Research

Paper Presented in the Conference

Cardiovascular disease now a leading cause of death in rural India

Rohina Joshi^*1, Magnolia Cardona¹, Rama Raju², S lyengar², A Sukumar², C Ravi Raju², Krishnam Raju³, K Srinath Reddy⁴, Bruce Neal¹
¹ The George Institute For International Health, University of Sydney, PO Box M 210, Missenden Road, Sydney 2050; ²Byrraju Foundation, Hyderabad, India; ³CARE Foundation, Hyderabad; ⁴All India Institute for Medical Sciences, New Delhi, India

Introduction: India is undergoing rapid epidemiological transition and cardiovascular disease is becoming an increasingly important cause of death. While some information is available for urban areas, data about cardiovascular disease in rural areas is scant. The aim of this study was to establish the proportion of deaths attributable to cardiovascular causes in rural Andhra Pradesh.

Methods: All deaths occurring in 45 villages (population 180,162) were recorded during a 12 month period in 2003-4. Primary healthcare workers trained in the use of a standard verbal autopsy tool collected data about the deaths and these data were then assessed independently by 2 physicians and a cause of death was defined according to the international classification of disease -10 criteria. In the event of a disagreement in the causes of death assigned, a third physician reviewed the information provided in the verbal autopsy tool and made a decision about the diagnosis. Underlying, immediate and contributory cause of death were assigned wherever possible.

Results: 1332 deaths were identified giving a crude death rate of 7.4/1000. Verbal autopsies were completed on 98% of all deaths. Cardiovascular diseases were the leading causes of mortality, responsible for one third of all deaths. The rates of ischemic heart disease and cerebrovascular disease were similar and these two constituted the majority of the vascular deaths recorded. Cardiovascular diseases were responsible for a greater proportion of deaths among men than women and about one quarter of all cardiovascular deaths occurred below the age of 60 years.

Conclusion: The study shows that cardiovascular disease is the leading causes of death in poor areas of rural India. This mortality pattern presents a challenge to a health system whose resources are focused on communicable diseases and reproductive health.

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