India: Health of the Nation’s States The India State-Level Disease Burden Initiative INDIAN COUNCIL OF MEDICAL RESEARCH PUBLIC HEALTH FOUNDATION OF INDIA INSTITUTE FOR HEALTH METRICS AND EVALUATION
This report was prepared by the Indian Council of Medical Research (ICMR), Public Health Foundation of India (PHFI), and the Institute for Health Metrics and Evaluation (IHME) through funding from the Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India, and the Bill & Melinda Gates Foundation.
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CITATION: Indian Council of Medical Research, Public Health Foundation of India, and Institute for Health Metrics and Evaluation. India: Health of the Nation's States — The India State-Level Disease Burden Initiative. New Delhi, India: ICMR, PHFI, and IHME; 2017.
Indian Council of Medical Research V. Ramalingaswami Bhawan Ansari Nagar New Delhi 110029 India Telephone: +91 11 2658 8895 Email: dg@icmr.org.in www.icmr.nic.in
Public Health Foundation of India Plot 47, Sector 44 Gurugram 120002 National Capital Region India Telephone: +91 124 478 1400 Email: dbi@phfi.org www.phfi.org
Institute for Health Metrics and Evaluation 2301 Fifth Ave, Suite 600 Seattle 98121 Washington USA Telephone: +1 206 897 2800 Email: engage@healthdata.org www.healthdata.org
Cover photo: Alexandra Lande, Shutterstock photo stream, Varkala, India, December 2012
Published on 14 November 2017, updated 20 December 2017 ISBN 978-0-9976462-1-4 Š 2017 Indian Council of Medical Research, Public Health Foundation of India, and Institute for Health Metrics and Evaluation
India: Health of the Nation’s States The India State-Level Disease Burden Initiative INDIAN COUNCIL OF MEDICAL RESEARCH PUBLIC HEALTH FOUNDATION OF INDIA INSTITUTE FOR HEALTH METRICS AND EVALUATION
Disease Burden Trends in the States of India 1990 to 2016
Contents Acknowledgements Message by Hon’ble Vice-President of India Message by Hon’ble Minister of Health and Family Welfare, Government of India Message by Hon’ble Vice Chairman of NITI Aayog, Government of India Preface Acronyms Glossary of terms Executive Summary About the India State-Level Disease Burden Initiative About the Global Burden of Disease Study Introduction Key concepts used in this report Methods used for the analysis Findings Life expectancy India’s epidemiological transition Deaths and their causes Years of life lost due to premature death Years lived with disability Total health loss and its causes Rate of occurrence of diseases Risk factors causing disease burden Disease burden and risk factors profile of each state Andhra Pradesh Arunachal Pradesh Assam Bihar Chhattisgarh Delhi Goa Gujarat Haryana Himachal Pradesh Jammu and Kashmir Jharkhand Karnataka Kerala Madhya Pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland Odisha Punjab Rajasthan
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Sikkim Tamil Nadu Telangana Tripura Uttar Pradesh Uttarakhand West Bengal Policy implications of the findings Addressing the major risk factors Child and maternal malnutrition Unsafe water and sanitation Air pollution Risk factors for cardiovascular disease and diabetes Addressing persistent and increasing disease conditions Under-5 disease burden Tuberculosis Other communicable diseases Other non-communicable diseases Injuries Inter-sectoral collaborations Universal coverage and health assurance Increasing health financing Improving human resources for health Strengthening the health information system Better cause of death data Improved surveillance Other Conclusion India State-Level Disease Burden Initiative Advisory Board Members India State-Level Disease Burden Initiative Contributors
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Figures and Tables Figure 1: Life expectancy by sex in India, 1990 and 2016 Figure 2: Contribution of major disease groups to total DALYs in India, 1990 and 2016 Figure 3: Epidemiological transition ratios of the states of India, 1990 and 2016 Figure 4: Contribution of major disease groups to total deaths in India, 1990 and 2016 Figure 5: Death rates of the leading individual causes in the states of India, 2016 Figure 6: Leading individual causes of years of life lost by sex in the state groups, 2016 Figure 7: Leading individual causes of disability by sex in the state groups, 2016 Figure 8: Percent change in all-ages and age-standardised DALY rate in the state groups, 1990 and 2016 Figure 9: Relative age-standardised DALY rate across the states of India, 2016 Figure 10: Change in DALYs number and rate for the leading individual causes in India from 1990 to 2016 Figure 11: Comparison of the leading individual causes of DALYs across the state groups, 2016 Figure 12: Change in DALYs number for the leading individual causes by sex in India from 1990 to 2016 Figure 13: Percent of DALYs by age in the state groups, 2016 Figure 14: DALY rates of the leading individual causes in the states of India, 2016 Figure 15: DALY rates due to diarrhoeal diseases and lower respiratory infections in the states of India, 2016 Figure 16: DALY rates due to ischaemic heart disease and chronic obstructive pulmonary disease in the states of India, 2016 Figure 17: DALY rate due to road injuries in the states of India, 2016 Figure 18: Ratio of observed to expected DALY rate for the leading individual causes in the states of India, 2016 Figure 19: Percent DALYs attributable to risk factors in India, 2016 Figure 20: Change in DALYs number and rate attributable to risk factors in India from 1990 to 2016 Figure 21: Percent DALYs attributable to risk factors in the state groups, 2016 Figure 22: Percent DALYs attributable to leading risk factors by sex in the state groups, 2016 Figure 23: DALY rate attributable to risk factors in the states of India, 2016 Figure 24: DALY rate attributable to child and maternal malnutrition and attributable to unsafe water, sanitation, and handwashing in the states of India, 2016 Figure 25: DALY rate attributable to ambient air pollution and attributable to household air pollution in the states of India, 2016 Figure 26: DALY rate attributable to high blood pressure and attributable to high blood sugar in the states of India, 2016
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Table 1: Grouping of states of India in this report Table 2: Year of crossover to majority NCDs and injuries burden by the state groups Table 3: Distribution of deaths from major disease groups by age in the state groups, 2016 Table 4: Contribution of disease categories to deaths in the state groups, 2016 Table 5: Contribution of disease categories to DALYs in the state groups, 1990 and 2016 Table 6: Comparison of the percent change in prevalence of leading NCDs and incidence rate of leading injuries with the percent change in their DALY rate in India from 1990 to 2016 Table 7: Change in summary exposure value of the leading individual risk factors in the state groups from 1990 to 2016
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28 30 34 37 40 42 44 45 48 50 51 53 55 56 57 58 59 64 65 66 67 71 72 73 74
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About ICMR The Indian Council of Medical Research (ICMR) is the apex government body in India for the formulation, coordination, and promotion of biomedical and health research. It is one of the oldest medical research bodies in the world. Besides the headquarters in New Delhi, ICMR has 32 research institutes, centres, and units across India. ICMR funds both intramural and extramural research in India. The priorities of ICMR coincide with the national health priorities and have the goal of reducing the total burden of disease and promoting the health and well-being of India’s population. As part of this agenda, ICMR is interested in improving the estimates of disease burden and risk factors in India, especially at the subnational levels, for better health planning, policy framing, and fund allocation. www.icmr.nic.in
About PHFI The Public Health Foundation of India (PHFI) is a premier public health institution in India with presence across the country. It collaborates with multiple constituencies including Indian and international academia, state and central governments, multi- and bi-lateral agencies, and civil society groups. The vision of PHFI is to strengthen India’s public health institutional and systems capability and provide knowledge to achieve better health outcomes for all through strengthening training, research and policy development in public health. As part of this vision, PHFI has major interest in improving the robustness of subnational disease burden estimates to inform health action and in evaluating the impact of large-scale population health interventions. www.phfi.org
About IHME The Institute for Health Metrics and Evaluation (IHME) is a global health research institute at the University of Washington in Seattle that provides independent, rigourous, and comparable measurement of the world’s most important health problems and evaluates the strategies used to address them. IHME aims to identify the best strategies to build a healthier world by measuring health, tracking program performance, finding ways to maximise health system impact, and developing innovative measurement systems to provide a foundation for informed decision-making that will ultimately allocate resources to best improve population health. www.healthdata.org
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Acknowledgements The India State-Level Disease Burden Initiative is grateful to the Ministry of Health and Family Welfare of the Government of India for its support and encouragement of this Initiative. The guidance of the Advisory Board, chaired by J.V.R. Prasada Rao, was invaluable in advancing the work of this Initiative. The analysis and interpretation of the findings benefitted immensely from the contributions of the following 14 expert groups and over 200 collaborators of the India State-Level Disease Burden Initiative: Cancer (Chair A. Nandakumar), Cardiovascular Diseases (Chair D. Prabhakaran), Chronic Kidney Disease (Chair S.K. Agarwal), Chronic Respiratory Diseases (Chair Sundeep Salvi), Diabetes (Chair Nikhil Tandon), Dietary Risks (Chair B. Sesikeran), Environmental Risk Factors (Chair Kalpana Balakrishnan), Injuries (Chair Rakhi Dandona), Maternal and Child Health (Chair Vinod Paul), Mental and Neurological Health (Chair Vikram Patel), Musculoskeletal Disorders (Chair Arvind Chopra), Tobacco Disease Burden (Chair Prakash C. Gupta), Tuberculosis (Chair Soumya Swaminathan), and Vector Borne and Neglected Tropical Diseases (Chair A.P. Dash). This report was prepared by teams at the Indian Council of Medical Research led by Soumya Swaminathan, the Public Health Foundation of India led by Lalit Dandona, and the Institute for Health Metrics and Evaluation led by Christopher Murray. The Disease Burden India Secretariat provided crucial support for the work of this Initiative. Funding by the Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India, and the Bill & Melinda Gates Foundation for the work leading to this report is gratefully acknowledged.
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Message by Hon’ble Vice-President of India
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Message by Hon’ble Minister of Health and Family Welfare, Government of India Occus autecto omniminis et quis adit lacepe cus millene volupta dent mi, quam, imagnihil et porrum, sus, te sapici tet, tem quostis mi, officita as essenis que volest, sitibusda ducienti nus volor assuntem. Natiam essimus, quo te velest hic tenduci psapid eiunt endit prerchil exero comnias secto di voluptatium eos consequia voluptat et quam latum quam quati seque latempos maximaio estiis as eaqui del maiore nonsedi in et del inventi doloriatium soluptas moluptis dit et vellaboreri nimaior suntes sinciis eosam, omnimpore, sanit optate nos magniminctur sincim voluptur ad magnimi nvendi beatem qui untiis volore occus accus poribus, que volorem essit magnis erferrum que litas es ma dis repelibus siminve llorae officil igeniti onsecatem aceperro mil molore molestem repratem. Opta por ariorem verion pe pliquae doloriorum que eum utesse sint. Harum accus solorio remporitius, omnis etur alic tem arum ero ipsunt. Susti ut as eos id quati debitiis volupta tquam, omnis erfernat. Ad quid magnihil etur aut quiderro cones repella boribus velluptibus ra autem fuga. Bus, que et que nis perumet andae accum nos estem et etus il iur, con ped esecum etur suntur, sit, sed que nobiscitia pa aliciliquia volest rereictas volorpor autatur sam hilique consedi psundusam que plibus. Itatium in et laborehent aut eiustor magnimusto delitis sent atia dolorro molumqui ipsae doloriasse magnam este cuptia cum re, sequiam a alignihit as vendisi molesti int et voluptas esecerestia con corerferum que ad que pre, sam in pre pre nienien destrum idem ipit eatinvellaut quaercitecum con re dolupta dolestrunt labo. Et ommolorem in nobit, si dis ma voluptassit, sam venihilla doluptae quassinullo beatempos dolorum la voloriatis maio quos aut aborera temperi oribus am fugia con pel ex et ute provide bitatescit qui cumenditium eum, coreheni blatur amus dest, susapicit ea dolluptae dipistiaspe comnimin explitium sinulla nulparum quam nobis num estis numenias mi, expelig nimporro et laci comnihi lluptat et velis et quo totaes verum eratus, ut vent. Aborum rem apelita distet esed es cum liatis ipiducipid moluptatus que rerci bea dendelenihil il eum re sit venda quam, es maximus antisci isitiam aut pel il ex et hillaccus mos modictis ped minctet eveniet essim rest, et ex explant acea dempore libus, to comnietur sum eum quate duci voluptur, asitiossum hil ima nienit unt moditam voluptat officiis adiscitibus et volupic te serum eos aped quam quundem porerum quiatquiatus soluptati re cusam, sam ium rehenihil illant qui dolorest prepro moluptatur? Us serrupt assimod ipidem que vendam experro in re moditiate qui voloriaesti ius auda quatur asperspit, omnihil inciani hicitium nulpa vent ipis perum laut volupientem qui cullabor repelluptas ea quibus quaturit laboris dolorumque rae. Itatempos earitat usaepero verchitis estio magni ut omnis ero et, quodicto ipsume inistem lique lam, sitati unt alita aliquas ut vendam, consendi volut quasimi llecabor arum facepudae. Um, sinctem imagnihil imendel in conem fugia
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Message by Hon’ble Vice Chairman of NITI Aayog, Government of India
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Preface For some time now, health planners in India have been seeking better availability of disease burden data and trends at subnational levels. These are necessary for informed health policy and programming at the state and district levels, a prerequisite to improve population health based on local trends. Useful trends of some health indicators for the states of India have been available, but not a complete understanding of the magnitude and time trends of all major diseases and risk factors for every state of the country. Computation of a complete matrix of the best possible estimates for which diseases and risk factors cause the most premature deaths and disability in each state based on all available data, and how these trends have changed over time, would be a crucial contributor to the planning of what needs to be done in each state to maximise population health gains. This exercise would also highlight the major data gaps that need to be addressed in different parts of the country for better monitoring of health and disease trends. Faced with this compromising knowledge gap, a confluence of scientific and political interests enabled the launch of the India State-Level Disease Burden Initiative in October 2015. This Initiative received strong support from the Ministry of Health and Family Welfare of the Government of India, and was launched as a collaboration between the Indian Council of Medical Research, Public Health Foundation of India, and the Institute for Health Metrics and Evaluation, with the intent of engaging domain experts and stakeholders across the country. This Initiative was approved by the Health Ministry Screening Committee of the Indian Council of Medical Research. The public good importance of this effort was soon recognised widely, resulting in the engagement of experts from about a hundred institutions in India as collaborators, and the support of the top government leadership in accessing crucial data needed for computing the estimates. The fourteen domain expert groups that were formed as part of this Initiative contributed their knowledge and skills generously to bring incisive insights into relevant data, analysis, and findings, which has certainly resulted in much more reliable findings in this report than would have otherwise been possible. After two years of intense collaborative effort that included many leading health experts and policymakers in India, it is a matter of great satisfaction that this report is now being presented to the government, policymakers, health planners, academics, and other stakeholders, elucidating the disease burden and risk factors trends in every state of the country from 1990 to 2016. We anticipate that these estimates will continue to be produced at regular intervals and with improving accuracy as more data become available, enabling increasingly more robust monitoring of the progress in health parameters in all parts of India. We are grateful for the constructive engagement of a large number of highly skilled people with this effort to produce an open-access public good knowledge base, which has the potential of making fundamental and long-term contributions to improving health in every state of the country through provision of the best possible composite trends of disease burden and risk factors for policymakers to utilise in their decision-making. More broadly, in order to achieve its full development potential, India has to ensure a better health status of its citizens, akin to the optimism and sparkle seen on the faces of the children on the cover of this report. This can be more than just rhetoric if public health science and political will come together to make evidence-based policy making a norm in all parts of the country. We believe that this Initiative can contribute significantly to this goal. To put
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things in perspective, however, many other efforts to strengthen health system research and implementation science commensurate with the health status heterogeneity in different parts of India are needed as well. A tangible policy relevant output from the India State-Level Disease Burden Initiative can serve as an example of how other necessary public health science initiatives can be established through large-scale collaborative efforts to achieve reduction in health inequalities between Indians and progress toward a better health status of all in India. Soumya Swaminathan Secretary to the Government of India, Department of Health Research, Ministry of Health and Family Welfare; Director-General, Indian Council of Medical Research
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Lalit Dandona Director, India State-Level Disease Burden Initiative
Acronyms CMNNDs Communicable, maternal, neonatal, and nutritional diseases COPD
Chronic obstructive pulmonary disease
DALYs
Disability-adjusted life years
EAG
Empowered Action Group
ETL
Epidemiological transition level
GBD
Global Burden of Disease
ICMR
Indian Council of Medical Research
IHME
Institute for Health Metrics and Evaluation
NCDs
Non-communicable diseases
PHFI
Public Health Foundation of India
SDI
Socio–demographic Index
UT
Union territory
WaSH
Unsafe water, sanitation, and handwashing
YLDs
Years lived with disability
YLLs
Years of life lost
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Glossary of terms Age-standardisation A statistical technique used to compare populations with different age structures, in which the characteristics of the populations are statistically transformed to match those of a reference population. Useful because relative over- or underrepresentation of different age groups can obscure comparisons of age-dependent diseases (e.g., ischaemic heart disease or neonatal disorders) across populations.
Attributable burden
The share of the burden of a disease that can be estimated to occur due to exposure to a particular risk factor.
Disability-adjusted life years (DALYs) Years of healthy life lost to premature death and suffering. DALYs are the sum of years of life lost and years lived with disability.
Disability weight Number on a scale from 0 to 1 that represents the severity of health loss associated with a health state.
Empowered Action Group (EAG) states A group of eight states that receive special development effort attention from the Government of India, namely, Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Odisha, Rajasthan, Uttarakhand, and Uttar Pradesh.
Epidemiological transition level (ETL) Based on the ratio of the number of DALYs in a population due to communicable, maternal, neonatal, and nutritional diseases to the number of DALYs due to non-communicable diseases and injuries together. A decreasing ratio indicates advancing epidemiological transition with an increasing relative burden from non-communicable diseases as compared with communicable, maternal, neonatal, and nutritional diseases.
Global Burden of Disease (GBD) study A systematic, scientific effort to quantify the comparative magnitude of health loss due to diseases, injuries, and risk factors by age, sex, and geographies for specific points in time.
North-East states Eight states in the hilly northeastern region of India: Arunachal Pradesh, Assam, Manipur, Meghalaya, Mizoram, Nagaland, Sikkim, and Tripura.
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Risk factors Potentially modifiable causes of disease and injury.
Sense organ diseases A group of diseases that mainly cause hearing loss and vision loss, but also includes diseases that affect the other sense organs.
Sequelae Consequences of diseases and injuries.
Socio-demographic Index (SDI) A summary measure that identifies where countries or other geographic areas fall on the spectrum of development. Expressed on a scale of 0 to 1, SDI is a composite average of the rankings of the per capita income, average educational attainment, and fertility rates of all areas in the GBD study.
Summary exposure value A measure of a population’s exposure to a risk factor that takes into account the extent of exposure by risk level and the severity of that risk’s contribution to disease burden.
Uncertainty interval A range of values that is likely to include the correct estimate of health loss for a given cause. Narrow uncertainty intervals indicate that evidence is strong, while wide uncertainty intervals show that evidence is weaker.
Years of life lost (YLLs) Years of life lost due to premature mortality.
Years lived with disability (YLDs) Measure of years lived with disability due to a disease or injury, weighted for the severity of the disability.
Executive Summary Introduction With almost one-fifth of the world’s population living in India, the health status and the drivers of health loss are expected to vary between different parts of the country and between the states. Accordingly, effective efforts to improve population health in each state require systematic knowledge of the local health status and trends. While state-level trends for some important health indicators have been available in India, a comprehensive assessment of the diseases causing the most premature deaths and disability in each state, the risk factors responsible for this burden, and their time trends have not been available in a single standardised framework. The India State-Level Disease Burden Initiative was launched in October 2015 to address this crucial knowledge gap with support from the Ministry of Health and Family Welfare of the Government of India. This is a collaborative effort between the Indian Council of Medical Research, Public Health Foundation of India, Institute for Health Metrics and Evaluation, and experts and stakeholders from about 100 institutions across India. The work of this Initiative is overseen by an Advisory Board consisting of eminent policymakers and involves extensive engagement of 14 domain expert groups with the estimation process. Based on intense work over two years, this report describes the distribution and trends of diseases and risk factors for every state of India from 1990 to 2016.
