Prashant Jarhyan

Indices of thyroid epidemiology

This brief communication proposes various indices of epidemicity and endemicity which may be used to predict the future prevalence of hypothyroidism. Taking advantage of knowledge related to the natural progression of autoimmune thyroid disease, it uses data from two recent Indian epidemiological studies to assess the epidemicity or endemicity of thyroid disease in the country. The hypothesis generated in this communication will be of help to clinicians as well as policy makers.

Endemic or epidemic? Measuring the endemicity index of diabetes.

The terms “endemic” and “epidemic” were coined by hippocrates, who distinguished between diseases that were always present in a given population, and diseases which used to occur during certain periods of an year or during certain years.[1] These terms have now become an integral part of the medical etymology. Predominantly used to describe acute infectious diseases, the term “epidemic” is increasingly being utilized to describe the increasing prevalence of noninfectious, metabolic or chronic diseases. This communication tries to discuss the relevance and accuracy of these terms with relation to diabetes mellitus, suggests improvements in their usage, and proposes that diabetes can now be termed an endemic disease.

UDAY: A comprehensive diabetes and hypertension prevention and management program in India

Introduction Diabetes and hypertension are two leading non-communicable conditions, which are suboptimally managed in India. Thus, innovative comprehensive approaches that can concomitantly improve their detection, prevention and control are warranted. Methods and analysis UDAY, a 5-year initiative, aims to reduce the risk of diabetes and hypertension and improve management by implementing a comprehensive intervention programme in the two selected study sites, Sonipat and Visakhapatnam (Vizag). It has a pre-post evaluation design with representative cross-sectional surveys before and after intervention. Within these two sites, urban and rural subsites each with a total population of approximately 100 000 people each were selected and a baseline and postintervention assessment was conducted deploying five surveys [among general population (including body measurements or biosamples), patients, healthcare providers including physicians and pharmacists, health facilities], which will determine the knowledge levels about diabetes and hypertension, the proportion treated and controlled; the patient knowledge and self-management skills; healthcare providers’ management practices; the level of access and barriers to obtaining care. The interventions will include: tailored health promotion for improving public knowledge; screening of adults aged ≥ 30 years for identifying those at high risk of diabetes and/or hypertension for linkage to the healthcare system; patient education using technology enabled community health workers, geographic information system (GIS) based mapping of the communities, healthcare provider training on management guidelines, community based diabetes registry and; advocacy to improve access to healthcare. The baseline surveys have been completed, the study areas mapped using GIS and the interventions are being implemented. UDAY is expected to increase over baseline the levels of: public knowledge about diabetes and hypertension; those treated and controlled; patient self-management skills; the use of guideline based management by providers and; access to healthcare, leading to improved health outcomes and inform development of a India relevant chronic care model. Ethics and dissemination Ethical clearance for conduct of the study was obtained from the Institutional Ethics Committee (IEC) of the Public Health Foundation of India. The findings will be targeted primarily at public health policymakers and advocates, but will be disseminated widely through other mechanisms including conference presentations and peer-reviewed publications, as well as to the participating communities.

PS 06-11 PREVALENCE OF HYPERTENSION, PREHYPERTENSION AND THEIR ASSOCIATION WITH RISK FACTORS AND SOCIO- ECONOMIC CORRELATES IN INDIA

Objective: To measure the prevalence of hypertension, prehypertension and their association with risk factors and socio- economic correlates. Design and Method: We conducted a representative population based cross-sectional survey, as part of a large community intervention study entitled UDAY, among 12245 participants aged ≥ 30 years residing in rural and urban areas of North (Sonipat, Haryana) and South (Visakhapatnam, Andhra Pradesh) India. Participants were selected using a multistage cluster random sampling technique. Trained health workers collected the data using an interviewer administered questionnaire, obtained three blood pressure readings, conducted body measurements and collected bio-samples. Hypertension and prehypertension were defined according to standard definitions. Their association with risk factors and socio- economic correlates were measured using multinomial logistic regression models. Results: The overall age-standardized prevalence of hypertension was 28.2% (95% CI: 27.4%-29.0%) and prehypertension was 29.9% (29.1%-30.8%). Alcohol consumption [Adjusted Relative Risk Ratio (ARRR): 1.5 (95% CI: 1.3–1.8)] and [ARRR: 1.3 (1.1–1.5)], overweight [ARRR: 1.5 (1.3–1.8)] and [ARRR: 1.4 (1.2–1.6)], obesity [ARRR: 2.4 (1.9–2.9)] and [ARRR: 1.8 (1.5–2.2)], diabetes [ARRR: 2.4 (2.0–2.9)] and [ARRR: 1.6 (1.3–1.9)] and dyslipidemia [ARRR: 1.4 (1.2–1.5)] and [ARRR: 1.16 (1.03–1.29)] were more likely to be associated with both hypertension and prehypertension respectively. Participants reporting vigorous physical activity [ARRR: 0.8 (0.7–0.9)] and consuming ≥ 5 servings of fruits and vegetables [ARRR: 0.9 (0.8–0.9)] were at lower risk of having hypertension only. Among socio- economic correlates, participants who were male, had urban residence, were older and had education below graduate level, were at higher risk of having both hypertension and prehypertension. Conclusions: There is a high burden of both hypertension and prehypertension in India. Tailored strategies to control alcohol intake, overweight/obesity, blood glucose, and lipids as well as promotion of healthier lifestyles to increase consumption of fruits and vegetables and physical activity are required.

PS 06-03 PERFORMANCE OF DIFFERENT MEASURES OF OBESITY AMONG THOSE WITH HYPERTENSION IN INDIA

Objective: Obesity is an important modifiable risk factor for hypertension and cardiovascular disease. Body mass index (BMI) is widely used to estimate obesity but considered often as not the best measure, particularly in South Asians. We compared the prevalence of obesity among Indian hypertensives, using different obesity measures and the performance of these measures. Design and Method: We conducted a representative population based cross-sectional survey, as part of a large community intervention study entitled UDAY, among 12245 participants aged ≥ 30 years, residing in rural and urban areas of North (Sonipat, Haryana) and South (Visakhapatnam, Andhra Pradesh) India. Participants were selected using a multistage cluster random sampling technique. Data were obtained using an interviewer administered questionnaire and anthropometry. Blood pressure was measured and defined according to the standard guidelines and definitions. Body fat was estimated by bio-electrical impedance. BMI, waist circumference (WC), waist-hip ratio (WHR) and percent body fat (PBF) were used to estimate the prevalence of obesity. The cut offs chosen were based on international recommendations for estimating obesity among South Asians (BMI, WC, WHR) and Obesity Algorithm®, by the Obesity Medicine Association (PBF). Results: The age-standardized prevalence of hypertension was 28.2% (95% CI: 27.4% - 28.9%) while the age-standardized prevalence of obesity among hypertensives, using different measures is summarized in the table. The area under the curve with BMI as reference for WC was the highest among the three measures. WC performed well compared to BMI, with a sensitivity of 94.2% (93.0% - 95.3%) and specificity of 65.4% (63.0% - 67.8%). WC identified 535 hypertensives more than BMI as obese. These participants were more likely to be older and women. Conclusions: BMI underestimates obesity among Indian hypertensives. Waist circumference, which is easily measurable, can be an alternative measure to identify obese among hypertensives in community settings. Figure. No caption available.