Chronic diseases now a leading cause of death in rural India - mortality data from the Andhra Pradesh Rural Health Initiative
Chronic diseases now a leading cause of death in rural India - mortality data from the Andhra Pradesh Rural Health Initiative
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DOI：
10.1093/ije/dyl168
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发表时间：
2006-12-01
影响因子：
7.7
通讯作者：
Neal, Bruce
中科院分区：
文献类型：
--
作者：
Joshi, Rohina;Cardona, Magnolia;Neal, Bruce
1.由于经济和社会变革，印度正在经历流行病的迅速转变。死亡率的模式是随之而来的健康影响的一个关键指标，但最新的，准确的，可靠的统计数据很少，特别是在农村areas. Methods死亡发生在45个村庄（人口180 - 162）记录在2003 - 04年的12个月期间，由多用途的初级保健工作人员培训使用的死因推断工具。根据国际疾病分类第10版的有限列表，使用算法定义死亡原因。两个独立的医生分配的原因与分歧解决了third.Results共记录了1354例死亡与口头尸检完成了98%。在所有口头尸检中，有82%的人被指定为特定的潜在死因。粗死亡率为7.5/1000（95%置信区间，7.1 - 7.9）。循环系统疾病是死亡的主要原因（32%），缺血性心脏病和中风造成的死亡比例相似。其次是受伤和死亡的外部原因（13%），其中三分之一的死亡可归因于故意自我伤害。第三是传染病和寄生虫病（12%）。肺结核和肠道疾病各占这一类别死亡人数的三分之一。艾滋病毒被指定为2%的死亡原因。第四和第五大死亡原因是肿瘤（7%）和呼吸系统疾病（5%）。结论非传染性疾病和慢性疾病是印度农村这一地区死亡的主要原因。观察到的死亡模式不太可能是这些村庄独有的，并为印度农村流行病转变的快速发展提供了新的见解。
Introduction India is undergoing rapid epidemiological transition as a consequence of economic and social change. The pattern of mortality is a key indicator of the consequent health effects but up-to-date, precise, and reliable statistics are few, particularly in rural areas.Methods Deaths occurring in 45 villages (population 180 162) were documented during a 12-month period in 2003-04 by multipurpose primary healthcare workers trained in the use of a verbal autopsy tool. Algorithms were used to define causes of death according to a limited list derived from the international classification of disease version 10. Causes were assigned by two independent physicians with disagreements resolved by a third.Results A total of 1354 deaths were recorded with verbal autopsies completed for 98%. A specific underlying cause of death was assigned for 82% of all verbal autopsies done. The crude death rate was 7.5/1000 (95% confidence interval, 7.1-7.9). Diseases of the circulatory system were the leading causes of mortality (32%), with similar proportions of deaths attributable to ischaemic heart disease and stroke. Second was injury and external causes of mortality (13%) with one-third of these deaths attributable to deliberate self harm. Third were infectious and parasitic diseases (12%). Tuberculosis and intestinal conditions each caused one-third of deaths within this category. HIV was assigned as the cause for 2% of all deaths. The fourth and fifth leading causes of death were neoplasms (7%) and diseases of the respiratory system (5%).Conclusion Non-communicable and chronic diseases are the leading causes of death in this part of rural India. The observed pattern of death is unlikely to be unique to these villages and provides new insight into the rapid progression of epidemiological transition in rural India.