Methods and data The estimates were produced as part of the Global Burden of Disease Study 2016. The analytical methods of this study have been standardised over two decades of scientific work, which has been reported in over 16,000 peer-reviewed publications, making it the most widely used approach globally for disease burden estimation. These methods enable standardised comparisons of health loss caused by different diseases and risk factors, between geographic units, sexes, and age groups, and over time in a unified framework. The key metric used for this comparison is disability-adjusted life years (DALYs), which is the sum of the number of years of life lost due to premature death and a weighted measure of the years lived with disability due to a disease or injury. The use of DALYs to track disease burden is recommended by India’s National Health Policy of 2017. Through an elaborate process, all data sources and inputs available to estimate disease burden in every state and union territory of India were identified and attempts were made to access these data. These included censuses, vital registration, Sample Registration System, large-scale national household surveys, other population-level surveys and cohort studies, disease surveillance data, disease programme-level data, administrative records of health services, disease registries, and a wide range of other studies conducted across India. Access to several important datasets was facilitated by senior government officials. Data were included in the analysis if they met quality and inclusion criteria.
Health status improving, but major inequalities between 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 DALY 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 4-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.
Large differences between states in the changing disease profile Of the total disease burden in India measured as 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
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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.
Infectious and associated diseases reducing, but still high in many states The burden of most infectious and associated diseases reduced in India from 1990 to 2016, but five of the ten individual leading causes of disease burden in India in 2016 still belonged to this group: diarrhoeal diseases, lower respiratory infections, iron-deficiency anaemia, preterm birth complications, and tuberculosis. The burden caused by these conditions generally continues to be much higher in the Empowered Action Group (EAG) and North-East state groups than in the other states, but there were notable variations between the states within these groups as well. The range of disease burden or DALY rate among the states of India was 9-fold for diarrhoeal disease, 7-fold for lower respiratory infections, and 9-fold for tuberculosis in 2016, highlighting the need for targeted efforts based on the specific trends in each state. The burden also differed between the sexes, with diarrhoeal disease, iron-deficiency anaemia, and lower respiratory infections higher among females, and tuberculosis higher among males. The proportion of total disease burden caused by infectious and associated diseases was highest among children, which contributed to the disproportionately higher overall disease burden suffered by the under-5 years age group. For India as whole, the disease burden or DALY rate for diarrhoeal diseases, iron-deficiency anaemia, and tuberculosis was 2.5 to 3.5 times higher than the average globally for other geographies at a similar level of development, indicating that this burden can be brought down substantially.
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%. 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 9-fold for ischaemic heart disease, 4-fold for chronic obstructive pulmonary disease, and 6-fold for stroke, and 4-fold for diabetes across India. While ischaemic heart disease and diabetes generally had higher DALY rates in states that are at a more advanced epidemiological transition stage toward non-communicable diseases, the DALY rates of chronic obstructive pulmonary disease were generally higher in the EAG states that are at a relatively less advanced epidemiological transition stage. On the other hand, the DALY rates of stroke varied across the states without any consistent pattern in relation to the stage of epidemiological transition. This variety of trends of the different major non-communicable diseases indicates that policy and health system interventions to tackle their increasing burden have to be informed by the specific trends in each state.
Increasing but variable burden of injuries among states 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 self-harm, which includes suicides and non-fatal outcomes of self-harm, are the leading contributors to the injury burden in India. The range of disease burden or DALY rate varied 3-fold for road injuries and 6-fold for self-harm among the states of India in 2016. There was no consistent relationship between the DALY rates of road injuries or self-harm versus the stage of epidemiological transition of the states. The burden due to road injuries was much higher in males than in females. The DALY rate for self-harm for India as a whole was 1.8 times higher than the average globally for other geographies at a similar level of development in 2016.
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Unacceptably high risk of child and maternal malnutrition 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. This burden is highest in the major EAG states and Assam, and is higher in females than in males. Child and maternal malnutrition contributes to disease burden mainly through increasing the risk of neonatal disorders, nutritional deficiencies, diarrhoeal diseases, lower respiratory infections, and other common infections. As a stark contrast, 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. This situation after decades of nutritional interventions in the country must be rectified as one of the highest priorities for health improvement in India.
Unsafe water and sanitation improving, but not enough yet Unsafe water and sanitation was the second leading risk responsible for disease burden in India in 1990, but dropped to the seventh leading risk in 2016, contributing 5% of the total disease burden, mainly through diarrhoeal diseases and other infections. The burden due to this risk is also highest in several EAG states and Assam, and higher in females than in males. The improvement in exposure to this risk from 1990 to 2016 was least in the EAG states, indicating that higher focus is needed in these states for more rapid improvements. Remarkably, the per person disease burden due to unsafe water and sanitation was 40 times higher in India than in China in 2016. The massive effort of the ongoing Swachh Bharat Abhiyan in India has the potential to improve this situation.
Household air pollution improving, outdoor air pollution worsening 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 causes burden through a mix of non-communicable and infectious diseases, mainly cardiovascular diseases, chronic respiratory diseases, and lower respiratory infections. The burden of household air pollution decreased during this period due to decreasing use of solid fuels for cooking, and that of outdoor air pollution increased due to a variety of pollutants from power production, industry, vehicles, construction, and waste burning. Household air pollution was responsible for 5% of the total disease burden in India in 2016, and outdoor air pollution for 6%. The burden due to household air pollution is highest in the EAG states, where its improvement since 1990 has also been the slowest. 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. Control of air pollution has to be ramped up through inter-sectoral collaborations based on the specific situation of each state.
Rising risks for cardiovascular diseases and diabetes Of the total disease burden in India in 1990, a tenth was caused by 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. The contribution of this group of risks increased massively to a quarter of the total disease burden in India in 2016. The combination of these risks was highest in Punjab, Tamil Nadu, Kerala, Andhra Pradesh, and Maharashtra in 2016, but importantly, the contribution of these risks has increased in every state of the country since 1990. The other significant contributor to cardiovascular diseases and diabetes, as well as to cancers and some other diseases, is tobacco use, which was responsible for 6% of the total disease burden in India in 2016. All of these risks are generally higher in males than in females. The sweeping increase of the burden due to this combination of risks in every part of the country indicates emphatically that major efforts need to be put in place to control their impact in every state before the situation gets totally out of control.
Importance of understanding the specific health situation of each state Understanding the health and disease trends in groups of states at a similar level of development or epidemiological transition is an important intermediate step in teasing apart the heterogeneity of disease and risk factor epidemiology in India. However, effective action to improve health must finally be based on the specific health situation of each state. This point is elucidated by significant variations in the burden from leading diseases and risk factors in 2016 between the following pairs of states that have physical proximity and are at similar levels of development and epidemiological transition.
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The major EAG states of Madhya Pradesh and Uttar Pradesh both have a relatively lower level of development indicators and are at a similar less advanced epidemiological transition stage. However, Uttar Pradesh had 50% higher disease burden per person from chronic obstructive pulmonary disease, 54% higher burden from tuberculosis, and 30% higher burden from diarrhoeal diseases, whereas Madhya Pradesh had 76% higher disease burden per person from stroke. The cardiovascular risks were generally higher in Madhya Pradesh, and the unsafe water and sanitation risk was relatively higher in Uttar Pradesh. The two North-East states of Manipur and Tripura are both at a lower-middle stage of epidemiological transition but have quite different disease burden rates from specific leading diseases. Tripura had 49% higher per person burden from ischaemic heart disease, 52% higher from stroke, 64% higher from chronic obstructive pulmonary disease, 159% higher from iron-deficiency anaemia, 59% higher from lower respiratory infections, and 56% higher from neonatal disorders. Manipur, on the other hand, had 88% higher per person burden from tuberculosis and 38% higher from road injuries. Regarding the level of risks, child and maternal malnutrition, air pollution, and several of the cardiovascular risks were higher in Tripura. The two adjoining north Indian states of Himachal Pradesh and Punjab both have a relatively higher level of development indicators and are at a similar more advanced epidemiological transition stage. However, there were striking differences between them in the level of burden from specific leading diseases. Punjab had 157% higher per person burden from diabetes, 134% higher burden from ischaemic heart disease, 49% higher burden from stroke, and 56% higher burden from road injuries. On the other hand, Himachal Pradesh had 63% higher per person burden from chronic obstructive pulmonary disease. Consistent with these findings, Punjab had substantially higher levels of cardiovascular risks than Himachal Pradesh. These examples highlight why it is necessary to understand the specific disease burden trends in each state, over and above the useful broad insights provided by trends common for groups of states at similar levels of epidemiological transition, if health action has to be planned for the specific context of each state. The chances of achieving the overall health targets set by India would be much higher if the biggest health problems and risks in each state are tackled on priority than with a more generic approach that does not take into account the specific disease burden trends in each state.
Application of the state-level disease burden findings and future work The findings in this report of the India State-Level Disease Burden Initiative can be used for planning of state health budgets, prioritisation of interventions relevant to each state, informing the government’s Health Assurance Mission in each state, monitoring of health-related Sustainable Development Goals targets in each state, assessing impact of large-scale interventions based on time trends of disease burden, and forecasting population health under various scenarios in each state. The findings are also available in easily understandable visual graphics in an online open-access interactive visualisation tool at https://vizhub.healthdata.org/gbd-compare/india. Future plans of the India State-Level Disease Burden Initiative include annual updates of the estimates based on newly available data, and more disaggregated findings such as the rural-urban estimates planned for next year and sub-state level estimates subsequently when adequate data become available.
Conclusion 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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About the India State-Level Disease Burden Initiative 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, is 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 work of this Initiative is approved by the Health Ministry Screening Committee of the Indian Council of Medical Research. The Advisory Board of this Initiative is chaired by a former Health Secretary to the Government of India, and includes some of the leading health policymakers of the country. This Initiative is built upon extensive collaborations across India and has 14 domain expert groups that are closely involved with the estimation process and interpretation of findings. The work of the Statelevel Disease Burden Initiative is directly guided by the Secretary to the Government of India, Department of Health Research, and Director General of Indian Council of Medical Research. This work is coordinated by the Disease Burden India Secretariat based at the Public Health Foundation of India. The first comprehensive set of state-level disease burden and risk factors estimates are being disseminated in this report. An online open-access interactive visualisation tool that will bring to life in an easily understandable manner the disease burden and risk factors trends over time across the Indian states is also being made available. An extensive engagement with central and state-level policymakers is anticipated for utilisation of the findings. The major anticipated utilisation of findings to inform policy includes planning of state health budgets, prioritisation of interventions relevant to each state, informing the government’s Health Assurance Mission in each state, monitoring of health-related Sustainable Development Goals targets in each state, assessing the impact of large-scale interventions based on time trends of disease burden, and forecasting population health under various scenarios in each state. It is envisaged that the data gaps identified in this estimation process will inform enhancement of the health information system of India. More detailed topic-specific publications and policy reports will also be produced for major diseases and risk factors for further granular insights to plan their control. Annual production of state-level disease burden estimates is planned, with estimates improving with increasing availability of data. Additional disaggregation of estimates is planned – for example, rural-urban estimates for each state next year, and geospatial mapping at a fine-grid level for key diseases and risk factors. Capacity-building in India to generate and analyse large-scale health data using strong methods is anticipated over the next five years of this work.
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About the Global Burden of Disease Study The history and evolution of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), which was initiated over two decades ago for a comprehensive quantitative assessment of population health, has been described recently.1 Prior to GBD, previous studies generally examined single causes or some groups of diseases, which often led to overestimation, with the sum of the deaths from individual causes being much larger than the total deaths in a population. The first preliminary GBD results for the year 1990 were published in the World Bank’s World Development Report 1993. The construction of the metric disability-adjusted life years (DALYs), methods, assumptions, and data sources were debated, and the revised GBD 1990 study results were published in The Lancet in 1997. Since that first effort, four additional cycles of GBD estimates have been published for the years 2010, 2013, 2015, and 2016. The GBD study can be described as a systematic, scientific effort to quantify the comparative magnitude of health loss from diseases, injuries, and risks by age, sex, and population over time. The goal of the study is to provide decision-makers at the local, regional, national, and global levels with the best possible and most up-to-date evidence on trends of population health and their drivers so that decisions are increasingly more evidence-based. During the past quarter-century, the scope, magnitude, and uses of the GBD study have increased substantially, as has the global network of collaborators. GBD 2016 had over 2,500 collaborators from 133 countries and three territories, half of whom were from low- or middle-income countries. With each cycle of the GBD study, the granularity of the analysis has increased. GBD 2016 included more than 3.5 billion estimated quantities. Health-related Sustainable Development Goal indicators are also reported, starting with GBD 2015. GBD 2016 covered 195 countries and territories, with subnational assessments for 12 countries, calculated for each year since 1990. It is comprehensive, including 333 diseases and injuries, 2,982 sequelae of these diseases and injuries, and 84 risks or combinations of risks. The increasing scope of work is guided by the GBD Scientific Council since 2013 to resolve scientific issues, decide on the adoption of new methods, diseases, or risks, and review and critique preliminary findings. In addition, an Independent Advisory Committee for GBD, chaired by Professor Peter Piot, provides an overall review of the GBD work and strategic guidance on areas that can be strengthened. The GBD study has now become an annual assessment of the state of the world’s health. With more than 16,000 peer-reviewed publications and reports generated from the GBD work, and references to the GBD study cited more than 700,000 times according to Google Scholar, the GBD study has become the most extensively used source for health, disease, and risk factors status of populations around the world. GBD findings have been utilised to inform prioritisation of specific policy interventions by many governments, and many global organisations use GBD results extensively. Recent inclusion of subnational estimates is further enhancing the utility of the GBD study to inform improvements in population health. Subnational estimates of disease burden have been reported previously by GBD for Brazil, China, Japan, Kenya, Mexico, Saudi Arabia, South Africa, UK, and USA, and are being reported for India and Indonesia in GBD 2016. 1. Murray CJL, Lopez AD. Measuring global health: motivation and evolution of the Global Burden of Disease Study. Lancet 2017; 390: 1460–1464.
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Introduction India is home to a wealth of cultural, social, and ethnic diversity across its 1.3 billion people. Its 29 states and seven union territories – many of which have populations larger than countries – vary widely in terms of their ecology, economy, and demography, all of which impact health outcomes. Accurate, comparable data on what is driving health loss is crucial for policymakers as they strive to make the best decisions possible for improving health. National-level data can obscure disparities across India’s varied landscape, so a detailed understanding of health challenges at the state level is necessary to ensure that policies are responsive to the specific context of each state. While the central government policies have significant influence on health initiatives across the country, health is a state subject in the Indian federal structure, with the majority of public spending on health from the state budgets. A robust disaggregated understanding of the disease burden and risk factors trends in each state of India is therefore essential for effective health system and policy action to improve population health at the state level. The Sample Registration Survey of India reports state-level estimates of key indicators such as neonatal, infant, and under-5 mortality rates annually. The major national surveys in India, the National Family Health Survey, District Level Household Survey, and the Annual Health Survey have provided valuable periodic data on key health indicators, which are mostly related to child and reproductive health. The National AIDS Control Organization of India produces state-level estimates of HIV. In addition, a large number of studies from many parts of India provide a variety of data on the distribution of many diseases and risk factors. However, a comprehensive composite assessment of all major diseases and risk factors together across all states of India, providing estimates over an extended period of time, which is needed for an informed health system and policy development in each state, has not been available so far. This report provides the first comprehensive set of findings for the distribution of diseases and risk factors across all states of the country from 1990 to 2016. These findings have been produced by the India State-Level Disease Burden Initiative as part of the Global Burden of Disease study collaboration, utilising all available data identified through an extensive effort involving over 200 leading health scientists and policymakers in India from about 100 institutions. The generation of these estimates and their interpretation have benefitted from the insights of domain experts through an intensive collaborative process over two years. The specific state-level findings presented in this report could serve as important tools for the data-driven and decentralised health planning, and for the tracking of subnational disease burden in India using DALYs, as recommended by the National Institution for Transforming India (NITI Aayog) of the Government of India and the National Health Policy 2017 released by the Ministry of Health and Family Welfare.1,2 1. National Institution for Transforming India (NITI Aayog), Government of India. Three-Year Action Agenda, 2017-18 to 2019-20. http://niti.gov.in/content/three-year-action-agenda-2017-18-2019-20 2. Ministry of Health and Family Welfare, Government of India. National Health Policy 2017. New Delhi: Ministry of Health and Family Welfare; 2017. http://www.mohfw.nic.in/ documents/policy
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Key concepts used in this report In order to make informed decisions about how best to allocate resources, policymakers need to understand the relative harm caused by different health problems across time, geography, age, and sex. In response to this, the GBD study approach uses methods and metrics that emphasise comparability between different diseases. Comparing the burden of health problems can be difficult. Some conditions kill people early in life while others cause death at older ages. Some conditions are not fatal but cause varying degrees of disability. The GBD’s principal metric, the disability-adjusted life year (DALY), allows decision-makers to directly compare the seemingly disparate impacts of diseases and injuries, from heart disease to anaemia to road accidents. DALYs express the premature death and disability attributable to a particular cause, and are made up of two components: years of life lost (YLLs) and years of life lived with disability (YLDs). YLLs measure all the time people lose when they die prematurely, before attaining their ideal life expectancy. Ideal life expectancy is based on the highest life expectancy observed in the world for that person’s age group. YLDs measure years of life lived with any short- or long-term condition that prevents a person from living in full health. They are calculated by multiplying an amount of time (expressed in years) by a disability weight (a number that quantifies the severity of a disability). Adding together YLLs and YLDs yields DALYs, a measure that portrays in one metric the total health loss a person experiences during their life. Adding all instances of health loss in a population together – and thereby estimating burden of premature death and disability – enables policymakers and researchers to make comparative, actionable assessments of population health. Decision-makers can use DALYs to quickly compare the impact caused by very different conditions, such as cancer and depression, since the conditions are assessed using a single, comparable metric. Considering the number of DALYs instead of causes of death alone provides a more accurate picture of the main drivers of poor health. Information about changing disease patterns is a crucial input for decision-making, effective resource allocation, and policy planning. Beyond providing a comparable and comprehensive picture of causes of premature death and disability, GBD also estimates the disease burden attributable to different risk factors. The GBD approach goes beyond risk factor prevalence, such as the number of smokers or heavy drinkers in a population. With comparative risk assessment, GBD incorporates both the prevalence of a given risk factor as well as the relative harm caused by that risk factor. It counts premature death and disability attributable to high blood pressure, tobacco and alcohol use, air pollution, poor diet, and other risk factors that lead to ill-health.
