 2014 have found the average 10-year risk of a cardiovascular disease event varying from 13.2% in Jharkhand to 19.5% in Kerala. The mean risk is 12.7% among females and 21.4% among males. And adults living in urban areas have higher risk than those in rural areas.
Two household surveys of nearly 8,00,000 adults aged 34-70 years carried out between 2012 and 2014 across India found the average 10-year risk of a fatal or nonfatal cardiovascular disease event varied widely among States. A paper published in PLOS Medicine found the risk ranging from 13.2% (both sexes combined) in Jharkhand to 19.5% in Kerala.
The study used the data from the District Level Household Survey-4 (DLHS-4) and the second update of the Annual Health Survey (AHS). The surveys covered 27 of the 29 States and five of the seven Union Territories and used the same questionnaire and methodology to collect clinical, anthropometric, and biomarker measurements.
In Goa, rural areas show a higher mean risk than urban areas, while the difference between highest mean risk in rural and urban areas is meagre in Kerala.
While smoking (a risk factor for CVD) was more prevalent in poorer households and rural areas, wealthy household and urban locations had other risk factors — high body mass index, high blood glucose and high systolic blood pressure.
The mean 10-year cardiovascular risk in the population was found to vary widely between males and females. The mean risk is 12.7% among females and 21.4% among males.
Among both males and females, cardiovascular risk is highest in South India (Kerala, Tamil Nadu, Telangana, Andhra Pradesh, Karnataka, Pondicherry and Goa), North India (Himachal Pradesh, Punjab and Uttarakhand) and Northeast States (except Assam) and West Bengal (particularly among males). This variation between States remained largely the same in different age groups (30-39 years, 40-49 years, 50-59 years and 60-74 years) studied and within urban and rural populations.
Cardiovascular risk in males, females
Females in Goa had the highest mean cardiovascular risk (16.73%) across all age groups and were closely followed by Kerala (15.81%) and Punjab (15.11%). In contrast, females in Assam had the lowest mean risk (10.25%) followed by Jharkhand (10.43%) and Bihar (10.54%).
In the case of men, those living in Himachal Pradesh and Nagaland had the highest mean cardiovascular risk (24.23%) across all age groups, followed by Kerala (24.13%) and Manipur (23.76%). The lowest mean risk among males was seen in Chhattisgarh (16.63%) followed by Jharkhand (16.81%) and Madhya Pradesh (17.03%).
Cardiovascular risk in rural, urban areas
The study, led by researchers at Public Health Foundation of India and Harvard T.H. Chan School of Public Health, also found adults living in urban areas, as well as those with a higher household wealth, tended to have a greater cardiovascular risk.
With 19.90%, adults living in urban areas in Kerala had the highest mean risk, followed by West Bengal (19.12%) and Himachal Pradesh (18.97%). In contrast, those living in urban areas of Daman and Diu had the lowest mean risk (12.60%), followed by Bihar (13.63%) and Arunachal Pradesh (14.71%).
In general, the cardiovascular risk is lower in rural areas compared with urban areas. But Goa has bucked this trend with the rural areas showing a higher mean value (18.92%) than the urban areas (18.79%). In the case of Kerala, the difference between highest mean risk in rural (19.23%) and urban areas (19.90%) is meagre.
“The key findings and mapping of cardiovascular risk across the states of India may guide us to reach the pockets at high risk for immediate and effective implementation of relevant programs and towards formulation of new policies,” says Dr. Ashish Awasthi, Assistant Professor (INSPIRE Faculty) at Public health Foundation of India and one of the authors of the paper. “Cardiovascular disease has emerged as a leading cause of death in India. So assessment of cardiovascular disease among high-risk population and targeted efforts can reduce substantial premature mortality and morbidity.”