Self-reported Prevalence of Cardiovascular Diseases in an Urban Area of Chandigarh City
Author(s): Sitanshu Sekhar Kar, JS Thakur
Vol. 32, No. 4 (2007-10 - 2007-12)
ISSN No. 0970-0218
Sitanshu Sekhar Kar, JS Thakur
Non-communicable disease (NCD) epidemics are
emerging or accelerating in most developed countries,
and cardiovascular diseases (CVD), cancers, diabetes
and chronic obstructive pulmonary diseases are
becoming major contributors to the burden of disease.1
India too illustrates the phenomenon of ‘health transition’,
which positions NCDs as a major public health challenge
of growing magnitude in the 21st century. In 1990, India
accounted for 19% of all deaths, 16% of all NCD deaths
and 17% of all CVD deaths in the world. In India alone
CVDs accounted for around 2.4 million deaths, in contrast
to nearly 3.2 million deaths in all industrialized countries
put together.1 In recent times, life expectancy has
increased with several undesirable alterations in lifestyle.
Hence, there is an increase in both the dose and duration
of risk factors, leading to an increase in lifestyle diseases
and their consequences.
The incidence of CVDs is greater in urban areas than
in rural areas, reflecting the acquisition of several risk
factors such as tobacco consumption, lack of physical
activity, unhealthy diet and obesity. Usually skilled
workers estimate the prevalence of CVDs after surveys.
However, there is less evidence available regarding the
use of alternative methods of estimating prevalence.
Keeping these things in mind, a study was carried out
in a selected community of Chandigarh to find out the
prevalence of self-reported cardiovascular diseases.
Materials and Methods
A cross-sectional survey was carried out in ≥40-year
age group, in a purposively selected urban sector of
Chandigarh. The study was conducted during January to
April 2005. Nine hundred subjects selected purposively
were considered for the study. The first house for the
survey was selected randomly, and thereafter houses to
the left were taken continuously. A health worker who was
trained in WHO CVD risk assessment and management
package2 sought information regarding physiciandiagnosed
cardiovascular diseases. Diseases included
in the survey were hypertension, diabetes and heart
disease (angina, heart attack). The prescriptions of the
doctors and intake of medicines for these problems were
verified with the subjects. The self-reported prevalence
was compared with organized studies done on similar
problems in the area.
Results
A total of 541 families were surveyed, and a total of 969
eligible populations were identified. Almost half (50.7%)
the study subjects were males and 49.3% were females.
Approximately half (45.4%) belonged to the age group
of 40-50 years.
The prevalence of physician-diagnosed self-reported
hypertension was found to be 32.3% in the study
population with prevalence being 31.7% and 32.9%
in males and females, respectively. The prevalence of
self-reported hypertension was found to be more (64%)
in the age group of >70 years.
As mentioned before, angina and heart attack
were considered heart diseases. The prevalence of
self-reported heart disease was found to be 10.8%
(male: 11.2%, female: 10.5%). The overall prevalence
of self-reported diabetes was found to be 13.4% with
prevalence in males and females being 15.2 and 11.5%,
respectively. It was observed that 11.6% cases had
co-morbid conditions. The prevalence of physiciandiagnosed
CVDs is given in Table 1.
Discussion
The prevalence of hypertension has almost doubled over
30 years in Chandigarh. The prevalence of hypertension
in 1968 was 26.9%, and it has increased to 44.9% in
1996-97 among males of >30 years of age.3 Unfavourable
changes including prevalence of hypertension, physical
inactivity and body fat make Chandigarh population highly
vulnerable to cardiovascular morbidity and mortality. Our
study shows the prevalence of self-reported hypertension
to be 32.3%. Another study among the elderly (>65
years) in Chandigarh in 2002 showed the prevalence to
be 58%.4 In our study, the prevalence of self-reported
hypertension was found to be 64% in the age group of
>70 years.
Table 1: Distribution of self-reported cardiovascular diseases in study population
Age group (years)
Sex
Hypertension
Heart disease*
Diabetes
Co-morbidity
40-50
Male
40 (18.8)
13 (6.1)
25 (11.7)
18 (8.4)
Female
46 (20.3)
7 (3.1)
18 (7.9)
9 (3.9)
51-60
Male
37 (30.1)
9 (7.3)
17 (13.8)
10 (8.1)
Female
27 (24.5)
8 (7.2)
9 (8.2)
7 (6.3)
61-70
Male
28 (44.4)
11 (17.4)
14 (22.2)
12 (19)
Female
30 (43.5)
12 (17.4)
13 (18.8)
12 (17.4)
≥70
Male
51 (54.8)
22 (23.6)
19 (20.4)
23 (24.7)
Female
54 (76)
23 (32.4)
15 (21.1)
22 (30.9)
Overall
156 (31.7)
55 (11.2)
75 (15.2)
63 (12.8)
Male
157 (32.9)
50 (10.5)
55 (11.5)
50 (10.4)
Female
313 (32.3)
105 (10.8)
130 (13.4)
113 (11.6)
*Heart disease includes angina and heart attack. Figures in parentheses are percentages
Another study conducted in Chandigarh showed the
prevalence of angina as ascertained by questionnaire
to be 6.3% in both males and females in the age group
of >55 years.5 Similarly, the prevalence of physiciandiagnosed
heart attack was found to be 7.5 and 3.1%
in males and females, respectively.5 In our study, the
prevalence of self-reported heart disease was 10.8%
(11.2% and 10.8% in males and females, respectively).