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Methods used for the analysis Details of the methods used for the analysis leading to the findings in this report are provided in technical papers.1,2,3,4,5,6 A brief summary follows. Extensive attempts were made to identify and access all data sources that could contribute to the estimation of disease burden and risk factors at the population level in every state and union territory of India. The data sources included censuses; vital registration; Sample Registration System; large-scale national household surveys such as National Family Health Surveys, District Level Household Surveys, Annual Health Survey, and surveys conducted by the National Sample Survey Organization; representative population-level surveys and cohort studies; surveillance system data on disease burden; programme-level data on disease burden from government agencies; administrative records of health services; disease registries; and a wide range of other studies conducted across India and systematic reviews of epidemiological studies. The scope and quality of the data were assessed, and if the inclusion criteria were met the data were included in the analysis. The 14 expert groups formed as part of the India State-Level Disease Burden Initiative, which included many of the leading health experts in India, engaged intensely to provide guidance on suitable sources of data, accessing those data, participation in the analytical process, and interpretation of the findings over a period of two years. Life expectancy was estimated. Death rates, causes of death, prevalence and incidence of diseases, exposure to risk factors, and YLLs, YLDs, and DALYs were estimated for 333 disease conditions and injuries and 84 risk factors for each state of India, the union territory of Delhi, and the union territories other than Delhi from 1990 to 2016 as part of the GBD 2016 study. Standardised methods that have been described in detail in the published technical papers were used to compute the estimates. 1. GBD 2016 Mortality Collaborators. Global, regional and national under-5 mortality, adult mortality, age-specific mortality and life expectancy 1970–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017; 390: 1084–1150. 2. GBD 2016 Cause of Death Collaborators. Global, regional and national age-sex mortality for 264 cause of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017; 390: 1151–1210. 3. GBD 2016 Disease and Injury Incidence and Prevalence Collaborators. Global, regional and national incidence, prevalence, and years lived with disability for 328 disease and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017; 390: 1211–1259. 4. GBD 2016 DALYs and HALE Collaborators. Global, regional and national disabilityadjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017; 390: 1260–1344. 5. GBD 2016 Risk factors Collaborators. Global, regional and national comparative risk assessment of 84 behavioural, environmental and occupational and metabolic risks or clusters of risks, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017; 390: 1345–1422. 6. India State-Level Disease Burden Initiative Collaborators. Nations within a nation: variations in epidemiological transition across the states of India, 1990–2016 in the Global Burden of Disease Study. Lancet 2017; 390: 2437–2460.
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Uncertainty intervals were computed around the estimates to indicate the margin of error that could be expected for each estimate. Disease burden and risk factors estimates were compared between the states of India. The DALY estimates for the leading diseases in each state were also compared with the estimates of those diseases in geographies that had a similar Socio-demographic Index level that was computed from income level, educational attainment, and fertility level. In the GBD approach, when data are scarce for the estimation of a particular variable, strength is drawn from the covariates that have known association with that variable in order to make the best possible estimates for all diseases and risk factors included in the GBD list. This has the advantage of providing a complete set of estimates for policymakers to help them ascertain priorities. At the same time, data gaps identified in this process are useful in informing the generation of relevant data and improving those estimates subsequently. In summary, the GBD methods enable standardised comparison of the burden of diseases and risk factors across ages, sexes, geographies, and time through the use of all available data.
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India: Health of the Nation’s States
Findings Life expectancy One of the simplest measures for understanding overall health outcomes is life expectancy at birth. If a country is generally expanding its longevity, it usually means that people are dying prematurely at lower rates. Around the world, people are living longer on average and populations are growing older. In 1990, life expectancy at birth in India was 58.3 years for males and 59.7 years for females. By 2016, life expectancy at birth increased to 66.9 years for males and 70.3 years for females. India has made substantial progress in improving the life expectancy at birth. However, life expectancy varied widely between the states of India. In 2016, the range was from 66.8 years in Uttar Pradesh to 78.7 years in Kerala for females, and 63.6 years in Assam to 73.8 years in Kerala for males. While life expectancy is a useful simple measure of a country’s or state’s health status, it does not reflect the variations and nuances in health loss throughout a person’s lifespan, the understanding of which is necessary to minimise health loss at the population level.
Figure 1 Life expectancy by sex in India, 1990 and 2016
58.3
1990
Year
59.7
66.9 2016
70.3
40
50
60
70
Age Female
Male
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India’s epidemiological transition In tandem with its rapid social and economic development, India is undergoing a major epidemiological transition. Over the last 26 years, the country’s disease patterns have shifted: mortality due to communicable, maternal, neonatal, and nutritional diseases (CMNNDs) has declined substantially and India’s population is living longer, meaning that non-communicable diseases (NCDs) and injuries are increasingly contributing to overall disease burden. India’s health system therefore faces a dual challenge. Although the absolute burden from diseases such as diarrhoea, lower respiratory infections, tuberculosis, and neonatal disorders is being reduced, it remains high. At the same time, the contribution to health loss of non-communicable conditions such as heart disease, stroke, and diabetes is rising. The precise nature of this challenge, though, varies across the country. While all states have experienced a change in disease patterns to some degree, clear differences emerge both in terms of the extent of this change and the rate at which it has occurred. Disability-adjusted life years (DALYs) are a summary measure of the health loss burden caused by different conditions, and take into account both premature mortality and disability in one combined measure.
Figure 2 Contribution of major disease groups to total DALYs in India, 1990 and 2016 Communicable, maternal, neonatal, and nutritional diseases
Injuries
Non-communicable diseases
1990
2016
8.6%
11.9%
32.7% 30.5% 60.9% 55.4%
India had 33% of the total DALYs from CMNNDs, 55% from NCDs, and 12% from injuries in 2016. In 1990, this was 61%, 30%, and 9% of DALYs, respectively.
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Epidemiological transition ratio is defined as the ratio of DALYs caused by CMNNDs to those caused by NCDs and injuries. A ratio greater than one indicates a higher burden of CMNNDs than NCDs and injuries, while a ratio less than one indicates the opposite. The lower the ratio, the greater the contribution of NCDs and injuries to a state’s overall disease burden. Most of the states had ratios more than one in 1990, whereas all states had ratios less than one in 2016. This means that the proportion of DALYs caused by NCDs and injuries has increased heavily across the country since 1990, and in 2016 accounted for the majority of premature death and disability for all states – a major shift in drivers of health loss. There are wide variations in the epidemiological transition ratio between individual states, ranging from 0.16 in Kerala, which is far along in this progression, to 0.74 in Bihar, where the challenge of the double burden of diseases is more acute. The states with ratio 0.56–0.75 in 2016 were considered as having the lowest epidemiological transition level (ETL), those with ratio 0.41–0.55 as lower-middle ETL, those with ratio 0.31–0.40 as higher-middle ETL, and those with ratio 0.30 or less as highest ETL.
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30
Kerala [0.49]
Karnataka [1.16]
Telangana [1.33]
Tamil Nadu [1.02]
Jharkhand [2.04]
Bihar [2.06]
West Bengal [1.34]
More than 1.70
More than 1.70
The states of Chhattisgarh, Jharkhand, Telangana, and Uttarakhand did not exist in 1990, as they were created from existing larger states in 2000 or later. They are shown in the 1990 map for comparison with 2016.
1.31 − 1.70
0.76 − 1.00 0.76 − 1.00
1.31 − 1.70
0.56 − 0.75 0.56 − 0.75
1.01 − 1.30
0.41 − 0.55 0.41 − 0.55
1.01 − 1.30
0.31 − 0.40
Ratio
0.31 − 0.40
Tamil Nadu [0.26]
Mizoram [0.53]
Manipur [0.42]
Nagaland [0.47]
Meghalaya [0.64]
Tripura [0.45]
West Bengal [0.33]
Andhra Pradesh [0.37]
Odisha [0.58]
Assam [0.62]
Sikkim [0.45]
Arunachal Pradesh [0.55]
Less than 0.31
Kerala [0.16]
Karnataka [0.34]
Telangana [0.38]
Chhattisgarh [0.6]
Jharkhand [0.69]
Bihar [0.74]
Delhi [0.38]
Himachal Pradesh [0.3]
Uttar Pradesh [0.68]
Madhya Pradesh [0.6]
Maharashtra [0.33]
Gujarat [0.46]
Goa [0.21]
Haryana [0.4]
Uttarakhand [0.46]
Jammu and Kashmir [0.34]
Rajasthan [0.66]
Punjab [0.29]
2016
Less than 0.31
Ratio
Meghalaya [1.98]
Tripura [1.38]
Mizoram [1.18]
Manipur [1.37]
Nagaland [1.52]
Arunachal Pradesh [1.96]
Assam [1.66]
Sikkim [1.44]
Andhra Pradesh [1.5]
Chhattisgarh [1.97] Odisha [2.00]
Madhya Pradesh [2.05]
Maharashtra [1.1]
Gujarat [1.47]
Uttar Pradesh [2.08]
Delhi [1.16]
Himachal Pradesh [1.14]
The states of Chhattisgarh, Jharkhand, Telangana, and Uttarakhand did not exist in 1990, as they were created from existing larger states in 2000 or later. Data for these four new states were disaggregated from their parent states based on their current district composition. These states are shown in the 1990 map for comparison with 2016.
India: Health of the Nation’s States
Goa [0.84]
Haryana [1.34]
Uttarakhand [1.4]
Jammu and Kashmir [1.14]
Rajasthan [2.05]
Punjab [1.05]
1990
Figure 3 Epidemiological transition ratios of the states of India, 1990 and 2016
These findings highlight the fact that India’s states will require very different policy approaches according to the nature of the disease burden they are facing. The rest of this report takes a deeper look into the diseases and injuries that are driving these trends across the states, in order to help decision-makers determine just what those approaches should be. The health planning for each state and union territory in India should ideally be based on its specific disease and risk factors profile. However, it is also useful to understand disease and risk factors trends among groups of states at similar levels of development and epidemiological transition. In India the development efforts are often focussed on the relatively less developed eight north Indian states and eight states in the hilly northeastern region. The former are referred to as the Empowered Action Group (EAG) states and the latter the North-East states. The remaining states and union territories are often referred to as the “Other” states. We provide the disease and risk factors profile of each state in this report, but also present trends by these state groups used in India. In addition, we subdivided states within these groups by their ETL, as described in the previous section. As the union territories other than Delhi have relatively smaller populations, these six union territories of Andaman and Nicobar Islands, Chandigarh, Dadra and Nagar Haveli, Daman and Diu, Lakshadweep, and Puducherry were considered together in the analysis. The year in which health loss from NCDs and injuries exceeded that from CMNNDs varied widely between the state groups and sub-groups, ranging from 1986 to 2010 (Table 2). The epidemiological transition ratio dropped below one for the EAG states group in 2009, for the North-East states group in 2005, and for the Other states group in 1995. This crossover year for India as a whole was 2003.
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Table 1 Grouping of states of India in this report Empowered Action Group (EAG) states Bihar Chhattisgarh Jharkhand Lowest ETL group
Madhya Pradesh Odisha Rajasthan Uttar Pradesh
Lower-middle ETL group
Uttarakhand North-East states
Lowest ETL group
Assam Meghalaya Arunachal Pradesh Mizoram
Lower-middle ETL group
Nagaland Tripura Sikkim Manipur Other states
Lower-middle ETL group
Gujarat Andhra Pradesh Delhi Haryana Jammu and Kashmir
Higher-middle ETL group
Karnataka Maharashtra Telangana Union Territories other than Delhi West Bengal Goa Himachal Pradesh
Highest ETL group
Kerala Punjab Tamil Nadu
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India: Health of the Nation’s States
Table 2 Year of crossover to majority NCDs and injuries burden by the state groups State groups (population) India (1,316 million) EAG states (599 million)
Crossover year 2003 2009
Lowest ETL group (588 million)
2010
Lower-middle ETL group (11 million)
2002
North-East states (52 million)
2005
Lowest ETL group (38 million)
2007
Lower-middle ETL group (14 million)
2001
Other states (665 million)
1995
Lower-middle ETL group (67 million)
2000
Higher-middle ETL group (446 million)
1996
Highest ETL group (152 million)
1986
India: Health of the Nation’s States
33
Deaths and their causes India’s epidemiological transition has been driven in part by the fact that fewer lives are cut short by CMNNDs, and hence more people survive to develop and die from NCDs or suffer injuries. What one is likely to die of, though, depends both on age and where one lives. As such, decision-makers need to understand trends in causes of death across age groups and states in order to enact effective policies.
Figure 4 Contribution of major disease groups to total deaths in India, 1990 and 2016 Communicable, maternal, neonatal, and nutritional diseases
Injuries
Non-communicable diseases
2016
1990
8.5%
10.7% 27.5%
53.6%
37.9%
61.8%
The proportion of all deaths in India due to CMNNDs reduced from 53.6% in 1990 to 27.5% in 2016, those due to NCDs increased from 37.9% to 61.8%, and those due to injuries changed from 8.5% to 10.7%.
34
India: Health of the Nation’s States
Table 3 Distribution of deaths from major disease groups by age in the state groups, 2016 Death rate per 100,000 [percent of total deaths in that age group]
Age group
EAG states group
North-East states group
Other states group
India
Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
Injuries
0-14 years 15-39 years 40-69 years 70 plus years All ages
277 [82.4] 76 [34.4] 278 [21.9] 2609 [29.5] 268 [34.6]
37 [10.9] 70 [31.6] 873 [68.9] 5799 [65.5] 426 [55.1]
23 [6.7] 75 [34.0] 116 [9.2]] 444 [5.0] 79 [10.2]
0-14 years 15-39 years 40-69 years 70 plus years All ages 0-14 years 15-39 years 40-69 years 70 plus years All ages 0-14 years 15-39 years 40-69 years 70 plus years All ages
261 [83.0] 77 [33.8] 238 [19.7] 2466 [27.2] 236 [32.1] 157.5 [77.2] 41.9 [23.1] 133.7 [13.1] 1304.2 [17.3] 145.3 [20.2] 225.6 [80.8] 58.4 [29.1] 195.8 [17.4] 1867.0 [23.0] 204.6 [27.5]
32 [10.3] 82 [35.8] 881 [73.0] 6260 [69.2] 433 [58.8] 30 [14.6] 68 [37.2] 785 [77.2] 5784 [76.9] 493 [68.5] 34 [12.0] 69 [34.4] 824 [73.2] 5805 [71.6] 460 [61.8]
21 [6.7] 69 [30.3] 88 [7.3] 327 [3.6] 67 [9.1] 17 [8.2] 72 [39.8] 98 [9.7] 435 [5.8] 81 [11.3] 20 [7.2] 73 [36.5] 105 [9.4] 435 [5.4] 80 [10.7]
The death rate due to NCDs was over two times that due to CMNNDs in India in 2016. The proportion of deaths and the death rates due to CMNNDs were higher in EAG and North-East states groups as compared with the Other states group, whereas the proportion of deaths and the death rates due to NCDs were highest in the Other states group. CMNNDs caused the predominant proportion of deaths in the age group 0-14 years in all the states groups. Injuries caused 34%–40% of the deaths in the age group 15-39 years across the three states groups. NCDs were the dominant cause of death in those 40 years or older. The proportion of deaths in the different age groups differed widely across the individual states of India: 3%–19% of total deaths in the 0-14 years age group, 7%–16% in the 15-39 years age group, 35%–44% in the 40-69 years age group, and 30%–52% in those 70 or more years old.
India: Health of the Nation’s States
35
Table 4 Contribution of disease categories to deaths in the state groups, 2016 Percent of deaths to total deaths Disease categories
Communicable, maternal, neonatal, and nutritional diseases
EAG states group (599 million)
North-East states group (52 million)
Other states group (665 million)
India (1316 million)
34.6
32.1
20.2
27.5
6.4
6.1
4.3
5.4
19.9
17
11.2
15.5
Neglected tropical diseases and malaria
1.1
1.2
0.6
0.8
Maternal disorders
0.6
0.7
0.3
0.5
Neonatal disorders
4.9
4.6
2.8
3.8
0.7
0.5
0.3
0.5
1
2.1
0.8
0.9
55.1
58.8
68.5
61.8
HIV/AIDS and tuberculosis Diarrhoea, lower respiratory, and other common infectious diseases
Nutritional deficiencies Other communicable, maternal, neonatal, and nutritional diseases Non-communicable diseases Cancers
7.8
9.5
8.7
8.3
Cardiovascular diseases
21.9
23
34.5
28.1
Chronic respiratory diseases
12.4
9.6
9.6
10.9
Cirrhosis and other chronic liver diseases
1.7
3.8
2.4
2.1
Digestive diseases
2.6
3.3
1.7
2.2
Neurological disorders
1.8
1.8
2.4
2.1
Mental and substance use disorders
0.4
0.4
0.4
0.4
Diabetes, urogenital, blood, and endocrine diseases
5.2
6.2
7.9
6.5
Musculoskeletal disorders
0.1
0.1
0.1
0.1
Other non-communicable diseases Injuries Transport injuries Unintentional injuries Suicide and interpersonal violence Other
1.3
1.1
0.9
1.1
10.2
9.1
11.3
10.7
2.9
2.4
3
2.9
5
3.9
4.9
4.9
2.3
2.8
3.4
2.8
0
0
0
0
The disease categories among CMNNDs that caused the highest proportion of death were diarrhoea, lower respiratory infections, and other common infectious diseases; HIV/AIDS and tuberculosis; and neonatal disorders. The proportion of deaths due to these categories were relatively higher in the EAG and North-East states groups as compared with Other states group. Among NCDs, the category of cardiovascular diseases was the leading cause of death, followed by chronic respiratory diseases, cancers, and the category containing diabetes and urogenital disorders. The proportion of deaths due to cardiovascular diseases and the diabetes category were highest in the Other states group, whereas the proportion of deaths due to chronic respiratory diseases was highest in the EAG states group.
36
India: Health of the Nation’s States
India: Health of the Nation’s States
37
93 96 122 72 95 99
Chhattisgarh
Jharkhand
Madhya Pradesh
Odisha
Rajasthan
Uttar Pradesh
51 107 65 69 167
Nagaland
Tripura
Sikkim
Manipur
Other states
208 170
Tamil Nadu
Kerala
100
Union Territories other than Delhi
136
164
Maharashtra
Goa
146
West Bengal
261
169
Karnataka
114
143
Jammu and Kashmir
Punjab
163
Andhra Pradesh
Himachal Pradesh
135
Telangana
204
108
Highest ETL group
175
Delhi
154
160
Haryana
Higher-middle ETL group
Gujarat
160
27
Mizoram
Lower-middle ETL group
37
Arunachal Pradesh
72
66
Assam
Lower-middle ETL group
39
Meghalaya
64
66
Lowest ETL group
100
120
Uttarakhand
North-East states
39
40
31
47
97
44
22
64
48
63
74
56
50
22
82
56
64
64
55
32
31
67
18
58
23
43
63
22
60
55
100
97
111
38
61
38
40
55
76
76
64
ases 20
41
14
36
33
34
13
39
38
53
31
52
54
11
41
42
31
31
39
55
14
60
17
35
35
44
75
41
72
65
35
35
80
51
129
69
120
84
83
81
81
59
59
40
46
43
29
45
25
61
118
57
39
51
44
22
34
69
33
33
58
62
19
97
42
18
29
61
91
32
86
80
33
33
30
32
98
56
37
90
41
44
44
53
Diarrh oeal d ise
a se
COPD †
120
Lower-middle ETL group
103
Bihar
100
100
Lowest ETL group
132
India
e Strok
rt dise Ischae mic h ea
EAG States
32
35
19
29
17
32
22
21
22
21
21
17
14
16
18
20
16
16
22
20
13
20
12
14
11
17
18
12
18
17
16
16
11
10
24
12
15
15
13
13
13
18
21
30
11
10
13
23
17
19
24
31
9
25
22
8
16
22
17
17
21
13
12
30
5
7
16
17
16
8
16
16
13
13
15
12
15
18
9
20
7
13
13
18
18
29
18
16
21
24
20
19
11
17
12
19
17
10
14
16
17
17
18
5
15
7
9
12
9
8
9
8
9
9
19
19
17
12
22
14
11
15
12
15
15
16
6
8
5
8
16
8
4
12
10
14
13
12
11
4
15
11
14
14
11
6
5
15
4
10
5
9
15
5
14
13
18
18
23
23
9
14
9
10
13
17
17
14
3
6
4
5
5
5
7
9
8
11
6
11
10
8
8
9
13
13
9
6
7
13
5
7
9
9
15
8
14
13
9
9
14
16
9
16
10
16
12
14
14
11
15
16
7
10
9
14
16
10
9
9
8
10
9
6
10
9
8
8
10
11
6
9
6
5
5
8
11
6
10
10
10
10
10
8
11
10
8
10
10
10
10
10
Significantly higher than national mean
8
1
2
3
5
4
2
3
5
5
5
6
4
3
8
9
5
8
8
5
4
6
6
3
7
6
5
11
5
10
9
7
7
13
13
9
14
9
13
13
13
13
8
5
7
3
7
6
7
7
7
8
8
7
8
7
7
7
8
7
7
7
7
4
9
5
3
4
6
10
5
9
9
8
8
9
8
12
9
8
10
11
9
10
5
5
7
7
6
6
7
8
8
9
3
11
13
4
6
9
8
8
8
19
4
5
14
11
11
11
7
3
6
8
8
8
3
5
12
7
8
7
8
6
6
7
5
5
4
4
4
5
5
4
4
7
5
6
5
4
5
5
7
7
5
3
3
5
3
5
4
4
7
5
7
6
5
5
9
5
5
7
6
5
13
8
8
6
0
3
0
7
4
3
2
4
2
3
2
6
5
6
8
4
5
5
4
6
6
3
8
12
4
5
5
9
6
6
9
9
11
13
5
11
5
8
6
9
9
6
1
4
2
4
4
3
4
4
3
7
3
6
5
5
5
5
7
7
5
4
3
5
4
5
5
4
9
7
9
8
5
5
7
6
8
5
7
7
11
7
7
6
4
5
6
2
6
4
5
3
6
8
13
9
8
2
9
6
2
2
5
4
7
3
10
21
14
7
4
5
4
5
9
9
9
7
8
5
6
5
3
7
7
6
11
3
6
8
6
6
5
5
6
5
5
6
6
6
6
5
6
6
6
4
6
6
4
11
6
6
9
8
9
8
6
6
6
5
7
5
5
6
5
5
5
6
2
2
1
3
3
2
3
4
6
2
5
8
7
3
4
5
4
4
4
4
6
8
8
6
11
7
17
5
16
14
7
7
5
4
10
6
6
7
6
6
6
5
C o n g enital birth defec ts Inte s ti n al infe ctious disea ses Neon a ta l e nceph alopa thy Stom ach c ancer Other cance rs
rate per 100,000 population COPD is chronic obstructive pulmonary disease.
