Macrolevel Association of COVID-19 with Non-Communicable Disease Risk Factors in India

Abstract

Objective: Greater COVID-19 related mortality has been reported among persons with various non-communicable diseases (NCDs). We performed an ecological study to determine the association of state-level cases and deaths with NCD risk factors and healthcare and social indices.Methods: We obtained cumulative national and state-level data on COVID-19 cases and deaths from publicly available database www.covid19india.org from February to end November 2020. To identify association with major NCD risk factors, NCDs, healthcare related and social variables we obtained data from public sources. Association was determined using univariate and multivariate statistics.Results: More than 9.5 million COVID-19 cases and 135,000 deaths have been reported in India at end November 2020. There is significant positive correlation (Pearson’s r) of state-level COVID-19 cases and deaths per million, respectively, with NCD risk factors- obesity (0.64, 0.52), hypertension (0.28, 0.16), diabetes (0.66, 0.46), literacy, NCD epidemiological transition index (0.58, 0.54) and ischemic heart disease mortality (0.22, 0.33). Correlation is also observed with indices of healthcare access and quality (0.71, 0.61), urbanization (0.75, 0.73) and human (0.61, 0.56) and sociodemographic (0.70, 0.69) development. Multivariate adjusted analyses shows strong correlation of COVID-19 burden and deaths with NCD risk factors (r²=0.51, 0.43), NCDs (r²=0.32, 0.16) and healthcare related factors (r²=0.52, 0.38).Conclusions: COVID-19 disease burden and mortality in India is ecologically associated with greater state-level burden of NCDs and risk factors, especially obesity and diabetes.KEY MESSAGES: There is significant state-level variability in COVID-19 cases and deaths in India. In a macrolevel statistical analysis we find that Indian states with better human and sociodemographic indices, more literacy, longer age, greater burden of non-communicable diseases and risk factors have greater COVID-19 case burden and mortality. Non-communicable disease risk factors- obesity and diabetes are the most important determinants on multivariate analyses.