Association of Hypertension and Diabetes with Ischemic Heart Disease and Stroke Mortality in India: The Million Death Study.
cardiovascular disease
epidemiology
mortality
nationally representative
Journal
Global heart
ISSN: 2211-8179
Titre abrégé: Glob Heart
Pays: England
ID NLM: 101584391
Informations de publication
Date de publication:
2021
2021
Historique:
received:
03
04
2021
accepted:
22
09
2021
entrez:
25
10
2021
pubmed:
26
10
2021
medline:
18
11
2021
Statut:
epublish
Résumé
The cardiovascular outcomes of hypertension and diabetes in India have never been studied at the national level. We conducted a nationally-representative proportional mortality study to measure the associations of hypertension and diabetes with premature mortality due to ischemic heart disease (IHD) and stroke among Indian adults. We determined causes of death by verbal autopsy from 2001-14 among 2.4 million households. We defined cases as those who died of the study outcomes and controls as those who died of injuries, respiratory causes, or cancer. We used multivariable logistic regression models to compute adjusted odds ratios (OR) measuring the association of hypertension and diabetes with IHD or stroke mortality, population-attributable fractions (PAF), and time trends. The mean age at death was 55.6 (standard deviation 9.9) years for IHD, 58.2 (9.0) years for stroke, and 46.8 (injury) to 59.8 (respiratory) years for controls. There were more men among both the cases (IHD: 70.1%; stroke: 59.0%) and controls (injury: 76.6%; cancer: 55.4%; respiratory: 59.8%). Hypertension was associated with six- to eight-fold increases in the odds of IHD (OR 5.9, 99% CI 5.6-6.2) and stroke mortality (7.9, 7.4-8.5). Diabetes was associated with double the odds (1.9, 1.7-2.0) of IHD mortality and increased odds of stroke mortality (1.6, 1.4-1.7). Hypertension accounted for an increasing PAF of IHD mortality and decreasing PAF of stroke mortality. Diabetes was associated with relatively lower PAFs and variable time trends. Hypertension is associated with an unexpectedly high burden of cardiovascular mortality, and contributes to an increasing proportion of IHD deaths and a decreasing proportion of stroke deaths. Better management of hypertension and diabetes is urgently required to reduce premature cardiovascular mortality.
Sections du résumé
Background
The cardiovascular outcomes of hypertension and diabetes in India have never been studied at the national level.
Objectives
We conducted a nationally-representative proportional mortality study to measure the associations of hypertension and diabetes with premature mortality due to ischemic heart disease (IHD) and stroke among Indian adults.
Methods
We determined causes of death by verbal autopsy from 2001-14 among 2.4 million households. We defined cases as those who died of the study outcomes and controls as those who died of injuries, respiratory causes, or cancer. We used multivariable logistic regression models to compute adjusted odds ratios (OR) measuring the association of hypertension and diabetes with IHD or stroke mortality, population-attributable fractions (PAF), and time trends.
Results
The mean age at death was 55.6 (standard deviation 9.9) years for IHD, 58.2 (9.0) years for stroke, and 46.8 (injury) to 59.8 (respiratory) years for controls. There were more men among both the cases (IHD: 70.1%; stroke: 59.0%) and controls (injury: 76.6%; cancer: 55.4%; respiratory: 59.8%). Hypertension was associated with six- to eight-fold increases in the odds of IHD (OR 5.9, 99% CI 5.6-6.2) and stroke mortality (7.9, 7.4-8.5). Diabetes was associated with double the odds (1.9, 1.7-2.0) of IHD mortality and increased odds of stroke mortality (1.6, 1.4-1.7). Hypertension accounted for an increasing PAF of IHD mortality and decreasing PAF of stroke mortality. Diabetes was associated with relatively lower PAFs and variable time trends.
Conclusions
Hypertension is associated with an unexpectedly high burden of cardiovascular mortality, and contributes to an increasing proportion of IHD deaths and a decreasing proportion of stroke deaths. Better management of hypertension and diabetes is urgently required to reduce premature cardiovascular mortality.
Identifiants
pubmed: 34692394
doi: 10.5334/gh.1048
pmc: PMC8516008
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
69Subventions
Organisme : FIC NIH HHS
ID : D43 TW010543
Pays : United States
Informations de copyright
Copyright: © 2021 The Author(s).
Déclaration de conflit d'intérêts
DX reports grants from Cadila Pharmaceuticals, grants from Boehringer Ingelheim, grants from Sanofi Aventis, grants from Pfizer, grants from Bristol Myers Squibb, grants from United Health, outside the submitted work. The other authors have no conflicts of interest to disclose.
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