22
13
13
15
17
16
9
12
11
12
10
11
11
7
12
11
11
11
12
11
8
12
8
10
7
10
9
8
9
9
13
13
10
10
12
10
8
9
8
10
10
11
†
14
23
13
29
17
22
15
18
16
18
31
20
17
14
28
18
17
17
19
22
12
15
13
17
13
16
16
10
16
16
29
29
22
22
18
19
19
18
14
20
20
19
*Death
28
53
33
44
13
43
18
23
16
42
16
24
19
18
25
23
21
21
28
33
14
18
11
14
14
19
23
13
23
22
24
24
19
10
20
19
18
22
19
18
18
23
Falls
Indistinguishable from national mean
8
24
11
22
22
19
18
24
19
21
18
19
18
20
35
21
42
42
23
33
19
16
22
19
25
22
43
35
42
37
40
40
58
41
43
38
38
41
25
43
44
33
Prete rm b ir th comp licatio ns Alzhe imer d isease Hype r te n sive h eart d isease O th e r neona tal dis order s
Significantly lower than national mean
17
26
21
30
26
25
17
32
31
24
34
26
22
19
34
28
31
31
28
40
38
45
28
33
26
37
46
33
45
43
51
51
53
52
46
48
34
48
41
48
48
38
Asthm a
Figure 5 Death rates of the leading individual causes in the states of India, 2016*
Lowe r resp irato
ry infe
ctions rculos is Tube
s Diabe te
isease Chron ic kid
ney d Suicid e
ase HIV/A IDS
rt dise c h ea
Rheum ati
s injurie Road
s Hepa titi
r 11
5
3
6
5
7
4
5
7
5
10
4
3
7
6
5
5
5
6
11
5
7
3
20
4
8
5
5
5
6
7
7
5
4
5
5
3
4
4
5
5
5
3
6
6
5
2
4
3
6
4
4
3
4
5
5
3
5
4
4
7
4
4
4
4
5
4
5
3
5
3
4
4
3
4
4
7
7
7
4
12
7
4
5
4
12
4
3
4
6
9
6
7
3
5
4
5
5
6
4
4
6
14
11
7
9
7
10
9
9
9
9
9
4
4
4
3
4
4
6
5
5
4
4
5
1
3
3
3
5
3
2
4
3
3
3
3
2
4
5
3
3
3
3
2
5
6
4
7
4
4
8
7
8
7
7
7
9
4
9
7
9
8
5
7
7
5
Urina ry dis eases Cirrho s is d u e to h Paraly epatiti sB intestitic ileus & nal ob structi on
10
cance Lung
gitis 3
4
2
4
3
4
4
4
4
5
4
4
4
4
5
4
6
6
4
3
3
3
3
5
3
3
4
5
4
4
6
6
7
5
4
6
4
4
4
6
6
5
Menin
g 4
5
4
3
2
4
3
5
6
5
4
4
3
2
4
5
4
4
4
5
3
4
4
3
4
4
8
3
8
7
5
5
4
5
5
6
7
6
6
5
5
5
Drow nin
The leading individual cause of death in India in 2016 was ischaemic heart disease, the death rate from which was twice as much as the next leading cause. The other NCDs in the top 10 individual causes of death included chronic obstructive pulmonary disease (COPD), stroke, diabetes, and chronic kidney disease. Diarrhoeal diseases, lower respiratory infections, and tuberculosis were the leading CMNND individual causes of death, and road injuries and suicides were the leading injury individual causes of death among the top 10 in India. There were wide variations in death rates from the leading causes between the states. The highest death rate from ischaemic heart disease among the states was 12 times the lowest rate, and these death rates were generally higher among the states belonging to the higher epidemiological transition level groups. On the other hand, the death rate from COPD was generally higher in the EAG states, with the highest rate nine times the lowest rate across the states of India. The death rates from diarrhoeal diseases and tuberculosis were also higher in the EAG states and had a 12-fold and 7-fold variation in rates, respectively, between all the states. The range of death rates from suicide was 6-fold across the states.
38
India: Health of the Nation’s States
Years of life lost due to premature death While deaths are a useful metric for understanding some aspects of population health, they do not take into account the amount of life lost when a person dies. For example, a death at the age of 80 is given the same weight as a death at the age of 10. In addition to deaths, decision-makers also need to know how much premature mortality is caused by a particular disease or injury. Years of life lost (YLLs) is a measure that quantifies the number of years of life a person loses at the age of their death, based on the highest life expectancy for their age group anywhere in the world. YLLs therefore give greater weight to causes of death that kill people at younger ages, such as common childhood infections, than those that tend to occur later in life, such as heart disease or stroke. Ischaemic heart disease was the leading cause of YLLs in the Other states group by a big margin and was also the leading cause in the EAG states group, but stroke was the leading cause of YLLs in the North-East states group. Infectious and neonatal causes were more prominent causes of YLLs in the EAG and North-East states groups than in the Other states group. Suicide and road injuries were among the leading 10 causes of YLLs in all state groups, with suicide as a prominent third leading cause in the Other states group. In order to ensure that health policies and interventions target those who need them most, it is also vital that decision-makers understand how specific diseases and injuries affect females and males differently. Across all three states groups, ischaemic heart disease caused a much greater proportion of total YLLs among males than among females, accounting for 14% of premature mortality for males in India as a whole compared to 10% for females. Road injuries also caused a higher proportion of YLLs among males than females. On the other hand, diarrhoeal diseases and lower respiratory infections were responsible for a higher proportion of YLLs among females. Policy efforts to address causes of premature mortality in India should therefore be responsive to these differences and the relative challenges that NCDs, injuries, and CMNNDs pose along the lines of both sex and different parts of the country.
India: Health of the Nation’s States
39
Figure 6 Leading individual causes of years of life lost by sex in the state groups, 2016 Females
EAG states
Males
Ischaemic heart disease Diarrhoeal diseases Lower respiratory infections COPD* Tuberculosis Neonatal preterm birth Other neonatal Stroke Road injuries Suicide Congenital defects Neonatal encephalopathy Intestinal infectious Asthma Falls Diabetes Chronic kidney disease Malaria Meningitis HIV/AIDS
20
15 10 5 Percent of total years of life lost
0
Females
0
5 10 15 Percent of total years of life lost
North-East states
20
Males
Stroke Lower respiratory infections Diarrhoeal diseases Ischaemic heart disease Tuberculosis Neonatal preterm birth COPD* Suicide Other neonatal Road injuries Neonatal encephalopathy Hepatitis Chronic kidney disease Malaria Congenital defects Diabetes Drowning HIV/AIDS Intestinal infectious Asthma
20
15 10 5 Percent of total years of life lost
0
Females
0
5 10 15 Percent of total years of life lost
20
Males
Other states Ischaemic heart disease Stroke Suicide COPD* Lower respiratory infections Diarrhoeal diseases Road injuries Neonatal preterm birth Tuberculosis Chronic kidney disease Diabetes Falls Neonatal encephalopathy Congenital defects Other neonatal HIV/AIDS Asthma Intestinal infectious Drowning Rheumatic heart disease
20
15 10 5 Percent of total years of life lost
0
Communicable, maternal, neonatal, and nutritional diseases
0
5 10 15 Percent of total years of life lost
Non-communicable diseases
*COPD is chronic obstructive pulmonary disease. 40
India: Health of the Nation’s States
Injuries
20
Years lived with disability As more Indians live into adulthood and old age, they are increasingly likely to experience poor health from disabling conditions. This has important implications for the country’s health system, which will have to care for a growing number of patients, many of them suffering from chronic conditions. Years lived with disability (YLDs) is a measure that takes into account both the number of individuals suffering from disability (or non-fatal poor health as a result of a particular disease or injury), and also the severity of the disability. The contribution of YLDs to the total disease burden (DALYs) increased in India from 17% in 1990 to 33% in 2016. The YLD proportion in 2016 was highest in the Other states group at 36% and lowest in the EAG states group at 30%.
India: Health of the Nation’s States
41
Figure 7 Leading individual causes of disability by sex in the state groups, 2016 Females EAG states
Males
Iron-deficiency anaemia Sense organ diseases† Low back & neck pain Migraine Skin diseases Other musculoskeletal Depressive disorders COPD* Anxiety disorders Diabetes Neonatal preterm birth Oral disorders Falls Protein-energy malnutrition Diarrhoeal diseases Osteoarthritis Haemoglobinopathies Schizophrenia Congenital defects Gynaecological diseases
16 12 8 4 0 0 4 8 12 Figure 7 Percent of total years lived with disability Percent of total years lived with disability Leading individual causes of years of life lost and by nutritional sex in the state groups, 2016 Communicable, maternal, neonatal, diseases Non-communicable diseases Injuries Females North-East states Males Sense organ diseases includes mainly hearing and visual loss.
16
†
*COPD is chronic obstructive pulmonary disease. Iron-deficiency anaemia
Sense organ diseases† Migraine Low back & neck pain Skin diseases Other musculoskeletal Depressive disorders COPD* Anxiety disorders Diabetes Neonatal preterm birth Oral disorders Falls Osteoarthritis Drug use disorders Schizophrenia Gynaecological diseases Diarrhoeal diseases Haemoglobinopathies Other mental & substance
16 12 8 4 0 0 4 8 12 Percent of total years lived with disability Percent of total years lived with disability Figure 7 Leading individual causes of years of life lost and by nutritional sex in the state groups, 2016 Communicable, maternal, neonatal, diseases Non-communicable diseases Injuries Females Other Males Sense organ diseases includesstates mainly hearing and visual loss.
16
†
*COPD is chronic obstructive pulmonary disease.
Iron-deficiency anaemia Sense organ diseases† Low back & neck pain Migraine Depressive disorders Skin diseases Other musculoskeletal COPD* Diabetes Anxiety disorders Oral disorders Falls Neonatal preterm birth Osteoarthritis Schizophrenia Road injuries Drug use disorders Gynaecological diseases Other mental & substance Diarrhoeal diseases
16
12 8 4 Percent of total years lived with disability
0
Communicable, maternal, neonatal, and nutritional diseases †
42
0
4 8 12 Percent of total years lived with disability
Non-communicable diseases
Sense organ diseases includes mainly hearing and vision loss. *COPD is chronic obstructive pulmonary disease.
India: Health of the Nation’s States
Injuries
16
The majority of the leading individual causes of YLDs in 2016 were NCDs, but iron-deficiency anaemia was the top cause across all three state groups, accounting for 11% of all disability in India in 2016. Its effects were most severe among females, contributing to 15% of YLDs in the EAG and North-East states group and 12% in the Other states group. The NCD conditions that were the leading contributors to disability burden in all three state groups included sense organ diseases (hearing and vision loss), lower back and neck pain, migraine, depressive disorders, skin diseases, and musculoskeletal disorders. Among these, migraine and depressive disorders were responsible for a higher proportion of YLDs among females than among males in all three state groups. As many of these diseases are not fatal, these rankings highlight the importance of looking specifically at YLDs to identify major individual causes of poor health in the population, as these may be overlooked by focusing on mortality. As India’s population structure moves further toward a higher proportion of elderly, these diseases will likely make an increasingly important contribution to the country’s disease burden and will require stronger efforts to address them.
India: Health of the Nation’s States
43
Total health loss and its causes For a complete assessment of the burden caused by health problems, we can evaluate the impact of different diseases and injuries by taking into account both premature mortality and disability in one combined measure: disability-adjusted life years (DALYs). DALYs provide a more comprehensive look at the drivers of overall health loss in India and its states.
Figure 8 Percent change in all-ages and age-standardised DALY rate in the state groups, 1990 and 2016 India
EAG states
North-East states
Other states
Percent change from 1990 to 2016
0
-20%
-33.4%
-36.2%
-37.9%
-40%
-40.2%
-43.1% -47.2%
-60% All ages
Age-standardised
The limit bars indicate 95% uncertainty interval around estimates.
The DALY rate reduced significantly by 43% in India from 1990 to 2016. This reduction was relatively higher in the EAG states group. After adjusting for the changes in population age structure during this period, the age-standardised DALY rate dropped by 36% in India, suggesting a reduction in the disease burden per person over this period.
44
India: Health of the Nation’s States
-35.9% -39.4%
Figure 9 Relative age-standardised DALY rate across the states of India, 2016 (1.81)
(1.77) (1.71) (1.64) (1.63) (1.63) (1.61) (1.59) (1.59)
(1.56) (1.51)
1.50
(1.49) (1.48) (1.47) (1.46)
(1.43)
(1.41) (1.41) (1.4)
(1.37) (1.37)
(1.35) (1.34) (1.34)
(1.31) (1.26)
(1.23)
(1.21)
(1.17)
(1.04)
(1.00)
Ratio
1.00
0.50
Od
es
h ish Jh ark a ha nd Bi h Ra ar jas th a Ha n rya Ut tar na ak ha nd Tri pu Ka ra rn ata ka Gu j a M e ra An gha t lay dh ra a Pr a Ja m We desh m st u a Be nd ng Ka al sh m ir Ar un P un ac ha j l P ab rad e M sh a M nip ah u ara r sh t M ra izo Ta ram m il N Te adu lan ga n Na a Un ga ion lan Te d rri to D elh rie so S i th er ikkim t Hi h m an ac ha Delh lP i rad es h Go a Ke ral a
hy
aP
rad
h
arh
sg
es
tti
Ch
M
ad
ha
ad
Pr
Ut
tar
As
sa
m
0.00
EAG states
North-East states
Other states
The ratio shown on the top of each bar is the ratio of each state age-standardised DALY rate to the DALY rate of Kerala.
The range of DALY rates varied almost two-fold across the states in 2016, after adjusting for the population structure of the states. Assam and the EAG states had the highest DALY rates. The lowest DALY rates were in Kerala and Goa.
India: Health of the Nation’s States
45
46
India: Health of the Nation’s States
1.4 12.9
Maternal disorders
Neonatal disorders
0
1.4
Other
4.4
Suicide and interpersonal violence
1.9
Musculoskeletal disorders
Unintentional injuries
2.1
Diabetes, urogenital, blood, and endocrine diseases
1.5
2.4
Mental and substance use disorders
Transport injuries
1.7
Neurological disorders
4.1
1.4
Digestive diseases
7.4
0.6
Cirrhosis and other chronic liver diseases
Other non-communicable diseases
4.4
Chronic respiratory diseases
Injuries
4.9
2
25.4
1.6
Cardiovascular diseases
Cancers
Non-communicable diseases
Other communicable, maternal, neonatal, and nutritional diseases
4.2
2.8
Neglected tropical diseases and malaria
Nutritional deficiencies
38.9
5.3
HIV/AIDS and tuberculosis
Diarrhoea, lower respiratory, and other common infectious diseases
67.1
Communicable, maternal, neonatal, and nutritional diseases
EAG states group (369 million)
0.1
2.2
3.9
1.4
7.6
4.1
2.1
2.6
3
1.9
1.9
1.7
4.8
5.9
2.6
30.5
2.1
3.6
14
2.3
2.7
31.7
5.5
61.9
North-East states group (32 million)
0.1
2.9
4.9
2
9.9
5.9
2.7
3.2
3.5
2.3
1.1
1.1
4.6
9
2.6
35.9
1.3
3.4
15
1.3
1.3
27.2
4.8
54.2
0.1
2.1
4.6
1.7
8.6
4.9
2.3
2.6
2.9
2
1.3
0.9
4.5
6.9
2.3
30.5
1.5
3.8
13.9
1.4
2.1
33.2
5.1
60.9
0
2.5
5.5
3.2
11.2
7.2
3.9
4.6
4.8
3.2
1.8
1.2
6.7
10.9
4.6
48.9
1.2
5
9.5
0.8
2
16.6
4.8
39.9
Other states EAG states India group group (864 million) (463 million) (599 million)
Percent of DALYs, 1990
Table 5 Contribution of disease categories to DALYs in the state groups, 1990 and 2016
0
3.1
4.7
2.7
10.5
6.7
4.1
5.2
5.4
3.4
2.3
2.8
5.5
11.5
5.6
52.5
2.2
4.5
9.1
0.9
1.9
13.8
4.7
37
0
3.8
5.4
3.5
12.7
7.7
5.4
6.7
6.4
4.1
1.2
1.8
6.1
17.7
5.4
62.4
0.9
4.2
6.2
0.4
1.1
8.6
3.6
24.9
0
3.1
5.4
3.3
11.9
7.4
4.6
5.6
5.6
3.6
1.5
1.6
6.4
14.1
5
55.4
1.1
4.6
7.9
0.6
1.5
12.7
4.2
32.7
Other states India group (1,316 million) (665 million)
Percent of DALYs, 2016 North-East states group (52 million)
The proportion of DALYs due to CMNNDs dropped substantially in all three state groups between 1990 and 2016, making up 25% to 40% of the total DALYs in 2016. There were large declines in the proportion of health loss from diarrhoea, lower respiratory infections, and other common infections, and from neonatal disorders. These proportions, however, continued to be higher in the EAG and North-East states groups than in the Other states group. Conversely, the proportion of DALYs due to NCDs increased substantially in all three state groups during this period to 49%-62% of the total DALYs in 2016. This proportion continued to be highest in the Other states group for most of the NCD categories. The proportion of DALYs due to injuries also increased in all three state groups, contributing to 11%-13% of the total DALYs in 2016. For India as whole, the disease categories that were responsible for more than 5% of the total DALYs in 2016 included cardiovascular diseases; diarrhoea, lower respiratory infections, and other common infectious diseases; neonatal disorders; chronic respiratory diseases; diabetes, urogenital and endocrine diseases; mental and substance abuse disorders; unintentional injuries; and cancers.
