Comprehensive health study in India finds rise of non-communicable diseases

November 14, 2017

A new state-by-state health analysis in India finds that over two decades heart- and lung-related conditions, as well as other non-communicable diseases (NCDs), have surpassed infectious diseases, such as diarrhea and tuberculosis, as the nation's leading killers. The extent of this difference, however, varies significantly among the nation's 29 states and seven union territories.

The study, which covers 1990 through 2016, also concludes that while child and maternal malnutrition has dropped substantially, this remains the most pernicious risk factor causing loss of healthy life. Moreover, road injuries and suicides are leading contributors to death among young people, with a nearly four-fold difference in suicide rates among different Indian states.

"India has come a long way, but our individual state estimates reveal major health inequalities between the 'nations' within this nation," said Dr. Lalit Dandona, Distinguished Professor at the Public Health Foundation of India in New Delhi and a Professor of Global Health at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington. "Over the past two decades the Government of India has launched many initiatives and programs to address a variety of diseases and risk factors. However, these data show that what we have being doing up to now is not enough. With the availability of state-specific findings now identifying the diseases and risk factors that need most attention in each state, we can act more effectively to improve health in every state of the country. This has the potential of reducing the major health inequalities observed currently between the states, and this would also help achieve better health outcomes for India as a whole."

The study, published today in the international medical journal The Lancet, notes that life expectancy at birth improved from about 60 years of age in 1990 to just over 70 years in 2016 for females, and from about 58 years to nearly 67 years for males. However, among states, there are inequalities of up to 10 years.

The overall loss of healthy life from all diseases and conditions together was about one-third less per person in India in 2016 as compared to 1990. However, progress is mixed. The disease burden rate at present is significantly higher in states in a less advanced phase of development, such as Assam, Uttar Pradesh, and other poorer northern states, as compared with those in the nation's most advanced phases of development, such as Kerala and Goa.

In addition, water quality and sanitation conditions have improved over the past 26 years, but they remain major factors in disease transmission and, by comparison, their contribution to disease burden is 40 times more per person in India than in China.

Air pollution also has emerged as a growing health risk in India, which has some of the most polluted air in the world. While indoor air pollution has decreased since 1990, outdoor pollution has increased from power production, industry, vehicles, construction, and waste burning.

The top conditions in India causing health loss are (in order of severity): ischemic heart disease, chronic obstructive pulmonary disease (COPD), diarrhea, lower respiratory infections, stroke, iron-deficiency anemia, preterm birth complications, tuberculosis, sensory organ diseases such as eyesight and hearing impairments, road injuries, suicide, low back and neck pain, and diabetes.

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%). More than 60% of deaths, about 6.1 million, in 2016 were due to NCDs, up from about 38% in 1990.

Even states with similar levels of development showed striking differences in rates of death and illness from some leading NCDs. For instance, Punjab has much higher rates of premature death and ill health due to diabetes and , but lower rates due to COPD compared to neighboring Himachal Pradesh, despite the two states both being at an advanced level.

Similarly, Uttar Pradesh has much higher rates due to COPD and tuberculosis, but lower rates from stroke compared to Madhya Pradesh, despite both states being at a similarly early stage of epidemiological transition. These differences are due to variations in exposures to risk factors as well as other determinants.

Urbanization is responsible for rising deaths and health loss from road injuries in most states since 1990, highlighting the lack of a comprehensive national policy for injury prevention. Road injures were highest in Jammu and Kashmir, with rates of premature death and illness nearly three times higher than that of Meghalaya. The burden of suicide was highest in Tripura, with rates almost six times higher than in Nagaland.

"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.

Other highly preventable risks, such as diets high in salt and low in vegetables and fruit, high blood pressure, high cholesterol, and high body mass index, are contributing to the growing burden of non-communicable diseases. Together, they accounted for almost a quarter of poor health in 2016 - over twice that from 1990.

