#1Profile of Cancer and Related Health Indicators in the North East Region of India MEGHALAYA 80 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 5: Cancer and health status profile of Meghalaya A. Health Status Profile 5.1 Socio-demographic profile [1] Population (Total) 2966889 Number of males 1491832 Number of females 1475057 Sex Ratio 989 Literacy rate (%) Total 74.4 Males Females 76.0 72.9 The total population of the region is 2966889, with a sex ratio of 989. The total literacy rate is 74.4%, being 76.0% in males and 72.9% in females. 81 10 Since 2011 ICMR National Centre for Disease Informatics and Research icm NCDIR#35.2 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 47.0 59.8 Females 34.2 Current smoked tobacco use (age 15 or above) (%) Total 31.6 Males 53.7 Females Current smokeless tobacco use (age 15 or above) (%) 9.5 Total 20.3 Males Females Alcohol consumption Age 15 years or above (%) [13] 11.6 29.1 Urban Rural Total Men Women Men Women Men Women 28.5 1.0 33.5 1.6 32.4 1.5 Metabolic risk factors [13] Overweight/Obese BMI >25 (age 15-49 years) (%) 30.2 17.9 10.6 9.7 13.9 11.5 Raised blood pressure (age 15 years or above) (%) Raised random blood glucose (age 15 years or above) (%) Air Pollution, DALYS per 100,000 [3] 28.5 24.6 19.9 17.1 21.4 18.7 16.0 10.3 13.4 9.3 13.9 9.5 2059.25 The prevalence of current tobacco use is 47.0%, higher for the smoked form (31.6%) than the smokeless form (20.3%). The DALYs' due to air pollution is reported to be 2059.25 per 100,000. Close to one-third, (32.4%) of males over the age of 15 years consumed alcohol, while the proportion of alcohol use in females was negligible. 13.9% of the men in the age group of 15-49 years are obese, slightly 82 ICMR - National Centre for Disease Informatics and Research 10 Since 2011 icm NCDIR#4Profile of Cancer and Related Health Indicators in the North East Region of India higher than female prevalence (11.5%). A higher proportion of males (21.4%) have raised blood pressure than females (18.7%). The prevalence of raised blood glucose is 9.5% in women and 13.9% in men. 5.3 Mortality related statistics Life expectancy (2016) [5] Males Females Leading causes of death (MCCD 2018) [6] Major Cause Group Circulatory System Respiratory System Certain Infectious & Parasitic Diseases Neoplasms Certain Conditions originating in Perinatal Period 66.8 years 72.4 years Percentage 21.1 10.0 11.2 11.6 8.4 Status of Medical certification of cause of death [6] Percentage of Medically Certified Deaths to Total Registered Deaths (%) 43.1 Medical Institutions covered under MCCD Medical Institutions Reported MCCD Data as per the National List 170 170 Ranking of States/UTS in the medical certification of cause of death 2018 12 The life expectancy is marginally higher in females (72.4 years) than males (66.8 years). Circulatory system related causes comprise the leading cause of death (21.1%). The percentage of medically certified deaths to total registered deaths is 43.1%. The state ranks twelfth in the medical certification of cause of death. 83 ICMR National Centre for Disease Informatics and Research 10 Since 2011 icm NCDIR#55.4 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 (%) 1.3 0.2 0.5 0.4 0.4 0.4 0.6 0.6 0.6 Men aged 30-49 ever undergone an oral cavity examination for oral Cancer (%) 2.3 0.9 1.2 Immunization history Children age 12-23 months who have received 3 doses of penta or hepatitis B vaccine (%) 56.0 67.3 65.7 Household profile Population living in households that use an improved sanitation facility (%) 81.3 83.3 82.9 Households using clean fuel for cooking (%) 76.7 21.7 33.7 Households with any usual member covered under a health insurance/financing scheme (%) 52.8 66.5 63.5 The proportion of women who have undergone screening is 0.5% for breast cancer, 0.4% for oral cancer and 0.6% for cervical cancer. Only 1.2% of men had a history of screening for oral cancer. As many as 65.7% of children in 12-23 months had received immunization with Penta and hepatitis B vaccine. About 82.9% of the population live in households that use an improved sanitation facility—only 84 ICMR National Centre for Disease Informatics and Research 10 Since 2011 icm NCDIR#6Profile of Cancer and Related Health Indicators in the North East Region of India third (33.7%) of the population use clean fuel for cooking. The coverage with a health insurance scheme or financing scheme is 63.5%. 5.5 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] 445 32 110 08 28 00 11 386 01 00 00 00 C. State government health scheme [16] Megha Health Insurance Scheme (MHIS) The state has 445 SCs, 32 HWC - SCs', 110 PHCs', 08 HWC- PHCS', 28 CHCs' and 11 DHs. There is only one medical college. The state implements government health scheme known as Megha Health Insurance Scheme (MHIS). 