India: Health of the Nation’s States
47
Figure 10 Change in DALYs number and rate for the leading individual causes in India from 1990 to 2016 Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
Leading causes 1990
Diarrhoeal diseases [12.4%] Lower respiratory infect [9.8%] Preterm birth complications [5.5%] Tuberculosis [5.0%] Measles [4.2%] Ischaemic heart disease [3.7%] Other neonatal disorders [3.6%] COPD † [3.1%] Neonatal encephalopathy [3.0%] Iron-deficiency anemia [2.1%] Congenital defects [2.0%] Stroke [2.0%] Tetanus [1.8%] Self-harm§ [1.7%] Intestinal infectious diseases [1.6%] Road injuries [1.5%] Sense organ diseases ‡ [1.3%] Meningitis [1.3%] Asthma [1.3%] Low back & neck pain [1.2%] Falls [1.1%] Protein-energy malnutrition [1.1%] Skin diseases [1.1%] Migraine [1.1%] Malaria [1.1%] Drowning [1.0%] Neonatal haemolytic [0.9%] Neonatal sepsis [0.9%] Depressive disorders [0.9%] Chronic kidney disease [0.8%] Other musculoskeletal [0.8%] Diabetes [0.7%] Rheumatic heart disease [0.7%] Anxiety disorders [0.5%] HIV/AIDS [0.1%]
Injuries
Leading causes 2016 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
102
*Change
not significant The percent figure in bracket next to each cause is DALYs from that cause out of the total DALYs.
109 †
In contrast, the CMNNDs that led the rankings in 1990 have seen notable declines. Diarrhoeal disease and lower respiratory infections, which were India’s top two individual causes of DALYs in 1990, dropped to third and fourth place in 2016. Other conditions, such as preterm birth complications, tuberculosis, and vaccine-preventable diseases like measles, also saw a drop
India: Health of the Nation’s States
104.1% 36.3% -67.7% -61.5% 52.9% 41.8% -46.3% -44.5% 85.3% 65.1% 29.8% 66.1% 174.2% -49.7% 69.1% 55.0% 41.3% -20.9%* 79.7% 71.0% 65.1% -56.1% -15.1%* -37.1% 1,004.6% 61.9% -46.7% 2.5%* -42.3% -36.0%
COPD is chronic obstructive pulmonary disease. Sense organ diseases includes mainly hearing and vision loss. Self-harm refers to suicide and the nonfatal outcomes of self-harm.
When looking at the leading individual causes of DALYs in India, most NCDs have risen in rank since 1990. Ischaemic heart disease and COPD were the top two causes of DALYs in 2016, up from sixth and eighth place, respectively, in 1990. Diabetes showed a particularly dramatic increase, from 35th place to 13th. The number of DALYs caused by ischaemic heart disease rose by 104% over this period and those caused by diabetes a striking 174%. Large increases in DALYs are evident for the majority of non-communicable conditions, including sense organ diseases, low back and neck pain, and depressive disorders. Injuries have seen similar rises in their relative ranking, with road injuries the 10th leading individual cause of health loss in 2016, followed by self-harm in 11th place. Road injuries caused 65% more DALYs in 2016 than they did in 1990. These trends are indicative not just of a population that is increasing in age and therefore living long enough to develop and suffer from chronic diseases, but also of the impact of lifestyle changes that come with a rapidly industrialising, urbanising society – from changes in diet and activity levels to more traffic on the roads.
48
Mean % change number of DALYs 1990-2016
Ischaemic heart disease [8.7%] COPD [4.8%] Diarrhoeal diseases [4.6%] Lower respiratory infect [4.3%] Stroke [3.5%] Iron-deficiency anemia [3.5%] Preterm birth complications [3.4%] Tuberculosis [3.2%] Sense organ diseases ‡ [2.9%] Road injuries [2.9%] Self-harm§ [2.5%] Low back & neck pain [2.3%] Diabetes [2.2%] Other neonatal disorders [2.1%] Migraine [2.1%] Skin diseases [1.9%] Falls [1.8%] Congenital defects [1.8%] Other musculoskeletal [1.6%] Chronic kidney disease [1.6%] Depressive disorders [1.6%] Neonatal encephalopathy [1.5%] Asthma [1.3%] Intestinal infectious diseases [1.2%] HIV/AIDS [1.1%] Anxiety disorders [0.9%] Meningitis [0.8%] Rheumatic heart disease [0.8%] Protein-energy malnutrition [0.7%] Drowning [0.7%] Malaria [0.7%] Neonatal sepsis [0.6%] Measles [0.4%] Neonatal haemolytic [0.3%] Tetanus [0.1%]
‡ §
same or increase
decrease Mean % change DALY rate 1990-2016
33.9% -10.5%* -78.8% -74.7% 0.4%* -6.9% -64.8% -63.5% 21.7% 8.3% -14.8%* 9.0% 80.0% -67.0% 11.0% 1.7%* -7.2%* -48.1% 18.0% 12.2% 8.4% -71.2% -44.3% -58.7% 625.0% 6.2% -65.0% -32.7% -62.1% -58.0%
in rank. The number of DALYs caused by diarrhoeal diseases fell by 68% over this period, while preterm birth complications caused 46% less DALYs in 2016 than in 1990. This represents India’s significant achievement in ensuring more children survive and thrive during their first weeks, months, and years of life. However, there is a striking outlier to this progress: Iron-deficiency anaemia showed an increase in both rank and health loss caused, suggesting a need for renewed policy attention to this cause.
India: Health of the Nation’s States
49
Figure 11 Comparison of the leading individual causes of DALYs across the state groups, 2016 Leading causes North-East states
Leading causes Other states
Rank
Leading causes EAG states
1
Ischaemic heart disease [6.3%]
Diarrhoeal diseases [5.3%]
Ischaemic heart disease [11.5%]
2
Diarrhoeal diseases [6.2%]
Stroke [5.3%]
COPD* [4.6%]
3
Lower respiratory infect [5.8%]
Lower respiratory infect [5.0%]
Stroke [4.1%]
4
COPD* [5.0%]
Ischaemic heart disease [4.3%]
Iron-deficiency anaemia [3.4%]
5
Tuberculosis [3.9%]
COPD* [4.0%]
Sense organ diseases† [3.3%]
6
Neonatal preterm birth [3.7%]
Neonatal preterm birth [3.7%]
Self-harmº [3.2%]
7
Iron-deficiency anaemia [3.6%]
Tuberculosis [3.5%]
Road injuries [3.0%]
8
Other neonatal [2.9%]
Iron-deficiency anaemia [3.5%]
Neonatal preterm birth [3.0%]
9
Stroke [2.8%]
Sense organ diseases† [2.5%]
Diarrhoeal [3.0%]
10
Road injuries [2.7%]
Road injuries [2.4%]
Diabetes [2.8%]
11
Sense organ diseases† [2.6%]
Self-harmº [2.3%]
Lower respiratory infect [2.8%]
12
Congenital defects [2.1%]
Other neonatal [2.2%]
Low back & neck pain [2.7%]
13
Low back & neck pain [1.9%]
Diabetes [2.0%]
Tuberculosis [2.4%]
14
Skin diseases [1.8%]
Migraine [2.0%]
Migraine [2.3%]
15
Self-harmº [1.8%]
Neonatal encephalopathy [1.9%]
Chronic kidney disease [2.1%]
16
Migraine [1.8%]
Low back & neck pain [1.9%]
Falls [2.0%]
17
Falls [1.7%]
Skin diseases [1.9%]
Skin diseases [2.0%]
18
Diabetes [1.7%]
Hepatitis [1.8%]
Depressive disorders [2.0%]
19
Neonatal encephalopathy [1.7%] ] Chronic kidney disease [1.6%]
Other musculoskeletal [1.9%]
20
Intestinal infectious [1.6%]
Other musculoskeletal [1.6%]
Congenital defects [1.5%]
21
Other musculoskeletal [1.4%]
Congenital defects [1.6%]
Neonatal encephalopathy [1.3%]
22
Asthma [1.4%]
Depressive disorders [1.5%]
HIV/AIDS [1.2%]
23
Depressive disorders [1.3%]
Malaria [1.3%]
Other neonatal [1.2%]
24
Chronic kidney disease [1.2%]
Falls [1.2%]
Asthma [1.1%]
25
Protein-energy malnutrition [1.0%] Asthma [1.2%]
Anxiety disorders [1.0%]
26
Malaria [1.0%]
HIV/AIDS [1.1%]
Oral disorders [0.8%]
27
Meningitis [0.9%]
Drowning [1.1%]
Rheumatic heart disease [0.8%]
28
HIV/AIDS [0.9%]
Intestinal infectious [1.0%]
Intestinal infectious [0.7%]
29
Animal contact [0.9%]
Cirrhosis hepatitis B [0.9%]
Meningitis [0.7%]
30
Rheumatic heart disease [0.9%]
Anxiety disorders [0.9%]
Hypertensive heart disease [0.7%]
Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
Injuries
*COPD is chronic obstructive pulmonary disease. †
Sense organ diseases includes mainly hearing and vision loss.
ºSelf-harm refers to suicide and the nonfatal outcomes of self-harm.
The percent figure in bracket next to each cause is DALYs from that cause out of the total DALYs.
However, these trends have not been uniform throughout the country. The relative rankings of causes of disease burden vary markedly among the three state groups. CMNND causes have not been superseded by NCD causes to the same extent everywhere in India, and generally ranked much higher in the EAG and North-East states groups than they did in the Other states group. Diarrhoeal diseases remained the leading cause of health loss in the North-East states group and second in the EAG states group, with lower respiratory infections in third place for both of these groups. In contrast, these conditions were in ninth and eleventh place in the Other states group. Moreover, the proportion of health loss caused by CMNNDs tended to be greater in the EAG and North-East states groups than in the Other states group, with the heaviest burden in the EAG states group. Alongside variations between state groups, decision-makers should also be aware of differences in the causes of health loss among females and males.
50
India: Health of the Nation’s States
Rheumatic heart disease [1.0%]* Protein-energy malnutrition [0.9%]
Malaria [0.9%]* Meningitis [0.8%] HIV/AIDS [0.8%] Encephalitis [0.7%]*
23 24 25 26 27 28 30 31 32 34
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
34
35
36
40
Other neonatal disorders [3.2%]
Ischaemic heart disease [2.9%]
Iron-deficiency anemia [2.8%]
COPD † [2.7%]
Neonatal encephalopathy [2.5%]
Congenital defects [1.9%]
Stroke [1.9%]
Self-harm§ [1.8%]
Intestinal infectious diseases [1.6%]
Tetanus [1.6%]
Low back & neck pain [1.4%]
Sense organ diseases ‡ [1.4%]
Meningitis [1.4%]
Migraine [1.3%]
Protein-energy malnutrition [1.3%]
Asthma [1.3%]
Malaria [1.2%]
Skin diseases [1.2%]
Falls [1.1%]
Maternal hemorrhage [1.0%]
Depressive disorders [1.0%]
Whooping cough [0.9%]
Neonatal sepsis [0.9%]
Other musculoskeletal [0.8%]
Encephalitis [0.8%]
Rheumatic heart disease [0.8%]
Road injuries [0.7%]
Chronic kidney disease [0.7%]
Diabetes [0.7%]
Anxiety disorders [0.6%]
Gynecological diseases [0.4%]
Lower respiratory infect [4.7%]
4
4
Measles [4.2%]
Tuberculosis [4.1%]
3
Preterm birth complications [6.0%]
Iron-deficiency anemia [4.9%]
3
3
2
Preterm birth complications [4.9%]
1
24 25 26 27 28 29 30 31 33 34 36
Chronic kidney disease [1.0%] Low back & neck pain [0.9%] Malaria [0.9%] Neonatal sepsis [0.9%] Animal contact [0.8%] Hepatitis [0.8%] Migraine [0.8%] Other musculoskeletal [0.7%] Diabetes [0.7%] Depressive disorders [0.7%]
Gynecological diseases [0.9%] Breast cancer [0.9%]
India: Health of the Nation’s States
*Change not significant. The percent figure in bracket next to each cause is DALYs from that cause out of the total DALYs.
51 COPD is chronic obstructive pulmonary disease. Sense organ diseases includes mainly hearing and vision loss. § Self-harm refers to suicide and the nonfatal outcomes of self-harm. ‡
†
Tetanus [0.1%]
100
90
HIV/AIDS [0.1%]
111
112
HIV/AIDS [0.0%]
62 48
Cirrhosis hepatitis B [0.4%]
Whooping cough [0.2%]*
81
52
Breast cancer [0.3%]
61
42
Alcohol use disorders [0.5%]
Measles [0.4%]
54
45
Tetanus [0.1%]
Measles [0.3%]
Neonatal hemolytic [0.3%]
Neonatal sepsis [0.6%]
Malaria [0.6%]*
Protein-energy malnutrition [0.6%] 47
Hepatitis [0.7%] 37
Animal contact [0.8%]*
Cirrhosis hepatitis B [0.8%]
Meningitis [0.8%]
Interpersonal violence [0.8%]
Alcohol use disorders [0.9%]
Drowning [0.9%]
Asthma [1.2%]*
Intestinal infectious diseases [1.2%]
HIV/AIDS [1.3%]
Depressive disorders [1.3%]
Other musculoskeletal [1.4%]
Migraine [1.5%]
Neonatal encephalopathy [1.6%]
Congenital defects [1.6%]*
Skin diseases [1.7%]
Chronic kidney disease [1.8%]
Falls [1.9%]
Low back & neck pain [1.9%]
Other neonatal disorders [2.0%]
Iron-deficiency anemia [2.2%]
Diabetes [2.3%]
Sense organ diseases ‡ [2.6%]
Self-harm§ [2.6%]
Preterm birth complications [3.5%]
Stroke [3.6%]
Tuberculosis [3.8%]
Diarrhoeal diseases [3.9%]
Lower respiratory infect [4.0%]
Road injuries [4.3%]
COPD † [5.2%]
Ischaemic heart disease [10.4%]
Leading causes 2016
33
31
30
29
28
27
26
25
24
23
22
21
20
19
18
17
16
15
14
13
12
11
10
9
8
7
6
5
4
3
2
1
48
Males
39
Interpersonal violence [0.6%]
Maternal hemorrhage [0.5%]
Neonatal sepsis [0.7%]*
Anxiety disorders [1.1%]
Intestinal infectious diseases [1.1%]
Protein-energy malnutrition [1.0%]
22
Neonatal hemolytic [1.1%]
23
21
20
Drowning [1.3%] Falls [1.2%]
19
18
Meningitis [1.3%] Sense organ diseases ‡ [1.3%]
17
Asthma [1.4%]
Skin diseases [1.0%]
Road injuries [1.2%]
Asthma [1.4%]*
Neonatal encephalopathy [1.4%]
Chronic kidney disease [1.4%]
Falls [1.8%]
Other musculoskeletal [1.9%]
Depressive disorders [2.0%]
Congenital defects [2.1%]*
Other neonatal disorders [2.1%]
Skin diseases [2.1%]
Diabetes [2.2%]
16
12
Stroke [2.1%]
Self-harm§ [2.4%]*
Iron-deficiency anemia [1.5%]
11
Congenital defects [2.1%]
Tuberculosis [2.5%]
15
10
Road injuries [2.2%]
Low back & neck pain [2.7%]
Self-harm§ [1.6%]
9
Neonatal encephalopathy [3.4%]
Migraine [2.7%]
14
8
COPD † [3.4%]
Sense organ diseases ‡ [3.2%]
Intestinal infectious diseases [1.7%]
7
Other neonatal disorders [4.0%]
13
6
Measles [4.2%]
Stroke [3.4%]
Tetanus [2.0%]
5
Preterm birth complications [3.2%]
4
Tuberculosis [5.8%] Ischaemic heart disease [4.4%]
COPD † [4.4%]
48
35
29
22
21
20
19
18
17
16
15
14
13
12
11
10
9
8
7
6
5
Leading causes 1990
decrease
Diarrhoeal diseases [10.1%]
same or increase
Lower respiratory infect [9.4%]
Diarrhoeal diseases [5.5%]
Ischaemic heart disease [6.6%]
2
2
1
1
Leading causes 2016
Injuries
Diarrhoeal diseases [14.8%]
Females
Non-communicable diseases
Lower respiratory infect [10.3%]
Leading causes 1990
Communicable, maternal, neonatal, and nutritional diseases
Change in number of DALYs and percent change in rate for the leading individual causes from 1990 to 2016 among males and females, India Figure 12 Change in DALYs number for the leading individual causes by sex in India from 1990 to 2016
While ischaemic heart disease was the leading individual cause of DALYs for both sexes combined in 2016, for males this was followed by COPD and road injuries, with both conditions seeing rapid increases in ranking since 1990. For females, diarrhoeal diseases and iron-deficiency anaemia were in second and third place, with anaemia climbing from eighth place over this period. This shows that females continue to suffer a higher burden from CMNNDs, while several leading NCDs and injuries cause a higher burden among males. This is also evident when looking at the proportion of health loss caused by each condition. Anaemia, for example, caused 4.9% of DALYs among females in 2016 as compared with 2.2% among males, and the proportion of DALYs from diarrhoea and lower respiratory infections was responsible for a larger percent of DALYs among females. A notable exception to this trend is tuberculosis, which ranks as the sixth leading cause of DALYs for males and 11th for females, and also causes substantially more health loss for males than females. On the other hand, ischaemic heart disease caused 10.4% of DALYs among males and 6.6% among females in 2016 despite being the leading cause for both. Different disease profiles are associated with different age groups, and so looking at the age structure of India’s disease burden illuminates patterns that are of utility to policymakers as they seek to target interventions.
52
India: Health of the Nation’s States
Figure 13 Percent of DALYs by age in the state groups, 2016 EAG states 25 [2.26]
Percent of total DALYs
20
15
10
5
[0.55]
[0.45]
[0.33]
[0.79]
[0.67]
[0.6]
[2.13]
[1.68]
[1.35]
[1.11]
[0.9]
[2.64] [3.26]
[0.32]
[3.51] [4.35] [4.11]
%) .3
%)
80
to
85
+
(0
.5
%) 84
(0
.9
%) to
79
(0
.4
%) 74
(1
.1
%) 69 to
to
75
[1.79]
70
[1.45]
(2
.1
%) to
64
(3
.6
%)
(3 to
59
(4
.2
%) [1.16]
65
[0.94]
60
[0.82]
55
[0.69]
50
[0.62]
to
54
(4
.8
%) 45
to
49
(5
.7
%) 40
to
44
(6
.5
%) 39
(7 35
to 30
25
to
34
29 to
24 to 20
.5
%)
.8 (8
(1 19
to 15
(8
%)
1%
)
0.
1% (1 14
to 10
5t
Un de r
o9
5(
(1
10
1.
.2
3%
%)
)
)
0
North-East states 25
[2.31]
Percent of total DALYs
20
15
10
[0.57]
[0.47]
5 [0.33]
[2.21] [2.82]
[3.32]
[0.32]
[3.58]
[4.46] [5.7]
%)
%)
to
85
+
(0
(0
.2
.5
%) 84
(0
.9
%) 79
(1
.2
%)
to
80
[2.12]
75
[1.69]
70
[1.35]
to
74
(1
.7
%) 65
to
69
(2
.6
%) 64 to
to
59
(3
.5
%) (4
.5
%) 54
60
[0.92]
55
[0.8]
50
45
[0.6]
[0.68]
to
49
(5
.4
%)
40
to
44
(6
.2
%) (7
35
to
39
(8
30
to
34
(9 to
29 to 25
.3
%) .3
%) .4
%) .4
to
15
20
to
24
(9 19
(9
.8
%)
) 2% 0. (1
14 to 10
Un
5t
de
o9
r5
(1
(8
0.
