India's twin epidemic: Prevalence data from a single mixed tertiary intensive care unit.

Sir,

Epidemiological transition is becoming increasingly evident in India. One of its indicators is rapidly increasing prevalence of life style related diseases such as diabetes mellitus (DM) and hypertension (HTN). Co-existence of these two conditions is also estimated to be high in India.[1] There is paucity of data from Indian health set ups for estimation of clinical and financial impact of this twin epidemic.[2] In this light, we would like to share with you the data from a single intensive care unit (ICU) which highlights the morbidity associated with these two conditions in terms of chronic organ failure.

These data were collected from the 28 bedded multidisciplinary ICU of a private 550 bedded tertiary hospital from Maharashtra, India. Patient records of 2006 consecutive admissions to this ICU in the year 2011 were retrospectively studied. After excluding readmissions (n = 111), records of 1895 patients were analyzed. Known history of (K/H/O) DM and/or HTN as obtained from the patient/relative or on-going medication and presence of chronic organ failure/s as defined for Acute Physiology and chronic health evaluation score were noted for each patient.[3]

It is to be noted that this hospital has separate Cardiac Care Unit which houses the major proportion of patients with cardiovascular diseases. Table 1 brings out the prevalence of DM and HTN singly and concurrently in this ICU with respect to chronic organ/system failure and age in the year 2011. More than half of all patients admitted to ICU had either or both of these conditions. Out of 695 (36.68%) patients who were admitted with at least one chronic organ/system failure, 387 patients suffered from chronic renal failure and 181 patients suffered from chronic cardiovascular failure. Prevalence of DM and/or HTN in patients with chronic cardiovascular and renal failure were 81.77% (95% Confidence interval (CI) 75.64-86.89) and 78.55% (95% CI74.25-82.43), respectively.

Table 1

Prevalence of diabetes mellitus and hypertension in a single mixed tertiary intensive care unit in Maharashtra, India in the year 2011 with respect to chronic organ/system failure* and age

Table 2 details the prevalence of DM and HTN in major subgroups (minimum 100 admissions) based on reason for admission as per International classification of diseases, 10th edition (ICD-10).

Table 2

Prevalence of diabetes mellitus and hypertension in subgroups based on ICD-10 in the year 2011

A glance at the tables gives one an idea about social and economic impact of the twin epidemic. Considering the possible presence of unrecognized cases, the actual prevalence is likely to be higher. Prevalence of 28.44% in the age group of 26-45 years is worrisome. Though this tertiary hospital caters mostly to urban population in a city with more than three million people, about 10% of the patients admitted to the ICU were from peripheral rural areas. The burden of chronic diseases is estimated to be high also in rural India.[4] Prevalence study of general population in surrounding areas (urban and rural) is warranted to estimate their clinical impact. Widespread awareness regarding modifiable risk factors, governmental policies encouraging health promoting life style, early detection and optimum management may mitigate the impact of this epidemic.