In 2016, three of the five leading individual causes of disease burden in India were non-communicable, with ischaemic heart disease and chronic obstructive pulmonary disease as the top two causes and stroke as the fifth leading cause. This figure has dropped to 33% in 2016.
Road injuries and self-harm, which includes suicides and non-fatal outcomes of self-harm, are the leading contributors to the injury burden in India. However, the magnitude and causes of disease burden and the risk factors vary greatly between the states. However, these data show that what we have being doing up to now is not enough.
While the disease burden due to child and maternal malnutrition has dropped in India substantially since 1990, this is still the single largest risk factor responsible for 15% of the total disease burden in India in 2016. Such evidence-based health planning in each state would result in overall health improvements in India and reduce the health inequalities between the 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. However, among states, there are inequalities of up to 10 years.
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, progress is mixed. "I wish continuing success for further work of the India State-level Disease Burden Initiative in providing the best possible annual disease burden estimates for every state and union territory that could be utilized in many ways for improving the health of Indians in every nook and corner of the country".
While the burden of most infectious and associated diseases reduced in India from 1990 to 2016, five of the ten individual leading causes of disease burden in India in 2016 still owed to diarrhoeal diseases, lower respiratory infections, iron-deficiency anaemia, preterm birth complications, and tuberculosis.
Urbanization and aging have led to increasing poor health conditions related to non-communicable diseases in all states. The fastest-growing causes of disease burden over the last 26 years were diabetes (rate increased by 80%) and ischemic heart disease (up 34%).
On the other hand, the burden due to outdoor air pollution is highest in a mix of northern states, including Haryana, Uttar Pradesh, Punjab, Rajasthan, Bihar and West Bengal. These differences are due to variations in exposures to risk factors as well as other determinants. Road injures were highest in Jammu and Kashmir, with rates of premature death and illness almost three times higher than that of Meghalaya.
"Larger and more organized efforts, supported by greater financial and human resources, are needed to control the growing burden of NCDs and injuries", said Dr. Dandona. Per person disease burden is 12 times more than in China and the lowest burden is that of Kerala, but even that is 2.7 times higher than China. Together, they accounted for nearly a quarter of poor health in 2016 - over twice that from 1990. The under-5 mortality rate has reduced substantially in all states, but it is four times higher in Assam and Uttar Pradesh compared to Kerala.
This report by the India State-level Disease Burden Initiative provides these comprehensive estimates for each state from 1990 to 2016 for the first time in India, and offers insights into the health inequalities between the states of India.
"The contribution of air pollution to disease burden remained high in India between 1990 and 2016, with levels of exposure among the highest in the world", it says.
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.
With a population of 1.3 billion, nearly one-fifth of the world's population lives in India.
More data are available through IHME's data visualization at: https://vizhub.healthdata.org/gbd-compare/india. The Indian Council of Medical Research, the Public Health Foundation of India and the Institute for Health Metrics and Evaluation prepared the report in collaboration with the Ministry of Health.This is a first state-wise report on disease burden and risk factors trends from 1990 to 2016.