#1Profile of Cancer and Related Health Indicators in the North East Region of India TRIPURA 123 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 9: Cancer and health status profile of Tripura A. Health Status Profile 9.1 Socio-demographic profile [1] Population (Total) Number of males 3673917 1874376 Number of females 1799541 Sex Ratio 960 Literacy rate (%) Total 87.2 Males Females 91.5 82.7 The total population of the region is 3673917, with a sex ratio of 960. The total literacy rate is 87.2%, being 91.5% in males and 82.7% in females. 124 10 Since 2011 icm NCDIR ICMR National Centre for Disease Informatics and Research#39.2. NCD related Risk factor profile Behavioral and lifestyle-related Tobacco use [2] Current tobacco use-smoked and/or smokeless (age 15 years and above) (%) Total Males Profile of Cancer and Related Health Indicators in the North East Region of India 64.5 67.5 Females 61.4 Current smoked tobacco use (age 15 or above) (%) Total 27.7 Males Females Current smokeless tobacco use (age 15 or above) (%) Total Males Females Alcohol consumption Age 15 years or above (%) [13] Metabolic risk factors [13] 44.4 10.3 48.5 40.8 56.5 Urban Rural Total Men Women Men Women Men Women 26.9 0.8 35.9 8.4 33.1 6.2 Overweight/Obese BMI >25 s (age 15-49 years) (%) Raised blood pressure (age 15 years or above) (%) Raised random blood glucose (age 15 years or above) (%) Air Pollution, DALYS per 100,000 [3] 28.3 29.2 21.4 18.4 23.4 21.5 27.3 26.4 20.6 18.6 22.7 20.9 21.2 21.1 18.5 16.3 19.3 17.7 3525.04 The prevalence of current tobacco use is (64.5%), higher for the smokeless form (48.5%) than the smoked form (27.7%). The DALYs' due to air pollution is reported to be 3525.04 per 100,000. One-third, (33.1%) of males over the age of 15 years consumed alcohol, while the proportion of alcohol use in females was 6.2%. Over 23.4% of the men in the age group of 15-49 years are obese, which is slightly higher than female prevalence (21.5%). A somewhat higher proportion of males (22.7%) have raised blood pressure than females (20.9%). The prevalence of raised random blood glucose is 17.7% in women and 19.3% in men. 125 ICMR National Centre for Disease Informatics and Research 10 Since 2011 icm NCDIR#49.3 Mortality related statistics Life expectancy (2016) [5] Males Females Leading causes of death (MCCD 2018) [6] Circulatory System Respiratory System Neoplasms Profile of Cancer and Related Health Indicators in the North East Region of India 66.3 71.5 Major Cause Group Percentage 38.3 10.2 9.1 7.0 3.9 Certain Infectious & Parasitic Diseases Certain Conditions originating in Perinatal Period Status of Medical certification of cause of death [6] Percentage of Medically Certified Deaths to Total Registered Deaths (%) Medical Institutions covered under MCCD 22.3 124 Medical Institutions Reported MCCD Data as per the National List 124 Ranking of States/UTs in the medical certification of cause of death 2018 20 The life expectancy is marginally higher in females (71.5 years) than males (66.3 years). Circulatory system causes comprise the leading cause of death (38.3%). The percentage of medically certified deaths to total registered deaths is 22.3%. The state ranks twentieth in the medical certification of cause of death. 126 ICMR National Centre for Disease Informatics and Research 10 Since 2011 icm NCDIR#59.4 Health seeking behaviour 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 (%) 0.8 0.2 0.4 0.8 0.5 0.6 1.2 0.4 0.7 Men aged 30-49 ever undergone an oral cavity examination for oral Cancer (%) Immunization history 0.0 0.3 0.2 Children aged 12-23 months who have received 3 doses of penta or hepatitis B vaccine (%) 88.1 80.7 82.5 Household profile Population living in households that use an improved sanitation facility (%) 78.5 71.6 73.6 Households using clean fuel for cooking (%) 75.4 32.6 45.3 Households with any usual member covered under a health insurance/financing scheme (%) 24.9 36.5 33.0 The proportion of women who have undergone screening is 0.4% for breast cancer, 0.6% for oral cancer and 0.7% for cervical cancer. Only 0.2% of men had a history of screening for oral cancer. As many as 82.5% of children in 12 to 23 months had received immunization with Penta and hepatitis B vaccine. About 73.6% of the population live in households that use an improved sanitation facility only 45.3% of the population uses clean fuel for cooking. The coverage with a health insurance scheme or financing scheme is low at a figure of 33.0%. 127 ICMR National Centre for Disease Informatics and Research 10 Since 2011 icm NCDIR 20#6Profile of Cancer and Related Health Indicators in the North East Region of India 9.5 Status of the health system A. Public sector health facilities [7],[8] Sub centres (SC) Health and Wellness Centre - Sub Centre (HWC-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] C. State government health scheme [20] 966 40 82 31 22 12 07 418 02 01 00 01 Ayushman Bharat -Pradhan Mantri Jan Arogya Yojana The state has 966 SCs, 40 HWC - SCS', 82 PHCs', 31 HWC - PHCS', 22 CHCs', 12 SDHs and 7 DHs. There are two medical colleges and one State Cancer Institute and Regional Cancer Centre. The state implements Ayushman Bharat -Pradhan Mantri Jan Arogya Yojana. 