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India State-level Disease Burden Initiative's report finds large differences between states in changing disease profile

Ramesh Shankar, Mumbai
Wednesday, November 15, 2017, 08:00 Hrs  [IST]

The first ever comprehensive estimates & trends of disease burden & risk factor for every state of India, prepared by the India State-level Disease Burden Initiative, in its first ever such report has found that there are large differences between states in the changing disease profile in the country.

Of the total disease burden in India measured as disability-adjusted life years (DALYs)  DALYs, 61% was due to communicable, maternal, neonatal, and nutritional diseases (termed infectious and associated diseases in this summary for simplicity) in 1990, which dropped to 33% in 2016. There was a corresponding increase in the contribution of non-communicable diseases from 30% of the total disease burden in 1990 to 55% in 2016, and of injuries from 9% to 12%.

 Infectious and associated diseases made up the majority of disease burden in most of the states in 1990, but this was less than half in all states in 2016. However, the year when infectious and associated diseases transitioned to less than half of the total disease burden ranged from 1986 to 2010 for the various state groups in different stages of this transition. The wide variations between the states in this epidemiological transition are reflected in the range of the contribution of major disease groups to the total disease burden in 2016: 48% to 75% for non-communicable diseases, 14% to 43% for infectious and associated diseases, and 9% to 14% for injuries. Kerala, Goa, and Tamil Nadu have the largest dominance of non-communicable diseases and injuries over infectious and associated diseases, whereas this dominance is present but relatively the lowest in Bihar, Jharkhand, Uttar Pradesh, and Rajasthan.

The report says that there is rising burden of non-communicable diseases in all states.
The contribution of most of the major non-communicable disease groups to the total disease burden has increased all over India since 1990, including cardiovascular diseases, diabetes, chronic respiratory diseases, mental health and neurological disorders, cancers, musculoskeletal disorders, and chronic kidney disease.

Among the leading non-communicable diseases, the largest disease burden or DALY rate increase from 1990 to 2016 was observed for diabetes, at 80%, and ischaemic heart disease, at 34%.

The report further finds that even though the health status is improving in the country, there are major inequalities between different states. Life expectancy at birth improved in India from 59.7 years in 1990 to 70.3 years in 2016 for females, and from 58.3 years to 66.9 years for males. There were, however, continuing inequalities between states, with a range of 66.8 years in Uttar Pradesh to 78.7 years in Kerala for females, and from 63.6 years in Assam to 73.8 years in Kerala for males in 2016. The per person disease burden measured as DALYs rate dropped by 36% from 1990 to 2016 in India, after adjusting for the changes in the population age structure during this period. But there was an almost two-fold difference in this disease burden rate between the states in 2016, with Assam, Uttar Pradesh, and Chhattisgarh having the highest rates, and Kerala and Goa the lowest rates. While the disease burden rate in India has improved since 1990, it was 72% higher per person than in Sri Lanka or China in 2016. The under-5 mortality rate has reduced substantially from 1990 in all states, but there was a four-fold difference in this rate between the highest in Assam and Uttar Pradesh as
compared with the lowest in Kerala in 2016, highlighting the vast health inequalities between the states.  

The India State-level Disease Burden Initiative is a collaboration between the Indian Council of Medical Research, Public Health Foundation of India, and Institute for Health Metrics and Evaluation at the University of Washington, and experts and stakeholders currently from close to 100 institutions across India.  

The goal of this Initiative, which was launched in October 2015, was to produce the best possible state-level disease burden and risk factors trends from 1990 onward as part of the Global Burden of Disease study, utilising all identifiable epidemiological data from India and in close engagement with the leading health scientists of India.

The disease burden and risk factor estimates for every state of India from 1990 to 2016 in this report are the most comprehensive description of disease epidemiology attempted so far in a single standardised framework for every part of the country. These included all available data and inputs from a large network of highly skilled collaborators.

This knowledge base can be a crucial aid for more informed policy and interventions to improve population health in every state and union territory of India and in reducing health inequalities between the states. These findings and the ongoing work of the India State-level Disease Burden Initiative could provide important inputs for the data-driven and decentralised health planning and monitoring recommended by the National Health Policy 2017 and the NITI Aayog Action Agenda 2017–2020.


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