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Vascular mortality in rural Andhra Pradesh, India
Joshi R1, Cardona M1, Raju R2, lyengar
S2, Sukumar A2, Raju C R2, Raju P K
3, Reddy K S4, Lopez A D5, Neal B1
1The George Institute for International Health, University of
Sydney, Sydney, Australia; 2Byrraju Foundation, Hyderabad,
India; 3CARE Foundation, Hyderabad, India; 4Centre
for Chronic Disease Control, New Delhi, India; 5University of
Queensland, Australia
India has a well-established epidemic of vascular disease occurring in
its major urban centres. However, 70% of the population resides in rural
areas where vascular diseases are projected to be a leading cause of
death but objective data are few.
A mortality surveillance system was established to define the proportion
of deaths attributable to vascular causes in a rural area of Andhra
Pradesh. All deaths occurring in 45 villages (population 180,162) were
recorded during a 12 month period in 2003-4. Trained primary healthcare
workers interviewed a close relative of the deceased using a validated
verbal autopsy questionnaire. Complete questionnaires were assessed by 2
independent physicians who arrived at a cause of death using predefined
algorithms and coded the results according to ICD-10.
Verbal autopsies were completed for 98% (1329) of all the deaths
identified (1354). Vascular diseases were the leading cause of mortality
responsible for one-third (33%) of all deaths: ischaemic heart disease
(14%), cerebrovascular disease (13%), and other vascular causes (6%).
Vascular diseases were responsible for a greater proportion of deaths
among men than women and about one-quarter of vascular deaths occurred
below the age of 60. A validation study done to compare the verbal
autopsy diagnoses against diagnoses based on comprehensive hospital
records provided substantial reassurance about the reliability of the
findings.
Vascular disease is a major health problem in rural, as well as urban,
India. Policy makers need to reorient healthcare infrastructure to
accommodate the growing need for vascular disease prevention and care.
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