Chronic diseases now a leading cause of death in rural India--mortality data from the Andhra Pradesh Rural Health Initiative.
BACKGROUND
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%).


CONCLUSIONS
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.
Joshi
Rohina
R
The George Institute for International Health, PO Box M201, Missenden Road, Sydney NSW 2050, Australia. rjoshi@thegeorgeinstitute.org
Cardona
Magnolia
M
Iyengar
Srinivas
S
Sukumar
A
A
Raju
C Ravi
CR
Raju
K Rama
KR
Raju
Krishnam
K
Reddy
K Srinath
KS
Lopez
Alan
A
Neal
Bruce
B
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy; D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease / Q000401:mortality*; D003141:Communicable Diseases / Q000401:mortality; D005260:Female; D015658:HIV Infections / Q000401:mortality; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D007410:Intestinal Diseases / Q000401:mortality; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000401:mortality; D009369:Neoplasms / Q000401:mortality; D010272:Parasitic Diseases / Q000401:mortality; D011159:Population Surveillance / Q000379:methods; D012140:Respiratory Tract Diseases / Q000401:mortality; D012423:Rural Health; D016728:Self-Injurious Behavior / Q000401:mortality; D017678:Sex Distribution; D020521:Stroke / Q000401:mortality; D014376:Tuberculosis / Q000401:mortality; D014947:Wounds and Injuries / Q000401:mortality