#1Profile of Cancer and Related Health Indicators in the North East Region of India MIZORAM 90 ICMR National Centre for Disease Informatics and Research 10 Since 2011 icm NCDIR#2Profile of Cancer and Related Health Indicators in the North East Region of India Chapter 6: Cancer and health status profile of Mizoram A. Health Status Profile 6.1 Socio-demographic profile [1] Population (Total) 1097206 Number of males 555339 Number of females 541867 Sex Ratio 976 Literacy rate (%) Total Males Females 91.3 93.4 89.3 The total population of the region is 1097206, with a sex ratio of 976. The total literacy rate is 91.3%, being 93.3% in males and 89.3% in females. 91 ICMR National Centre for Disease Informatics and Research 10 Since 2011 icm NCDIR#36.2 NCD related Risk factor profile Behavioral and lifestyle-related Tobacco use [2] Current tobacco use-smoked and/or smokeless (age 15 years and above) (%) Profile of Cancer and Related Health Indicators in the North East Region of India Total 58.7 Males 64.9 Females 52.4 Current smoked tobacco use (age 15 or above) (%) Total 34.4 Males 54.1 Females Current smokeless tobacco use (age 15 or above) (%) Total Males Females Alcohol consumption Age 15 years or above (%) [13] 14.3 33.5 21.3 46.0 Urban Rural Total 22.8 Men Women 1.0 Men 25.2 Women 0.8 Men Women 23.8 0.9 Metabolic risk factors [13] Overweight/Obese BMI >25 s (age 15-49 years) (%) Raised blood pressure age 15 years or above (%) Raised blood glucose (random) age 15 years or above (%) Air Pollution, DALYS per 100,000 [3] 16.4 38.3 29.7 24.2 16.9 28.7 21.0 21.1 13.5 15.0 14.3 12.3 2003.7 31.9 24.2 25.2 17.7 15.4 13.8 The prevalence of current tobacco use is 58.7%, slightly higher for the smoked form (34.4%) than the smokeless form (33.5%). The DALYs' due to air pollution is reported to be 2003.7 per 100,000. 23.8% of males over the age of 15 years consumed alcohol, while the proportion of alcohol use in females was negligible. Close to one-third of the men (31.9%) in the age group of 15-49 years are obese, higher than female prevalence (24.2%). A higher proportion of males (25.2%) have raised blood pressure than females (17.7%). The prevalence of raised blood glucose is 13.8% in women and 15.4% in men. 92 ICMR National Centre for Disease Informatics and Research 10 Since 2011 icm NCDIR#46.3 Mortality related statistics Life expectancy (2016) [5] Males Females Leading causes of death (MCCD 2018) [6] Major Cause Group Diseases of the circulatory system Certain infections and parasitic infestations Diseases of the respiratory system Neoplasms Certain conditions originating in the perinatal period Profile of Cancer and Related Health Indicators in the North East Region of India 68.3 73.8 Percentage 16.0 15.3 13.2 12.5 5.3 Status of Medical certification of cause of death [6] Percentage of Medically Certified Deaths to Total Registered Deaths (%) 58.9 Medical Institutions covered under MCCD Medical Institutions Reported MCCD Data as per the National List Ranking of States/UTS in the medical certification of cause of death 2018 108 8 The life expectancy is marginally higher in females (73.8 years) than males (68.3 years). Diseases of the circulatory system account for 16.0% of the deaths the percentage of medically certified deaths to total registered deaths is 58.9%. The state ranks eighth in the medical certification of cause of death. 93 10 Since 2011 icm NCDIR ICMR National Centre for Disease Informatics and Research#56.4 Health seeking behavior and health practices [13] History of cancer screening Profile of Cancer and Related Health Indicators in the North East Region of India Urban Rural Total Women aged 30-49 ever undergone a breast examination for breast cancer (%) Women aged 30-49 ever undergone an oral cavity examination for oral Cancer (%) Women aged 30-49 ever undergone screening for cervical cancer (%) 3.6 1.3 2.7 1.4 0.3 0.9 9.4 3.3 6.9 Men aged 30-49 ever undergone an oral cavity examination for oral Cancer (%) 0.2 2.4 1.2 Immunization history Children aged 12-23 months who have received 3 doses of penta or hepatitis B vaccine (%) 74.6 78.1 76.4 Household profile Population living in households that use an improved sanitation facility (%) 97.1 93.2 95.3 Households using clean fuel for cooking (%) 97.9 66.4 83.8 Households with any usual member covered under a health insurance/financing scheme (%) 41.2 52.8 46.4 The proportion of women who have undergone screening is 2.7% for breast cancer, 0.9 % for oral cancer and 6.9% for cervical cancer. Only 1.2% of men had a history of screening for oral cancer. As many as 76.4% of children in 12 to 23 months had received immunization with Penta and hepatitis B vaccine. About 95.3% of the population lives in households that use an improved sanitation facility, 83.0% of the population are using clean fuel for cooking. The coverage with a health insurance scheme or financing scheme is low at a figure of 46.4%. 