1. Prevention and control of lifestyle disease

2. Proportion of global deaths under the age 70 years, by cause of death, comparable estimates, 2012

3. Age-standardized NCD death rates by WHO region

4. Probability of dying from the four main noncommunicable diseases between the ages of 30 and 70 years comparable estimates, 2012

6. NCD and risk factors

8. Cardiovascular diseases

9. Cardiovascular diseases
Cardiovascular diseases is the leading cause of mortality in Kerala contributing to as much as 40% of all deaths.
The age adjusted death rate due to cardiovascular in the state is 490 per lakh for men and 231 per lakh for women every year

10. Coronary artery diseases
State reports a higher prevalence of coronary artery diseases when compared to other states in India
7.4% in rural (in 1991)
13.5% in urban(in 1995)
The estimated prevalence of coronary artery disease in the age group years for is %.(31)
*Kutty VR, Balakrishnan KG, Jayasree AK, Thomas J. Prevalence of coronary heart disease in the rural population of Thiruvananthapuram district, Kerala, India. Int J Cardiol [Internet] Apr [cited 2015 Apr 24];39(1):59–70. Available from:
**Begom R, Singh RB. Prevalence of coronary artery disease and its risk factors in the urban population of South and North India. Acta Cardiol [Internet] Jan [cited 2015 May 7];50(3):227–40. Available from:
***National Commission on Macroeconomics and Health. NCMH Background Papers·Burden of Disease in India. New delhi; p. 1–388. Available from: of disease_(29 Sep 2005).pdf

11. Death due to coronary artery disease in kerala
Mohanan PP, Mathew R, Harikrishnan S, Krishnan MN, Zachariah G, Joseph J, et al. Presentation, management, and outcomes of acute coronary syndrome admissions in Kerala, India: results from the Kerala ACS Registry. Eur Heart J [Internet] Jan 7 [cited 2015 May 8];34(2):121–9. Available from:

12. Acute coronary event in Kerala
CAD in Kerala is both premature and malignant
Average age is 60 years (56 in males and 69 in females)
60% of CAD deaths in men and 40% of CAD deaths in women occur before the age of 65 (USA-18%)
1 month case fatality rate following STEMI- 8.5% ( around 4 in developed countries)
Soman CR, Kutty VR, Safraj S, Vijayakumar K, Rajamohanan K, Ajayan K. All-cause mortality and cardiovascular mortality in Kerala state of India: results from a 5-year follow-up of 161,942 rural community dwelling adults. Asia Pac J Public Health [Internet] Nov [cited 2015 Apr 23];23(6):896–903. Available from:
Mohanan PP, Mathew R, Harikrishnan S, Krishnan MN, Zachariah G, Joseph J, et al. Presentation, management, and outcomes of acute coronary syndrome admissions in Kerala, India: results from the Kerala ACS Registry. Eur Heart J [Internet] Jan 7 [cited 2015 May 8];34(2):121–9. Available from:

13. Stroke
Prevalence stroke among adults (>18 years ) in the state was 0.3%
The age adjusted annual incidence of stroke in Kerala in was 135 per 100,000
were more in males (143 )compared to females (128)
Ischemic stroke was the most common type of stroke ( 73 per )
#Menon J, Joseph J, Thachil A, Attacheril T V, Banerjee A. Surveillance of noncommunicable diseases by community health workers in Kerala: the epidemiology of noncommunicable diseases in rural areas (ENDIRA) study. Glob Heart [Internet] Dec [cited 2015 Apr 1];9(4):409–17. Available from:
##Soman CR, Kutty VR, Safraj S, Vijayakumar K, Rajamohanan K, Ajayan K. All-cause mortality and cardiovascular mortality in Kerala state of India: results from a 5-year follow-up of 161,942 rural community dwelling adults. Asia Pac J Public Health [Internet] Nov [cited 2015 Apr 23];23(6):896–903. Available from:

14. Stroke No urban rural difference in incidence
average age of stroke patients was 67 years
stroke in the young( <40 years,)only 4%
case fatality rate within one month was 24.5% for urban and 37.1% for rural populations which is comparable to national figures
Sridharan SE, Unnikrishnan JP, Sukumaran S, Sylaja PN, Nayak SD, Sarma PS, et al. Incidence, types, risk factors, and outcome of stroke in a developing country: the Trivandrum Stroke Registry. Stroke [Internet] Apr 1 [cited 2015 May 5];40(4):1212–8. Available from:

15. Cancer

16. Incidence of cancer in Kerala
1.Three Year Report of PBCR [Internet]. [cited 2015 Apr 28]. Available from:
2 GLOBOCAN :Fact Sheets by Population [Internet]. [cited 2015 Apr 27]. Available from:

17. Trend in incidence of cancer in Kerala
*CI5 - Home [Internet]. [cited 2015 Apr 27]. Available from:
**Three Year Report of PBCR [Internet]. [cited 2015 Apr 28]. Available from:

18. Among males lung cancer (14
Among males lung cancer (14.5%) was the leading site followed by cancer of oral cavity (14.2%).
Among females cancer of breast (29.8%) was the leading site of cancer followed by cancer of thyroid( 12.5%)
Children (0-14years) constituted 4.8% of all cancers and leukemia was the predominant cancer among them in both genders ( males 57.5% and females 47.5%).

21. Chronic Lung diseases

22. Chronic lung diseases
Chronic obstructive pulmonary diseases (COPD) accounted for 5.2% of the total NCD burden and 12.2% of the NCD related mortality.
In Kerala, 15.3% of the death were due to respiratory causes of which COPD was the main culprit

23. Prevalence of chronic respiratory disease in Kerala
Jindal SK. Indian Study on Epidemiology of Asthma , Respiratory Symptoms and Chronic Bronchitis ( INSEARCH ) A Multi ‐ Centre Study ( 2006 ‐ 2009 ) Department of Pulmonary Medicine [Internet] Available from: _Report.pdf

25. Prevalence of chronic bronchitis

26. Chronic Kidney disease
Age-adjusted incidence rate of ESRD in India to be per lakh population.
7500 new chronic kidney diseases every year in Kerala
Prevalence in hospitalized patients is 17 %
33 % in Kerala
Main causes are diabetes nephropathy and hypertensive nephrosclerosis
*Modi GK, Jha V. The incidence of end-stage renal disease in India: a population-based study. Kidney Int [Internet] Dec 25 [cited 2015 May 2];70(12):2131–3. Available from:
**Singh AK, Farag YMK, Mittal B V, Subramanian KK, Reddy SRK, Acharya VN, et al. Epidemiology and risk factors of chronic kidney disease in India - results from the SEEK (Screening and Early Evaluation of Kidney Disease) study. BMC Nephrol [Internet] Jan [cited 2015 Apr 22];14(1):114. Available from:
***Rajapurkar MM, John GT, Kirpalani AL, Abraham G, Agarwal SK, Almeida AF, et al. What do we know about chronic kidney disease in India: first report of the Indian CKD registry. BMC Nephrol [Internet] Jan [cited 2015 Apr 17];13:10. Available from:

27. Diabetes

28. Age-standardized prevalence of diabetes, 2014

30. Comparison of current age standardized prevalence of diabetes in above 18 years
Thankappan KR, Shah B, Mathur P, Sarma PS, Srinivas G, Mini GK, et al. Risk factor profile for chronic non-communicable diseases: Results of a community-based study in Kerala, India. Indian J Med Res. 2010;131(1):53–63.
World Health Organization. Global Status Report On Noncommunicable Diseases

31. Diabetes in Kerala over last 25 year

32. Thankappan KR, Shah B, Mathur P, Sarma PS, Srinivas G, Mini GK, et al
Thankappan KR, Shah B, Mathur P, Sarma PS, Srinivas G, Mini GK, et al. Risk factor profile for chronic non-communicable diseases: Results of a community-based study in Kerala, India. Indian J Med Res. 2010;131(1):53–63.

