Burden of female breast cancer in India: estimates of YLDs, YLLs, and DALYs at national and subnational levels based on the national cancer registry programme.

PURPOSE: Female breast cancer (BC) is the leading cause of cancer incidence and mortality in India, and accounted for 13.5% of new cancer cases and 10% of cancer-related deaths in 2020. This study aims to estimate and report the female BC burden in India at state level from 2012 to 2016 in terms of years of life lost, years lived with disability, and disability-adjusted life years (DALYs), and to project the burden for the year 2025. METHODS: The cancer incidence and mortality data from 28 population-based cancer registries were analysed. The mean mortality to incidence ratio was estimated, and mortality figures were adjusted for underreporting. The burden of female BC was estimated at national and subnational levels using Census data, World Health Organisation's lifetables, disability weights, and the DisMod-II tool. A negative binomial regression is employed to project burden for 2025. RESULTS: The burden of BC among Indian women in 2016 was estimated to be 515.4 DALYs per 100,000 women after age standardization. The burden metrics at state level exhibited substantial heterogeneity. Notably, Tamil Nadu, Telangana, Karnataka, and Delhi had a higher burden of BC than states in the eastern and north-eastern regions. The projection for 2025 indicates to a substantial increase, reaching 5.6 million DALYs. CONCLUSION: The female BC burden in India was significantly high in 2016 and is expected to substantially increase. Undertaking a multidisciplinary, context-specific approach for its prevention and control can address this rising burden.

Burden of cancers in India - estimates of cancer crude incidence, YLLs, YLDs and DALYs for 2021 and 2025 based on National Cancer Registry Program.

BACKGROUND: Cancer is the major cause of morbidity and mortality worldwide. The cancer burden varies within the regions of India posing great challenges in its prevention and control. The national burden assessment remains as a task which relies on statistical models in many developing countries, including India, due to cancer not being a notifiable disease. This study quantifies the cancer burden in India for 2016, adjusted mortality to incidence (AMI) ratio and projections for 2021 and 2025 from the National Cancer Registry Program (NCRP) and other publicly available data sources. METHODS: Primary data on cancer incidence and mortality between 2012 and 2016 from 28 Population Based Cancer Registries (PBCRs), all-cause mortality from Sample Registration Systems (SRS) 2012-16, lifetables and disability weight from World Health Organization (WHO), the population from Census of India and cancer prevalence using the WHO-DisMod-II tool were used for this study. The AMI ratio was estimated using the Markov Chain Monte Carlo method from longitudinal NCRP-PBCR data (2001-16). The burden was quantified at national and sub-national levels as crude incidence, mortality, Years of Life Lost (YLLs), Years Lived with Disability (YLDs) and Disability Adjusted Life Years (DALYs). The projections for the years 2021 and 2025 were done by the negative binomial regression model using STATA. RESULTS: The projected cancer burden in India for 2021 was 26.7 million DALYsAMI and expected to increase to 29.8 million in 2025. The highest burden was in the north (2408 DALYsAMI per 100,000) and northeastern (2177 DALYsAMI per 100,000) regions of the country and higher among males. More than 40% of the total cancer burden was contributed by the seven leading cancer sites - lung (10.6%), breast (10.5%), oesophagus (5.8%), mouth (5.7%), stomach (5.2%), liver (4.6%), and cervix uteri (4.3%). CONCLUSIONS: This study demonstrates the use of reliable data sources and DisMod-II tools that adhere to the international standard for assessment of national and sub-national cancer burden. A wide heterogeneity in leading cancer sites was observed within India by age and sex. The results also highlight the need to focus on non-leading sites of cancer by age and sex. These findings can guide policymakers to plan focused approaches towards monitoring efforts on cancer prevention and control. The study simplifies the methodology used for arriving at the burden estimates and thus, encourages researchers across the world to take up similar assessments with the available data.

Zone-wise examination of optical coherence tomography features and their correspondence to multifocal electroretinography in eyes with nonproliferative diabetic retinopathy.