94 ICMR National Centre for Disease Informatics and Research 10 Since 2011 icm NCDIR 20#66.5 Status of the health system Profile of Cancer and Related Health Indicators in the North East Region of India A. Public sector health facilities [7].[8] Sub centres (SC) Primary Health Centres (PHC) Health and Wellness Centre - Primary Health Centre (HWC-PHC) Community Health Centres (CHC) Sub-District Hospitals (SDH) District Hospitals (DH) Number of government allopathic doctors and dental surgeons B. Tertiary health care facilities Medical Colleges [9] State cancer institute [10] Tertiary cancer care centre [10] Regional cancer care centre [11] Number 370 65 04 9 02 09 138 01 00 01 01 C. State government health scheme [17] Mizoram State Health Care Scheme (MSHCS) The state has 370 SCs, 65 PHCs',04 HWC - PHCs', 09 CHCS', 02 SDHs and 09 DHs. There is only one medical college, one Tertiary Cancer Care Center and Regional Cancer Centre. The state implements health scheme known as Mizoram State Health Care Scheme (MSHCS). 95 Since 2011 10 20 icm NCDIR ICMR National Centre for Disease Informatics and Research#7Profile of Cancer and Related Health Indicators in the North East Region of India 6.6 Details of Cancer Registries in the State Population Based Cancer Registry Location Established Year B. Profile of Cancer Civil Hospital, Aizawl 2003 Coverage Area Mizoram state Sources of registration 37 Area (in Sq.km) Urban & Rural (%) 21087 52.1 & 47.9 Hospital Based Cancer Registries :1. Mizoram State Cancer Institute (Civil Hospital), Aizawl 2. Zoram Medical College, Aizawl The Population Based Cancer Registry is located at Civil Hospital, Aizawl and covers the entire state through 37 sources of registration. 6.7 Number of cancer cases and Age Adjusted Incidence Rate (AAR) per 100,000 population Mizoram state Gender Number of New Cancer Cases AAR Aizawl District Number of New Cancer Cases AAR Males Females 4323 3736 207.0 172.3 269.4 214.1 2180 1900 In Mizoram state, the AAR is higher in males (207.0 per 100,000 males) than females (172.3 per 100,000 females). Similarly, in Aizawl district, a higher AAR has been reported in males (269.4 per 100,000 males) in comparison to females (214.1 per 100,000 females). 96 Since 2011 10 20 icm NCDIR ICMR National Centre for Disease Informatics and Research#86.8 Age Specific Incidence Rate (ASPR) Rate per 100,000 1600 1200 800 400 Males Females 00-04 → 05-09 → 10-14 15-19 20-24 → 25-29 30-34 35-39 40-44 45-49 50-54 69-99 60-64 65-69 70-74 75+ Profile of Cancer and Related Health Indicators in the North East Region of India The Age-Specific Incidence Rates in both the genders show a rise from 30-34 years age-group onwards. In males, the highest Age-Specific Incidence Rate is seen at 75+ years while in females, the incidence is highest in the 70 to 74 years age group. Age Group 6.9 Probability of One in number of Persons developing cancer in 0-74 years age Males Stomach ቀጥ Females Lung Oesophagus Hypopharynx Liver - 10 Males 1 in 21 Lung 1 in 26 Cervix Uteri 1 in 29 Breast 1 in 83 Stomach 1 in 86 Oesophagus - 10 Females 1 in 29 1 in 43 1 in 43 1 in 43 1 in 110 In males, the probability of developing stomach cancer is the highest (1 in every 21 males), followed by lung cancer (1 in every 26 males) and oesophageal cancer (1 in every 29 males). In females, the probability of developing lung cancer is highest (1 in every 29 females) followed by cancer of cervix uteri, breast cancer and stomach cancer (1 in every 43 females). 