Association of Hypertension and Diabetes with Ischemic Heart Disease and Stroke Mortality in India: The Million Death Study

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 isch...

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Autores principales:	Calvin Ke, Rajeev Gupta, Baiju R. Shah, Thérèse A. Stukel, Denis Xavier, Prabhat Jha
Formato:	article
Lenguaje:	EN
Publicado:	Ubiquity Press 2021
Materias:	cardiovascular disease mortality epidemiology nationally representative Diseases of the circulatory (Cardiovascular) system RC666-701 Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/5a6030dcb0934ac8976af195000e49e4
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spelling	oai:doaj.org-article:5a6030dcb0934ac8976af195000e49e42021-11-08T08:07:54ZAssociation of Hypertension and Diabetes with Ischemic Heart Disease and Stroke Mortality in India: The Million Death Study2211-817910.5334/gh.1048https://doaj.org/article/5a6030dcb0934ac8976af195000e49e42021-10-01T00:00:00Zhttps://globalheartjournal.com/articles/1048https://doaj.org/toc/2211-8179Background: 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.Calvin KeRajeev GuptaBaiju R. ShahThérèse A. StukelDenis XavierPrabhat JhaUbiquity Pressarticlecardiovascular diseasemortalityepidemiologynationally representativeDiseases of the circulatory (Cardiovascular) systemRC666-701Public aspects of medicineRA1-1270ENGlobal Heart, Vol 16, Iss 1 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	cardiovascular disease mortality epidemiology nationally representative Diseases of the circulatory (Cardiovascular) system RC666-701 Public aspects of medicine RA1-1270
spellingShingle	cardiovascular disease mortality epidemiology nationally representative Diseases of the circulatory (Cardiovascular) system RC666-701 Public aspects of medicine RA1-1270 Calvin Ke Rajeev Gupta Baiju R. Shah Thérèse A. Stukel Denis Xavier Prabhat Jha Association of Hypertension and Diabetes with Ischemic Heart Disease and Stroke Mortality in India: The Million Death Study
description	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.
format	article
author	Calvin Ke Rajeev Gupta Baiju R. Shah Thérèse A. Stukel Denis Xavier Prabhat Jha
author_facet	Calvin Ke Rajeev Gupta Baiju R. Shah Thérèse A. Stukel Denis Xavier Prabhat Jha
author_sort	Calvin Ke
title	Association of Hypertension and Diabetes with Ischemic Heart Disease and Stroke Mortality in India: The Million Death Study
title_short	Association of Hypertension and Diabetes with Ischemic Heart Disease and Stroke Mortality in India: The Million Death Study
title_full	Association of Hypertension and Diabetes with Ischemic Heart Disease and Stroke Mortality in India: The Million Death Study
title_fullStr	Association of Hypertension and Diabetes with Ischemic Heart Disease and Stroke Mortality in India: The Million Death Study
title_full_unstemmed	Association of Hypertension and Diabetes with Ischemic Heart Disease and Stroke Mortality in India: The Million Death Study
title_sort	association of hypertension and diabetes with ischemic heart disease and stroke mortality in india: the million death study
publisher	Ubiquity Press
publishDate	2021
url	https://doaj.org/article/5a6030dcb0934ac8976af195000e49e4
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Association of Hypertension and Diabetes with Ischemic Heart Disease and Stroke Mortality in India: The Million Death Study

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