PURPOSE: To examine (1) the retinal structure by optical coherence tomography (OCT) and function by means of multifocal electroretinography (mfERG) in eyes with and without nonproliferative diabetic retinopathy (NPDR) (2) for correspondence between local retinal function and OCT zones with retinal lesions. METHODS: One hundred and thirty-two eligible participants (30 with nonproliferative DR (NPDR) and 102 with diabetes with no DR) underwent comprehensive ophthalmic examination, optical coherence tomography for retinal thickness measures, mfERG, and ultra-wide field fundus photography. OCT Early Treatment Diabetic Retinopathy Study (ETDRS) grid was overlaid on to mfERG plots. RESULTS: Those with NPDR had significantly thicker full retinal measures in the nine (ETDRS) zones compared to no DR. mfERG P1 latencies in rings 1-6 were significantly delayed, while the response densities in rings 4-6 were lower in the NPDR group. Significant negative correlation was noted between OCT thickness and mfERG P1 response densities in many ETDRS zones. Significant positive correlation was noted between P1 latencies and OCT thickness in a few zones. The combination of cystic spaces, microaneurysms, and hard exudates were present in all zones and were associated with a decrease in P1 response densities compared to no lesions. Reduced P1 response densities were associated with a sporadic delay in the mfERG latencies and vice versa. The number of lesions did not show correspondence to the mfERG measures. CONCLUSIONS: In eyes with NPDR, retinal function is differentially correlated with the DR lesions on OCT and can be assessed using multimodal imaging modalities.

Regional estimates of noncommunicable diseases associated risk factors among adults in India: results from National Noncommunicable Disease Monitoring Survey.

BACKGROUND: This study describes regional differences and determinants on key noncommunicable disease (NCD) risk factors in adults from the National NCD Monitoring Survey (NNMS) across six geographic regions of India. METHODS: The NNMS was a cross-sectional multistage cluster survey conducted in 2017-18, on a representative sample of 300 urban and 300 rural primary sampling units (PSU) covering 20 households per PSU. One adult aged 18-69 years per household was selected using the KISH grid. Globally standard survey tools were adapted for data collection. To arrive at regional estimates, the country was divided into six regions (south, north, central, west, east and northeast) based on the distribution of a national sample. The results are presented as proportion with 95% confidence intervals (CI). Univariable and multivariable logistic regression analyses were performed to identify NCD risk factor determinants significant in the regions. A p-value < 0.05 was considered for statistical significance. RESULTS: The overall survey response rate was 96.3%. The prevalence of current tobacco (45.7%) and alcohol use (22.3%) was significantly high in the northeast region. The highest proportion of adults from northern India showed low levels of physical activity (49.6%). The prevalence of metabolic risk factors - obesity (12.5%), raised fasting blood glucose (21.2%) and raised blood pressure (35.6%) was highest in south India. The prevalence of raised blood pressure was high in north India (35.2%) similar in proportion to south India. Clustering of ≥3 risk factors (50.1%) and ten-year CVD risk of ≥30% or with existing CVD (18.1%) was highest in south India when compared to other regions. Older age, urban residents, alcohol consumption and overweight/obesity were significantly associated with higher odds of raised blood pressure and raised fasting blood glucose. CONCLUSION: The NNMS presents variations in NCD risk factors within the regions of India. It contributes to robust evidence for strengthening interventions and monitoring the progress in reducing NCDs and their associated risk factors.

Preparedness of primary and secondary health facilities in India to address major noncommunicable diseases: results of a National Noncommunicable Disease Monitoring Survey (NNMS).

BACKGROUND: The monitoring framework for evaluating health system response to noncommunicable diseases (NCDs) include indicators to assess availability of affordable basic technologies and essential medicines to treat them in both public and private primary care facilities. The Government of India launched the National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular diseases and Stroke (NPCDCS) in 2010 to strengthen health systems. We assessed availability of trained human resources, essential medicines and technologies for diabetes, cardiovascular and chronic respiratory diseases as one of the components of the National Noncommunicable Disease Monitoring Survey (NNMS - 2017-18). METHODS: NNMS was a cross-sectional survey. Health facility survey component covered three public [Primary health centre (PHC), Community health centre (CHC) and District hospital (DH)] and one private primary in each of the 600 primary sampling units (PSUs) selected by stratified multistage random sampling to be nationally representative. Survey teams interviewed medical officers, laboratory technicians, and pharmacists using an adapted World Health Organization (WHO) - Service Availability and Readiness Assessment (SARA) tool on handhelds with Open Data Kit (ODK) technology. List of essential medicines and technology was according to WHO - Package of Essential Medicines and Technologies for NCDs (PEN) and NPCDCS guidelines for primary and secondary facilities, respectively. Availability was defined as reported to be generally available within facility premises. RESULTS: Total of 537 public and 512 private primary facilities, 386 CHCs and 334 DHs across India were covered. NPCDCS was being implemented in 72.8% of CHCs and 86.8% of DHs. All essential technologies and medicines available to manage three NCDs in primary care varied between 1.1% (95% CI; 0.3-3.3) in rural public to 9.0% (95% CI; 6.2-13.0) in urban private facilities. In NPCDCS implementing districts, 0.4% of CHCs and 14.5% of the DHs were fully equipped. DHs were well staffed, CHCs had deficits in physiotherapist and specialist positions, whereas PHCs reported shortage of nurse-midwives and health assistants. Training under NPCDCS was uniformly poor across all facilities. CONCLUSION: Both private and public primary care facilities and public secondary facilities are currently not adequately prepared to comprehensively address the burden of NCDs in India.

