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. 2021 Jan-Feb;15(1):343-350.
doi: 10.1016/j.dsx.2021.01.005. Epub 2021 Jan 20.

Macrolevel association of COVID-19 with non-communicable disease risk factors in India

Kiran Gaur  1 , Raghubir S Khedar  2 , Kishore Mangal  2 , Arvind K Sharma  3 , Rajinder K Dhamija  4 , Rajeev Gupta  5
Affiliations

Macrolevel association of COVID-19 with non-communicable disease risk factors in India

Kiran Gaur et al. Diabetes Metab Syndr. 2021 Jan-Feb.

Abstract

Background & aims: Greater COVID-19 related mortality has been reported among persons with various non-communicable diseases (NCDs). We performed an ecological study to determine the association of state-level cases and deaths with NCD risk factors and healthcare and social indices.

Methods: We obtained cumulative national and state-level data on COVID-19 cases and deaths from publicly available database www.covid19india.org from February to end November 2020. To identify association with major NCD risk factors, NCDs, healthcare related and social variables we obtained data from public sources. Association was determined using univariate and multivariate statistics.

Results: More than 9.5 million COVID-19 cases and 135,000 deaths have been reported in India towards end of November 2020. There is significant positive correlation (Pearson r) of state-level COVID-19 cases and deaths per million, respectively, with NCD risk factors- obesity (0.64, 0.52), hypertension (0.28, 0.16), diabetes (0.66, 0.46), NCD epidemiological transition index (0.58, 0.54) and ischemic heart disease mortality (0.22, 0.33). Correlation is also observed with indices of healthcare access and quality (0.71, 0.61), urbanization (0.75, 0.73) and human (0.61, 0.56) and sociodemographic (0.70, 0.69) development. Multivariate adjusted analyses shows strong correlation of COVID-19 burden and deaths with NCD risk factors (r2 = 0.51, 0.43), NCDs (r2 = 0.32, 0.16) and healthcare (r2 = 0.52, 0.38).

Conclusions: COVID-19 disease burden and mortality in India is ecologically associated with greater state-level burden of NCDs and risk factors, especially obesity and diabetes.

Keywords: Diabetes; Epidemiology; Hypertension; Non-communicable diseases; SARS CoV-2; Social determinants; Vaccination.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Association of multiple non-communicable disease (NCD) risk factors with cumulative COVID-19 cases/million.
Fig. 2
Fig. 2
Association of non-communicable disease (NCD) risk factors with cumulative COVID-19 deaths/million.
See this image and copyright information in PMC

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