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. 2021 Oct 14;16(1):69.
doi: 10.5334/gh.1048. eCollection 2021.

Association of Hypertension and Diabetes with Ischemic Heart Disease and Stroke Mortality in India: The Million Death Study

Calvin Ke  1   2   3   4 , Rajeev Gupta  5 , Baiju R Shah  2   3   4 , Thérèse A Stukel  3   4 , Denis Xavier  6 , Prabhat Jha  1
Affiliations

Association of Hypertension and Diabetes with Ischemic Heart Disease and Stroke Mortality in India: The Million Death Study

Calvin Ke et al. Glob Heart. .

Abstract

Background: The cardiovascular outcomes of hypertension and diabetes in India have never been studied at the national level.

Objectives: We conducted a nationally-representative proportional mortality study to measure the associations of hypertension and diabetes with premature mortality due to ischemic heart disease (IHD) and stroke among Indian adults.

Methods: We determined causes of death by verbal autopsy from 2001-14 among 2.4 million households. We defined cases as those who died of the study outcomes and controls as those who died of injuries, respiratory causes, or cancer. We used multivariable logistic regression models to compute adjusted odds ratios (OR) measuring the association of hypertension and diabetes with IHD or stroke mortality, population-attributable fractions (PAF), and time trends.

Results: The mean age at death was 55.6 (standard deviation 9.9) years for IHD, 58.2 (9.0) years for stroke, and 46.8 (injury) to 59.8 (respiratory) years for controls. There were more men among both the cases (IHD: 70.1%; stroke: 59.0%) and controls (injury: 76.6%; cancer: 55.4%; respiratory: 59.8%). Hypertension was associated with six- to eight-fold increases in the odds of IHD (OR 5.9, 99% CI 5.6-6.2) and stroke mortality (7.9, 7.4-8.5). Diabetes was associated with double the odds (1.9, 1.7-2.0) of IHD mortality and increased odds of stroke mortality (1.6, 1.4-1.7). Hypertension accounted for an increasing PAF of IHD mortality and decreasing PAF of stroke mortality. Diabetes was associated with relatively lower PAFs and variable time trends.

Conclusions: Hypertension is associated with an unexpectedly high burden of cardiovascular mortality, and contributes to an increasing proportion of IHD deaths and a decreasing proportion of stroke deaths. Better management of hypertension and diabetes is urgently required to reduce premature cardiovascular mortality.

Keywords: cardiovascular disease; epidemiology; mortality; nationally representative.

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Conflict of interest statement

DX reports grants from Cadila Pharmaceuticals, grants from Boehringer Ingelheim, grants from Sanofi Aventis, grants from Pfizer, grants from Bristol Myers Squibb, grants from United Health, outside the submitted work. The other authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Total and stratified estimates of the association between (A) hypertension or (B) diabetes and ischemic heart disease mortality. Estimates are adjusted for age, sex, rurality, region, smoking, alcohol use, and year. The area of each box is proportional to the sample size (cases and controls).
Figure 2
Figure 2
Association between hypertension (A) or diabetes (B) and stroke* mortality. The total and stratified estimates are adjusted for age, sex, urban/rural residence, region, smoking, alcohol use, and year. The area of each box is proportional to the sample size (cases and controls). * These results pertain to the low-burden states; see Figure 4 for the high-burden states.
Figure 3
Figure 3
Population attributable fractions (%) for (A) ischemic heart disease and (B) stroke* during the beginning (2001–03) and end (2012–14) of the study period. Blue bars represent hypertension; red bars represent diabetes. * These results pertain to the low-burden states; see Figure 5 for the high-burden states.
See this image and copyright information in PMC

References

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