National Stroke Registry Programme in India for Surveillance and Research: Design and Methodology.

The burden of stroke is increasing, and India lacks comparable long-term data on stroke incidence and mortality. Disease surveillance using a registry model can provide long-term data on stroke for linking with public health interventions in stroke prevention, treatment, and rehabilitation. The objectives of the National Stroke Registry Programme (NSRP), India, are to generate reliable data on the incidence of first-ever stroke events in defined populations through a population-based stroke registry (PBSR) and to describe the patterns of care and outcomes of patients with stroke in different treatment settings through a hospital-based stroke registry (HBSR). Continuous systematic collection on a standardized format of diagnostic, treatment, and outcome information on stroke events in persons of defined population (PBSR) and those who attend hospitals (HBSR) is conducted through active data abstraction from review of records from all health facilities and imaging centres that cater to stroke patients. Data are ICD coded, verified, and completed by obtaining survival status of registered patients. IT tools are used for data collection,management and analysis. The NSRP shall establish a standardized stroke surveillance system that would reliably measure stroke incidence, subtypes, treatment patterns, complications, disability, case fatality, and survival. This evidence shall inform health planning of stroke interventions and control activities. It would facilitate improvement in stroke services to improve quality of care and outcomes of stroke. A thrust for research on stroke would be encouraged based on evidence-based hypothesis generation.

Four-year Incident Neuropathy and its Risk Factors in Subjects with Type 2 Diabetes.

OBJECTIVE: The study assessed the four-year incidence of diabetic peripheral neuropathy (DPN) and the risk factors that can predict incident neuropathy in a south Indian population with type 2 diabetes. RESEARCH DESIGN AND METHODS: 1175 diabetic individuals were identified with known diabetes at baseline. At baseline, individuals underwent assessment of fasting plasma glucose and HbA1c levels, body mass index, waist-hip ratio, blood pressure, blood cholesterol and lipid levels, and ophthalmic evaluation including visual acuity, specular microscopy of the corneal endothelium, cataract grading and diabetic retinopathy assessment. Subjects were re-examined after four years for the assessment of incident neuropathy; 713 individuals were found eligible at follow-up. The presence of neuropathy was assessed at baseline and at follow-up and was defined as a Vibration Perception Threshold of ≥ 20 Volts. RESULTS: : The four-year incidence of any neuropathy was 28.4%. Factors predictive of incident diabetic neuropathy were greater age at baseline (OR =1.068), higher body mass index (OR =1.034), presence of diabetic retinopathy (OR =4.879) and lower socioeconomic status (OR =4.841), when adjusted for several potential confounding factors. CONCLUSION: The four-year incidence of diabetic neuropathy in a south Indian population with type 2 diabetes is 28% and can be predicted by ophthalmic and clinical variables. These factors may be utilized in the assessment, monitoring and intervention in individuals with diabetes in an effort to prevent or delay the development of diabetic peripheral neuropathy.

Influence of serum lipids on the incidence and progression of diabetic retinopathy and macular oedema: Sankara Nethralaya Diabetic Retinopathy Epidemiology And Molecular genetics Study-II.

