An initiative by Apollo Hospitals

DECODING HIGHLIGHTS

THE INDIAN India, now the

Cancer Capital
HEALTH Diagnosis at a younger
age in India, compared

QUOTIENT
to other countries

Feeling
In its fourth edition, coinciding with the World Health the Blues
Day on April 7, Apollo Hospitals’ Health of the Nation Sharp increase in
mental health disorders
2024, is a detailed and deliberate attempt to highlight amongst those between
the growing “silent epidemic” that needs prioritized 18 and 40

action by every Indian.

Over the last two decades, non- inferences and insights from data Expanding
communicable diseases (NCDs)
have seen a steady rise as the
based on the people engaged
through the Apollo Hospitals Waistlines
leading cause of death in India. system as well as the medical Beneath the illusion of
Not only the growth in NCDs but ecosystem at large. normal BMI, significant
also their early arrival amongst increase in visceral fat
the Indian population is alarming . We believe this report will help
us recognise problem areas and
NCDs are worth reckoning
because they are personal
identify tangible solutions that
have the potential to improve
Stress on
as well as collective in their disease prevention, enhance the Pressure
impact; NCDs not only affect accuracy of diagnoses that will, in India’s pressure
an individual’s health and turn, lead to a more personalized points tighten as more
productivity but also impact the and patient-centric treatment hover in the pre-
overall economic growth of a approach. hypertension zone
nation.
The majority of the data shared
The Health of the Nation by through the Health of the Nation Sweet Tooth
Apollo Hospitals attempts to
offer insights into the prevalence
is based completely on Apollo
Hospitals’ de-identified hospital
turns Bitter
Prediabetes is
and risk factors of NCDs, putting information systems and EMR,
increasing amongst
the spotlight on diseases and and other studies as part of the
young adults
risk factors that need immediate Apollo Group, as well as publicly
(<45 years)
attention. The report draws available information.

APOLLO HOSPITALS’ HEALTH OF THE NATION REPORT 2024 01

 “Cancer is just a chapter in our lives and not the whole story”… But what’s the story?

WHEN CANCER
COMES TO TOWN
Cancers are one of the most common causes of death worldwide.
The number of cases are projected to go up in India over the years
to come, making it the cancer capital of the world.

IN WOMEN IN MEN

BREAST LUNG MOST

Cancer, CERVIX MOUTH COMMON
CANCERS
OVARY PROSTATE
Looking Up IN ORDER OF
OCCURRENCE

DISTRIBUTION OF CANCER
INCIDENCE IN INDIA 2020
(PER 100,000 POPULATION)
The number of cancer cases
Breast Cancer Lung Cancer
in India are on a sharp rise,
with projections showing an
increase from 13.9 lakh cases
in 2020 to 15.7 lakh cases in
2025. This data represents
a significant 13% growth in
merely five years. Alongside,
>30 >10
the cancer burden, measured
18-30 5-10
in Disability-Adjusted Life 10-18 3-5
Years (DALYs), is projected to <7 <3

grow from 27 million in 2021 to No Data Available No Data Available

almost 30 million by 2025.

Note: If state data is missing, we use district data as a substitute. For multiple districts, average is calculated.
Source: National Cancer Registry Program Report, 2020

Breast Cancer Incidence in Lung Cancer Incidence in

Indian Women Vs Other Countries India Vs Other Countries (Male%, Women%)

UK
Sweden
Japan
0.41%, 2.13%
Japan China
China -2.4%, 0.3%

UK
India -1.26%, 0.96%
USA
-3.35%, -2.35%
Sweden
-1.87%, -0.23%

India
0.18%, 3.68%

Source: Global Cancer Observatory, IARC, WHO

APOLLO HOSPITALS’ HEALTH OF THE NATION REPORT 2024 02

 THE MEDIAN AGE FOR CANCER DIAGNOSIS

BREAST CANCER CERVICAL CANCER LUNG CANCER

63 50 70
Coming
Home Early 50 60 68
63 50 75

52 54 59
Cancers are also making
their presence felt amongst
the young in the Indian
YEARS YEARS YEARS
population, even more so
when compared to other
countries like USA, Europe,
and China.
Source: American Cancer Society, Cancer Research UK, China CDC Weekly, Apollo Hospitals

COLON CANCER is increasing amongst younger people (< 50 years) globally and in
India, and is projected to double over the next decade. At Apollo Hospitals, 30% of colon
cancer patients are aged less than 50 years.

