Heart disease biggest killer in India and globally: study

Heart disease has emerged as the world's top cause of death, replacing lower respiratory (lung) infections, diarrhoeal diseases and preterm birth, which were the top three causes of deaths in 1990, according to the Global Burden of Disease Study 2013 published in The Lancet.

Globally, the number of deaths increased from 47.5 million to 54.9 million over the same interval, with India accounting for 19 per cent of the world's deaths in 2013.

The leading killers in India were ischaemic heart disease, chronic obstructive pulmonary disease and stroke, accounting for 30 per cent of all deaths in 2013. Tuberculosis and ischaemic heart disease were the top two causes of death for people between the ages of 15 and 49, resulting in 408,114 lives lost in 2013.

Among people 70 and older, ischemic heart disease claimed the most lives that year. The top cause of child mortality was neonatal encephalopathy in 2013, killing 212,686 children under the age of 5.

In India, hypertensive heart disease and suicide took more lives in 2013 than in 1990, with deaths increasing 138 per cent and 129 per cent respectively. Mortality from road injuries also increased 88 per cent between 1990 and 2013.

This largest-ever global health surveillance tracked 240 causes of deaths across 188 countries between 1990 and 2013. The data was sourced from registration of death, cancer registries, sibling history, police record, verbal autopsy, surveillance and survey, census, hospital and burial records.

"The disease and death trends are more or less the same for India, where non-communicable diseases are now killing more people than infections such as tuberculosis and pneumonia," says Prof A A Mahdi, head of the department of Biochemistry, King George's Medical University, Lucknow. He was among the team that validated data from India.

Globally, both men and women were living longer in 2013, with global life expectancy for both sexes increasing from 65.3 years in 1990, to 71.5 years in 2013. In 2013, women were living 6.6 years more than they were in 1990 and men by 5.8 years. If the median rate of change of the last 23 years continues, on average, women will live to be 85.3 years and men 78.1 years by 2030.

"India has had remarkable progress in reducing both child and adult deaths over the past 23 years. Average yearly rates of decline were 1.3 per cent per year for adults and 3.7 per cent for children, which pushed up life expectancy for India from around 59 years for women and 58 for men in 1990 to 69 years and 68.5 years respectively in 2013," said Dr Jeemon Panniyammakal, Centre for Chronic Disease Control, Public Health Foundation of India (PHFI).

Diarrhoeal diseases, lower respiratory infections, neonatal causes, and malaria are still in the top five causes of death in children younger than five years. The most deadly infective agents are rotavirus for diarrhoea and pneumococcus for lower respiratory infections.

"The bad news for India is that non-communicable diseases are rising and affecting people at a younger age than in most other parts of the world. In western societies, heart disease typically occurs after 70 years, but in India, more than half the heart attacks occur before the age of 70," Dr Dorairaj Prabhakaran, director, centre for chronic conditions and injuries, PHFI.

Increased life expectancy is mainly caused by a fall in death from lower respiratory infections and diarrhoeal diseases (contributing 2.2 years), cardiovascular and circulatory diseases (contributing 1.1 years), neonatal conditions (contributing 0.7 years), cancers (contributing 0.4 years), and chronic respiratory diseases (contributing 0·5 years).

These gains were offset by increased death from diabetes and chronic kidney diseases, as well as musculoskeletal disorders.

Globally, the five main causes that lowered life expectancy were deaths from HIV/AIDS in Africa; diabetes, chronic kidney disease, and other endocrine disorders in Oceania and central Latin America; mental disorders in high-income North America; intentional injuries in south Asia, high-income Asia Pacific, and southern sub-Saharan Africa; and cirrhosis in eastern Europe and central Asia.