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LETTER TO THE EDITOR
Year : 2021  |  Volume : 14  |  Issue : 6  |  Page : 732-733  

Chronic obstructive pulmonary disease mortality in India: Variations and associated factors


Department of Pediatrics, Safdarjung Hospital, New Delhi, India

Date of Submission25-Jan-2020
Date of Decision20-Apr-2020
Date of Acceptance24-Jun-2020
Date of Web Publication06-Jul-2021

Correspondence Address:
Manas Pratim Roy
Department of Pediatrics, Safdarjung Hospital, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mjdrdypu.mjdrdypu_27_20

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How to cite this article:
Roy MP. Chronic obstructive pulmonary disease mortality in India: Variations and associated factors. Med J DY Patil Vidyapeeth 2021;14:732-3

How to cite this URL:
Roy MP. Chronic obstructive pulmonary disease mortality in India: Variations and associated factors. Med J DY Patil Vidyapeeth [serial online] 2021 [cited 2021 Nov 30];14:732-3. Available from: https://www.mjdrdypv.org/text.asp?2021/14/6/732/320706



Dear Sir,

Chronic obstructive pulmonary disease (COPD), one of the most common chronic respiratory diseases, was responsible for 3.2 million deaths in the world in 2015.[1] In India, it is the second most common cause of death (9.7%).[2] With 64 deaths per 100,000 population, it stands second in India, just after ischemic heart disease (132 deaths per 100,000), as the common causes of mortality.[3] To mitigate the burden, COPD was included under the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke. With an emphasis on health promotion and screening for early diagnosis, the Programme ensures provision of treatment and timely referral through noncommunicable disease clinics.[4]

As evident from a recent report, Rajasthan (111/100,000) recorded six times higher mortality than Nagaland (18/100,000).[3] Notably, most of the states with high COPD burden are located in North India. COPD has often correlated with air pollution caused due to stubble burning. Delhi recorded low mortality (22/100,000), despite being one of the most polluted cities in the world and getting a big share of stubble-burning pollutants from neighboring states, probably because of quality medical treatments available there and presence of least agricultural fields. According to the available data, only 30% of land in Delhi is being cultivated, making direct exposure less likely.[5] Why disparity exists among different states of India is a matter of further analysis. Among different factors, smoking, despite thought to be the main cause of COPD, was earlier demonstrated to have no relation with COPD deaths.[6] Previous researches indicated that secondhand smoking increased the risk of COPD mortality.[7] Biased or missed reporting may be another cause. Unlike western countries, the presence of smoking is not always found here as an associate of COPD.[8]

Exposure to biomass also plays a crucial role in causing death in such patients.[8],[9] The government is encouraging the use of clean fuel for cooking by the population through Ujjwala Scheme. This could be hoped that the deadly exposure to biomass fuel could be minimized with the success of the Scheme. Promoting clean fuel would ensure indoor air quality; however, without efforts to bring outdoor air pollution under control, the problem of COPD could never be tamed.

The role of poverty in COPD death was documented earlier.[10] The frequency of COPD rises once gross national income per capita falls below USD 15,000.[6] Multisectoral efforts should target poverty alleviation and subsequent drop in tobacco consumption. For future strategy, the focus should be on the states having higher usage of tobacco and/or lower per capita income.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
GBD 2015 Chronic Respiratory Disease Collaborators. Global, regional, and national deaths, prevalence, disability-adjusted life years, and years lived with disability for chronic obstructive pulmonary disease and asthma, 1990-2015: A systematic analysis for the global burden of disease study 2015. Lancet Respir Med 2017;5:691-706.  Back to cited text no. 1
    
2.
Institute for Health Metrics and Evaluation. GBD Comparae: Viz Hub. Available from: https://vizhub.healthdata.org/gbd-compare/. [Last accessed on 2020 Apr 22].  Back to cited text no. 2
    
3.
Indian Council of Medical Research, Public Health Foundation of India, and Institute for Health Metrics and Evaluation. India: Health of the Nation's States – The India State-Level Disease Burden Initiative. New Delhi, India: Indian Council of Medical Research, Public Health Foundation of India, and Institute for Health Metrics and Evaluation; 2017.  Back to cited text no. 3
    
4.
Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India. National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke. Available from: http://dghs.gov.in/content/1363_3_ NationalProgrammePreventionControl.aspx. [Last accessed on 2019 Feb 02].  Back to cited text no. 4
    
5.
Government of Delhi. Agriculture and Allied Sector. Available from: http://web.delhi.gov.in/DoIT/DoIT_Planning/agm2.pdf. [Last accessed on 2020 Apr 22].  Back to cited text no. 5
    
6.
Burney P, Jithoo A, Kato B, Janson C, Mannino D, Nizankowska-Mogilnicka E, et al. Chronic obstructive pulmonary disease mortality and prevalence: The associations with smoking and poverty – A BOLD analysis. Thorax 2014;69:465-73.  Back to cited text no. 6
    
7.
Ukawa S, Tamakoshi A, Yatsuya H, Yamagishi K, Ando M, Iso H, et al. Passive smoking and chronic obstructive pulmonary disease mortality: Findings from the Japan collaborative cohort study. Int J Public Health 2017;62:489-94.  Back to cited text no. 7
    
8.
Bajpai J, Kant S, Bajaj DK, Pradhan A, Srivastava K, Pandey AK. Clinical, demographic and radiological profile of smoker COPD versus nonsmoker COPD patients at a tertiary care center in North India. J Family Med Prim Care 2019;8:2364-8.  Back to cited text no. 8
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9.
Silva R, Oyarzún M, Olloquequi J. Pathogenic mechanisms in chronic obstructive pulmonary disease due to biomass smoke exposure. Arch Bronconeumol 2015;51:285-92.  Back to cited text no. 9
    
10.
Sinha B, Vibha., Singla R, Chowdhury R. An epidemiological profile of chronic obstructive pulmonary disease: A community-based study in Delhi. J Postgrad Med 2017;63:29-35.  Back to cited text no. 10
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