IMPORTANCE: The importance of lipids on incidence and progression of diabetic retinopathy has not been studied in the Indian population. BACKGROUND: To elucidate the influence of serum lipid control on the incidence and progression of diabetic retinopathy and diabetic macular oedema in subjects with type 2 diabetes. DESIGN: Population-based longitudinal observational study in a hospital setting. PARTICIPANTS: Eight hundred ninety subjects were examined at baseline and follow-up. METHODS: Diabetic retinopathy was graded per Modified Early Treatment Diabetic Retinopathy Study scales; 45°, 4-field dilated stereoscopic digital photography was performed with an additional 30°, 7-field for those who had retinopathy. Macular oedema was evaluated per Proposed International Clinical Diabetic Retinopathy and Diabetic Macular Oedema Disease Severity Scales. MAIN OUTCOME MEASURES: Association of serum lipids and incidence and progression of diabetic retinopathy. RESULTS: Poor control of total cholesterol was associated with the incidence of sight-threatening retinopathy (odds ratio = 7.2 [95% confidence interval: 1.5-34.3], P = 0.012) and macular oedema (odds ratio = 5.5 [95% confidence interval: 1.4-27.4], P = 0.037) after adjusting for potential confounders. Poor control of triglycerides was associated with progression to proliferative diabetic retinopathy (odds ratio = 3.2 [95% confidence interval: 1.1-10.5], P = 0.048). Risk for incident macular oedema (P = 0.041) and progression to proliferative diabetic retinopathy (P = 0.028) was greater when all lipid types were abnormal. CONCLUSIONS AND RELEVANCE: Poor control of lipids is a risk factor for incidence of and progression to late stages of retinopathy. Abnormal levels of all lipid types are associated with risk of incident macular oedema and progression to proliferative diabetic retinopathy.

The association of smokeless tobacco use and pack-years of smokeless tobacco with age-related macular degeneration in Indian population.

AIM: To explore the association of use versus no use and the influence of pack-year use of smokeless tobacco with that of early and late age-related macular degeneration (AMD) in rural and urban south Indian population. We hypothesized that the use and pack-years of use would be significantly associated with both early and late AMD. We therefore sought to examine subjects who gave a history of using smokeless tobacco and we quantified the usage as pack-years, to examine the association with that of early and late AMD. MATERIALS AND METHODS: This was part of Sankara Nethralaya: Rural-Urban Age-related Macular degeneration study (SN-RAM study), which was conducted between 2007 and 2010. Subjects aged 60 years or older or those turning 60 in the present calendar year, with a history of using smokeless tobacco were noted along with duration and number of packs used per day. Smokeless tobacco was defined as chewed-tobacco (loose leaves) and/or snuff (finely chopped tobacco). Subjects underwent detailed ophthalmic evaluation including cataract grading using the Lens Opacities Classification System (LOCS III), 45° 4-field stereoscopic fundus photography and AMD evaluation. Pack-years of smokeless tobacco use was stratified as <15, 15-34 and ≥35 years; the association of tobacco use and pack-years of use with that of early and late AMD was examined. A p value of < 0.05 was considered statistically significant. RESULTS: The number of smokeless tobacco users was significantly higher in rural (n = 767) than in urban groups (n = 281), p < 0.001. Of the 1048 users, 238 subjects (23%) provided details regarding quantification of use. There were no significant differences in the pack-years between rural and urban areas, p = 0.756 or that between AMD and no AMD, p = 0.562. Use of smokeless tobacco compared with no use was significantly associated with late AMD, OR= 3.178, 95%CI: 1.095, 9.227, p = 0.033, when adjusted for age, gender, rural-urban differences, presence of diabetes, socioeconomic status, systolic and diastolic blood pressure, total cholesterol, low-density and high-density lipoprotein levels. The association was not significant for early AMD, p = 0.582. The pack-years of use did not show a statistically significant association with early or late AMD. Furthermore, out of the 1048 subjects, 547 reported as using areca nut. Of which, 415 (75.8%) subjects had no AMD, 119 (21.7%) showed evidence of early AMD and 13 (2.4%) had late AMD. There was no significant association between the use of areca nut and early AMD, (X2 (1, N = 930) = 2.345, p = 0.126) or with that of late AMD (X2 (1, N = 761) = 0.075, p = 0.785). CONCLUSIONS: Smokeless tobacco use compared with no use, is associated with late AMD, regardless of the pack-years of use. Tobacco use is a modifiable risk factor. Efforts to reduce or stop the use of smokeless tobacco is indicated in an effort to prevent vision loss with respect to late AMD.

