Academic journal article Bulletin of the World Health Organization

Methods for Establishing a Surveillance System for Cardiovascular Diseases in Indian Industrial Populations/ Methodes Pour Mettre En Place Un Reseau De Surveillance Des Maladies Cardiovasculaires Chez Les Emploves D'entreprises Industrielles Indiennes et Leurs families/Metodos Para Establecer Un Sistema De Vigilancia De Las Enfermedades Cardiovasculares En Poblaciones Industriales De la India

Academic journal article Bulletin of the World Health Organization

Methods for Establishing a Surveillance System for Cardiovascular Diseases in Indian Industrial Populations/ Methodes Pour Mettre En Place Un Reseau De Surveillance Des Maladies Cardiovasculaires Chez Les Emploves D'entreprises Industrielles Indiennes et Leurs families/Metodos Para Establecer Un Sistema De Vigilancia De Las Enfermedades Cardiovasculares En Poblaciones Industriales De la India

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Introduction

Cardiovascular diseases (CVDs are major contributors to the global burden of chronic diseases with 29.3% of global deaths and 9.9% of total disease burden, in terms of disability-adjusted life years (DALYs) lost, being reported in 2003. (1) Low- and middle-income countries accounted for 78% and 86% of the CVD deaths and DALYs lost, respectively, worldwide in 1998. (2) Recent estimates by WHO suggest that in 2005, 80% of chronic disease deaths occurred in low- and middle-income countries. (3) This burden of CVD is predicted to increase substantially in developing countries by year 2020. (4) Major causes for the increase in disease burden are rising rates of hypertension, dyslipidaemia, diabetes, overweight, obesity, physical inactivity and tobacco use. (5)

In India, CVD is projected to be the largest cause of death and disability by 2020, (5) with 2.6 million Indians predicted to die due to coronary heart disease, which constitutes 54.1% of all CVD deaths. Nearly half of these deaths are likely to occur among young and middle-aged individuals (30-69 years). This is because Indians experience CVD deaths at least a decade earlier than their counterparts in developed countries. (6) This has the potential to adversely affect India's economy with 52% of CVD deaths occurring in those below the age of 70 years compared to 23% in countries in established market economies. (4)

Demographic and health transitions, gene-environmental interactions and early life influences of fetal malnutrition have been implicated as the causes of increasing CVD burden in India. (7) However, the most important factors are changes in living habits, whereby behavioural risk factors are transformed into biological risk factors. Such environmentally-determined risk factors are more amenable to change through public health and clinical interventions and, therefore, warrant early recognition at the individual level and surveillance at the population level.

To formulate national policies for the prevention and control of CVDs, nationally representative data collected through standardized techniques would be required. However, published cross-sectional studies on risk factors, such as hypertension, (8-11) diabetes, (11-14) impaired fasting glucose, (14) dyslipidaemia, (15) overweight, (16-19) obesity, (18,20) and smoking, (21-23) are highly heterogeneous and limited by variations in measurement techniques, interviewer bias, and differing definitions for risk factors and time periods of survey. We designed and established a sentinel surveillance system for CVD risk factors in Indian industrial populations with the following objectives:

* to conduct a baseline survey and continual surveillance of CVD risk factors and their determinants;

* to ascertain the incidence of CVD morbidity and mortality;

* to impart health education for prevention of CVD and assess the impact of health education on control of CVD;

* to develop guidelines for detection and management of CVD in the industrial settings, using the results of the baseline study.

We report the methods and results of the baseline survey conducted in 2002-03, in accordance with the first objective.

Methods

Study setting

We selected 10 medium-to-large companies (employing 1500-5000 people) in the organized sector (both public and private), from different sites across India, based on their willingness to participate in the study and proximity to an academic medical institution. Ten medical colleges designated as study centres were linked to each of these selected companies (Table 1, web version only, available from: http://www.who.int/bulletin). The study team included faculty members from various departments (medicine, cardiology, preventive medicine, and biochemistry) of each medical college headed by a principal investigator and supported by a biochemical investigator from the medical college as well as an industrial medical officer who represented the company. …

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