85 ICMR National Centre for Disease Informatics and Research 10 Since 2011 icm NCDIR 20#7Profile of Cancer and Related Health Indicators in the North East Region of India 5.6 Details of Cancer Registries in the State B. Profile of Cancer Population Based Cancer Registry- Meghalaya Location Established Year Coverage Area Civil Hospital, Shillong 2010 East Khasi Hills, West Khasi Hills, Ri Bhoi & Janitia Hills Sources of Registration 22 Area (in Sq.km) Urban & Rural (%) Hospital Based Cancer Registry 14262 24.9 & 75.1 North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong The state has one PBCR situated at Civil Hospital Shillong, covering East Khasi Hills, West Khasi Hills, Ri Bhoi & Janitia Hills through 22 sources of registration for the period 2012-2016 and one HBCR at North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong. 5.7 Number of cancer cases and Age Adjusted Incidence Rate (AAR) per 1,00,000 population Gender Males Females Number of New Cancer Cases 4688 2832 AAR 176.8 96.5 The AAR is higher in males (176.8 per 100,000 males) than females (96.5 per 100,000 females). 86 ICMR National Centre for Disease Informatics and Research 10 Since 2011 icm NCDIR#85.8 Age specific Incidence Rate (ASPR) 900 800 700 600 500 400 300 200 100 Rate per 100,000 0 00-04 05-09 10-14 15-19 20-24 Males Oesophagus Hypopharynx Lung Stomach ii Tongue Males 25-29 30-34 Females 35-39 Age Group 40-44 45-49 50-54 55-59 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 both, the genders, highest Age-Specific Incidence Rate is seen in the 70-74 years age-group. 5.9 Probability of One in number of Persons developing cancer in 0-74 years age Females - 10 Males 1 in 17 Oesophagus 1 in 57 Mouth 1 in 61 Cervix Uteri 1 in 64 Stomach 1 in 92 Breast The probability of developing oesophageal cancer is highest in both genders (1 in every 17 males and 1 in every 36 females), followed by cancer of hypopharynx in males (1 in every 57 males) and mouth cancer in females (1 in every 94 females). 87 ICMR National Centre for Disease Informatics and Research -10 Females 1 in 36 1 in 94 1 in 109 1 in 125 1 in 142 Since 2011 icm NCDIR Da 10#95. 10 Leading Anatomical Sites of Cancer Liver (1.7, 3.8) Pharynx Unsp 12.1, 4.2) Tonsil 13.5.6.4 Mouth 14.5, 9.01 15.6.12.41 (5.8.12.2] Tongue (5.5.9.8) Lung Larynx 52, 10.01 Stomach Hypopharynx Cesophagus (8.2 (6.2 15.3) CRS and AARS given in parentheses. ° 10 31.0 30 Oesophagus Relative Proportion (%) 20 40 12.4 23.01 Cervix Uterl 15.6, 8.8) Mouth (46.8.61 14.5.7.0 169 01 Stomach isa Gall Bladder 12.5.4.5) Meghalaya 640 12.3, 4.31 Ovary (1.320) Tongue (1.2.2.3) Hypopharynx (1.2, 2.1) Profile of Cancer and Related Health Indicators in the North East Region of India The proportion of oesophageal cancer is highest in both the genders (31.0% in males; 22.3% in females). In males, hypopharynx (8.8%) and stomach (6.3%) are the second and third leading cancer sites respectively, whereas, in females, cervix-uteri (10.0%) and mouth (8.2%) rank as second and third leading cancer sites 5.11 Relative Proportion (%) of Cancer sites Associated with the use of Tobacco Males Relative proportion (%) 80 66.9 60 40 20 20 0 31.0 8.8 6.1 5.9 5.6 4.9 2.3 1.1 0.8 0.3 Total Oesophagus Hypopharynx Lung Tongue Larynx Mouth Pharynx Unsp. Oropharynx Urinary Bladder Lip Females Relative proportion (%) 80 60 60 43.1 40 22.3 20 8.2 0 4.1 2.2 2.1 1.7 1.2 0.6 0.5 0.1 Total Oesophagus Mouth Lung Tongue Hypopharynx 1 Larynx Lip Urinary Bladder Pharynx Unsp. Oropharynx As many as two thirds (66.9%) of cancers in males and 43.1% in females are tobacco use related cancer sites. Oesophagus is the leading cancer site related to tobacco use in both the genders (31.0% in males and 22.3% in females). 88 ICMR National Centre for Disease Informatics and Research 10 Since 2011 icm NCDIR#105.12 Mortality - Incidence Ratio (MI %) Meghalaya Males Females Total Profile of Cancer and Related Health Indicators in the North East Region of India Mortality - Incidence Ratio (MI %) Incidence Mortality MI % 4688 1848 39.4 2832 1098 38.8 7520 2946 39.2 The Mortality Incidence ratio is almost similar in males (39.4%) and females (38.8%). Key observations • Cancer ranks among the top five leading causes of death in the state. • Cancer of the oesophagus is the leading site of cancer in both genders. • Current use of tobacco is reported in nearly half of the population, while about one-third of the males consume alcohol. . Only one-third of households have access to clean fuel. • The cause in less than half of the deaths is medically certified. • The state has a scarcity of tertiary cancer care facilities. 89 ICMR National Centre for Disease Informatics and Research 10 Since 2011 icm NCDIR