Association of systemic and ocular risk factors with neurosensory retinal detachment in diabetic macular edema: a case-control study.

BACKGROUND: Diabetic macular edema (DME) with neurosensory retinal detachment (NSD) remains an important cause of visual loss in patients with diabetes. The aim of the study was to elucidate the association of systemic and ocular risk factors with NSD in DME. METHODS: In a retrospective case-control study, we reviewed clinical records of all the subjects with DME seen between January 2010 and December 2010. Cases and controls were selected based on optical coherence tomography and stereoscopic biomicroscopy review. NSD was defined as subfoveal fluid accumulation under detached retina with or without overlying foveal thickening. The association between the presence of NSD, blood pressure, lipid status and various other biochemical parameters was evaluated. RESULTS: Group I (cases) included 37 eyes of 33 patients having DME with NSD and Group II (controls) included 30 eyes of 21 patients having DME without NSD. Patients ranged in age (mean ± SD) from 50 to 62 years (56.6 +/-6.78) for cases and from 51 to 65 years (58.4+/-7.84) for controls. The duration of diabetes ranged from 4 to 15 year (mean 9.45+/-6.08) among cases and 4 to 14 years (9.7+/-5.12) among controls. Significant risk factors for NSD were high values of systolic and diastolic blood pressure (p = 0.039 and 0.043 respectively). CONCLUSION: High systolic and diastolic blood pressures are independent and significant risk factors for NSD in DME.

Topic modeling and social network analysis approach to explore diabetes discourse on Twitter in India.

Introduction: The utilization of social media presents a promising avenue for the prevention and management of diabetes. To effectively cater to the diabetes-related knowledge, support, and intervention needs of the community, it is imperative to attain a deeper understanding of the extent and content of discussions pertaining to this health issue. This study aims to assess and compare various topic modeling techniques to determine the most effective model for identifying the core themes in diabetes-related tweets, the sources responsible for disseminating this information, the reach of these themes, and the influential individuals within the Twitter community in India. Methods: Twitter messages from India, dated between 7 November 2022 and 28 February 2023, were collected using the Twitter API. The unsupervised machine learning topic models, namely, Latent Dirichlet Allocation (LDA), non-negative matrix factorization (NMF), BERTopic, and Top2Vec, were compared, and the best-performing model was used to identify common diabetes-related topics. Influential users were identified through social network analysis. Results: The NMF model outperformed the LDA model, whereas BERTopic performed better than Top2Vec. Diabetes-related conversations revolved around eight topics, namely, promotion, management, drug and personal story, consequences, risk factors and research, raising awareness and providing support, diet, and opinion and lifestyle changes. The influential nodes identified were mainly health professionals and healthcare organizations. Discussion: The study identified important topics of discussion along with health professionals and healthcare organizations involved in sharing diabetes-related information with the public. Collaborations among influential healthcare organizations, health professionals, and the government can foster awareness and prevent noncommunicable diseases.

Exploring stroke discourse on Twitter through content and network analysis among Indian users.

The study aimed to understand stroke-related Twitter conversations in India, focusing on topics, message sources, reach, and influential users to provide insights to stakeholders regarding community needs for knowledge, support, and interventions. Geo-tagged Twitter posts focusing on stroke originating from India and, spanning from November 7, 2022, to February 28, 2023, were systematically obtained via the Twitter application programming interface, using keywords and hashtags sourced through Symplur Signals. Preprocessing involved the removal of hashtags, stop words, and URLs. The Latent Dirichlet Allocation (LDA) topic model was used to identify recurring stroke-related topics, while influential users were identified through social network analysis. About half of the tweets about stroke in India were about seeking support and post-stroke bereavement sharing and had the highest reachability. Four out of 10 tweets were from the individual twitter users. Tweets on the topic risk factors, awareness and prevention (14.6%) constituted the least proportion, whereas the topic management, research, and promotion had the least retweet ratio. Twitter demonstrates significant potential as a platform for both disseminating and acquiring stroke-related information within the Indian context. The identified topics and understanding of the content of discussion offer valuable resources to public health professionals and organizations to develop targeted educational and engagement strategies for the relevant audience.

District-Wise Heterogeneity in Blood Pressure Measurements, Prehypertension, Raised Blood Pressure, and Their Determinants Among Indians: National Family Health Survey-5.

