N Goel, S Bhatia, A Abrol, T Bhatnagar, D Kumar, H Swami
epidemiological transition, infectious diseases, lifestyle behaviour, mortality
N Goel, S Bhatia, A Abrol, T Bhatnagar, D Kumar, H Swami. Changing Mortality Trends in Chandigarh, India. The Internet Journal of Epidemiology. 2006 Volume 5 Number 1.
Mortality statistics form an integral part of vital statistics. Mortality influences rate and growth of population and is an important factor for socio-economic and health planning of any country.1
Data on the causes of death provide an important source of information on Death. Such data are crucial for monitoring the reasons why people die and for targeting where, when, and how health resources should be expended.
The most striking demographic phenomenon of the twentieth century has been a marked decline in the mortality rates accompanied by a dramatic rise in life expectancy, especially in the developed regions of the world. This decline was most pronounced in the 1960's, leading demographers to coin the term “mortality transition”. The term describes essentially a state of high mortality, resulting from the high incidence of infections and parasitic diseases followed by a state of lower mortality, resulting from the successful control of communicable diseases. However, the mortality transition also suggests an epidemiological transition with the burden of disease shifting from the ‘age of pestilence and famine' to the ‘age of degenerative and manmade diseases'.
Over the last five decades, the Asian region following global trends, has experienced a distinct pattern, with countries in earlier stages of development struggling to manage health-related mortality problems linked to poorer socio-economic conditions, as well as a new set of challenges posed by emerging health threats stemming from environmental and lifestyle changes. As Countries develop, the risk factors associated with mortality change. Poverty, insanitary conditions, poor nutrition and inadequate health facilities are the main causes of morbidity and resultant mortality along with rising affluence and changing lifestyles that have changed the disease profile of developing countries.2
Developing Countries like India are following mortality patterns already evident in the more developed and westernized countries, characterised by a rise in the numbers of people with non-communicable diseases such as Cardiovascular diseases, Diabetes mellitus and Cancer. Dietary changes that include large amounts of saturated fats, sugars, and salt coupled with lower intake of dietary fiber found in fruits and vegetables are largely responsible for the higher incidence of heart diseases and cancer.3 Other lifestyle related factors affecting health status and therefore mortality rates in developing countries are lack of exercise and inactivity. A sedentary lifestyle, however is more prevalent among urban dwellers in contrast to those living in rural communities.4
This transition in disease trend is also characterised as the ‘diseases of affluence and lifestyle' or ‘diseases of development', identified as Cancer, Hypertension, Diabetes mellitus, heart and respiratory diseases and trauma leading to construction of the concept of the ‘new public health' which has to deal with new challenges associated with increasing longevity, over population, increasing industrialization and industrial decline, inequities in health, environmental damage and ecological imbalance.
Nevertheless, it is acknowledged that infectious diseases in particular, HIV/AIDS, Dengue fever, TB and Malaria will continue to pose a challenge.5
The present study was undertaken with the objective to bring out the causes of mortality and highlight its changing trend, if any, over the last 2 decades in Chandigarh.
Material And Methods
The study was conducted by collecting the mortality data from the District Registrar, Births and Deaths, Chandigarh for the years 1983, 1992 and 2002. Classification of causes of death was done according to the International Classification Diseases 10th revision (ICD-10). The tenth revision, which became effective in1999, categorizes deaths into seventeen broad categories
A total of 4435 deaths were recorded in the death register for the year 1983, out of which complete information was available for 3680 (83%) only. In 1992, a total of 5044 deaths were recorded and complete information was available for 3794 (74%) only. For the year 2002, 8844 deaths were registered, out of which 4239 individuals were residents of Chandigarh and 4483 were residing out of Chandigarh. Address records of 122 deaths were not available. Statistical analysis was done using the Z – test.
