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1.
Lancet Reg Health Southeast Asia ; 9: 100113, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37383035

RESUMO

Background: Hypertension is a significant contributor to mortality in India. Achieving better hypertension control rate at the population level is critical in reducing cardiovascular morbidity and mortality. Methods: Hypertension control rate was defined as the proportion of patients with their blood pressure under control (systolic blood pressure <140 mmHg and diastolic blood pressure <90 mmHg). We conducted a systematic review and meta-analysis of community-based, non-interventional studies published after 2001 that reported hypertension control rates. We searched PubMed, Embase, and Web of Science databases, and grey literature, and extracted data using a common framework, and summarized the study characteristics. We conducted random-effects meta-analysis using untransformed hypertension control rates and reported the overall summary estimates and subgroup estimates of control rates as percentages and 95% confidence intervals. We also conducted mixed-effects meta-regression with sex, region, and study period as covariates. The risk of bias was assessed, and level of evidence was summarized using SIGN-50 methodology. The protocol was pre-registered with PROSPERO, CRD42021267973. Findings: The systematic review included 51 studies (n = 338,313 hypertensive patients). 21 studies (41%) reported poorer control rates among males than females, and six studies (12%) reported poorer control rates among rural patients. The pooled hypertension control rate in India during 2001-2020 was 17.5% (95% CI: 14.3%-20.6%)-with significant increase over the years, reaching 22.5% (CI: 16.9-28.0%) in 2016-2020. Sub-group analysis showed significantly better control rates in the South and West regions, and significantly poorer control rates among males. Very few studies reported data on social determinants or lifestyle risk factors. Interpretation: Less than one-fourth of hypertensive patients in India had their blood pressure under control during 2016-2020. Although the control rate has improved compared to previous years, substantial differences exist across regions. Very few studies have examined the lifestyle risk factors and social determinants relevant to hypertension control in India. The country needs to develop and evaluate sustainable, community-based strategies and programs to improve hypertension control rates. Funding: Not applicable.

2.
J Family Med Prim Care ; 10(8): 2735-2738, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34660397

RESUMO

BACKGROUND: We analyzed the trends for two important cancers affecting females, breast cancer and cervical cancer, using the Indian cancer registry data and correlated the findings with selected relevant sociodemographic and behavioral indicators. METHODS: We examined National Family Health Survey data for the respective states in which registries are located, on relevant indicators like multiparity, early childbearing, cervical examination, multiple sexual partners/high-risk sexual behavior, and HIV prevalence (for cervical cancer), multiparity, early childbearing, duration of breastfeeding, overweight, alcohol use, and clinical breast examination (for breast cancer). We used Global Adult Tobacco Survey smoking data. RESULTS: The top four positions in cancer cervix were all in registries from northeast India with a higher proportion of multiparous women (≥3 births; around 40%), whereas three major metros in the south and the national capital of Delhi, all with a relatively low proportion of multiparous women (11-25%) topped the chart for breast cancer. Overweight/obesity was higher in states with a higher incidence of breast cancer (23.3-31%) compared to states with a lower incidence (12.2-16%). No clear patterns emerged with regard to alcohol consumption, duration of breastfeeding or clinical breast examination. CONCLUSION: The shift in the childbearing age group explains the increasing breast cancer rates in urban areas, whereas the persisting higher rate of multiparity explains higher cervical cancer rates especially in underserved states in the northeast. India needs to invest in transforming its cancer control program to be a more resilient one with a focus on screening and prevention.

3.
J Epidemiol Glob Health ; 11(2): 230-232, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33876594

RESUMO

BACKGROUND: On September 5, 2020, India reported the second highest COVID-19 cases globally. Given India's unique disease burden including both infectious and chronic diseases, there is a need to study the survival patterns of COVID-19. We aimed to describe the factors associated with COVID-19 deaths in the State of Tamil Nadu that has the highest COVID-19 case burden among the Indian states, and to compare deaths among COVID patients with and without comorbidities. METHODS: We analyzed the first 1000 COVID deaths (1 March to 26 June 2020) and 1000 recent deaths at the time of analysis (1-10 August 2020). We examined data on facility (public vs private), age, gender, duration of illness prior to and/or during hospitalizations, symptoms, comorbidities and cause of death. We used R statistical program to do the analysis. We compared deaths among patients with and without comorbidities using Wilcoxon rank sum test. p < 0.05 was considered significant. RESULTS: First, we found a shorter time interval from onset of symptoms to death in India than that was reported in the USA and China. Second, young adults without comorbidities had shorter survival from the time of onset of symptoms irrespective of their timing of hospitalization. Third, hypothyroidism is a COVID-19 associated co-morbidity. Longitudinal studies are needed to further assess the thyroid-COVID-19 link. CONCLUSION: As COVID-19 infection rates are accelerating rapidly in India, it is crucial to sensitize young adults while protecting the elderly and other vulnerable populations.


Assuntos
COVID-19/mortalidade , Comorbidade , Adulto , Feminino , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , SARS-CoV-2
4.
J Family Med Prim Care ; 5(1): 114-9, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27453854

RESUMO

INTRODUCTION: Hypertension is a major cause of cardiovascular morbidity and mortality in Kerala. Excess dietary salt, low dietary potassium, overweight and obesity, physical inactivity, excess alcohol, smoking, socioeconomic status, psychosocial stressors, and diabetes are considered as modifiable risk factors for hypertension. OBJECTIVES: To estimate and compare the distribution of modifiable risk factors among hypertensive (cases) and nonhypertensive (controls) patients and to estimate the effect relationship of risk factors. MATERIALS AND METHODS: Age- and sex-matched case-control study was conducted in a tertiary care hospital in Kerala using a pretested interviewer-administered structured questionnaire based on the WHO STEPS instrument for chronic disease risk factor surveillance. Bivariate and multiple logistic regression analyses were done. RESULTS: A total of 296 subjects were included in the study. The mean age of study sample was 50.13 years. All modifiable risk factors studied vis-ΰ-vis obesity, lack of physical activity, inadequate fruits and vegetable intake, diabetes, smoking, and alcohol use were significantly different in proportion among cases and controls. Obesity, lack of physical activity, smoking, and diabetes were found to be significant risk factors for hypertension after adjusting for other risk factors. CONCLUSION: Hypertension is strongly driven by a set of modifiable risk factors. Massive public awareness campaign targeting risk factors is essential in controlling hypertension in Kerala, especially focusing on physical exercise and control of diabetes, obesity, and on quitting smoking.

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