Objective: The objective of the study was to determine the prevalence and determinants of ever-measured blood pressure, prehypertension, and raised blood pressure at national, state and district levels in India. Methods: We analysed data from the National Family Health Survey (NFHS-5), on 743,067 adults aged 18-54 years. The sample consisted of 87.6% females and 12.4% males. We estimated prevalence rates and determined adjusted odds ratios for various dependent variables related to blood pressure. Geographical variations were visualized on the map of India, and multivariate logistic regression was employed at state and district levels, with significance set at p < 0.05. Results: The prevalence of ever-measured blood pressure varied widely, from 30.3% to 98.5% across districts, with southern and northern regions showing higher rates. Prehypertension affected 33.7% of the population, with varying prevalence across districts. Raised blood pressure was there in 15.9%, with notably higher rates in southern region (16.8%). Determinants included age, gender, education, wealth, lifestyle, obesity, and blood glucose levels. Conclusion: These findings demonstrate the subnational variations in blood pressure, can guide evidence-based interventions at the state and district level, towards reducing the burden of raised blood pressure and enhancing overall population health.

Stroke incidence, mortality, subtypes in rural and urban populations in five geographic areas of India (2018-2019): results from the National Stroke Registry Programme.

Background: Increasing stroke burden in India demands a long-term stroke surveillance framework. Earlier studies in India were urban-based, short term and provided limited data on stroke incidence and its outcomes. This gap is addressed by the establishment of five population-based stroke registries (PBSRs) of the National Stroke Registry Programme, India. This paper describes stroke incidence, mortality and age, sex, and subtypes distribution in the five PBSRs with urban and rural populations. Methods: First-ever incident stroke patients in age group ≥18 years, resident for at least one year in the defined geographic area, identified from health facilities were registered. Death records with stroke as the cause of death from the Civil Registration System (CRS) were included. Transient ischemic attack (TIA) was excluded. Three PBSRs (Cuttack, Tirunelveli, Cachar) included urban and rural populations. PBSRs in Kota and Varanasi were urban areas. The crude and age-standardized incidence rate (ASR) by age, sex, and residence (urban and rural), rate ratios of ASR, case fatality proportions and rates at day 28 after onset of stroke were calculated for years 2018-2019. Findings: A total of 13,820 registered first-ever stroke cases that included 985 death certificate-only cases (DCOs) were analysed. The pooled crude incidence rate was 138.1 per 100,000 population with an age-standardized incidence rate (ASR) of 103.4 (both sexes), 125.7 (males) and 80.8 (females). The risk of stroke among rural residents was one in seven (Cuttack), one in nine (Tirunelveli), and one in 15 (Cachar). Ischemic stroke was the most common type in all PBSRs. Age-standardized case fatality rates (ASCFR) per 100,000 population for pooled PBSRs was 30.0 (males) and 18.8 (females), and the rate ratio (M/F) ranged from 1.2 (Cuttack) to 2.0 (Cachar). Interpretation: Population-based registries have provided a comprehensive stroke surveillance platform to measure stroke burden and outcomes by age, sex, residence and subtype across India. The rural-urban pattern of stroke incidence and mortality shall guide health policy and programme planning to strengthen stroke prevention and treatment measures in India. Funding: The National Stroke Registry Programme is funded through the intramural funding of the Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, India.

Hypertension treatment cascade in India: results from National Noncommunicable Disease Monitoring Survey.

Hypertension is a major risk factor for ischemic heart disease and stroke. We estimated prevalence, awareness, treatment, and control of hypertension along with its determinants in India. We used data from the National NCD Monitoring Survey-(NNMS-2017-2018) which studied one adult (18-69 years) from a representative sample of households across India and collected information on socio-demographic variables, risk factors for NCDs and treatment practices. Blood pressure was recorded digitally and hypertension was defined as systolic blood pressure (SBP) ≥ 140 mmHg or diastolic blood pressure (DBP) ≥ 90 mmHg or currently on medications. Awareness was defined as being previously diagnosed with hypertension by a health professional; on treatment as taking a dose of medication once in the last 14 days and; control as SBP < 140 mmHg and DBP < 90 mmHg. Multivariate Logistic regression was performed to estimate determinants. Out of 10,593 adults with a blood pressure measurement (99.4%), 3017 (28.5%; 95% CI: 27.0-30.1) were found to have hypertension. Of these hypertensives, 840 (27.9%; 95% CI: 25.5-30.3) were aware, 438 (14.5%; 95% CI: 12.7-16.5) were under treatment and, 379 (12.6%; 95% CI: 11.0-14.3) were controlled. Significant determinants of awareness were being in the age group 50-69 years (aOR 2.45 95% CI: 1.63-3.69), women (1.63; 95% CI: 1.20-2.22) and from higher wealth quintiles. Those in the age group 50-69 (aOR 4.80; 95% CI: 1.74-13.27) were more likely to be under treatment. Hypertension control was poorer among urban participants (aOR 0.55; 95% CI: 0.33-0.90). Significant regional differences were noted, though without any clear trend. One-fifth of the patients were being managed at public facilities. The poor population-level hypertension control needs strengthening of hypertension services in the Universal Health Coverage package.