.5
4%
)
%)
0
Other states 25
15 [1.68] 10
[0.55]
5
[1.11]
[2.59] [3.19] [3.53]
[0.46]
[4.46]
[0.31]
[0.3]
[4.37]
%) .4 (0
(0
.6
%) + 85
%) 80
to
84
(1
.2
%) 75
to
79
(1
.7
%) 70
to
74
(2
.6
%) 65
to
69
(3
.6
%) 64 to 60
59
(4
.6
%) to 55
54
(5
.5
%) to 50
49
(6
.1
%) to 45
44
(6
.8
%) to 40
39
(7
.6
%) to 35
30
to
34
(8
.5
%) (9
.2
%) 25
to
29
(9
.3
%) 20
to
24
(8
.8
%) 15
to
19
(8
.4
%) (8
14 to 10
o9 5t
de
r5
(7
%)
0
Un
Percent of total DALYs
20
Age Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
Injuries
The number in the bracket on top of each vertical bar is the ratio of percent DALYs to population for that age group. The number in parentheses after each age group on the x-axis is the percent of population in that age group.
India: Health of the Nation’s States
53
There are different patterns of health loss across the lifespan. Age groups under-5 and 45 plus years suffered a higher proportion of the total DALY burden as compared with their proportion in the population across all three state groups of India in 2016, as shown by the ratios in the figure. However, the relative magnitude of the disease burden across the age groups differs between the state groups. While the under-5 age group had the highest proportion of DALYs in all state groups, this ranged between 23% of the total DALYs in the EAG states group, 19% in the North-East states group, and 12% in the Other states group. On the other hand, the proportion of DALYs in the middle and older age groups was highest in the Other states group. CMNNDs were responsible for the vast majority of the DALYs proportion among children under 5, which reduced with increasing age up to the middle ages, followed by a modest increasing trend in the older age groups. For India as a whole, the proportion of DALYs due to NCDs was more than half of the total starting with the 30-34 year age group, increasing to 79% in the 65-69 year age group. The proportion of total DALYs due to injuries was highest in the 15-39 year age groups, ranging from 18% to 28%. It is necessary to assess patterns of health loss across each state of India in order to inform health policy and interventions that address the specific situation of each state.
54
India: Health of the Nation’s States
India: Health of the Nation’s States
55
rculos is
Iro n -d e ficien c y an emia Prete r m b irth co mplic ations
1766 1177 2978 1555 2259 1246 2343 2570 1490 2706 2313 2402 2380 2240
Odisha
Rajasthan
Uttar Pradesh 793
1008 1056 1284
791
1218
960
1526 1568 1021 1364 1159 1488
Manipur 463
954 827
893
746
719
663
947
808
1004
763
885
758
959
1257
830
654
657
629
1547
254
335
819
883
859
429
824
840
797
713
811
689
763
671
762
678
658
677
699
1228 1390 1453
994
927
927 867
867 830
830
3257 1442 1391 4023 1585 1292 3256 1976 3892 1726 1228 3203 1377 3658 1638 2321
Andhra Pradesh
Jammu and Kashmir
Karnataka
West Bengal
Maharashtra
Union Territories other than Delhi 443
2463 2176 5758 1335 2933 1089 4788 1246 3309 1187
Himachal Pradesh
Punjab
Goa
Tamil Nadu
Kerala 438
920
402
881
749
4487 1292 781
818
927
993
821
925
1293
380
714
614
887
825
671
608
937
900
950
953
814
515
1199
645
1093
813
987
990
548
727
542
650
710
665
876
930
826
1473 1113
403
796
890
1071
1067
1123
950
862
916
857
950
1614
899
920
1207
1522
464
1065 1066 1246
1068
834
951
825
892
871
876
779
878
877
722
805
736
228
754
351
656
673
912 758
559
481
630
1273
706
928
1184 1121 1435
1098
1082 1425
1103
784
788
600
1202
586
841
733
869
817
807
729
729
930
947
549
734
440
513
527
681
787
468
762
740
795
795
651
443
730
741
632
776
611
225
414
420
451
489
320
286
696
748
412
669
669
406
324
494
574
263
622
531
457
955
430
913
791
619
619
1144
1159
780
1212
801
1109
1150
Significantly higher than national mean
Indistinguishable from national mean
512
1628
1090
1314
807
790
794
768
777
653
655
660
672
675
659
682
679
685
670
670
655
660
691
693
675
671
671
672
678
677
672
728
689
713
689
698
714
699
697
747
747
714
687
710
700
686
712
661
696
697
684
Falls 624
921
718
588
807
775
773
687
498
689
528
753
723
519
582
640
700
700
675
320
684
387
458
547
469
421
473
433
470
457
698
698
721
506
810
601
538
646
576
645
644
652
454
474
385
457
389
461
468
448
395
696
513
572
473
438
511
494
705
705
508
341
364
490
325
492
469
418
642
523
633
575
554
554
841
524
488
707
571
515
1205
787
788
638
658
638
632
636
607
641
563
680
624
618
556
615
598
580
580
631
587
587
627
582
517
600
514
554
502
562
590
506
583
578
569
569
523
544
612
551
526
576
509
537
537
584
679
857
613
505
593
729
633
734
570
619
490
790
786
475
703
666
536
536
669
610
500
513
503
467
608
539
571
581
572
563
505
505
462
474
739
496
486
468
424
486
485
581
138
348
230
368
377
301
363
369
309
614
302
559
439
451
432
425
661
661
421
366
311
455
350
476
448
410
824
646
809
702
462
462
592
528
689
428
607
660
972
641
641
532
284
296
249
293
442
299
228
376
376
445
403
434
381
192
485
385
444
444
375
240
303
518
257
383
251
357
493
284
476
444
552
552
665
679
329
448
343
339
423
531
533
450
Self-harm refers to suicide and the nonfatal outcomes of self-harm.
†
858
1026
613
850
515
922
708
679
715
677
683
580
492
536
584
652
537
537
699
632
444
644
438
473
412
555
625
437
610
595
517
517
402
359
792
441
492
537
446
453
453
583
Co n g e nital b irth d efects O th e r disordmusculosk eletal ers C h r o n ic kid ney d isease Depre ssive disord ers
*DALY rate per 100,000 population
87
165
297
422
391
789
774
763
774
785
728
768
769
763
734
769
744
744
770
752
707
748
723
733
699
736
727
693
724
727
734
734
682
710
739
707
680
731
659
638 1098 692
1039 1094
949
976
902
915
733
643 1098 692
792
Other n e o n atal d isorde rs
598 1181 1066 1075 960 1377 209
691
808
669
746
583
611
585
850
1157
Significantly lower than national mean
1153
938
1058
979
656
986
629
1341 1077 1044
894
1349 1106 1210
906
1214 1294 1150
1051 1055 1142
561
814
1074 2821 1157
777
1268
951
780
799
Telangana
485
2569
921
4244 2091 1109 1311
3514 1530 1048 932 1606 1114 1040 714 1060 943 1105 869
3736 1694
1125
712
816
722
903
717
863
911
579
884
879
1481
781 1076 992 1061 883
1024
644
545
762
639
888
902
923
769
3736 1694 959 1257 830 1228 1390 1453 994
Delhi
Highest ETL group
488
537
922 1352 1104 986
1527
Haryana
Higher-middle ETL group
Gujarat
606
3790 1516 981
961
993
933
1023
Sikkim
1087
678
887
2330 1676 1464 1847 2259 1197 1411
526
455
739
Tripura
648
1306
1167
919
1204 1210
Nagaland
786
663
Mizoram 1624
957
Arunachal Pradesh
Lower-middle ETL group
1255
1614 1208 1158 1422 1447 820 1049 745
1344 1500
1638 1653 2309 2018 2229 1472 1534 1531
767
1583 1582 2231 1976 2113 1451 1487 1508 911
Assam
Other states
996
1592 1482 1944 1828 1935 1282 1370 1304 908 957
Lower-middle ETL group
788
614
847
764
814
1170
1171
765
903
720
797
695
2773 2410 1059 1962
955
970
913
997
467
999
369
814
1319 1458 1991
1397 1640 1400
1382 1082
985
1018
920
773
729
729
806
2773 2410 1059 1962 793 1008 1056 1284 996 1481 654
734
775
989
Meghalaya
Lowest ETL group
North-East states
Uttarakhand
Lower-middle ETL group
2883 1599 1835 2090 1293 1335 1582 1294
925
Madhya Pradesh
1471 1147 1322
2313 1146 3420 1577
Jharkhand 932
2347 1219 2193 1933 2142 1196 1624 1362 1086
947
Chhattisgarh
871
2431 1452 2827 2378 1032 1610 1287
Bihar
2376 1917 2354 2182 1061 1376 1411 1487 975 1030 692
2382 1923 2351 2195 1061 1376 1413 1493 974 1040 692
Lowest ETL group
3062 1700 1642 1537 1243 1235 1195 1126 1023 1009 884
in ck pa k & ne Low b ac
ons Isch a e m ic hea rt dise Chron a se pulmoic obstruc nary d tive isease Diarrh oeal d isease s Low e r r e spirato ry infe cti
e
Strok
s Diabe te
thy alopa
Neon atal e
nceph Asthm a
isease s rgan d Sense o
India
Self-h arm †
EAG States
Tube
injurie s Road
ine
Migra
e a se s Skin d is
14
183
21
434
256
193
147
242
139
167
147
354
292
423
522
228
306
306
241
400
398
185
527
780
249
365
371
637
393
385
620
620
720
846
338
714
357
523
402
612
616
270
271
414
376
332
296
372
387
433
471
167
570
706
238
317
449
459
459
410
1010
213
291
793
609
592
603
365
193
351
418
413
413
188
288
625
381
432
406
432
331
332
420
314
271
298
331
337
326
326
341
325
315
325
326
322
315
329
290
290
326
415
303
319
313
312
303
337
311
301
310
318
317
317
292
328
316
243
321
250
290
292
292
310
HIV/A IDS
375
Intesti nal in fe c tious disea ses 417
disord ers Anxie ty
Figure 14 DALY rates of the leading individual causes in the states of India, 2016*
133
196
114
220
163
183
245
218
215
267
215
236
202
233
292
227
328
328
230
178
214
201
181
261
232
201
249
299
253
239
369
369
447
326
236
358
256
246
311
355
358
288
161
229
99
237
179
210
244
222
290
295
238
292
243
247
246
263
254
254
249
232
158
310
188
91
150
226
355
207
343
312
266
266
313
261
380
320
296
351
385
325
326
286
Rh
gitis
Menin
isease 80
125
130
118
69
110
78
184
157
217
122
136
148
159
309
169
243
243
169
68
141
198
82
112
197
137
257
223
254
223
309
309
449
344
241
415
315
396
292
371
374
265
euma tic h
eart d Prote
167
218
192
140
118
185
166
243
307
257
204
218
173
95
207
242
236
236
227
272
150
239
243
162
247
237
486
174
461
401
280
280
210
313
263
354
391
330
345
286
288
262
in-ene rgy
malnu trition g Drow nin
56
India: Health of the Nation’s States
Kerala
Goa
Gujarat
Punjab
Odisha
Jharkhand
Bihar
Andhra Pradesh
Chhattisgarh
Telangana
Tamil Nadu
Karnataka
Delhi
Himachal Pradesh
Uttar Pradesh
Madhya Pradesh
Maharashtra
Rajasthan
Haryana
Uttarakhand
Jammu and Kashmir
Diarrhoeal diseases
West Bengal
Sikkim
Meghalaya
Tripura
Assam
Odisha
Jharkhand
Bihar
750−999 1000−1249 1250−1499 1500−1749 1750−1999 2000−2499 2500 or more
1200−1599 1600−1999 2000−2399 2400−2799 2800−3199 3200 or more
Mizoram
Manipur
Nagaland
800−1199
Meghalaya
Tripura
Assam
Less than 750
West Bengal
Sikkim
Arunachal Pradesh
Less than 800
Andhra Pradesh
Chhattisgarh
Telangana
Tamil Nadu
Karnataka
Delhi
Uttar Pradesh
Madhya Pradesh
Maharashtra
Rajasthan
Haryana
Uttarakhand
Himachal Pradesh
DALYs per 100,000
Kerala
Goa
Gujarat
Punjab
DALYs per 100,000
Mizoram
Manipur
Nagaland
Arunachal Pradesh
Jammu and Kashmir
Lower respiratory infections
Figure 15 DALY rates due to diarrhoeal diseases and lower respiratory infections in the states of India, 2016
Kerala
Goa
Gujarat
Punjab
Odisha
Jharkhand
Bihar
Andhra Pradesh
Chhattisgarh
Telangana
Tamil Nadu
Karnataka
Delhi
Himachal Pradesh
Uttar Pradesh
Madhya Pradesh
Maharashtra
Rajasthan
Haryana
Uttarakhand
Jammu and Kashmir
Ischaemic heart disease
West Bengal
Sikkim
Meghalaya
Tripura
Assam
Odisha
Jharkhand
Bihar
1250−1499 1500−1749 1750−1999 2000−2249 2250 or more
2500−2999 3000−3499 3500−3999 4000 or more
DALYs per 100,000
Mizoram
Manipur
Nagaland
2000−2499
Meghalaya
Tripura
Assam
1000−1249
West Bengal
Sikkim
Arunachal Pradesh
1500−1999
Andhra Pradesh
Chhattisgarh
Telangana
Tamil Nadu
Karnataka
Delhi
Uttar Pradesh
Madhya Pradesh
Maharashtra
Rajasthan
Haryana
Uttarakhand
Himachal Pradesh
Less than 1000
Kerala
Goa
Gujarat
Punjab
Less than 1500
DALYs per 100,000
Mizoram
Manipur
Nagaland
Arunachal Pradesh
Jammu and Kashmir
Chronic obstructive pulmonary disease
Figure 16 DALY rates due to ischaemic heart disease and chronic obstructive pulmonary disease in the states of India, 2016
India: Health of the Nation’s States
57
Figure 17 DALY rate due to road injuries in the states of India, 2016
Jammu and Kashmir
Himachal Pradesh
Punjab Uttarakhand Haryana Rajasthan
Arunachal Pradesh Delhi
Sikkim
Uttar Pradesh
Assam
Bihar
Gujarat
Jharkhand
Madhya Pradesh
DALYs per 100,000
Manipur
Less than 600
Mizoram
600–749 750–899
Chhattisgarh
Tripura
Odisha
Meghalaya
Maharashtra
900–1049 1050–1199
West Bengal
Telangana Goa Karnataka
Tamil Nadu Kerala
58
Nagaland
India: Health of the Nation’s States
Andhra Pradesh
1200 or more
India
pain
Other n
Diabe te
s
eonata
l
neck ack & Low b
Self-h arm †
s injurie Road
Tube
Sense
organ
rculos is
disea
ses
comp licatio ns
c y an ficien Iron-d e
e Strok
Prete rm bir th
emia
fectio tory in Lowe r
respir a
ases Diarrh oeal d ise
Ischae mic h eart d isease Chron ic obs tr pulmo u nary d ctive isease
ns
Figure 18 Ratio of observed to expected DALY rate for the leading individual causes in the states of India, 2016
1.22
2.28
2.47
0.90
0.74
3.00
0.87
3.61
1.30
0.69
1.78
0.83
0.95
2.41
Bihar
1.12
1.87
0.91
0.49
0.60
2.19
0.51
0.91
1.26
0.49
0.83
0.89
0.81
1.67
Chhattisgarh
0.96
1.61
2.41
0.94
1.26
2.59
1.04
3.52
1.39
0.61
2.08
0.86
0.93
3.14
Jharkhand
0.98
1.49
2.56
0.59
0.54
2.75
0.63
2.56
1.19
0.66
1.00
0.83
0.76
1.86
Madhya Pradesh
1.21
2.09
1.44
0.81
0.76
2.54
0.89
2.61
1.27
0.65
1.93
0.87
0.89
2.90
Odisha
0.73
1.55
2.75
0.68
1.33
2.53
0.59
3.15
1.39
0.60
1.61
0.94
0.87
2.03
Rajasthan
0.99
3.35
1.17
1.05
0.45
2.66
0.92
2.82
1.25
0.76
1.32
0.75
0.53
2.77
Uttar Pradesh
0.99
3.11
1.54
0.74
0.43
2.32
0.75
3.43
1.24
0.75
1.72
0.84
0.79
2.44
Uttarakhand
1.04
3.37
3.00
1.77
0.49
3.19
1.04
6.82
1.25
1.10
1.22
0.75
0.99
2.81
Meghalaya
0.38
1.03
2.02
0.88
0.47
2.96
0.70
4.03
0.97
0.40
0.87
0.68
0.56
1.41
Assam
0.67
2.19
2.54
0.98
1.32
3.19
0.99
3.96
1.18
0.61
1.78
0.73
0.94
2.71
Arunachal Pradesh
0.38
1.06
1.92
0.74
0.44
2.21
0.76
2.98
0.96
0.49
1.64
0.69
0.63
1.79
Mizoram
0.25
2.25
2.33
1.09
0.28
2.04
0.86
3.09
1.11
0.66
0.63
0.72
0.63
2.65
Nagaland
0.43
0.92
1.83
1.14
0.62
1.89
0.82
4.90
0.96
0.56
0.46
0.61
0.56
1.35
Tripura
0.94
2.24
1.94
1.01
1.34
2.78
0.98
1.60
1.28
0.55
3.16
0.85
0.88
1.77
Sikkim
0.58
1.33
1.53
1.28
0.30
2.87
0.83
3.11
1.02
0.52
1.19
0.67
0.68
2.11
Manipur
0.61
1.39
2.76
0.83
0.90
1.27
0.69
4.12
1.20
0.80
1.28
0.78
1.15
1.23
Gujarat
1.45
2.32
2.05
0.93
0.50
3.44
1.18
6.11
1.25
0.66
1.68
0.81
0.89
2.61
Haryana
1.57
2.97
3.67
1.33
0.50
4.43
1.02
7.09
1.19
1.13
1.44
0.72
1.04
3.72
Delhi
0.85
1.45
3.71
1.47
0.37
5.19
1.78
13.09
1.03
0.79
0.62
0.51
1.26
6.55
Telangana
1.27
1.97
2.81
0.56
0.63
2.88
0.95
2.35
1.35
0.66
2.17
0.86
0.89
1.08
Andhra Pradesh
1.61
2.13
1.94
0.56
0.72
3.14
0.84
1.96
1.35
0.73
2.51
0.91
1.01
1.05
Jammu and Kashmir
1.28
2.68
1.48
0.84
0.54
2.48
0.64
2.14
1.20
1.13
0.92
0.78
0.71
1.75
Karnataka
1.51
2.37
2.63
0.58
0.82
3.10
1.03
3.14
1.42
0.68
2.95
0.85
1.47
1.76
West Bengal
1.28
1.84
1.40
0.61
1.68
2.75
0.63
2.06
1.36
0.58
2.45
0.91
0.72
1.33
Maharashtra
1.34
2.35
3.40
1.02
0.84
3.89
1.19
5.46
1.34
0.72
1.64
0.78
1.01
2.19
UTs other than Delhi
0.82
1.22
2.28
0.85
0.40
4.35
1.24
6.60
1.11
0.73
1.50
0.66
1.06
1.49
Himachal Pradesh
0.90
3.13
2.89
0.93
0.41
3.01
0.83
4.77
1.38
0.72
1.11
0.79
0.66
2.14
Punjab
2.15
1.88
2.77
0.86
0.60
3.64
0.68
3.83
1.36
1.08
0.88
0.81
1.66
2.04
Goa
0.98
1.70
2.84
1.07
0.69
3.42
1.00
4.92
1.37
0.71
0.88
0.71
1.56
2.60
Tamil Nadu
1.78
1.76
2.89
0.70
0.58
4.00
0.76
4.41
1.49
0.85
2.62
0.85
2.05
0.80
Kerala
1.18
1.74
1.96
0.48
0.73
2.07
0.71
1.88
1.59
0.58
1.59
0.86
1.45
0.52
0.66 or less
1.01-1.33
2.01-3.00
0.67-1.00
1.34-2.00
>3.00
†
Self-harm refers to suicide and the nonfatal outcomes of self-harm.
