by Suman Gupta

• Apollo unveils its annual report – Health of the Nation 2023 – highlighting the prevalence and growth of NCDs in India
• Finds an increase in prevalence of early risk factors like Obesity and Dislipidemia by 50% and 18% respectively between 2019 and 2022
• ‘MIND HEALTH’ and Sleep emerge as a major unrecognized contributor to NCDs
• Apollo also enhances ProHealth, a 100% doctor curated and AI-backed health program that captures one’s health status, personalizes tests, predicts risks and guides on a path to wellness, offering a one-stop preventive health solution, ending the era of generic health checks

National, 06 April 2023: Apollo, the world’s largest vertically integrated healthcare provider, has released its annual Health of the Nation report that deep dives into the prevalence and growth of NCDs and highlights the importance of the right preventive healthcare measures to ensure India stays healthy.

Dr Prathap Reddy, Chairman, Apollo Hospitals Group, stated that “Preventive healthcare needs to become a national priority. Over the past 3 decades, non-communicable diseases have become the leading cause of death and suffering, contributing to 65% of deaths in India. NCDs affect not just health, but also productivity and economic growth. The estimated economic burden on India is expected be about $4.8 trillion by 2030. As the youngest and fastest growing major economy in the world, the health of our nation is a critical indicator of our future, and the health of our people will determine how effectively we live up to our full potential. What we need is a proactive and highly defined strategy to minimize the impact of NCDs. And the best solution lies in prevention.”

The increasing trend for NCDs and a significant rise in early risk factors

The rise in preventive screenings has also led to an increase in the diagnosis of early risk factors like Obesity and Dyslipidemia (cholesterol irregularities) among Indians across age groups. These are indication of the potential onset of chronic conditions like diabetes and hypertension and a wake-up call for individuals to make early shifts in their lifestyle behaviours.

• There is a 50% increase in the prevalence of Obesity among Indians between 2019 and 2022.

o   Obesity has seen an uptick in diagnosis in those less than 45 years of age by 43% and by 60% in people over the age of 45.

• Dyslipidemia or Cholesterol irregularities has seen an 18% increase in prevalence among Indians between 2019 and 2022

o   This is also fuelled by a significant increase in its prevalence among those over 45 years of age by more than 35%

Along with these early risk factors, we also see a rise in the prevalence of conditions like Diabetes and Hypertension.

• Diabetes and Hypertension diagnosis have seen an 8% and 11% increase respectively between 2019-22

o    There is also an increasing risk of Hypertension amongst Indians over 45 years, its prevalence in diagnosis having increased from 14% to 16% in the last 3 years.

o    Chronic stress and anxiety increase the risk of incidence of hypertension by 1.5X and diabetes by up to 2X. Men with chronic stress have double the risk of incidence of diabetes than women.

We administered the PHQ9 Depression Questionnaire for about 2000 people with Type 2 Diabetes at Apollo Hospitals to understand their Mind Health status. Our analysis showed that with every one unit increase in age and BMI, PHQ9 the depression score also increases. About 50% had some form depression, and Diabetes along with any weight related comorbidity is an indicator to screen for depression.

• The report also puts the spotlight on the importance of getting more frequent or extended health tests for conditions that are prevalent in our families

o    The report finds that Diabetes is prevalent in 1 in 3 people with a history of the condition in their family.

• Healthy sleep is an important indicator of overall health.

o   In one study with 20,000 people, 47% have sleep problems and 52% have impairments in their mind health state, and 1 in 3 have both issues.

o   2 out of 3 individuals do not have an optimal gap between dinner and bedtime, which is critical for good quality sleep. It is either less than 1 hour or more than 2 hours, both scenarios leading to sub optimal sleep quality.

• Impaired metabolism is also closely linked with digestive irregularities, such as gas/bloating, heaviness post-meal, burning sensation, belch/burp. The analysis found that 64% of people had digestive irregularities, going up to 81% amongst diabetics.

Many ‘Indias’ in one India

Our diversity in lifestyle has led to the emergence of different NCD trends across regions, likely impacted by our regional diet preferences.

• While liver diseases saw maximum prevalence in East (at 50%), its lowest impact relatively is in the South (28%)
• West has seen the least relatively the lowest prevalence of diabetes (15%) while South has the highest (27%)
• Obesity trends have been similar across regions, ranging between 22-24%
• Dyslipidemia (cholesterol) has the highest prevalence across all regions, with North seeing the most (48%), followed by West (41%), East (39%) and then South (37%).

Power of prevention

The silent epidemic of NCDs is behind 40% of all hospital stays. While there is an increase in Indians taking preventive screenings, these are still largely symptom led. Regular and comprehensive health checks, starting at a young age, can significantly reduce mortality rates, disease incidence as well as the frequency of hospital visits through our lifespan.

There is also a need to reimagine preventive health assessments and design them to be more suitable to the Indian population.

For instance:

• The median age of breast cancer diagnosis from mammograms done at Apollo in the last year was 54-57 years; lower than that seen in mature markets (where the median age of detection is 62-65 years). This suggests an earlier onset of disease in Indian women, warranting annual screening for women from 40 years onwards.

o   According to clinically published sources, early diagnosis through preventive checks of breast cancer can reduce mortality rates by up to 30%.

• Undetected sleep disorders often lead to chronic health conditions due to late diagnosis and oversight by the healthcare systems

o   Obstructive Sleep Apnea (OSA) is known to increase the risk of heart problems, and is often screened only in the obese (BMI > 30) and with neck circumference > 40cm

o   Apollo’s study of people with Type 2 suggests that intermediate to high risk of OSA occurs even at a lower BMI (26) in the population screened, with a majority (91%) having a neck circumference < 40cm, thus highlighting the need to screen for OSA rigorously, irrespective of the BMI, especially for high-risk cohorts like patients with Diabetes.