Awareness, behavior, and determinants of dietary salt intake in adults: results from the National NCD Monitoring Survey, India.

A diet high in sodium contributes to a significant proportion of Disability Adjusted Life Years (DALYs) due to cardiovascular diseases. This paper describes the awareness, behaviour and determinants related to dietary salt intake in an adult population of 18-69 years that were assessed as part of the National NCD Monitoring Survey (NNMS) in India. A sub-sample of 3000 adults selected through simple random sampling from 150 nationally representative Primary Sampling Units (PSUs) was included. Data regarding awareness and behaviour related to dietary salt intake were collected. Urinary sodium excretion in spot urine samples was estimated and used to calculate dietary salt intake. The dietary salt intake's sociodemographic, behavioural and metabolic determinants were also analysed. Less than one-third of the adults of both genders in all age groups in rural and urban areas were aware that daily high salt intake could affect health. The estimated mean daily salt intake was 8.0 g (8.9 g/day for men and 7.1 g/day for women). The salt intake was significantly higher in men [Adjusted OR = 17.66 (5.24-59.46)], rural areas [Adjusted OR = 6.14 (1.83-20.60)], overweight and obese respondents [Adjusted OR = 17.62 (3.17-98.07)]. The perception of the harmful effects of high salt intake and practices to limit salt intake was low in the study population. The mean daily salt intake was higher than the WHO recommendation of up to 5 g daily. The mean dietary salt intake is high in the Indian population, which calls for planning and implementing control of dietary salt consumption measures.

Association of OCT and OCT angiography measures with the development and worsening of diabetic retinopathy in type 2 diabetes.

OBJECTIVE: To assess if optical coherence tomography (OCT) and OCT angiography (OCTA) measures are associated with the development and worsening of diabetic retinopathy (DR) over four years. METHODS: 280 participants with type 2 diabetes underwent ultra-wide field fundus photography, OCT and OCTA. OCT-derived macular thickness measures, retinal nerve fibre layer and ganglion cell-inner plexiform layer thickness and OCTA-derived foveal avascular zone area, perimeter, circularity, vessel density (VD) and macular perfusion (MP) were examined in relation to the development and worsening of DR over four years. RESULTS: After four years, 206 eyes of 219 participants were eligible for analysis. 27 of the 161 eyes (16.7%) with no DR at baseline developed new DR, which was associated with a higher baseline HbA1c and longer diabetes duration. Of the 45 eyes with non-proliferative DR (NPDR) at baseline, 17 (37.7%) showed DR progression. Baseline VD (12.90 vs. 14.90 mm/mm2, p = 0.032) and MP (31.79% vs. 36.96%, p = 0.043) were significantly lower in progressors compared to non-progressors. Progression of DR was inversely related to VD ((hazard ratio [HR] = 0.825) and to MP (HR = 0.936). The area under the receiver operating characteristic curves for VD was AUC = 0.643, with 77.4% sensitivity and 41.8% specificity for a cut-off of 15.85 mm/mm2 and for MP it was AUC = 0.635, with 77.4% sensitivity and 25.5% specificity for a cut-off of 40.8%. CONCLUSIONS: OCTA metrics have utility in predicting progression rather than the development of DR in individuals with type 2 diabetes.

Inter-observer agreement in grading severity of diabetic retinopathy in wide-field fundus photographs.