33. Kutty VR, Soman CR, Joseph A, Pisharody R, Vijayakumar K
Kutty VR, Soman CR, Joseph A, Pisharody R, Vijayakumar K. Type 2 diabetes in southern Kerala: variation in prevalence among geographic divisions within a region. Natl Med J India [Internet]. Jan [cited 2015 Apr 23];13(6):287–92
Jose R, Manojan KK, Augustine P, Nujum ZT, Althaf A, Haran JC, et al. Prevalence of Type 2 Diabetes and Prediabetes in Neyyattinkara Taluk of South Kerala [Internet]. Academic Medical Journal of India [cited 2015 Apr 23]. Available from:

34. Detection , treatment and control of diabetes in Kerala

35. Hypertension

36. Age standardized prevalence of hypertension in above 18 years
Thankappan KR, Shah B, Mathur P, Sarma PS, Srinivas G, Mini GK, et al. Risk factor profile for chronic non-communicable diseases: Results of a community-based study in Kerala, India. Indian J Med Res. 2010;131(1):53–63.
World Health Organization. Global Status Report On Noncommunicable Diseases

37. Trend in prevalence of hypertension in Kerala (above 30 year of age)

38. Burden of hypertension
The prevalence was almost same in both genders as well as in urban and rural areas.
The burden of hypertension increases with age
studies reports that 60-80% of people above age of 60 were hypertensive
proportion of people in pre-hypertension stage is also very high (upto 40%).

39. Detection , treatment and control of hypertension in Kerala

40. Status of risk factors in Kerala

41. Tobacco use in Kerala
International Institute for Population Sciences.Ministry of Health and Family Welfare. Government of India. Global adult tobacco survey India Global adult tobacco survey India Mumbai: International Institute for Population Sciences; 2010.

42. Tobacco use in Kerala
International Institute for Population Sciences.Ministry of Health and Family Welfare. Government of India. Global adult tobacco survey India Global adult tobacco survey India Mumbai: International Institute for Population Sciences; 2010.

43. Smoking in Kerala over past 30 years

44. Alcohol use in Kerala
Current use of alcohol ( within one month ) was seen in 20-23% of males aged above 15 years in Kerala.
Annual Per capita alcohol consumption was 10.2 L which is comparable to national average (11.4 L)
ICMR. NON-COMMUNICABLE DISEASE RISK FACTORS SURVEY India Phase - I

45. Obesity
The prevalence of overweight and obese (BMI>=25) in the state was estimated to around 30 % and is showing an upward trend.
Central obesity (based on waste circumference, WC) is more prevalent affecting as much as 40% of the population.
Obesity/overweight was more common in females (BMI- 38%, WC-52%) when compared to males (BMI- 24%,WC-26%).

46. Hyper-cholestrolemia

47. Dietary practice in Kerala

48. Dietary practice in Kerala

49. Physical inactivity
Low level of physical activity was seen in 75% of the population as per the STEPS survey report.
Lack of physical activity was more common in women when compared to men.
The low level of physical activity was same in both urban and rural areas as well as across different age groups

50. Is there a solution?

51. Prevention oriented health care

52. Levels of prevention

53. Levels of prevention

55. Secondary and tertiary prevention prevention
Primodial prevention
Primary prevention

56. Primary prevention Promoting healthy diet
Promoting recreational physical activity
Avoiding tobacco , alcohol
Stress management

57. Primary prevention Health promotion Specific protection
Health education
Environmental modification
Lifestyle and behavioral changes
Specific protection
Legislation and its proper implementation
Immunization

58. Secondary prevention
Early diagnosis
Screening
Proper treatment