97 Since 2011 10 20 icm NCDIR ICMR National Centre for Disease Informatics and Research#96.10 Leading Anatomical Sites of Cancer 40 30 Mizoram Profile of Cancer and Related Health Indicators in the North East Region of India The proportion of stomach cancer (18.0%) is the highest among males, followed by cancer of the oesophagus (15.4%) and lung cancer (14.3%). In Females, Cervix uteri is a leading cancer site (15.4%) followed by lung (14.1%) and breast (13.5%). 20.9, 32.11 Mouth (2.8, 3.8) Larynx 13.6.5.11 Colon (3.7, 5.5 Nasopharynx (3.8.5.2 Rectum (4.7.6.7) Liver 172, 10.0) Hypopharynx (7.6. 10.4) CRS and AARS given in parentheses. Lung 122.5, 30.2) *126.2 39.14 Oesophagus Stomach 20 10 0 19.7,23,2) [18.0, 27.6 17.3.21.6) Cervix Uteri Bum Relative Proportion (%) Breast Stomach 12.8, 188) Oesophagus Ovary 4 4.8) Liver 4.2, 5.9) Thyroid 33: Rectum 13.2, 4.5| Gall Bladder 3.0, 4.3) 6.11 Relative Proportion (%) of Cancer Sites Associated with the Use of Tobacco Males Relative proportion (%) 501 25 43.3 25 15.4 14.3 5.2 о Total Oesophagus Lung Hypopharynx 2.5 1.9 1.7 Larynx 123 1.3 0.6 0.4 10 0.1 Mouth Tongue Urinary Bladder Pharynx Unsp. Oropharynx Lip Females Relative proportion (%) 25 22.1 14.1 3.7 1.3 0.7 0.7 0.6 0.6 0.2 0.0 0.0 Tongue Lip Total Lung Oesophagus Mouth Urinary Bladder Larynx Hypopharynx Pharynx Unsp. Oropharynx Over one third (43.3 %) of cancers in males and close to one-fourth (22.1%) in females are tobacco Use related cancer sites. Among these, lung (males-14.3%, females- 14.1%) and oesophagus females-3.7%) (males-15.4%, are leading sites in both the genders. 98 ICMR National Centre for Disease Informatics and Research 10 20 Since 2011 icm NCDIR#106.12 Trends over time in cancer incidence Profile of Cancer and Related Health Indicators in the North East Region of India Crude Rate (CR) Per 100,000 Cancer Site 2004 2016 Oesophagus_F Ovary Rectum_M Breast F Oesophagus_M Liver_M 9.5* Oesophagus _F 2.2 4.9 8.5* Ovary 2.2 5.5 6.4* Rectum_M 2.5 4.2 5.7* Breast_F 12.3 19.4 4.6* Oesophagus M 15.3 21.0 4.5* Liver_M 4.7 5.4 Liver_F 3.6 Liver_F 2.6 3.3 Cervix Uteri 2.8* Cervix Uteri 17.9 20.1 Rectum_F 2.8* Rectum_F 2.6 3.3 All Site_F Lung_M Hypopharynx M Lung_F 2.5* All Site_F 102.4 138.4 2.4* Lung_M 18.0 18.7 1.8 Hypopharynx M 7.4 8.5 1.6 Lung_F 13.4 16.5 All Site_M 1.6* All Site_M 134.7 144.1 Nasopharynx_M 1.2 Nasopharynx M 2.5 3.6 Stomach_F -1.5 Stomach_F 11.2 11.9 Stomach_M -2.2* Stomach_M 35.2 25.2 -3 0 3 6 9 12 Annual Percent Change (%) Increase in APC, Decrease in APC, Increase or Decrease in APC for All Sites; * Significant Increase or Decrease at 95% Confidence Level Annual Percent Change (APC) in cancer incidence for all sites is observed to be 1.6% in males and 2.5% in females from 2004 to 2016. In females, an increasing trend has been observed for cancer of oesophagus, ovary, breast, liver, cervix uteri, rectum and lung, whereas stomach cancer has shown a decline. Among males, cancer of rectum, oesophagus, liver, lung, hypopharynx and nasopharynx show an increasing trend, whereas stomach cancer is declining. 99 ICMR National Centre for Disease Informatics and Research 10 Since 2011 icm NCDIR 20#116.13 Mortality - Incidence Ratio (MI %) Mizoram state Males Females Total Aizawl district Males Females Total Profile of Cancer and Related Health Indicators in the North East Region of India Mortality - Incidence Ratio (MI %) Incidence Mortality MI % 4323 2492 57.6 3736 1566 41.9 8059 4058 50.4 2180 1216 55.8 1900 757 39.8 4080 1973 48.4 The total Mortality - Incidence ratio is 50.4%, being higher in males (57.6%) compared to females (41.9%) in Mizoram state. In Aizawl district, total MI is 48.4%, higher in males (55.8%) than in females (39.8%). Key observations • Cancer ranks among the top five leading causes of death in the state. • There is a significant increase in oesophageal cancer and rectal cancer in both genders. • The increase in incidence for lung and liver cancer is substantial in males, and for ovary, breast and cervical cancer in females. • The incidence of stomach cancer has declined over time. • Close to two-thirds of males and half of the females are current tobacco users. • About a quarter of the men consume alcohol, about one third are overweight or obese, and one fourth are hypertensive. The cause of more than half of the deaths are medically certified. 100 Since 2011 10 20 icm NCDIR ICMR National Centre for Disease Informatics and Research