India: Health of the Nation’s States
59
Among the leading CMNND individual causes, the DALY rate for diarrhoeal diseases was highest in Jharkhand, Odisha, and Bihar, followed by Uttar Pradesh and Assam in 2016. The DALY rate for lower respiratory infections was highest in Rajasthan, Bihar, Uttar Pradesh, Madhya Pradesh, and Assam, followed by Uttarakhand and Chhattisgarh. Bihar, Assam, and Jharkhand had the highest DALY rate for iron-deficiency anaemia, followed by Rajasthan, Madhya Pradesh, and Uttar Pradesh. The DALY rate for neonatal preterm birth complications was highest in Rajasthan, Chhattisgarh, Madhya Pradesh, and Assam. For tuberculosis the DALY rate was highest in Uttar Pradesh, followed by Assam, Gujarat, Rajasthan, Odisha, Chhattisgarh, Jharkhand, and Madhya Pradesh. The wide range of DALY rates for the leading CMNND causes across the states of India are highlighted by the finding that the range of DALY rates was 9-fold for diarrhoeal diseases, 7-fold for lower respiratory infections, and 9-fold for tuberculosis. Another way in which policymakers can assess the relative success of a state or country in confronting the burden of a particular disease is by comparing its observed DALY rate with the DALY rate that would be expected on average for geographic units globally that are at a similar level of development. This can be done using the Socio-demographic Index (SDI) level as a measure of development, which is based on income level, educational attainment, and fertility level. Diarrhoeal diseases, iron-deficiency anaemia, tuberculosis, and other neonatal disorders had higher DALY rates in almost all states as compared with the average globally for their respective SDI levels. For India as a whole, the DALY rate for diarrhoeal diseases was 2.5 times, for iron-deficiency anaemia 3.0 times, for tuberculosis 3.5 times, and for other neonatal disorders 2.4 times higher than the average globally for its SDI level. Among the leading NCD individual causes, the DALY rate for ischaemic heart disease was highest in Punjab and Tamil Nadu, followed by Haryana, Andhra Pradesh, Karnataka, Gujarat, and Maharashtra. For COPD, the highest DALY rates were in Rajasthan, Uttarakhand, and Uttar Pradesh, followed by Himachal Pradesh, Haryana, and Jammu and Kashmir. The DALY rate for stroke was highest in West Bengal, followed by Odisha, Tripura, Assam, and Chhattisgarh. Tamil Nadu had the highest DALY rate for diabetes, followed by Punjab, Karnataka, Kerala, Goa, and Manipur. The range of DALY rates across the states of India was 9-fold for ischaemic heart disease, 4-fold for COPD, 6-fold for stroke, and 4-fold for diabetes. The DALY rate for COPD was higher in most states as compared with the average globally for their respective SDI levels, and it was 2.3 times higher in India than the average globally for its SDI level. Punjab stood out as having over two times the DALY rate for ischaemic heart disease than the average globally for its SDI level. Among the leading injuries individual causes, the DALY rate for road injuries was highest in Jammu and Kashmir, Uttarakhand, Haryana, and Punjab, followed by Rajasthan and Uttar Pradesh. For self-harm, the highest DALY rates were in Tripura, Karnataka, and Tamil Nadu, followed by Andhra Pradesh, West Bengal and Telangana. The range of DALY rates across the states of India was 3-fold for road injuries and 6-fold for self-harm. The DALY rate for suicide in India as a whole was 1.8 times higher than the average globally for its SDI level.
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India: Health of the Nation’s States
These state-specific DALY rates highlight that there are some broad trends across the EAG, North-East, and Other states groupings, and across the various epidemiological transition level groupings. However, there are many variations within these groupings. This points to the utility of these groupings as an intermediate step in understanding broad disease trends in groups of states, but at the same time emphasises the need for titrating health policy and interventions to the specific disease burden situation in each state.
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61
Rate of occurrence of diseases The net changes in disease burden over time are influenced by several factors, including (i) ageing of the population that can lead to higher numbers of persons with conditions that are more common in the older age groups, (ii) changes in exposure to risk factors that could influence the rate of occurrence of diseases or injuries, and (iii) improvements in development and health care that could reduce the likelihood of premature mortality or disability once a disease or injury has occurred. It is therefore useful to compare the changes in the rate of occurrence of diseases or injuries on the one hand, and the changes in the final disease burden caused by them over time. This is particularly useful in understanding the increasing overall disease burden due to NCDs and injuries.
Table 6 Comparison of the percent change in prevalence of leading NCDs and incidence rate of leading injuries with the percent change in their DALY rate in India from 1990 to 2016 Percent change from 1990 to 2016 Non-communicable diseases Ischaemic heart disease
Prevalence
DALY rate
Age-standardised prevalence
Age-standardised DALY rate
9.4
2.2
53
33.9
COPD
29.2
-10.5
-5
-35.9
Cerebrovascular disease
53.9
0.4
12.2
-25.7
Sense organ diseases
21.2
21.7
-0.9
-4.4
Low back & neck pain
9.3
9
-11.2
-11.6
Diabetes
64.3
80
29.3
39.6
Migraine
8.5
11
-2.7
-0.7
Skin diseases
4.9
1.7
4.5
5.3
-13.6
-48.1
-8.1
-20.3
Other musculoskeletal
17.8
18
-2
-1.3
Chronic kidney disease
26.1
12.2
-4.3
-8.3
Depressive disorders
11.1
8.4
-6.2
-7.9
Asthma
8.6
-44.3
-3.8
-53.6
Anxiety disorders
6.4
6.2
-4
-3.6
Rheumatic heart disease
-1.1
-32.7
-10.8
-39.8
Congenital defects
Percent change from 1990 to 2016 Injuries Road injuries Self-harm Falls Drowning
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India: Health of the Nation’s States
Incidence rate
DALY rate
Age-standardised incidence rate
Age-standardised DALY rate
55.8
8.3
43.4
3.9
4.8
-14.8
-3.2
-19.5
6.3
-7.2
-0.4
-12.6
-27.3
-58
-20.4
-48.2
The prevalence of most leading NCDs increased in India from 1990 to 2016, but the age-standardised prevalence remained similar for many NCDs and increased for diabetes, cerebrovascular disease, ischaemic heart disease, and skin diseases. This indicates that the overall increase in NCD prevalence in India is a mixed phenomenon, with ageing of the population causing an increase in many NCDs, along with an additional increase due to exposure to risk factors for the causes that have an age-standardised increase in prevalence. The percent increase in prevalence was more than or similar to the percent change in the DALY rates for most of the leading NCDs, indicating that while the prevalence has been increasing on the one hand, the improvements in health interventions have countered the increase in disease burden to some degree. However, progress in the control of NCDs needs a much bigger and more organised effort in order to achieve stronger declining trends in the DALY rates of most NCDs. Among the leading causes of injuries, the percent increase in the incidence rate of road injuries from 1990 to 2016 was quite high even after adjusting for the changes in the population age structure during this period. However, the increase the DALY rate for road injuries was quite modest. There was a slight increase in the prevalence of suicide and falls, but a decrease in the DALY rate. This again indicates the impact of improving health interventions.
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63
Risk factors causing disease burden Risk factors are the drivers of diseases and injuries that cause premature death and disability. If the relevant risk factors are addressed successfully, much of India’s disease burden could be reduced.
Figure 19 Percent DALYs attributable to risk factors in India, 2016 Child and maternal malnutrition Air pollution Dietary risks High systolic blood pressure High fasting plasma glucose Tobacco use Unsafe water, sanitation, and handwashing High total cholesterol High body-mass index Alcohol and drug use Occupational risks Impaired kidney function Unsafe sex Other environmental risks Low physical activity Low bone mineral density Sexual abuse and violence 0
5
Percent of total DALYs
HIV/AIDS and tuberculosis
Nutritional deficiencies
Diarrhoea, lower respiratory, and other common infectious diseases Maternal disorders
Other communicable, maternal, neonatal, and nutritional diseases Cancers
Chronic respiratory diseases Cirrhosis and other chronic liver diseases Digestive diseases
Neonatal disorders
Cardiovascular diseases
Neurological disorders
Child and maternal malnutrition was India’s leading risk factor for health loss in 2016, causing 14.6% of the country’s total DALYs. This is due largely to the contribution that malnutrition makes to the high-burden conditions such as neonatal disorders and nutritional deficiencies as well as diarrhoea, lower respiratory infections, and other common infections. Air pollution was the second leading risk factor in India as a whole. This risk factor encompasses both outdoor air pollution from a variety of sources as well as household air pollution that mainly results from burning solid fuels in the home for cooking and heat. Outdoor air pollution caused 6.4% of India’s total DALYs in 2016, while household air pollution caused 4.8%. Combined, they make a substantial contribution to India’s burden of cardiovascular diseases, chronic respiratory diseases, and lower respiratory infections. 64
India: Health of the Nation’s States
10
15
Mental and substance use disorders
Transport injuries
Diabetes, urogenital, blood, and endocrine diseases Musculoskeletal disorders
Unintentional injuries
Other non-communicable diseases
Forces of nature, conflict and terrorism, and executions and police conflict
Suicide and interpersonal violence
The behavioural and metabolic risk factors associated with the rising burden of NCDs have become quite prominent in India. Dietary risks, which include diets low in fruit, vegetables, and whole grains, but high in salt and fat, were India’s third leading risk factor, followed closely by high blood pressure and high blood sugar (high fasting plasma glucose). These risks drive health loss mainly from cardiovascular disease and diabetes, and also from cancer in the case of dietary risks. Despite the increasing global awareness of the health risks it poses, tobacco use, including smoking, secondhand smoke, and smokeless tobacco, remains a major risk factor in India and caused 5.9% of the total DALYs in 2016. Unsafe water, sanitation, and handwashing was the second leading risk factor in 1990, but its ranking dropped to seventh in 2016. However, it is even now responsible for 4.6% of the disease burden through diarrhoeal diseases and other infections. In line with India’s epidemiological transition, the composition of risk factors that drives its disease burden has also changed over time. This is a process linked to socioeconomic development. While the burden of poor health attributable to risks such as malnutrition and unsafe water, sanitation, and handwashing has fallen since 1990, it still remains quite high. At the same time, the burden caused by risks such as unhealthy diets, high blood pressure, high blood sugar, high cholesterol, and high body mass index is on the rise. Figure 20 Figure 20 Change DALYs number and rate to risk factors in India fromin 1990 to 2016 Changeinin DALYs number andattributable rate attributable to risk factors India from 1990 to 2016 Behavioural risks
Environmental/occupational risks
Leading causes 1990
Metabolic risks
Leading causes 2016
Mean % change number of DALYs 1990-2016
Mean % change DALY rate 1990-2016
Malnutrition [35.5%]
1
1
Malnutrition [14.6%]
-64.3%
-76.6%
WaSH* [12.8%]
2
2
Air pollution [9.8%]
-23.6%
-49.9%
Air pollution [11.1%]
3
3
Dietary risks [8.9%]
70.8%
12.1%
Dietary risks [4.5%]
4
4
High blood pressure [8.5%]
89.3%
24.2%
Tobacco use [4.4%]
5
5
High fasting plasma glucose [6.0%]
High blood pressure [3.9%]
6
6
Tobacco use [5.9%]
High fasting plasma glucose [2.3%]
7
7
Occupational risks [2.0%]
8
8
High total cholesterol [1.7%]
9
127.9%
49.6%
14.7%
-24.7%
WaSH* [4.6%]
-69.0%
-79.6%
High total cholesterol [4.1%]
106.2%
35.3%
9
High body mass index [3.6%]
281.6%
150.5%
Alcohol & drug use [1.7%]
10
10
Alcohol & drug use [3.6%]
80.6%
18.5%
Impaired kidney function [1.4%]
11
11
Occupational risks [3.0%]
32.4%
-13.1%
High body mass index [0.8%]
12
12
Impaired kidney function [2.8%]
Other environmental [0.5%]
13
13
Unsafe sex [1.1%]
Low physical activity [0.4%]
14
14
Other environmental [1.0%]
63.4%
7.2%
Unsafe sex [0.3%]
15
15
Low physical activity [0.9%]
109.6%
37.6%
Low bone mineral density [0.2%]
16
16
Low bone mineral density [0.6%]
127.4%
49.3%
Sexual abuse & violence [0.2%]
17
17
Sexual abuse & violence [0.3%]
48.0%
-2.9%
76.4%
15.8%
214.4%
106.4%
The percent figure in bracket next to each risk factor is DALYs attributable to that risk factor out of the total DALYs. * WaSH is unsafe water, sanitation, and handwashing.
The large increases in DALYs caused by metabolic risks such as high blood pressure, high blood sugar, and high body mass index, alongside behavioural ones such as dietary risks, warrant serious attention from policymakers. These trends indicate that strong strategies will need to be implemented to curb their trajectory, in order to prevent and control NCDs in India. Tackling environmental risk factors, such as outdoor air pollution, will also be an important part of this effort. While the total burden from air pollution in India declined between 1990 and 2016, this was largely driven by efforts to reduce the use of solid fuels in households. Outdoor air pollution continues to pose a significant and growing challenge to population health. India: Health of the Nation’s States
65
Given that India’s states differ widely in both their level of development and disease burden, it follows that the profile of health risks their populations face would also be very different. In order to more effectively reduce the disease burden in India, it is necessary to understand the variations in health risk factors across the states of India and also how these differ between the two sexes.
Figure 21 Percent DALYs attributable to risk factors in the state groups, 2016 Child and maternal malnutrition
Air pollution
Dietary risks
High systolic blood pressure
Tobacco use
High fasting plasma glucose
Unsafe water, sanitation, and handwashing
High total cholesterol
High body-mass index
Alcohol and drug use 0
5
10
Percent of total DALYs EAG states
North-East states
Considering broad state groupings, the proportion of total DALYs due to child and maternal malnutrition was much higher in the EAG and North-East states groups than in the Other states group in 2016. The proportion for air pollution was also higher in the EAG states group. On the other hand, the proportion of total DALYs due to dietary risks, high systolic blood pressure, high fasting plasma glucose, high cholesterol, and high body mass index was highest in the Other states group in 2016.
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India: Health of the Nation’s States
Other states
15
Figure 22 Percent DALYs attributable to leading risk factors by sex in the state groups, 2016 Females
Males
EAG states Malnutrition* Air pollution Dietary risks WaSH† High blood pressure Tobacco use High fasting plasma glucose Alcohol & drug use Occupational risks High total cholesterol
40
30
20
10
0
0
10
Percent of total DALYs
20
30
40
30
40
30
40
Percent of total DALYs
North-East states
Females
Males
Malnutrition* Air pollution High blood pressure Dietary risks Tobacco use WaSH† High fasting plasma glucose Alcohol & drug use High body mass index Occupational risks
40
30
20
10
0
0
10
Percent of total DALYs
20 Percent of total DALYs
Females
Other states
Males
Dietary risks High blood pressure Malnutrition* Air pollution High fasting plasma glucose Tobacco use High total cholesterol High body mass index Alcohol & drug use Impaired kidney function
40
30
20
10
0
0
Percent of total DALYs
10
20 Percent of total DALYs
Behavioural †
Environmental/occupational
Metabolic
*Malnutrition is child and maternal malnutrition. WaSH is unsafe water, sanitation, and handwashing.
India: Health of the Nation’s States
67
While child and maternal malnutrition was the leading risk factor in the EAG and North-East states groups in 2016, it was third in the Other states group, overtaken by dietary risks and high blood pressure. Unsafe sanitation remained the fourth leading risk in the EAG and sixth in the North-East, but did not feature in the top 10 risks for Other states. Though malnutrition is a serious risk for both sexes, it was a much bigger contributor to health loss for females than for males across all three state groups. Similarly, unsafe water, sanitation, and handwashing, another risk factor associated with lower levels of socioeconomic development, was a much more significant risk for females. India has had a long history of efforts to reduce malnutrition and improve sanitation, and these findings bolster the case for further strengthening programmes that provide focussed nutritional support and safe sanitation to women and children, particularly girls. Conversely, dietary risks, high blood pressure, high blood sugar, high cholesterol, and high body mass index all ranked higher and caused considerably more health loss in the Other states group than in the EAG and North-East states groups. Males tend to face a relatively higher burden from risk factors associated with NCDs, with a greater proportion of their health loss caused by dietary risks and high blood pressure, blood sugar, and cholesterol as compared with females. Alcohol and drug use and tobacco use were also much larger contributors to disease burden among males, suggesting a need for more targeted preventive measures for these risks. These trends can be seen across all three state groups.
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Table 7 Change in summary exposure value of the leading individual risk factors in the state groups from 1990 to 2016 Summary exposure value 2016 Risk factor
Percent contribution to DALYs in India, 2016
EAG states North-East group states group
Other states group
Percent change from 1990 to 2016
India
EAG North-East Other states states states India group group group
Short gestation for birth weight
6.5
11.6
11.5
12.2
11.9
2.3
3.4
2.8
2.5
Low birth weight for gestation
3.4
8.7
8.7
8.3
8.5
-0.6
-0.7
-1.8
-1.1
Child wasting
3.3
8.5
8.4
9.7
9.1
-31.8
-28.9
-22.9
-27.3
Iron deficiency
3.6
14.8
14.8
13.8
14.3
1.6
-1.1
0.9
1.3
Unsafe water source
3.3
38.2
26.2
26.9
32
-11.2
-20.8
-23.9
-16.9
Unsafe sanitation
2.5
59.9
47.2
36
47.3
-32.1
-40.7
-55.1
-43.5
Ambient particulate matter pollution
6.4
78
54.4
60.5
68.2
14.7
21.6
16.7
16.6
Household air pollution from solid fuels
4.8
38.4
28.2
17.9
27.6
-40.1
-52.9
-66
-52.2
High systolic blood pressure
8.5
22.2
24.3
24.2
23.3
0.6
3.5
7.7
4.3
High fasting plasma glucose
6
2.8
2.7
4.1
3.5
46.3
19.9
36.8
37.4
High total cholesterol
4.1
9.8
8.7
13.3
11.5
11
16.6
19
14.8
High body mass index
3.6
3.7
5.2
5.7
4.8
87.3
105.9
148.2
119.8
Impaired kidney function
2.8
4.8
4.8
5.3
5
4.8
5.1
4.1
4.1
Diet low in fruits
2.8
74.4
71.7
71.9
73
-16.4
-19.1
-16.2
-16.4
Diet low in nuts and seeds
2.3
88.2
88.9
64.7
76.4
-3.9
-3.1
-22
-12.2
Smoking
4.5
9.1
11.4
8.8
9
-20.8
-19.9
-24.8
-22.9
Alcohol use
2.9
3.1
3.6
4
3.6
71.6
86.5
84.5
76.7
This list includes the individual risk factors that contributed more than 2% of DALYs in India, 2016
India: Health of the Nation’s States
69
It is useful to understand the changes in people’s exposure to health risk factors that have taken place over time in different parts of the country in order to set priorities for interventions and tailor appropriate policy responses. Summary exposure value is a measure that estimates exposure to a particular risk, taking into account both the severity of exposure and the size of the population that is exposed to it. Instead of classifying exposure to a risk as either present or not present, summary exposure value allows for the estimation of continuous risk exposure, or exposure that happens at different times and in different amounts. This is important because in reality people are exposed to many risk factors intermittently or continuously, rather than all at once or not at all. The summary exposure value metric also takes into account the severity of exposure to a risk factor, since some risk factors are more likely to lead to health problems than others. Among the leading components of child and maternal malnutrition, the summary exposure value for child wasting reduced from 1990 to 2016 in India by 27%. On the other hand, the summary exposure values for short gestation, low birth weight, and iron deficiency did not change much during this period in any of the three state groups. The summary exposure value of unsafe sanitation reduced from 1990 to 2016 in India by 44% and that of unsafe water by 17%.This reduction was least in the EAG states group where the magnitude of exposure to these risks continued to be the highest. Looking at the two different types of air pollution, there were divergent trends in the summary exposure value. Exposure to household air pollution from solid fuels has dropped by 52% in India since 1990. This decrease was lowest in the EAG states group and intermediate in the North-East states group, and the magnitude of this exposure also remained highest in the EAG states groups and intermediate in the North-East states group in 2016. On the other hand, the summary exposure value of outdoor air pollution increased by 17% in India from 1990 to 2016. The magnitude of this exposure was higher in the EAG states group as compared with the North-East and Other states groups. The summary exposure value for high body mass index increased by 120%, for high blood sugar increased by 37%, and for cholesterol by 15% for India as a whole from 1990 to 2016. These increases were observed in all three state groups. The exposure level of high blood pressure was relatively higher than these risks in 2016, but the change in its level since 1990 was modest. The exposure level of smoking decreased during this period in all three state groups, but that of alcohol use increased across all three state groups.