Other findings of the paper include:

  • The rate of under-age-5 mortality has dropped substantially since 1990 in all states; however, there was a more than four-fold difference between the top and bottom performing states.
  • Of the total disease burden in 1990, 61% was due to communicable, maternal, neonatal, and nutritional diseases; this dropped to 33% in 2016.
  • There was a corresponding increase in non-communicable diseases to 55% in 2016, as compared to 31% in 1990.
  • Injuries increased from 9% of total burden in 1990 to 12% in 2016.
  • Major increased throughout India, including cardiovascular diseases, diabetes, mental health and neurological disorders, cancers, musculoskeletal disorders, and chronic kidney .

"The study and our related policy report have significant policy implications for Indian officials, said Dr. Christopher Murray, IHME's Director. "This research is the culmination of many years of work and it represents a starting point from which, we hope, new initiatives will be developed to improve the lives and livelihoods of many of India's 1.3 billion people."

Explore further: What is the scope of neurological diseases in the world today?

More information: "Nations within a nation: variations in epidemiological transition across the states of India, 1990-2016 in the Global Burden of Disease Study," The Lancet (2017).

Related Stories

What is the scope of neurological diseases in the world today?

October 16, 2017
Globally, the burden of neurological disorders (Alzheimer's disease, Parkinson's disease, stroke, epilepsy etc) has increased substantially over the past 25 years. This problem is the topic of a recent report by the Global ...

New global study finds countries saving more lives, despite a 'triad of troubles'

September 14, 2017
Countries have saved more lives over the past decade, especially among children under age 5, but persistent health problems, such as obesity, conflict, and mental illness, comprise a "triad of troubles," and prevent people ...

Life expectancy increases globally as death toll falls from major diseases

December 17, 2014
People are living much longer worldwide than they were two decades ago, as death rates from infectious diseases and cardiovascular disease have fallen, according to a new, first-ever journal publication of country-specific ...

Death rates from rheumatic heart disease falling since 1990

August 23, 2017
The risk of dying from rheumatic heart disease, a condition of damaged heart valves caused by bacterial infection that leads to rheumatic fever, has dropped around the world over the last 25 years, according to a new scientific ...

Large increase in rate of death from chronic respiratory diseases

September 26, 2017
Between 1980 and 2014, the rate of death from chronic respiratory diseases, such as COPD, increased by nearly 30 percent overall in the U.S., although this trend varied by county, sex, and chronic respiratory disease type, ...

Life expectancy climbs globally but more time spent living with illness and disability

August 26, 2015
People around the world are living longer, even in some of the poorest countries, but a complex mix of fatal and nonfatal ailments causes a tremendous amount of health loss, according to a new analysis of all major diseases ...

Recommended for you

Hormone therapy in the menopause transition did not increase stroke risk

November 24, 2017
Postmenopausal hormone therapy is not associated with increased risk of stroke, provided that it is started early, according to a report from Karolinska Institutet published in the journal PLOS Medicine.

When traveling on public transport, you may want to cover your ears

November 22, 2017
The noise levels commuters are exposed to while using public transport or while biking, could induce hearing loss if experienced repeatedly and over long periods of time, according to a study published in the open access ...

Different types of alcohol elicit different emotional responses

November 22, 2017
Different types of alcohol elicit different emotional responses, but spirits are most frequently associated with feelings of aggression, suggests research published in the online journal BMJ Open.

Air pollution linked to poorer quality sperm

November 22, 2017
Air pollution, particularly levels of fine particulate matter (PM2.5), is associated with poorer quality sperm, suggests research published online in Occupational & Environmental Medicine.

Sunrise and sunset guide daily activities of city-dwellers

November 21, 2017
Despite artificial lightning and social conventions, the dynamics of daylight still influence the daily activities of people living in modern, urban environments, according to new research published in PLOS Computational ...

Older men need more protein to maintain muscles

November 21, 2017
The amount of protein recommended by international guidelines is not sufficient to maintain muscle size and strength in older men, according to a new study.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.