128 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 9.6 Details of Cancer Registries in the State B. Profile of Cancer Population Based Cancer Registry Location Regional Cancer Centre, Agartala Established Year 2010 Coverage Area Tripura state Sources of Registration 30 Area (in Sq.km) Urban & Rural (%) 10492 26.2 & 73.8 Hospital Based Cancer Registry: Regional Cancer Centre, Agartala The Population Based Cancer Registry is located at Regional Cancer Centre, Agartala and covers the entire state through 30 sources of registration. 9.7 Number of cancer cases and Age Adjusted Incidence Rate (AAR) per 1,00,000 population Gender Males Females Number of New Cancer Cases AAR 6559 4914 80.9 58.3 The AAR is higher in males (80.9 per 100,000 males) than females (58.3 per 100,000 females) in Tripura state. 129 10 Since 2011 icm NCDIR ICMR National Centre for Disease Informatics and Research#8Lung 9.8 Age Specific Incidence Rate (ASPR) 600 Rate per 100,000 Males Females 400 200 00-04 05-09 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 Age Group 69-99 Profile of Cancer and Related Health Indicators in the North East Region of India 60-64 65-69 70-74 75+ The Age-Specific Incidence Rates (ASPR)in both the genders show a rise from 30-34 years age-group onwards. In males, the highest Age-Specific Incidence Rate is seen in the 70-74 years age-group, whereas in females it was highest in 60-64 age group. 9.9 Probability of One in number of Persons developing cancer in 0-74 years age Males Oesophagus Larynx Stomach Mouth Females - 20 Males 1 in 54 1 in 125 1 in 147 1 in 157 1 in 178 Cervix Uteri Breast Gallbladder Mouth Ovary - 20 Female: 1 in 94 1 in 123 1 in 142 1 in 254 1 in 297 The probability of developing lung cancer is the highest in males (1 in every 54 males), followed by oesophageal cancer (1 in every 125 males) and cancer of larynx (1 in every 147 males). Among females, the probability of developing cancer of cervix-uteri is highest (1 in every 94 females) followed by breast cancer (1 in every 123 females) and cancer of gallbladder (1 in every 142 females). 130 ICMR National Centre for Disease Informatics and Research Da Since 2011 icm NCDIR 10#99.10 Leading Anatomical Sites of Cancer Liver (1.6.1.9) Tonsil 12.0.2.5) Gall Bladder 2.5, 3.0) Hypopharynx 13.5, 4.4) CRS and AARS given in parentheses Males 60 52.1 36.31 (11.3. 14.4) Tongue (3.7,4,4] Mouth 13.9, 4.6) Stomach Larynx Oesophagus (4.1.5.01 14.5.5.5) Bun 0 10 30 40 Cervix Uteri Breast Gall Bladder 15.0, 5.71 Mouth (2.9.3.4) Ovary 12.8, 3.11 Lung (2.8, 3.3) Oesophagus (2.6.3.11 Stomach (1.9.2.1) Liver (1.1, 1.3) Tongue 0 1.2) Relative Proportion (%) Profile of Cancer and Related Health Indicators in the North East Region of India Tripura The proportion of lung cancer (16.8 %) is highest among males, followed by oesophageal cancer (7.7%) and cancer of the larynx (6.7%). In females, the cervix-uteri is a leading cancer site (16.5%) followed by breast (14.4%) and gallbladder (9.5%). 9.11 Relative Proportion (%) of Cancer sites Associated with the Use of Tobacco 40 40 Relative proportion (%) о 10 20 Total Lung 16.8 7.7 6.7 5.8 5.5 5.3 1.8 1.5 0.8 0.2 Larynx Oesophagus Mouth Tongue Hypopharynx Urinary Bladder Oropharynx Pharynx Unsp. Lip Females 60 Relative proportion (%) 40 20 20 0 Total 21.1 5.6 5.4 4.9 2.0 1.5 0.7 0.4 0.3 0.2 0.1 Mouth Lung Tongue Oesophagus Larynx Urinary Bladder Hypopharynx Lip Oropharynx Pharynx Unsp. Approximately half (52.1%) of cancers in males and close to one-fourth (21.1%) in females are tobacco Use related cancer sites. Among these, lung (16.8%) and oesophagus (7.7%) are leading cancer sites in males, whereas mouth (5.6%) and lung (5.4%) are the cancer sites in leading females. 131 ICMR National Centre for Disease Informatics and Research 10 20 Since 2011 icm NCDIR#109.12 Mortality - Incidence Ratio (MI %) Mortality - Incidence Ratio (MI %) Tripura state Males Females Total Profile of Cancer and Related Health Indicators in the North East Region of India Incidence Mortality MI % 6559 3682 56.1 4914 11473 2395 48.7 6077 53.0 The total Mortality - Incidence ratio is 53.0%, higher in males (56.1%) than females (48.7%). Key observations . Cancer ranks among the top five leading causes of death in the state. • The incidence of cancer is 1.4 times higher in males than females. • . The lung and oesophagus are the first two leading site of cancer in males, while in females, it is cervical cancer followed by breast cancer. Current use of tobacco is present in nearly two-thirds of males and females, while about one-third of the men consume alcohol. The cause of less than a quarter of the deaths is medically certified. • Less than half of the population use clean fuel. • Only one-third of the households are covered with a health insurance scheme. 132 ICMR National Centre for Disease Informatics and Research 10 Since 2011 icm NCDIR