OBJECTIVE: To examine the inter-observer agreement between two retina specialists in grading diabetic retinopathy (DR) severity in ultra-wide-field fundus photographs. METHODS: Two hundred and seventy patients with diabetes, who visited the vitreoretinal specialty at a tertiary eye care hospital, with or without DR underwent comprehensive ophthalmic examination, dilated retinal exam and Optos ultra-wide-field (UWF) retinal photography. Optos images were graded for DR severity based on the International Clinical Diabetic Retinopathy Disease Severity Scale by two retina specialists with same number of years of experience, masked to the clinical details of the participants. RESULTS: The two graders showed agreement in 229/270 images (84.8%) and disagreement in 41/270 images (15.2%). The unweighted kappa for agreement between graders was k = 0.715, SE = 0.037 and the weighted kappa was k = 0.838, SE = 0.022. No DR was identified in 170/270 (62.9%) patients, mild NPDR in 15/270 (5.6%) patients, moderate NPDR in 35/270 (12.9%) patients, severe NPDR in 4/270 (1.48%) patient and PDR in 5/270 (1.85%) patients by both graders. Disagreement was neither related to the learning curve of graders nor with the patient's age (p = 0.574), gender (p = 0.169), duration of diabetes (0.660) or the lens being phakic or pseudophakic (p = 0.171) on logistic regression. CONCLUSIONS: The impact of disagreement noted between observers in grading DR on UWF fundus photographs should be considered when utilizing UWF system in clinical studies.

Influence of dietary-fibre intake on diabetes and diabetic retinopathy: Sankara Nethralaya-Diabetic Retinopathy Epidemiology and Molecular Genetic Study (report 26).

BACKGROUND: The present study aims to report the influence of dietary-fibre intake on diabetes and diabetic microangiopathies among subjects >40 years in Urban India. DESIGN: Population-based cross-sectional study. PARTICIPANTS: A total of 1383 patients were included in the study, 1261 diabetics and 122 controls. METHODS: All subjects underwent comprehensive eye examination including assessment of diabetic retinopathy using fundus photography. Dietary-fibre intake was assessed using a validated questionnaire. All questions were validated based on factor analysis (overall communalities value >0.5). The cut-off for low-fibre diet was calculated by the average of study scores (≤ 32 for low-fibre diet). MAIN OUTCOME MEASURES: Prevalence of diabetes in subjects with low-fibre diet versus healthy diet and risk of microangiopathies. RESULTS: Subjects with low-fibre diet intake, had 1.51 times more risk of microalbuminuria than those with a healthy-fibre diet. Similarly, the odds of having diabetic retinopathy and sight-threatening diabetic retinopathy (odds ratio 1.41 [95% CI 1.02-1.94] and odds ratio 2.24 [95% CI 1.01-5.02], respectively) in low-fibre diet subjects were more. Low-fibre diet was consumed predominantly by lower socioeconomic status group (11.9 vs. 6.5, P=0.002). CONCLUSIONS: Subjects with type II diabetes had a lower dietary-fibre intake. The presence of diabetic retinopathy, sight-threatening diabetic retinopathy and microalbuminuria were also associated with lower dietary-fibre intake.

Prevalence and Correlates of Insufficient Physical Activity Among Adults Aged 18-69 Years in India: Findings From the National Noncommunicable Disease Monitoring Survey.

BACKGROUND: Sufficient physical activity (PA) significantly contributes to the prevention and control of noncommunicable diseases. This study aims to determine the prevalence of insufficient PA and associated sociodemographic and lifestyle factors among adults aged 18-69 years in India. METHODS: A national population-based, cross-sectional survey was conducted during 2017-2018 among 12,000 adults that adapted globally standard data collection tools. The data were weighted and analyzed using complex samples analysis. Logistic regression analysis was performed to identify the sociodemographic and lifestyle factors associated with insufficient PA. RESULTS: Age standardized prevalence of insufficient PA among adults in India was 41.4%. A higher proportion of women (52.4%) and urban adults (51.7%) were not doing sufficient PA. Men (118.8 min) spent more time in PA per day than women (55.3 min). Higher odds of insufficient PA were significantly associated with unemployment (adjusted odds ratio [aOR] = 6.45), highest wealth quintile (aOR = 1.86), presence of central obesity (aOR = 1.24), and raised blood pressure (aOR = 1.22). CONCLUSION: This study provides the baseline prevalence of insufficient PA to monitor the set PA targets for India by 2025. The identified associated factors can guide policy makers to plan tailored interventions targeting high-risk groups and a multisectoral approach to promote PA.