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Image of a doctor speaking to a patient in a bed in hospital.

As the only study of its kind in India, the Indian Study of Healthy Ageing (ISHA-Barshi) aims to shed light on the burden, causes, and consequences of chronic diseases among the rural population of Barshi in Maharashtra, India. A profile explaining the characteristics of the study participants is published in the International Journal of Epidemiology.

Since its inception in 2015, the study has recruited approximately 220,000 men and women aged 30 ‒ 69. Upon completion, ISHA-Barshi will be the largest blood-based prospective study in South Asia.

As well as completing questionnaires on lifestyle, medical history, and mood, study participants have physical measurements such as height, weight, and blood pressure recorded and blood samples taken. Researchers will be able to look for biological indicators that may help them understand why some people develop certain diseases, such as heart disease or stroke, since participants provided informed consent which includes permission to access their health records over time to see whether or not they have developed diseases.   

The participants were recruited from 362 villages and three small towns. 50% of the participants are women and the participants had an average age of 47 years when they were recruited into the study.

The preliminary findings, based on data collected from the first 39,000 participants, have revealed several key insights: 

  • Among men, 41% of participants reported that they had completed more than six years of education, compared with 14% of women;
  • More than two-thirds (67%) of men reported that they had ever chewed tobacco, and 8% reported that they had ever smoked tobacco. Conversely, 14% of women reported having ever chewed tobacco and less than 1% that they had ever smoked tobacco;
  • Few women reported ever drinking alcohol (less than 1%) compared with 25% of men;
  • 1 in 10 men and women were underweight, while one-fifth of women and men were overweight with 6% of women and 3% of men were obese. These levels of adiposity are much lower than those typical of more widely studied Western populations;
  • 6% of participants reported a prior diagnosis of high blood pressure (hypertension) but 26% of participants were found to have undiagnosed hypertension when their blood pressure was measured as part of the study. There were few cases of diabetes (3%), cardiovascular disease (1%), and cancer (<1%), but the prevalence of these diseases was higher in older participants;
  • There was a high frequency of depressive symptoms, with 58% of participants reporting at least one symptom.

Fiona Bragg, Clinical Research Fellow and joint first author of the study, said, ‘ISHA aims to understand the impact of both environmental and genetic risk factors on common chronic diseases. India’s rapid development has been accompanied by major transitions in lifestyle behaviours. These are continuing, particularly in rural India, and by focusing on a predominantly rural population, the study will provide an understanding of the relevance of these transitions for chronic diseases.’

Sharayu Mhatre, Study Coordinator and joint first author of the report, said, ‘Our finding that almost two thirds of participants reported experiencing symptoms of depression underscores the urgent need for further mental health research in this region. This will help us to understand the relevance of these striking findings and the best approaches for assessment of depression in this population.’

Professor Rajesh Dikshit, the study’s principal investigator from the Centre for Cancer Epidemiology, based at the Tata Memorial Centre in Mumbai, said, ‘Since February this year, the number of participants for whom we have collected detailed data has grown to 50,000. This is expected to be completed for all 220,000 participants by the end of 2026. Further expansion of the study to sites in diverse areas of India, including Varanasi, Guwahati, Sangrur, and Mullanpur, will further strengthen the study and its findings.’

Sarah Lewington, Professor of Epidemiology and Medical Statistics and joint senior author of the study, said ‘One of the key challenges of biobank-type studies is ensuring that the study population is sufficiently diverse to be able to provide robust answers to some of the world’s most pressing health challenges that can benefit us all. ISHA presents a unique opportunity to understand the risk factors for disease in a rural South Asian population meaning that we can develop more personalised and more effective prevention and intervention strategies to help more people stay healthy for longer.’

The ISHA study not only provides critical data on chronic diseases but will provide vital understanding to facilitate development of comprehensive healthcare strategies, particularly in rural areas. The expansion to additional sites will enhance the robustness of the study, providing valuable insights that can inform public health policies and interventions both in India and globally.

Specific proposals for future collaboration are welcome and can be submitted to the study’s International Steering Committee by email once data collection is complete from the full study population.