Cardiovascular disease burden in a country: In the context of Sri Lanka

Abstract

Cardiovascular diseases (CVDs) are the leading cause of death worldwide and account for a significant portion of health loss and avoidable health system costs. The burden of CVDs has increased in recent decades almost everywhere in the world, but it has disproportionately affected low and middle-income countries. While more studies on the prevalence of CVDs are available, there is limited evidence presenting a complete picture on the burden of CVDs in Sri Lanka. In this context, this study aims to provide comprehensive picture on the burden of CVDs in the country. This study used of data available on the websites of ministry of health and department of census and statistics in Sri Lanka to present the comprehensive picture of the burden of CVDs in Sri Lanka. Overall, in 2019, there were an estimated 398,027 cases, 17144 deaths, due to CVDs in Sri Lanka. The proportion of deaths attributable to CVDs increased from 24.92% to 28.05% between 2004 and 2019. Aside from implementing preventive measures, the health sector must also prepare for long-term care of patients with CVDs, which could have substantial repercussions for resources and operations.

Full text

Cardiovascular disease burden in a country: In the
context of Sri Lanka
N.A.M.R.Senaviratna 
Department of Mathematics, The Open University of Sri Lanka
Abstract
Cardiovascular diseases (CVDs) are the leading cause of death worldwide and
account for a significant portion of health loss and avoidable health system
costs. The burden of CVDs has increased in recent decades almost
everywhere in the world, but it has disproportionately affected low and
middle-income countries. While more studies on the prevalence of CVDs are
available, there is limited evidence presenting a complete picture on the
burden of CVDs in Sri Lanka. In this context, this study aims to provide
comprehensive picture on the burden of CVDs in the country. This study used
of data available on the websites of ministry of health and department of
census and statistics in Sri Lanka to present the comprehensive picture of the
burden of CVDs in Sri Lanka. Overall, in 2019, there were an estimated
398,027 cases, 17144 deaths, due to CVDs in Sri Lanka. The proportion of
deaths attributable to CVDs increased from 24.92% to 28.05% between 2004
and 2019. Aside from implementing preventive measures, the health sector
must also prepare for long-term care of patients with CVDs, which could
have substantial repercussions for resources and operations.
Introduction
Sri Lanka is an island nation of 65,610 square
kilometers, with a population of approximately 21
million. The recent estimates for mortality from CVD
(cardiovascular diseases) for Sri Lanka was 524 deaths
per 100,000 which is higher than that observed in many
high-income countries. Coronary artery disease (CAD) is
the leading cause of death in Sri Lanka while stroke is
the third cause of death. CAD accounted for 34% of
deaths in an autopsy study. For comparison, CAD
accounts for only 17% of deaths in the US and UK. Many
of these deaths are premature (the person dies too
early) and could be prevented, delayed or even well-
controlled when it is diagnosed at the early stages of
the atherosclerosis process, through a number of
lifestyle changes and accurate pharmaceutical
treatment and management. CVD refers to all the diseases
of the heart and circulation, including coronary heart disease,
atrial fibrillation, heart attack, congenital heart disease and stroke
[1].
Materials and Methods
The objective of this this is to provide comprehensive
picture on the burden of CVDs in the country. This study
used the publicly accessible data available in the
Department of Census and Statistics and medical
statistics unit of Ministry of Health websites [2-3].
Descriptive summary measures were used to describe
the data.
Results
There were an estimated 398,027 prevalent cases of
CVDs in both sexes in 2019. About half (52.19%) of
these cases were male in Sri Lanka. In 2019, there were
58976 total number of deaths in Sri Lanka. Among them
29% was due to cardiovascular diseases.
Figure 1: Number of deaths due to leading causes in
Sri Lanka
More Information
How to cite this article: Senaviratna
NAMS.
Cardiovascular disease
burden in a country: In the context
of Sri Lanka. Eur J Med Health Res,
2023;1(3):55-8.
DOI: 10.59324/ejmhr.2023.1(3).09
Keywords:
Cardiovascular disease,
number of deaths,
Sri Lanka,
CVD.
This work is licensed under a Creative
Commons Attribution 4.0 International
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unrestricted use, distribution, and
reproduction in any medium, on the
condition that users give exact credit to
the original author(s) and the source,
provide a link to the Creative Commons
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EUR J MED HEALTH RES
Volume 1 | Number 3 |November-December 2023
56
Figure 1 illustrates leading causes for deaths in last8
years in Sri Lanka. It can be clearly seen that the first
leading cause for deaths is cardiovascular diseases.
When compare with other causes number of deaths
due to cardiovascular diseases significantly high.
Figure 2: Deaths due to CVDs from 2004 to 2019 in Sri
Lanka
A total of 17144 CVD deaths were estimated to have
occurred in 2019, with 9557 deaths among males and
7587 deaths among females (Figure 2). It implies that
death rates are much lower among women compared
with men. Furthermore, it can be seen that number of
deaths per 100,000 population has gradually increased
from 2004 to 2019.
The number of deaths of CVDs increased steadily with
age, reaching a peak at the70 plus age group (Figure 3).
Moreover, figure 3 also depicts the number of deaths
due to CVDs in age groups 50-69 and 70+ have
drastically increased with past decades. Those two age
groups are the significant age groups for CVDs. In 50-69
group, number of deaths of CVDs has increased from
4095 in 2004 to 6906 in 2019. Similarly, in 70+ age
group number of deaths of CVDs has increased from
4665 in 2004 to 8803 in 2019.
Figure 4 indicates that kids below five year of age, 43 of
the deaths are due to CVDs in 2019, which increased
steadily with age. The highest proportion of deaths
being attributable to CVDs in the age group 70+ years,
8813. The mortality rate due to CVDs is higher in males
than in females. A total of 17144 CVD deaths were
estimated to have occurred in 2019, with 9557 deaths
among males and 7587 deaths among females. In 2019,
approximately 2.6% of the total deaths from CVDs is
from the age groups below 16 years.
Figure 3: Number of deaths with age and year
Figure 4: Number of deaths with age and gender
There has been a steep rise in the proportion of deaths
attributable to CVDs out of total deaths. In 2004,
approximately 24.92% (95% UI: 21.23-27.51)) of the
total deaths were due to CVDs, which has increased to
28.05% (95% UI: 25.54-31.37) of the total deaths in
2019. In 2004, 28.17% (95% UI: 25.92-31.13) of the
deaths in males and 27.09% (95% UI: 24.94-30.28) of
the deaths in females were due to CVDs, which
increased to 30.47% (95% UI: 27.82-33.69) of the total
deaths in males and 29.07% (95% UI: 26.34-32.46) of
the total deaths in females in 2019 (Table 1).
Table 1: Proportion of total deaths attributable to CVDs
Year
Proportion of deaths in
both sexes (95% UI)
Proportion of deaths in
male (95% UI)
Proportion of deaths in
female (95% UI)
2004
24.92 (21.23-27.51)
28.17(25.92-31.13)
27.09(24.94-30.28)
2009
26.87(23.21-29.68)
31.79(28.64-35.27)
28.72(25.94-31.63)
2014
29.28(25.73-32.19)
32.28(29.17-35.82)
30.5(27.34-33.37)
2019
28.05(25.54-31.37)
30.47(27.82-33.69)
29.07(26.34-32.46)
Discussion
The proportion of deaths attributable to CVDs
increased from 24.92% to 28.05% in both sexes
(28.17%–30.47% in males and 27.09%–29.07% in
female) from 2004 to 2019 in Sri Lanka. Similar trend
has been observed in neighbouring countries. In India,
the proportion of deaths attributable to CVDs has
increased from 14.52% to 27.4% of the total deaths