POPULATION SCREENING RATES

BREAST CANCER CERVICAL CANCER LUNG CANCER Screaming for

74 - 82% 71 - 74% 14 - 16% Screenings
70% 75% 20 - 52%
21 - 24% 37 - 43% 33% There is a dire need to ramp
up cancer screenings in
the country. Based on data
Not yet
1.9% 0.9%
sourced, the percentage
of screenings in India are
tracked
very low compared to other
countries.
Source: NFHS-5, CDC, NIH, NHS

PSA MATTERS
THRESHOLD FOR 8.8
PSA VALUES BY AGE GROUP
(NG/ML)
An analysis of about 90,000 values by Apollo Hospitals Indian Male
5.8
found that the threshold for PSA (Prostate-Specific Caucasian Male
Antigen) in Indian males is different from the current
standards, which is based on Caucasian populations. 3.5 4.5 6.5
The threshold value is lower for younger age groups and,
2.5 3.1
with age, this value increases. This suggests that there is
a need to create new guidelines for what is considered 1.7
normal PSA levels for Indian men, to improve how
doctors make decisions about prostate health. 41-50 51-60 61-70 71-80

Source: Addla et al., 2023 Oesterling et al.,1993

APOLLO HOSPITALS’ HEALTH OF THE NATION REPORT 2024 03

 “Because your mental health is as important as your physical health”

WHEN THE
BLUES SING
Mental health disorders are increasingly making their
way amongst the young in India. The country seems to
1 in 4 be grappling with a range of cognitive disorders and NCDs
at risk of that are caused by anxiety, depression and poor sleep.
disturbed sleep PEOPLE WITH HIGH RISK OF
SLEEP APNOEA BY AGE GROUP

From amongst 5,000 persons who

Men are 2X more at risk for disturbed
were screened for quality of sleep, sleep patterns than women
1 in 4 persons were at a high risk for
obstructive sleep apnoea (OSA). If not
treated and managed proactively, this
can result in - in the short-term - sleep
38%
disturbances, decreased cognitive
function and mood changes; and in
the long-term can put one at a higher 19%
13%
risk for cardiovascular diseases,
3%
hypertension and metabolic syndromes 18-25 25-40 40-55 >55

(like diabetes, high cholesterol, etc). Source: Apollo Preventive Health

PEOPLE WITH DEPRESSION

BY AGE GROUP
1 in 5
depressed in
18-25 age group
21%
15%
9% 7% In another cohort of 5,000 persons
18-25 25-40 40-55 >55 who were screened, 1 in every
Source: Apollo Preventive Health
10 had depression. What is worth
reckoning is that the percentage of
Depression is more than just feeling sad. It’s a medical illness, depression is highest amongst those
which when recognised early is fully treatable. in the age category of 18 and 25.

APOLLO HOSPITALS’ HEALTH OF THE NATION REPORT 2024 04

 Stress levels manifest as anxiety, obesity, fatigue,
insomnia, lack of stamina and low productivity.
Stress worthy From amongst 11,000 persons who were surveyed
to assess their stress levels, almost 80% of young
adults (18-30 years) and seniors (>65 years)
reported significant stress levels. Stress can have
a direct effect on some NCDs like hypertension
and diabetes.

PEOPLE WHO SELF-REPORTED

SIGNIFICANT STRESS

80% 65% 63% 88%

18-30 30-45 45-65 >65

Source: Apollo Preventive Health

AVERAGE INCIDENCE OF NCDS WITH AND WITHOUT CHRONIC STRESS

No Stress Chronic Stress

0.35

1.5X
HYPERTENSION 0.23

0.32

X
DIABETES 0.07
2-3

Chronic stress increases the incidence of hypertension and diabetes

by 1.3 - 2 times, with women being more susceptible

APOLLO HOSPITALS’ HEALTH OF THE NATION REPORT 2024 05

 “Don’t dig your grave with your own knife and fork”

WHEN THE
SCALE GOES UP
Obesity is the most common risk factor for all chronic NCDs,
such as hypertension, high cholesterol, Type 2 diabetes,
cardiovascular diseases, metabolic syndromes and cancers.

Weight of 3 in 4
the Matter obese or
overweight Using the Waist-to-Hip
High Body Mass Index (BMI) ratio to measure “central
is the most common measure obesity” (proxy for visceral
for overall obesity. Based on fat),we observed that 90%
data from Apollo Hospitals, of women and 80% of men
3 in 4 persons who came had a higher ratio than
for preventive health check- recommended.
ups were either obese or
overweight, as per their BMI.
There is also a significant
All obese people (BMI
increase in the overweight and
>30) had high visceral
obese population, amongst
fat levels (or “central
those screened from the years
obesity”), which is
2016 to 2023.
likely to compromise
organ function, thereby
accelerating the path to
BMI TRENDS chronic NCDs.
BETWEEN 2016 - 2023 26%

Above 45 years of age

Below 45 years of age

20%
The Thin-Fat Conundrum:
Even among those with
normal BMI (<25), nearly
half (46%) of them had
10% higher visceral fat levels
8%
than recommended.

