POTENTIAL GAIN
IN LIFE EXPECTANCY WITH CONTROL OF CARDIOVASCULAR
DISEASE IN INDIA
A CASE STUDY FROM GOA STATE |
| MS Kulkarni, AMA
Ferreira, DD Motghare |
 |
Department of
Preventive and Social Medicine, Goa Medical
College, Bambolim, Goa INDIA |
|
| |
 ABSTRACT |
| |
| Cardiovascular disease has become
a major cause of morbidity and mortality in developing
countries including India. The present study was
conducted to find out the potential gain in average
years of life due to prevention of mortality related
to diseases of cardiovascular system. The study
was based on complete records of registered mortality
in the state of Goa as per ICD-9 classification
for the year 1991. The gain in life expectancy at
birth measured using cause elimination life table
technique. When mortality due to cardiovascular
diseases was eliminated the life expectancy at birth
increased by 12.95(18.86%) years for entire population,
11.5(17.81) years for male and 15.23(20.73%) for
females. This has an important implication for developing
countries, which are in the process of epidemiological
transition from communicable to noncommunicable
diseases. |
| |
|
INTRODUCTION |
| |
| Many developing countries including
India are undergoing epidemiological transition
from communicable to non-communicable diseases,
which brought about a decline in crude death rate
and a surge in life expectancy. The leading causes
of death now faced by these countries are cardiovascular
diseases, accidents, injury, neoplasm etc, which
are largely preventable. |
| |
| Table 1: Life Expectancy of
the Goa Population in 1991 |
| |
| Age |
Male |
Female |
Total |
| 0 |
64.6 |
73.5 |
68.7 |
| 1 |
65.0 |
73.6 |
69.0 |
| 5 |
61.5 |
70.1 |
65.5 |
| 15 |
51.9 |
60.4 |
55.8 |
| 25 |
42.5 |
50.8 |
46.4 |
| 35 |
33.8 |
41.5 |
37.4 |
| 45 |
25.5 |
32.2 |
28.7 |
| 55 |
18.6 |
23.4 |
21.0 |
| 65 |
13.0 |
15.6 |
14.4 |
| 70 |
10.8 |
12.5 |
11.7 |
|
| |
| In this research article, an attempt
has been made to estimate the gain in life expectancy,
should mortality due to cardiovascular diseases
be eliminated, by using cause elimination life table
technique. The life tables are routinely used to
study mortality experience of a cohort. The expectation
of life at birth reflects the number of years a
person is expected to survive under existing conditions
while expectation of life at various ages indicates
the average number of years of life remaining at
attainment of the given age. The article seeks to
study the gain in average year of life at birth
at various ages due to prevention of cardiovascular
disease. |
| |
|
MATERIAL AND METHODS |
| |
| The data for the present study has
been obtained from the records on Registration of
Births and Deaths for the State of Goa for the year
19912 . The registration
of vital events in Goa is almost 100% and more than
90% of deaths are medically certified. The ninth
revised International Classification of Disease
(ICD-9) including codes 390-459 was used for classification
of deaths pertaining to cardiovascular diseases
while 1991 census population of Goa was used to
compute the age and sex specific mortality rates
to compute life table by Greville's method. The
cause elimination life table technique was used
to find the gain in life expectancy following elimination
of deaths due to cardiovascular diseases and involve
the following steps3. |
| |
1. First a conventional abridged life
table was constructed.
2. Then cause elimination life table was obtained
by constructing a life table devoid of mortality
due to cardiovascular disease.
3. Expectation of life at various ages was computed
for the hypothetical situation in which this cause
of death was assumed as eliminated. |
| |
| Table 2: Cause-eliminated life
expectancy due to cardiovascular diseases in the
Goa Population |
| |
| Age |
Male |
Female |
Total |
| 0 |
76.1 |
88.7 |
81.6 |
| 1 |
76.8 |
89.0 |
82.2 |
| 5 |
73.3 |
85.6 |
78.7 |
| 15 |
63.6 |
75.9 |
59.6 |
| 25 |
54.3 |
66.4 |
50.8 |
| 35 |
45.8 |
57.1 |
42.2 |
| 45 |
37.8 |
47.8 |
34.6 |
| 55 |
31.1 |
39.0 |
34.6 |
| 65 |
25.7 |
30.1 |
28.5 |
| 70 |
23.4 |
27.9 |
25.8 |
|
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|
RESULTS AND DISCUSSION |
| |
| The crude death rate for Goa for
the year 1991 was 6.74/1000 population. It was higher
for males (7.97/1000) than females (5.46/1000).