In the same study, the prevalence of physician-diagnosed
diabetes was found to be 13.8 and 13.2% in males and
females, respectively. In our study, the overall prevalence
of self-reported diabetes was found to be 13.4%, with
prevalence in males and females being 15.2 and 11.5%,
respectively. The results of both these studies were
comparable.
The study is different from other studies because of its
methodology. The prevalence pattern found out by this
method showed comparable results with that of surveys
conducted in this area by skilled workers. The findings of
the study are important for developing countries due to the
shortage of skilled manpower for undertaking organized
surveys. This methodology could be used in literate urban
population to find out the magnitude of CVDs.
References
- Murray CLJ, Lopez AD. Global health statistics: Global
burden of disease and injury series. Volumes 1 and 2.
Harvard School of Public Health: Boston; 1996.
- WHO CVD risk management package for low and medium
resource settings. WHO: Geneva; 2002.
- Ahlawat S, Singh MM, Kumar R, Kumari S, Sharma BK.
Time trends in prevalence of hypertension and associated
risk factors in Chandigarh. JIMA 2002;100:547-55.
- Kumar R, Singh MC, Ahlawat SK, Thakur JS, Srivasatava A,
Sharma MK, et al. Urbanization and coronary heart
disease: A study of urban-rural differences in Northern
India. Indian Heart J 2006;58:126-30.
- Swami HM, Bhatia V, Gupta M, Bhatia SP, Sood A.
Population based study of hypertension among the elderly
in northern India. Public Health 2002;116:45-9.
Department of Community Medicine, School of Public
Health, Post-graduate Institute of Medical Education and
Research, Chandigarh – 160 012, India
Correspondence to:
Dr. J. S. Thakur,
School of Public Health, Department of Community Medicine,
PGIMER, Chandigarh – 160 012, India.
E-mail: jsthakur_in(at)yahoo.co.in
Received: 22.06.07
Accepted: 16.10.07
ISSN No. 0970-0218
Sitanshu Sekhar Kar, JS Thakur
Non-communicable disease (NCD) epidemics are emerging or accelerating in most developed countries, and cardiovascular diseases (CVD), cancers, diabetes and chronic obstructive pulmonary diseases are becoming major contributors to the burden of disease.1 India too illustrates the phenomenon of ‘health transition’, which positions NCDs as a major public health challenge of growing magnitude in the 21st century. In 1990, India accounted for 19% of all deaths, 16% of all NCD deaths and 17% of all CVD deaths in the world. In India alone CVDs accounted for around 2.4 million deaths, in contrast to nearly 3.2 million deaths in all industrialized countries put together.1 In recent times, life expectancy has increased with several undesirable alterations in lifestyle. Hence, there is an increase in both the dose and duration of risk factors, leading to an increase in lifestyle diseases and their consequences.
The incidence of CVDs is greater in urban areas than in rural areas, reflecting the acquisition of several risk factors such as tobacco consumption, lack of physical activity, unhealthy diet and obesity. Usually skilled workers estimate the prevalence of CVDs after surveys. However, there is less evidence available regarding the use of alternative methods of estimating prevalence. Keeping these things in mind, a study was carried out in a selected community of Chandigarh to find out the prevalence of self-reported cardiovascular diseases.
Materials and Methods
A cross-sectional survey was carried out in ≥40-year age group, in a purposively selected urban sector of Chandigarh. The study was conducted during January to April 2005. Nine hundred subjects selected purposively were considered for the study. The first house for the survey was selected randomly, and thereafter houses to the left were taken continuously. A health worker who was trained in WHO CVD risk assessment and management package2 sought information regarding physiciandiagnosed cardiovascular diseases. Diseases included in the survey were hypertension, diabetes and heart disease (angina, heart attack). The prescriptions of the doctors and intake of medicines for these problems were verified with the subjects. The self-reported prevalence was compared with organized studies done on similar problems in the area.
Results
A total of 541 families were surveyed, and a total of 969 eligible populations were identified. Almost half (50.7%) the study subjects were males and 49.3% were females. Approximately half (45.4%) belonged to the age group of 40-50 years.
The prevalence of physician-diagnosed self-reported hypertension was found to be 32.3% in the study population with prevalence being 31.7% and 32.9% in males and females, respectively. The prevalence of self-reported hypertension was found to be more (64%) in the age group of >70 years.