2016 2019 2022 2023

Source: Apollo Preventive Health

APOLLO HOSPITALS’ HEALTH OF THE NATION REPORT 2024 06

 “The best way to keep your blood pressure down is to know what makes it go up”

WHEN BLOOD
PRESSURE RISES
In India, hypertension is unarguably on the rise. With a whole host
of lifestyle and environmental factors that have increased stress
levels and triggered obesity, the spotlight is on blood pressure.

2 in 3 moving
PER 100 PEOPLE
SCREENED

13

toward high
HYPERTENSIVE

pressure
Hypertension is often referred to as a
“silent killer” because it often shows no
66
symptoms. The only way to recognise PRE-
the condition is to get your blood HYPERTENSIVE

pressure checked and regularly. High

blood pressure puts a person at an
increased risk for heart disease, heart
failure, and stroke amongst others
diseases. The most common risk factors
for hypertension are smoking, stress,
high salt intake, hormonal health and
age. Year-on-year, the prevalence of 21
NORMAL
hypertension is increasing from 9% in
2016 to 13% in 2023. Source: Apollo Preventive Health

17%

HYPERTENSION TRENDS
BETWEEN 2016 - 2023
14%
Above 45 years of age

Below 45 years of age

8%
With 66% in the pre-hypertensive
stage, there’s a large population
6%
at risk of developing hypertension
2016 2019 2022 2023
and stroke, if not controlled.

Source: Apollo Preventive Health

APOLLO HOSPITALS’ HEALTH OF THE NATION REPORT 2024 07

 “Diabetes doesn’t define me; it’s just a small part of who I am”

WHEN SUGAR
GOES BAD
India is now home to 101 million diabetics with an
equivalent number of pre-diabetics.

1 in 3 have Typical progression from

pre-diabetes to uncontrolled

pre - diabetes
diabetes leading to
complications is about 15
years. And the first five years
Traditionally, > 45 years of age could be asymptomatic.
is considered as a risk factor for
pre-diabetes but data reveals that Classical symptoms
20% of the age group below 45 also like frequent urination,
had pre-diabetes. While there is excessive thirst and
significant and growing awareness hunger, unexplained weight
about diabetes, actively managing changes, frequent infection
in the pre-diabetic stage is the only are observed typically when
real way to ‘reverse’ diabetes as
well as slow the progression to other
the blood sugars levels are
uncontrolled.
1 in 10
complications. Uncontrolled
Diabetes
Above 45 years of age
DIABETES TRENDS
BETWEEN 2016 - 2023 Below 45 years of age

37%
36%

12% 12%

2022 2023
2016 2019

Source: Apollo Preventive Health

ALL SUGAR
Almost 40% of women who have had gestational diabetes
are likely to develop Type 2 diabetes within 5 years. 1 in 4
Therefore, close monitoring of blood glucose is a must.
Diabetes

APOLLO HOSPITALS’ HEALTH OF THE NATION REPORT 2024 08

 PAVING THE
WAY FORWARD

HIGHLIGHTS

Screen in Time
Regular screening is
the need of the hour

Monitoring
Matters
Apollo’s Health of the Nation report highlights the rising Consistent monitoring
prevents, improves
trends posed by non-communicable diseases amongst and manages
India’s growing population and how important it is to conditions

take health seriously in a world that is mechanical,

time-poor and technology-obsessed.
Committed to the cause of health, Apollo Hospitals believes the The Nudge
insights and analysis presented in this document have the potential Effect
of becoming a reference guide on the prevalence and rising growth of Apollo ProHealth
cancers and other NCDs in India, allowing all stakeholders in the health program significantly
ecosystem to engage and take effective action to monitor, control and impacts people by
prevent these diseases. guiding them on their
path to wellness

APOLLO HOSPITALS’ HEALTH OF THE NATION REPORT 2024 09

 A SCREEN IN TIME
SAVES LIFE
Regular and timely health checks, based on each individual’s risk factors, can help
keep NCDs at bay.

Those who monitored their In the context of cancers,

health on a consistent basis regular and early screening
through health checks, more can be life-saving. Almost
than three times in the last five 98% of women diagnosed with
years, noticed a significant breast cancer at an earlier
lowering of their blood glucose stage have a better 5-year
levels, blood pressure and body survival rate compared to
weight. 31% of those diagnosed at an
advanced stage.
The study also reveals that 1 Women > 40 years should do
in 4 people who were initially a mammogram (gold standard
at high risk of developing heart for breast cancer screening)
disease within the next ten every two years; those with
years successfully lowered their risk factors should start early
risk to a low or medium level. and do annually.