The cause specific death rate due to cardiovascular
disease was 253.89 per 100000 population with higher
mortality due to cardiovascular disease among males
(286.15/100000 population) compared to females (220.52/100000
population). |
| |
| The life expectancy at birth was
65.67 years for males and 73.46 years for female,
while the combined life expectancy was 68.68 years
for the year 1991(Table-1). The life expectancy
was consistently higher for females at all age groups. |
| |
| The cause eliminated life table constructed
by eliminating all deaths due to cardiovascular
disease showed the life expectancy at birth to be
81.63 years for combined population; 76.07 years
for males and 88.69 years for females (Table 2). |
| |
| The potential gain in life expectancy
at birth following elimination of cardiovascular
diseases was estimated 12.95 years (18.86%) in the
combined population (Table 3). In terms of absolute
number of years the gain in life expectancy would
be about 13 years for population aged above one
year. For males, the potential gain in life expectancy
at birth due to prevention of cardiovascular diseases
in adult life would be 11.50 years (17.81%). The
net gain would be around 12 years for ages above
34 years. Likewise, for females, the potential gain
in life expectancy at birth due to control of cardiovascular
disease would be 15.24 years (20.74%). The net gain
in the life expectancy at subsequent ages would
be 15.5 years. |
| |
| In the United States of America,
Tsai et al (1978)4
estimated that elimination of cardiovascular disease
would result in addition to expectation of life
at birth of 12.36 years for combined population,
11.10 years for white males and 10.74 years for
non-white males. For white females the gain in life
expectancy was 12.81 years and 15.66 years for non-white
females. Krishnan Namboodari and Suchindran C.M.5
reported the gain in life expectancy at age 65 years
attributed to eliminating cardiovascular disease
was 12.61 years. |
| |
| Table 3: Potential gain in life
expectancy due to cardiovascular disease |
| |
| Age |
Male |
Female |
Total |
| 0 |
11.5
(17.8) |
15.2
(20.7) |
13.0
(18.9) |
| 1 |
11.7
(18.0) |
15.4
(21.0) |
13.2
(19.1) |
| 5 |
11.8
(19.1) |
15.5
(22.1) |
13.2
(20.2) |
| 15 |
11.8
(22.7) |
15.5
(25.7) |
13.3
(23.7) |
| 25 |
11.8
(27.8) |
15.6
(30.6) |
13.3
(28.6) |
| 35 |
12.0
(35.5) |
15.6
(37.7) |
13.4
(35.9) |
| 45 |
12.2
(47.9) |
15.7
(48.7) |
13.5
(47.2) |
| 55 |
12.5
(67.4) |
15.6
(66.5) |
13.6
(65.0) |
| 65 |
12.7
(97.9) |
15.4
(98.3) |
14.1
(97.9) |
| 70 |
12.6
(116.5) |
15.5
(124.2) |
14.1
(120.6) |
|
| |
| CONCLUSIONS |
| |
| This study was conducted to estimate
the potential gain in life expectancy when mortality
due to cardiovascular diseases is eliminated. The
present study showed that the net gain in life expectancy
at birth would be 18.86% years and this gain is
higher among females than males. Such life tables
are adjusted for the impact of differential risks
of dying from other causes that operates in the
various subgroups. The particular technique serves
as a useful tool to gauge the potential benefits
of cause elimination in both developed and the developing
countries in planning health services. |
| |
| REFERENCES |
| |
| 1. |
Omran AR: The
epidemiologic transition: a theory of the
epidemiology of population change. Millbank
Mem Fund Q 1971; 49, 509-538. |
| 2. |
Office of the
Chief Registrar of Birth and Deaths, Government
of Goa, Panaji, Goa. Annual report on registration
of birth and deaths. 1991. |
| 3. |
Suchindran
CM, Koo HP. Demography and Public health.
Oxford Textbook Public Health. 3rd Ed. pp.
829-848. |
| 4. |
Tsai SP, Lee
ES, Hardy RJ .The effects of a reduction in
leading causes of death: potential gain in
life expectancy. Am J Public Health 1978;
68: 966-71. |
| 5. |
Namboodari
K, Suchindran CM . Textbook on life table
techniques and their applications. Chapter
6- Multiple Decrement Life Tables. Academic
Press. 1987 pp.92-105. |
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