As mentioned before, angina and heart attack were considered heart diseases. The prevalence of self-reported heart disease was found to be 10.8% (male: 11.2%, female: 10.5%). The overall prevalence of self-reported diabetes was found to be 13.4% with prevalence in males and females being 15.2 and 11.5%, respectively. It was observed that 11.6% cases had co-morbid conditions. The prevalence of physiciandiagnosed CVDs is given in Table 1.
Discussion
The prevalence of hypertension has almost doubled over 30 years in Chandigarh. The prevalence of hypertension in 1968 was 26.9%, and it has increased to 44.9% in 1996-97 among males of >30 years of age.3 Unfavourable changes including prevalence of hypertension, physical inactivity and body fat make Chandigarh population highly vulnerable to cardiovascular morbidity and mortality. Our study shows the prevalence of self-reported hypertension to be 32.3%. Another study among the elderly (>65 years) in Chandigarh in 2002 showed the prevalence to be 58%.4 In our study, the prevalence of self-reported hypertension was found to be 64% in the age group of >70 years.
Table 1: Distribution of self-reported cardiovascular diseases in study population
| Age group (years) | Sex | Hypertension | Heart disease* |
Diabetes | Co-morbidity |
|---|---|---|---|---|---|
| 40-50 | Male | 40 (18.8) | 13 (6.1) | 25 (11.7) | 18 (8.4) |
| Female | 46 (20.3) | 7 (3.1) | 18 (7.9) | 9 (3.9) | |
| 51-60 | Male | 37 (30.1) | 9 (7.3) | 17 (13.8) | 10 (8.1) |
| Female | 27 (24.5) | 8 (7.2) | 9 (8.2) | 7 (6.3) | |
| 61-70 | Male | 28 (44.4) | 11 (17.4) | 14 (22.2) | 12 (19) |
| Female | 30 (43.5) | 12 (17.4) | 13 (18.8) | 12 (17.4) | |
| ≥70 | Male | 51 (54.8) | 22 (23.6) | 19 (20.4) | 23 (24.7) |
| Female | 54 (76) | 23 (32.4) | 15 (21.1) | 22 (30.9) | |
| Overall | 156 (31.7) | 55 (11.2) | 75 (15.2) | 63 (12.8) | |
| Male | 157 (32.9) | 50 (10.5) | 55 (11.5) | 50 (10.4) | |
| Female | 313 (32.3) | 105 (10.8) | 130 (13.4) | 113 (11.6) |
*Heart disease includes angina and heart attack. Figures in parentheses are percentages
Another study conducted in Chandigarh showed the prevalence of angina as ascertained by questionnaire to be 6.3% in both males and females in the age group of >55 years.5 Similarly, the prevalence of physiciandiagnosed heart attack was found to be 7.5 and 3.1% in males and females, respectively.5 In our study, the prevalence of self-reported heart disease was 10.8% (11.2% and 10.8% in males and females, respectively). In the same study, the prevalence of physician-diagnosed diabetes was found to be 13.8 and 13.2% in males and females, respectively. In our study, the overall prevalence of self-reported diabetes was found to be 13.4%, with prevalence in males and females being 15.2 and 11.5%, respectively. The results of both these studies were comparable.
The study is different from other studies because of its methodology. The prevalence pattern found out by this method showed comparable results with that of surveys conducted in this area by skilled workers. The findings of the study are important for developing countries due to the shortage of skilled manpower for undertaking organized surveys. This methodology could be used in literate urban population to find out the magnitude of CVDs.
References
- Murray CLJ, Lopez AD. Global health statistics: Global burden of disease and injury series. Volumes 1 and 2. Harvard School of Public Health: Boston; 1996.
- WHO CVD risk management package for low and medium resource settings. WHO: Geneva; 2002.
- Ahlawat S, Singh MM, Kumar R, Kumari S, Sharma BK. Time trends in prevalence of hypertension and associated risk factors in Chandigarh. JIMA 2002;100:547-55.
- Kumar R, Singh MC, Ahlawat SK, Thakur JS, Srivasatava A, Sharma MK, et al. Urbanization and coronary heart disease: A study of urban-rural differences in Northern India. Indian Heart J 2006;58:126-30.
- Swami HM, Bhatia V, Gupta M, Bhatia SP, Sood A. Population based study of hypertension among the elderly in northern India. Public Health 2002;116:45-9.
Department of Community Medicine, School of Public Health, Post-graduate Institute of Medical Education and Research, Chandigarh – 160 012, India
Correspondence to:
Dr. J. S. Thakur,
School of Public Health, Department of Community Medicine,
PGIMER, Chandigarh – 160 012, India.
E-mail: jsthakur_in(at)yahoo.co.in
Received: 22.06.07
Accepted: 16.10.07