India shows rise in deaths from non-communicable diseases, women hit harder: Lancet

While there has been a decline in deaths from non-communicable diseases (NCD) like cancer, diabetes and heart attacks globally in 2010-2019 compared to the decade before, India is showing the opposite trend, according to a new study published in The Lancet.

For males, the probability of dying from NCDs between birth and age 80 years increased to 57.8 and 57.9 per cent in 2010 and 2019, from 56 per cent in 2001.

The trend for females is more troubling. After a slight decrease in the probability of dying from NCDs between 2001 and 2010, the likelihood of death from these diseases rose sharply in the following decade. The probability of a female dying from an NCD between birth and age 80 years was 46.7 per cent in 2001. This showed a small decline to 46.6 per cent in 2011, before rising sharply to 48.7 per cent in 2019.

For men, the findings showed, the smaller increase in fatality risk from NCDs during 2010-19 was due to improvements in eight of the 20 causes of death analysed, including chronic obstructive pulmonary disease (COPD), ischaemic heart disease and cirrhosis of the liver. But men did not see progress in other causes such as upper aerodigestive tract cancers and stroke.

For women, no improvements were seen in any of the causes of death, barring cirrhosis of the liver, COPD and the residual category of all other NCDs.

The study highlighted that the quality of data from India is “very low” and that the results are subject to substantial uncertainty.

India also saw concerning trends in lung cancer. Though global mortality declined in 92 per cent of the places for males, only five countries — India, along with Armenia, Iran, Egypt and Papua New Guinea, showed an increase in mortality.

Deaths from most chronic diseases increased, with heart disease and diabetes contributing heavily, the study highlighted. The analysis tracked global progress to reduce deaths from chronic or ‘non-communicable’ diseases in 185 countries from 2010-2019.

Globally, mortality from non-communicable diseases dropped in around 80 per cent of the countries, which is home to more than 70 per cent of the world population, from 2010 to 2019. However, compared to the preceding decade, the decline from 2010 to 2019 in 60 per cent of countries was either smaller or showed a reversal of the earlier decline.

In most countries, the study noted, reductions in deaths from cardiovascular diseases, including heart attacks and strokes, played a major part in reducing deaths from chronic diseases, including cancers like stomach, colorectal, cervical, breast, lung and prostate.   

However, increases in deaths from dementia, other neuropsychiatric conditions, including alcohol use disorder, and some other cancers (like pancreatic and liver), counteracted the gains.

The global slowdown or reversal in progress in reducing mortality from chronic diseases in 2010-19 compared to the preceding decade could be due to several factors, the authors noted. These include medications for diabetes, hypertension and cholesterol, and timely cancer screening and heart attack treatment not reaching people in need.

Other drivers could be macroeconomic responses to the 2008 global recession, which curbed expansion of health budgets and development assistance for health in many countries. 

The tumultous period led to a rise in poverty, destitution and employment insecurity. People affected by these social conditions account for a disproportionately large share of deaths relative to their share of the population. This can be because these groups typically have lower access to and utilisation of clinical interventions, or to fresh, healthy foods.

Majid Ezzati, professor, School of Public Health at Imperial College London and Imperial Global Ghana and senior author of the study, called for increased investment in healthcare programmes and tobacco and alcohol control campaigns that have been effective in reducing deaths in many countries.