Kerala Risk Factors

• The overall prevalence of risk factors is 50-100% higher in Kerala than the national average with narrower urban-rural gradient.^{1, 2} The difference in the prevalence of risk factors is particularly high between rural Keralans and rural Indians (Figure 035).^{1, 2}

• Prevalence of high blood pressure is 30-36% compared to 21-30% nationally with some studies showing rates as high as 47% in some urban areas.^{1, 2 6} Prehypertension is also high. Both awareness and treatment of high blood pressure is low (<20%).^{1, 3}

• Tobacco use is equally high in rural (45%) and urban (43%) Keralans with  highest rates among slum dwellers (63%) but uncommon in women, consistent with cultural differences throughout India.¹ Smoking in Kerala is nearly double that of national average as well as the US average.^{1, 2} Smoking is associated with a lower prevalence of obesity.¹ However, this is not a justification not to quit smoking or to start smoking.

• Prevalence of obesity (Body Mass Index or BMI >25) is 31%. Mean BMI is higher by 2 units, waist circumference is higher by 2-5cm and obesity is 2 times more prevalent in urban men and women compared with their rural counterparts.^{1, 2} The urban-rural difference is much narrower than the national average.

• Keralans have the highest cholesterol level in India that ranges from 197 to 229mg/dl compared to 157 to 180mg/dl nationally which is attributable to the high intake of saturated fat from coconut meat, milk, and oil.^{1, 2} (see Kerala Paradox and Coconut)

• Prevalence of diabetes ranges from 11-19% in men and 15-22% in women with rural Keralans having paradoxically higher rates of diabetes than urban dwellers.^{1, 2} Only 20% of the diabetics are treated and adequately controlled (see Diabetes in Kerala).

• Physical inactivity is common and associated with greater prevalence of overweight, abdominal obesity and diabetes. 35-70% of Keralans do not consume 5 servings of fruits and vegetables per day compared to 80% -90% nationally.¹

• As high as 50% of diabetes and high blood pressure are undiagnosed.³ The proportion of undiagnosed high cholesterol is likely to be even higher since the general practitioners are virtually excluded from testing and treating dyslipidemia.

• In one study from Trivandrum city ( n=482) 47% had high blood pressure and 42% had prehypertension but only 81 (17%) patients with high blood pressure were aware of their disease.³

• Since today’s risk factors are tomorrow’s disease, the high and escalating prevalence of risk factors portend a continuing epidemic that warrants urgent action by the medical community and all stakeholders.

Sources 

1. Thankappan K R, Shah B, Mathur P, et al. Risk factor profile for chronic non-communicable diseases: results of a community-based study in Kerala, India. Indian J Med Res. Jan 2010;131:53-63.

2. Shah B, Mathur P. Surveillance of cardiovascular disease risk factors in India: the need & scope. Indian J Med Res. Nov 2010;132(5):634-642.

3. Vimala A, Ranji SA, Jyosna MT, Chandran V, Mathews SR, Pappachan JM. The prevalence, risk factors and awareness of hypertension in an urban population of Kerala (South India). Saudi J Kidney Dis Transpl. Jul 2009;20(4):685-689.