The per person disease burden in India dropped by 36 per cent from 1990 to 2016, with Assam, Uttar Pradesh and Chhattisgarh recording the highest rates and Kerala and Goa the lowest, a report released on Tuesday said.
The ‘India State-level Disease Burden Initiative’ report said that of the total disease burden in India, 61 per cent was due to communicable, maternal, neonatal and nutritional diseases in 1990, which dropped to 33 per cent in 2016.
It said there was a corresponding increase in the contribution of non-communicable diseases from 30 per cent of the total disease burden in 1990 to 55 per cent in 2016, and of injuries from 9 per cent to 12 per cent.
According to the report, there were wide variations between the states.
The report said that 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.
It said that the under-five 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 and the lowest in Kerala in 2016.
The report is the result of a joint initiative between the Indian Council of Medical Research, Public Health Foundation of India, and Institute for Health Metrics and Evaluation in collaboration with the Ministry of Health and Family Welfare, along with experts and stakeholders associated with over 100 Indian institutions.
The report records a comprehensive set of state-level disease burden, risk factor estimates, and trends for each state.
“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.”
It said that the burden of most infectious and associated diseases reduced in India from 1990 to 2016, but five of the 10 individual leading causes of disease burden in India in 2016 still belonged to this group — like diarrhoeal diseases, lower respiratory infections, iron-deficiency anaemia, neonatal preterm births, and tuberculosis.
“The range of disease burden among the states of India was nine-fold for diarrhoeal diseases, seven-fold for lower respiratory infections, and nine-fold for tuberculosis in 2016, highlighting the need for efforts based on the specific trends in each state,” the report said.
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.
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.
The range of disease burden, or DALY rate, among the states in 2016 was nine-fold for ischaemic heart disease, four-fold for chronic obstructive pulmonary disease, and six-fold for stroke, and four-fold for diabetes, the report said.
The report also said that the contribution of injuries to the total disease burden has increased in most states since 1990.
“The highest proportion of disease burden due to injuries is in young adults. Road injuries and suicides are the leading contributors to the injury burden in India. The range of disease burden, or DALY rate, varied three-fold for road injuries and six-fold for suicide among the states of India in 2016.”
A group of risks, including unhealthy diet, high blood pressure, high blood sugar, high cholesterol, and overweight, which mainly contribute to ischaemic heart disease, stroke and diabetes, contributed about 25 per cent of the total disease burden in India in 2016, up from about 10 per cent in 1990.
“There were large variations between states in the degree to which these risks are rising,” the report said.
It said the disease burden due to child and maternal malnutrition has dropped in India substantially since 1990, though it still is the single largest risk factor responsible for 15 per cent of the total disease burden in India in 2016.
The report said the disease burden due to child and maternal malnutrition in India was 12 times higher per person than in China in 2016.
“Kerala had the lowest burden due to this risk among the Indian states, but even this was 2.7 times higher per person than in China.”
The disease burden due to unsafe water and sanitation has also reduced significantly in India, but this burden is still 40 times higher per person in India than in China.
The contribution of air pollution to disease burden has remained high in India between 1990 and 2016, with levels of exposure among the highest in the world.
“The burden of household air pollution has decreased during this period due to decreasing use of solid fuels for cooking, and that of outdoor air pollution has increased due to a variety of pollutants from power production, industry, vehicles, construction, and waste burning.”
The report said that 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 63.6 years in Assam to 73.8 years for males in Kerala in 2016.