Source: Apollo Preventive Health, NCCDPHP

30% OF PEOPLE SURVEYED HAVE NEVER DONE A HEALTH CHECK.

HERE ARE THE TOP 3 REASONS
FULL PROOF
Blood tests give you
only part of your health
picture. Most NCDs like
FOLLOW A
cancer, heart disease,
HEALTHY
ROUTINE AND fatty liver, osteoporosis,
DON’T NEED ONE! WORRIED cognitive dysfunction can
A HEALTH be asymptomatic until the
ISSUE condition is fairly advanced.
MAY SHOW UP
A thorough screening with
imaging and clinically
validated assessment tools
DON’T according to individual
HAVE TIME risks will give you a more
complete health picture.

Source: Apollo Preventive Health Survey

APOLLO HOSPITALS’ HEALTH OF THE NATION REPORT 2024 10

 MONITORING
MATTERS
Monitoring is crucial for living a long and healthy life.
It gives a glimpse into health trends and helps make
informed decisions early. Tracking your parameters in
a single place is important.
70% OF PEOPLE SURVEYED ARE
A series of curated programmes 13% DOING HEALTH CHECKS, HERE’S
to help keep NCDs well within HOW THEY BENEFITTED
control is the need of the hour.
These programmes, crafted Got to know
with cause and outcome in of a new health
mind, have yielded tangible condition
results amongst patients that needed
suffering from these NCDs. intervention
20%
Monitoring regularly ensures 49%
early recognition of any
undiagnosed issues, prevents
Realised that
misdiagnosis, detects 15% they were not
asymptomatic medical managing existing
problems, and encourages to Are in good shape health properly
make better choices. and will continue
Found out that their health
Maintaining a digital record of
there was an routines
all health parameters in a single improvement in
places enables tracking trends existing health Source: Apollo Preventive Health Survey

over time. condition

MANAGING THE SUGAR HIGH

Apollo Sugar’s Long Term Diabetes The Apollo 24/7 Diabetes Structured
Management Program, which uses a Management program, a 12-week support
structured approach and evidence-based and monitoring plan, led to notable
close monitoring with regular physical health improvements: on average, the
touchpoints, successfully reduced the blood glucose marker, glycosylated
blood glucose marker HbA1C levels by haemoglobin (HbA1C) decreased by
0.1 to 4.2 percentage points, with 80%
upto 3.3 percentage points compared to
of the participants losing weight, 73%
those not enrolled in the program.
of participants became more physically
In addition, all patients in the program active, and 75% of those experiencing
achieved improved outcomes in other sleep disturbances were sleeping >6hrs
parameters (cholesterol, triglycerides) per day.
Source: Apollo Sugar Clinics Source: Apollo 24/7

APOLLO HOSPITALS’ HEALTH OF THE NATION REPORT 2024 11

 ACCURATE PREDICTION
WITH APOLLO’S AI RISK
SCORES
Apollo’s AI based cardiac risk score, built
APOLLO’S AI
with data from the Indian population and
ALGORITHM optimised for 21 parameters that impact
BUILT ON CLINICIANS heart health, has accurately predicted
INDIAN DATA TO GUIDE heart problems in a study of over 50,000
BASED USED FOR
ON RISK PREVENTIVE people, followed over 5 years. We are now
CARDIOLOGY using this score to help identify the risk
SCREENING of heart issues early on and guide people
AT SCALE
to diagnose and manage their conditions
proactively.
Source: Apollo Clinical AI Analysis

This risk assessment tool, validated

at different national & international
institutions has been built as an adjunct
tool for the physicians to identify the
forward-looking risk for the individual
making it tangible and action-oriented

APPROPRIATE
ASSOCIATED
SYMPTOM INVESTIGATION
FACTORS
NEEDED
APOLLO 24/7
SYMPTOM CHECKER
Apollo 24/7’s Symptom Checker is REFERRAL TO ACCURATE
available to efficiently guide users SPECIALISTS DIAGNOSIS
experiencing symptoms to finding
solutions, offering a precise pathway
compared to generic internet searches.
HOW DOES THIS WORK IN
30% of the 1 lakh searches using Apollo’s THE EVERYDAY?
Symptom Checker happened between A web search for backache gives
9pm to 6am. an exhaustive list of over 18 causes
starting from spinal fractures to
Waiting for symptoms to manifest can depression. On the other hand,
delay the diagnosis and treatment efficacy. through a series of chatbot interactions,
Apollo’s AI-powered Symptom Checker
can narrow this to 3 - 4 potential
diagnoses, with relevant follow up
suggestions for action.