Results And Discussion
In the mortality trends in Chandigarh for the last 2 decades 19836- 2002 ,(Table- 1) it was observed that deaths due to infectious and parasitic diseases have decreased from 18.7% to 9.5% ( Z=14.35; p < 0.001) followed by respiratory diseases having declined from 10.5% to 7.4% ( Z=5.79 ; p <0.001) and diseases of the digestive system that have shown a decline from 8.4% to 1.9% ( Z=16.92 ; p < 0.01).The decline in mortality due to Infectious and parasitic diseases is explained by improvements in sanitation, socio-economic development, advances in health care delivery services and better accessibility to preventive and curative services.
However, deaths due to diseases of circulatory system have increased remarkably from 18.1% to 35.0% (Z=20.9; p < 0.01). This increase in mortality due to cardiovascular causes is significant and highlights the change in lifestyle from active to sedentary, dietary changes along with stress associated with modern living. A study on diet change in China reveals that during the last half century, there has been a rapid shift towards a pattern of food consumption linked with a high risk of non-communicable diseases.7
Between 1989 and 1998, the percentage of people consuming a high fat diet has increased from 14% to 38%. Similar findings have been reported in Japan and Singapore also. According to WHO reports8, six of nine major risk factors of mortality among men in Japan and Singapore are related to substance abuse (Tobacco and excessive alcohol consumption). Other major risk factors that have been enumerated for the increase in Non-communicable diseases include physical inactivity and air-pollution.
The total number of deaths reported in Chandigarh during the year 2002 were 8844 (males=5640; females=3204).
Among the leading causes of mortality (Table-2) it was observed that mortality was highest due to circulatory system diseases (35.0%). Similar findings have been reported by Rohina et al 9(32%) in Andhra Pradesh, India. This is followed by Symptoms, signs and abnormal clinical and laboratory findings not classified elsewhere (19.3%), infectious and parasitic diseases (9.5%), diseases of Respiratory diseases (7.4%), Injury, poisoning and certain other consequences of external causes (3.4%).
On further analysis, it was seen that the mortality rate among males is higher as compared to females in case of deaths due to Respiratory system diseases (Z= 2.5; p < 0.01),
Injury, poisoning and other consequences of external causes (Z=3.3; p < 0.001) and external causes of morbidity and mortality (Z =8; p < 0.001).
However, mortality was more in females due to neoplasm's (Z=4.07; p < 0.001), and endocrinal, nutritional and metabolic diseases ( Z=2.0; p < 0.01).
The rural – urban differences in causes of mortality revealed that deaths due to Infectious and parasitic diseases, Diseases of respiratory system and Diseases of Digestive system were higher in rural areas as compared to urban areas. It was also observed that deaths due to Diseases of circulatory system were more in rural areas (37.2%) as against 31.0% in urban areas.
No significant rural-urban differential in deaths among residents of Chandigarh was observed except for diseases of circulatory system. This may be due to the fact that the rural and urban residents of Chandigarh enjoy almost same life style pattern and also do not vary much in exposure to risk of mortality due to other factors leading to death.
Similar to the experience of other developing countries, India also finds itself in the epidemiological transition. As a result, major risk factors of mortality include both poverty-related risk factors and lifestyle-related risk factors. These countries have to deal with the double burden of solving poverty as well as lifestyle-related risk factors in the future. Efforts to reduce undernourishment among the poor and promote healthy eating habits among the economically better off segment should be high on the public health agenda. Lowering the common risk factors such as tobacco, and alcohol use, controlling high blood pressure, high cholesterol levels, increasing intake of fruits and vegetables, better physical activity and practice of safe sex will result in improvements in health conditions and a reduction in mortality in the near future. Strategies should be developed for modifying rapidly changing life style among residents of Chandigarh.
Dr. Naveen Krishan Goel Prof and Head Deptt. of Community Medicine Govt Medical College, Chandigarh. Phone : 0172-2665253, Ext. 1043(O) Mobile : 9876521536 E-mail : email@example.com