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from 1990 to 2019 [1]. Similar pattern has also been
noted in other neighbouring countries including Bhutan
and Pakistan [1]. This could be because of the successes
in reducing mortality due to other health conditions
than CVDs, leading to dramatic increase in the share of
deaths attributable to CVDs.
The underlying causes of the rise in CVD prevalence,
mortality, and burden include social, economic, and
cultural changes brought about by globalization and
urbanization [1]. Tobacco use, unhealthy food, low
level of physical activity, and harmful alcohol use
gradually manifest as intermediate risk factors such as
raised BP, raised blood glucose, dyslipidaemia, and high
body mass index (BMI) [1]. Addressing these risk factors
effectively can also help control diseases other than
CVDs, such as diabetes, kidney disease, and cancer.
CVD prevention measures include encourage a healthy
diet, adequate physical activity, and a reduction in
tobacco and alcohol use. Therefore, it is better to
promote physical activity levels through the
construction of public parks, cycle lanes, physical
fitness centres, yoga, and meditation centres.
Apart from behavioral risk factors, environmental risk
factors like particulate matter pollution, including
ambient and indoor air pollution, increases the risk of
CVDs [1]. Local governments might endeavor to reduce
indoor and outdoor air pollution, which would help to
lower the prevalence and death from CVDs. Shifting
high-polluting industries away from residential areas
and controlling and regulating vehicular emissions
could be a useful strategy to reduce ambient air
pollution, while promoting clean fuels in domestic use
could help reduce indoor air pollution, as people often
struggle to find peaceful and less polluted areas for
physical activity, morning walks, and jogging in city
areas.
Healthy lifestyle counselling could cover risk factors of
CVDs such as unhealthy diet, tobacco use, insufficient
physical activity, and harmful use of alcohol as
important contributors to CVDs.
The country should also promote healthy dietary habits
such as increased intake of whole grains, legumes,
fruits and vegetables, fibre-rich foods, and food rich in
polyunsaturated fatty acids and reduced intake of
sweetened beverages, salted foods, high sodium foods,
trans fat, and red meat. Health education messages
alone are insufficient to promote a healthy diet; several
other aspects must be considered, such as the cost of
processed foods versus fresh items, the distance to fruit
and vegetable markets, and the cost of fruits and
vegetables [1,5].
Early identification and management of intermediate
risk factors, such as raised BP, raised blood glucose
levels, and dyslipidaemia may be able to stop the
development of CVDs and, consequently, the
complications and fatalities that go along with them..
Screening programmes at primary level health facilities
could be useful. Previous studies
have revealed that such screening programmes at the
primary health care level could be effective in the early
detection of the disease [1].
In the meantime, the health service provider's
preparedness is just as crucial. It should be mandatory
for various governmental levels to guarantee the
availability of necessary medications and technology.
Conclusion
This study aims to provide comprehensive picture on
the burden of CVDs in the country. This study is based
on the data from 2004 to 2019 in Sri Lanka.
CVDs have emerged as a major public health issue in Sri
Lanka, accounting for a large and growing proportion of
deaths in 2019. One key factor could be success in
reducing mortality from other diseases, but CVD
mortality has stayed steady. Others may be altering
their lifestyles, notably their food and physical exercise.
Addressing the rising CVD burden in Sri Lanka
necessitates addressing the risk factors for these
diseases on numerous fronts, with the involvement of
all sectors.
Opportunistic screening in health facilities and
community screening programmes could aid in the
early detection and prevention of disease. Aside from
implementing preventive measures, the health sector
must also prepare for long-term care of patients with
CVDs, which could have substantial repercussions for
resources and operations.
Limitations
Availability of data is the major limitations of this study.
There is no up to date information regarding CVD
records. Officials have updated 2019 database recently.
Conflict of Interests
Author declares no conflict of interest.
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