Burden of non-communicable diseases in South Asia
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《英国医生杂志》
EDITOR—Ahmad and Bhopal's concern about the inadequate data available to document a rise in the prevalence of coronary heart disease in India is justified. This reinforces our own expressed concerns about inadequate data from South Asia on non-communicable disease related burdens and their trends.
Despite the fact that there are methodological weaknesses in the meta-analysis published by Gupta et al,1 several types of data indicate a rising burden of coronary heart disease in India. Recent epidemiological surveys show a high urban prevalence of 11%,2 consistent with earlier reports.3 4 Rural surveys have been inadequate and nationally representative surveys, using standardised methods, are unavailable.
Unpublished data from a multicentre study of men aged 35-59 years, conducted on behalf of the Indian Council of Medical Research during 1990-4, showed rising prevalence rates of coronary heart disease with increasing urbanisation (rural Vellore 3.15 per 1000 male population; rural Haryana 4.48/1000; urban Vellore 5.92/1000; and urban Delhi 8.72/1000 male population). Tertiary care centres have documented a steep rise in the proportion of admissions for coronary heart disease.5
Although each of these datasets has several sources of bias, the direction of change consistently points to an increase in coronary heart disease burdens, however defined. A clear need exists to develop better systems for accurately measuring and clearly documenting the epidemiological transition that is under way in India.
Abdul Ghaffar, public health specialist
Global Forum for Health Research, Geneva, Switzerland ghaffara@who.int
K Srinath Reddy, professor
Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
Monica Singhi, research assistant
Initiative for Cardiovascular Health Research in the Developing Countries, New Delhi
Competing interests: None declared.
References
Gupta R, Gupta VP. Meta-analysis of coronary heart disease prevalence in India. Indian Heart J 1996;48: 241-5.
Mohan V, Deepa R, Rani SS, Premalatha G. Prevalence of coronary heart disease and its relationship to lipids in a selected population in India: the Chennai urban population study (CUPS No. 5). J Am Coll Cardiol 2001;38: 682-7.
Chadha SL, Gopinath N, Shekhawat S. Urban-rural differences in the prevalence of coronary heart diseases and its risk factors in Delhi. Bull WHO 1997;75: 31-8.
Reddy KS. Cardiovascular diseases in India. World Health Stat Q 1993;46: 101-7.
Krishnaswami S. Joseph G, Richard J. Demands on tertiary care for cardiovascular diseases in India: analysis of data for 1960-89. Bull WHO 1991:68; 325-30.(Authors' reply)
Despite the fact that there are methodological weaknesses in the meta-analysis published by Gupta et al,1 several types of data indicate a rising burden of coronary heart disease in India. Recent epidemiological surveys show a high urban prevalence of 11%,2 consistent with earlier reports.3 4 Rural surveys have been inadequate and nationally representative surveys, using standardised methods, are unavailable.
Unpublished data from a multicentre study of men aged 35-59 years, conducted on behalf of the Indian Council of Medical Research during 1990-4, showed rising prevalence rates of coronary heart disease with increasing urbanisation (rural Vellore 3.15 per 1000 male population; rural Haryana 4.48/1000; urban Vellore 5.92/1000; and urban Delhi 8.72/1000 male population). Tertiary care centres have documented a steep rise in the proportion of admissions for coronary heart disease.5
Although each of these datasets has several sources of bias, the direction of change consistently points to an increase in coronary heart disease burdens, however defined. A clear need exists to develop better systems for accurately measuring and clearly documenting the epidemiological transition that is under way in India.
Abdul Ghaffar, public health specialist
Global Forum for Health Research, Geneva, Switzerland ghaffara@who.int
K Srinath Reddy, professor
Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
Monica Singhi, research assistant
Initiative for Cardiovascular Health Research in the Developing Countries, New Delhi
Competing interests: None declared.
References
Gupta R, Gupta VP. Meta-analysis of coronary heart disease prevalence in India. Indian Heart J 1996;48: 241-5.
Mohan V, Deepa R, Rani SS, Premalatha G. Prevalence of coronary heart disease and its relationship to lipids in a selected population in India: the Chennai urban population study (CUPS No. 5). J Am Coll Cardiol 2001;38: 682-7.
Chadha SL, Gopinath N, Shekhawat S. Urban-rural differences in the prevalence of coronary heart diseases and its risk factors in Delhi. Bull WHO 1997;75: 31-8.
Reddy KS. Cardiovascular diseases in India. World Health Stat Q 1993;46: 101-7.
Krishnaswami S. Joseph G, Richard J. Demands on tertiary care for cardiovascular diseases in India: analysis of data for 1960-89. Bull WHO 1991:68; 325-30.(Authors' reply)