Source: Apollo Clinical AI Analysis

APOLLO HOSPITALS’ HEALTH OF THE NATION REPORT 2024 12

 THE NUDGE
EFFECT
In the world we live in, a little nudge from health experts,
coaches, and relevant information can go a long way in
improving the health of the nation. Apollo Hospitals’
ProHealth program enables just this with nudges at
regular intervals, urging people to take stock of their
health and prevent the onset of cancer and other NCDs.

The risk-stratified care continuum program as part of

ProHealth, where health coaches call and nudge
you to adopt healthy habits, has led to significant
health improvements.

57%
DECREASED
THEIR BMI
70%
PRESSURE
DROPS
CONSISTENTLY
BY GOOD
60%
REDUCED
MARGINS THEIR SUGAR
Amongst those LEVELS
with high blood For those diagnosed
Amongst those found pressure initially, on with diabetes initially,
overweight or obese an average, systolic 60% lowered their
initially, average and diastolic blood HbA1C by an average
weight loss of 4.8 kg pressures dropped of 1.45 percentage
and a BMI decrease by 24 mmHg and 15 points over 12-18
of 1.8 kg/m2 was mmHg, respectively. months.
observed.
Source: Apollo Preventive Health

APOLLO HOSPITALS’ HEALTH OF THE NATION REPORT 2024 13

ACKNOWLEDGEMENTS
Dr. Anupam Sibal Dr. Sathya Sriram Chaitanya Bharadwaj
Dr. Anusha C P Dr. Shreevidya Elancheziyan Solaimuthu
Dr. Dinesh Madhavan Dr. Srividya Gowtham Krishna
Dr. Ima Rashid Dr. Suchitra Mrinal Panda Murali Thangarajan
Dr. Karthik Madesh Ratnavelu Dr. Sujoy Kar Purnima Joshi
Dr. Khader Hussain Dr. Sunil Singh Choudhary Shankar Krishna A
Dr. Manjula Rao Dr. Tania Talwar Tasneem
Dr. Madhu Sasidhar Dr. Tarun Sahni Vaibhav Bhosale
Dr. Mehta Y Dr. Udhaya Balasubramaniam Vaishnavi Ramakrishnan
Dr. Mukta Mahajan Dr. Usha Ayyagari Varun Dubey
Dr. Narasimhan Ragavan Dr. Vaishali Lokhande Vijaya Rajagopalan
Dr. Prabash P R Dr. Vijay Agarwal
Dr. Rama Narasimhan Dr. Venkatesh Munikrishnan
Dr. Rahul Gupta Aazathraj P
Dr. Raj Palaniappan Amrit Ravi
Dr. Rani Bhat Anindita Ghatak
Dr. Roheet Rao Ashokkan Somuveerappan
Dr. Sanjai K Addla Bharath Potla

SOURCES
1.3 million health checks done at Apollo Hospitals or Clinics (de-identified)

56,000 followed up over 5 years on AICVD risk by Apollo Clinical AI Team

Addla et al., Determining age-specific prostate-specific antigen for healthy Indian men:A retrospective
study, 2023

750+ customer survey on preventive health checks

National Family Health Survey (NFHS-5), 2019-21

National Cancer Registry Program Report, 2020

Global Cancer Observatory, International Agency for Research on Cancer, World Health Organization

National Institute of Health, U.S Department of Health

U.S Centers for Disease Control and Prevention

National Centre for Chronic Disease Prevention and Health Promotion

Power of Prevention, Health and Economic Benefits of Breast Cancer Interventions, National Center for
Chronic Disease Prevention and Health Promotion (NCCDPHP)
“In today’s fast-paced life, staying
healthy is a challenge, and health
has a new enemy called NCDs or
non-communicable diseases.

Scientists estimate the value of

one human body to be 6 trillion
dollars. That is how priceless
human life is. Hence, our focus is
on preventing the occurrence of
NCDs, a smarter, holistic approach
compared to just curing them.

Let’s together declare war on

NCDs and ensure the health and
happiness of our people, our
communities and our country.”

DR. PRATHAP C REDDY

Founder & Chairman, Apollo Hospital

#BeProHealth

Your ProHealth score is the first step to under-

stand your current health status and enables you
to make informed lifestyle shifts
www.askapollo.com/apollo-prohealth

An initiative by

© Copyright 2024. Apollo Hospitals Group. All Rights Reserved.