70
India: Health of the Nation’s States
It is important to understand the scale of health loss attributable to individual risk factors across states. Looking at the rate of DALYs caused by each risk factor for each state gives a better sense of exactly how much health loss each causes.
India
5169 3469 3159 3000 2112 2081 1626 1464 1262 1260 1069 978
403
358
336
217
EAG States
6978 4099 2498 2338 1662 2108 2389 1061 940 1192 1062 754
363
346
256
201
96
7344 4337 2702 2563 1808 2206 2617 1121 1022 1302 1136 844
405
374
272
222
107
Bihar
8045 4308 2580 2362 1407 1780 2928 1006
862
982
737
439
367
241
161
102
Chhattisgarh
6364 3667 3054 3085 2093 1735 2224 1292 1154 1224
988
957
439
384
280
210
103
Jharkhand
6005 3117 2407 2405 1564 1023 3332
804
835
902
927
772
440
314
230
171
98
Madhya Pradesh
6663 3809 2899 2760 2150 2214 1879 1375
956
1285 1041
810
413
351
372
200
100
Odisha
4960 3201 2720 2979 2018 1565 2904
1234 1472
965
1188
562
383
249
276
150
Rajasthan
7331 4528 2292 2052 1289 2317 1570 1309
969
1186 1128
622
312
253
217
168
79
Uttar Pradesh
7195 4390 2273 2013 1613 2445 2421
1005 1303 1136
663
256
358
230
217
85
4818 3300 2622 2680 1958 3141 970 1381 1691 1302 1140 831
432
314
405
253
94
Lowest ETL group
Lower-middle ETL group Uttarakhand North-East states Lowest ETL group
4818 3300 2622 2680 1958 3141
970
821 935
564
1381 1691 1302 1140
831
432
314
405
253
94
923
396
309
193
136
100 102
6749 3329 2634 2903 1849 2258 2205 737 1328 1537 978
951
345
326
190
136
Meghalaya
4720 1798 1416 1431 1064 1878 1294
466
490
726
593
197
194
112
101
71
Assam
6928 3464 2741 3032 1918 2292 2285
761
1402 1555 1000
983
358
338
196
139
104
Lower-middle ETL group
3746 2293 2169 2374 1719 2198 1118 830
747 1291 905
843
535
261
202
136
94
Arunachal Pradesh
4139 1436 1308 1394 1108 1375 1099
426
557
1097
721
565
531
179
111
125
120
Mizoram
3408 1585 1070
1030 3255
848
301
510
1200
891
575
575
166
125
169
87
Nagaland
2607 1408 1546 1893 1063 1129
510
663
504
1347
695
646
621
184
139
118
69
Tripura
5131 3598 3069 3363 2303 2746 1478 1157
849
1254 1092 1079
298
327
286
134
93
Sikkim
3703 1620 1473 1803 1232 1472
478
747
996
1095
847
634
220
200
157
160
68
Manipur
2494 1822 2264 2369 1993 2316 1287
876
905
1469
889
916
878
307
204
139
109
3478 2933 3805 3615 2540 2043 917 1881 1558 1305 1084 1184 440
373
419
239
113
5013 3102 3544 3090 1987 2108 879 1844 786 1364 1079 930
456
302
343
217
79
5013 3102 3544 3090 1987 2108
456
302
343
217
79
3556 3016 3697 3540 2247 2048 993 1753 1327 1312 1079 1142 472
361
376
220
116
Haryana
4603 3928 3587 3298 2189 3032
981
2281 1701 1658 1166 1031
111
Delhi
3473 1890 2246 2118 2281 1619
370
1364 1532 1243
Telangana
3596 2710 3134 2747 1871 1578 1330 1598 1446
Other states Lower-middle ETL group Gujarat Higher-middle ETL group
983
879
1844
786
1364 1079
930
320
289
391
214
894
796
291
230
244
149
77
1064
894
627
372
322
255
124
Andhra Pradesh
4050 3007 3992 3655 2234 2085 1238 2044 1858 1146 1099 1049
546
401
572
259
140
Jammu and Kashmir
3296 3029 3162 3001 1634 3039
209
258
300
185
66
Karnataka
3766 2871 3392 3692 2931 1946 1149 1885
1463 1167 1156
541
466
398
232
110
787
974
1551 1580 1003 1072 1070 849
West Bengal
3445 3761 4311 4252 1945 2834 1010 1731 1054 1261 1097 1319
440
328
301
172
111
Maharashtra
3382 2816 3745 3387 2316 1570
835
1728 1474 1487 1052 1173
444
350
395
243
124
Union Territories other than Delhi
2760 1355 2196 2409 1991 1336
380
1181 1845 1374
378
207
230
233
98
2375 2443 4260 4113 3657 1815 712 2177 2507 1192 1087 1440 366
451
578
304
120
Himachal Pradesh
2614 2318 2251 2470 1321 1838
678
1255
793
380
249
242
256
68
Punjab
3016 3523 4920 5167 3370 1633
793
2232 2971 1228 1222 1482
415
325
545
242
85
Goa
1945 1482 2552 2938 2400
825
272
1432 1915 1306
994
375
226
318
254
88
Tamil Nadu
2676 2412 4815 4106 4336 1878
862
2396 2699 1278 1069 1557
369
592
654
354
159
Kerala
1212 1698 3060 3646 3015 1867
363
1896 2070
318
316
526
263
80
Highest ETL group
Significantly lower than national mean
967
833
1153 1126
991
937
983
1016 1313
violen ce
105
5946 3052 2509 2762 1814 2242 1914 762 1172 1471 958 1331
e and
ensity eral d
Sexua l abus
one m in
Low b
tal ris ks hysica l activ ity Low p
enviro nmen Other
ose co us e Unsafe and h water, san it andw ashin ation, g High total c holes terol High body mass index Alcoh ol and drug use O ccu pation al risk s Impair ed kid ney fu nction Unsafe sex Tobac
plasm a gluc
fastin g
c bloo d pre
High
s
systoli High
Dieta ry risk
Air po llution
Child malnuand mater nal trition
ssure
Figure 23 DALY rate attributable to risk factors in the states of India, 2016*
*DALY rate per 100,000 population
Indistinguishable from national mean Significantly higher than national mean
India: Health of the Nation’s States
71
72
India: Health of the Nation’s States
Kerala
Goa
Gujarat
Punjab
Odisha
Jharkhand
Bihar
Andhra Pradesh
Chhattisgarh
Telangana
Tamil Nadu
Karnataka
Delhi
Himachal Pradesh
Uttar Pradesh
Madhya Pradesh
Maharashtra
Rajasthan
Haryana
Uttarakhand
Jammu and Kashmir
Child and maternal malnutrition
West Bengal
Sikkim
Meghalaya
Tripura
Assam
Odisha
Jharkhand
Bihar
1200−1599 1600−1999 2000−2399 2400 or more
4000−4999 5000−5999 6000−6999 7000−7999 8000 or more
800−1199
DALYs per 100,000
Mizoram
Manipur
Nagaland
3000−3999
Meghalaya
Tripura
Assam
400−799
West Bengal
Sikkim
Arunachal Pradesh
2000−2999
Andhra Pradesh
Chhattisgarh
Telangana
Tamil Nadu
Karnataka
Maharashtra
Madhya Pradesh
Uttar Pradesh
Delhi
Less than 400
Kerala
Goa
Gujarat
Rajasthan
Haryana
Uttarakhand
Himachal Pradesh
Less than 2000
DALYs per 100,000
Mizoram
Manipur
Nagaland
Arunachal Pradesh
Punjab
Jammu and Kashmir
Unsafe water, sanitation, and handwashing
Figure 24 DALY rate attributable to child and maternal malnutrition and attributable to unsafe water, sanitation, and handwashing in the states of India, 2016
Kerala
Goa
Gujarat
Punjab
Odisha
Jharkhand
Bihar
Andhra Pradesh
Chhattisgarh
Telangana
Tamil Nadu
Karnataka
Delhi
Himachal Pradesh
Uttar Pradesh
Madhya Pradesh
Maharashtra
Rajasthan
Haryana
Uttarakhand
Jammu and Kashmir
Ambient air pollution
West Bengal
Sikkim
Meghalaya
Tripura
Assam
Odisha
Jharkhand
Bihar
India: Health of the Nation’s States
2250 or more
1750−1999 2250−2499
2750 or more
1500−1749 2000−2249
2000−2249
1250−1499 1750−1999
2500−2749
1000−1249
DALYs per 100,000
Mizoram
Manipur
Nagaland
1500−1749
Meghalaya
Tripura
Assam
750−999
West Bengal
Sikkim
Arunachal Pradesh
1250−1499
Andhra Pradesh
Chhattisgarh
Telangana
Tamil Nadu
Karnataka
Maharashtra
Madhya Pradesh
Uttar Pradesh
Delhi
Less than 750
Kerala
Goa
Gujarat
Rajasthan
Haryana
Uttarakhand
Himachal Pradesh
Less than 1250
DALYs per 100,000
Mizoram
Manipur
Nagaland
Arunachal Pradesh
Punjab
Jammu and Kashmir
Household air pollution
Figure 25 DALY rate attributable to ambient air pollution and attributable to household air pollution in the states of India, 2016
73
74
India: Health of the Nation’s States
Kerala
Goa
Gujarat
Punjab
Odisha
Jharkhand
Bihar
Andhra Pradesh
Chhattisgarh
Telangana
Tamil Nadu
Karnataka
Delhi
Himachal Pradesh
Uttar Pradesh
Madhya Pradesh
Maharashtra
Rajasthan
Haryana
Uttarakhand
Jammu and Kashmir
High blood pressure
West Bengal
Sikkim
Meghalaya
Tripura
Assam
Odisha
Jharkhand
Bihar
1500−1899 1900−2299 2300−2699 2700−3099 3100 or more
2500−2999 3000−3499 3500−3999 4000 or more
DALYs per 100,000
Mizoram
Manipur
Nagaland
2000−2499
Meghalaya
Tripura
Assam
1100−1499
West Bengal
Sikkim
Arunachal Pradesh
1500−1999
Andhra Pradesh
Chhattisgarh
Telangana
Tamil Nadu
Karnataka
Maharashtra
Madhya Pradesh
Uttar Pradesh
Delhi
Less than 1100
Kerala
Goa
Gujarat
Rajasthan
Haryana
Uttarakhand
Himachal Pradesh
Less than 1500
DALYs per 100,000
Mizoram
Manipur
Nagaland
Arunachal Pradesh
Punjab
Jammu and Kashmir
High blood sugar
Figure 26 DALY rate attributable to high blood pressure and attributable to high blood sugar in the states of India, 2016
The DALY rates attributable to child and maternal malnutrition and to unsafe water and sanitation tended to be higher in the EAG states group and Assam. The rate for malnutrition was highest in Bihar, Rajasthan, and Uttar Pradesh, and for unsafe water and sanitation was highest in Jharkhand, Bihar, and Odisha in 2016. For household air pollution, too, the DALY rate in 2016 was higher in the EAG states and Assam, with the highest rates in Rajasthan, Bihar, and Uttar Pradesh. The DALY rate pattern for outdoor air pollution was more mixed, with the highest rates in Haryana and Uttar Pradesh, followed by Punjab, Rajasthan, Bihar, and West Bengal. Considering the DALY rates attributable to unhealthy diet, high blood pressure, high blood sugar, high cholesterol, and high body mass index in 2016, all of these were among the highest in Punjab and Tamil Nadu; four of these were high in Kerala, Andhra Pradesh, and Maharashtra; three of these were high in Karnataka and West Bengal; and two of these were high in Goa and Haryana. The DALY rate attributable to tobacco use was highest in Mizoram, Uttarakhand, Jammu and Kashmir, Haryana, West Bengal, and Tripura.
India: Health of the Nation’s States
75
76
India: Health of the Nation’s States
Disease burden and risk factors profile of each state The following key findings are illustrated for each state of India and the union territory of Delhi to inform policymakers of the most pressing disease burden and risk factors that need to be addressed to improve population health: 1. 2. 3. 4. 5. 6. 7. 8. 9.
Life expectancy by sex in 1990 and 2016 Under-5 mortality rate from 1990 to 2016 Leading causes of death by age in 2016 Leading causes of years of life lost due to premature death by sex in 2016 Leading causes of years lived with disability by sex in 2016 Changes in leading individual causes of DALYs from 1990 to 2016 Age-distribution of DALYs in 2016 Changes in risk factors contributing to DALYs from 1990 to 2016 Leading risk factors contributing to DALYs by sex in 2016
India: Health of the Nation’s States
77
78
Andhra Pradesh 1990 life expectancy Females: 58.4 years Males: 57.7 years
2016 life expectancy Females: 71.9 years Males: 67.3 years
How much did the under-5 mortality rate change from 1990 to 2016? How much did the under-5 mortality rate change from 1990 to 2016? Under-5 mortality rate, both rate, sexes combined, 1990-2016 Under-5 mortality both sexes combined, 1990-2016 Andhra Pradesh under-5 rate
India under-5 rate
Comparative average rate globally for similar Socio-demographic Index as Andhra Pradesh
Deaths per 1,000 live births
150
100
50 39.2 33.7 33.4
The shaded bands indicate 95% uncertainty intervals around the estimates
0 1990
1995
2000
2005
2010
2016
Year What caused the most deaths in different age groups in 2016? Percent top 10 causesdeaths of death byin agedifferent group, both sexes, Whatcontribution causedofthe most age 2016 groups
in 2016? Percent contribution of top 10 causes of death by age group, both sexes, 2016 0−14 years [7.6% of total deaths]
15−39 years [11.7% of total deaths]
1.5% 3.8% 5.8%
HIV/AIDS & tuberculosis
1.2%
9.9%
9.6%
29.1%
2.5%
11%
NTDs† & malaria Maternal disorders
1% 2.1%
1.2%
Diarrhoea/LRI*/other
8.5% 19.9%
5.8%
Neonatal disorders Nutritional deficiencies Other communicable diseases
2.5%
14.9%
9.2%
42.1%
Cancers Cardiovascular diseases
11.3%
Chronic respiratory diseases
3.2%
Cirrhosis
3.7%
Digestive diseases Neurological disorders
40−69 years [43.7% of total deaths]
70+ years [37% of total deaths]
2.8% 7.7%
5.2%
4.6% 2.9%
17.7%
3.1%
Unintentional injuries
8%
Suicide & violence
4.4%
7%
1.4%
Other causes of death
1%
6.5% 14.1%
9.8%
40%
Other non-communicable Transport injuries
4.6% 5.7%
11.7%
Diabetes/urog‡/blood/endo§
2% 2.9%
*LRI is lower respiratory infections. † NTDs are neglected tropical diseases. ‡ Urog is urogenital diseases. § Endo is endocrine diseases.
36.8%
Andhra Pradesh
79
Proportion of total disease burden from: Premature death: 64.4% | Disability or morbidity: 35.6% What caused the most years of life lost, by sex, in 2016? Top 15 causes of YLLs, ranked by percent for both sexes combined, 2016 Males
Females Ischaemic heart disease Suicide Diarrhoeal diseases Stroke COPD* Lower respiratory infections Preterm birth complications Road injuries Tuberculosis Neonatal encephalopathy HIV/AIDS Diabetes Chronic kidney disease Congenital birth defects Falls
20
15
10
5
0
0
Percent of total years of life lost due to premature mortality
5
10
15
20
Percent of total years of life lost due to premature mortality
Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
Injuries
What caused the most years lived with disability, by sex, in 2016? *COPD is chronic obstructive pulmonary disease. Top 15 causes of YLDs, ranked by percent for both sexes combined, 2016 Females
Males Iron-deďŹ ciency anaemia Sense organ diseases* Low back & neck pain Depressive disorders Migraine Skin diseases Other musculoskeletal COPD* Diabetes Anxiety disorders Falls Oral disorders Preterm birth complications Osteoarthritis Road injuries
16
12 8 4 Percent of total years lived with disability
0
Communicable, maternal, neonatal, and nutritional diseases
0
4 8 12 16 Percent of total years lived with disability
Non-communicable diseases
*COPD is chronic obstructive pulmonary disease. *Sense organ diseases includes mainly hearing and vision loss.
80
Andhra Pradesh
Injuries
Proportion of total disease burden from: CMNNDs: 27.0% | NCDs: 59.7% | Injuries: 13.3% How have have the the leading combined changed from 1990 to 2016? How leading causes causesofofdeath deathand anddisability disability combined changed from 1990 to 2016? Change in top 15 causes of DALYs, both sexes, ranked by number of DALYs, 1990–2016 Change in top 15 causes of DALYs, both sexes, ranked by number of DALYs, 1990–2016 Communicable, maternal, neonatal, and nutritional diseases
Injuries
Non-communicable diseases
Leading causes of DALYs 1990
same or increase
decrease
Leading causes of DALYs 2016
Diarrhoeal diseases [16.4%] Lower respiratory infections [8.1%] Preterm birth complications [6.6%] Ischaemic heart disease [4.4%] Tuberculosis [4.1%] Measles [3.8%] Neonatal encephalopathy [3.7%] COPD † [2.4%] Congenital birth defects [2.4%] Self-harm § [2.3%] Iron-deficiency anaemia [2.2%] Other neonatal disorders [2.2%] Stroke [2.0%] Neonatal haemolytic disease [1.6%] Intestinal infectious diseases [1.5%] Road injuries [1.5%] Sense organ diseases ‡ [1.3%] Low back & neck pain [1.2%] Falls [1.2%] Depressive disorders [1.1%] Migraine [1.1%] Diabetes [0.7%]
1
1
2
2
3
3
4
4
5
5
6
6
7
7
8
8
9
9
10
10
11
11
12
12
13
13
14
14
15
15
16
18 20
18 19 20
22
22
27
23
49 82
Ischaemic heart disease [11.6%] COPD † [4.6%] Iron-deficiency anaemia [3.7%] Diarrhoeal diseases [3.7%] Self-harm § [3.6%]* Stroke [3.5%]* Preterm birth complications [3.3%] Road injuries [3.1%] Sense organ diseases ‡ [3.1%] Lower respiratory infections [2.7%] Low back & neck pain [2.5%] Diabetes [2.4%] Depressive disorders [2.3%] Migraine [2.2%] Falls [2.2%]* Tuberculosis [1.8%] Congenital birth defects [1.6%] Neonatal encephalopathy [1.6%] Intestinal infectious diseases [1.0%] Other neonatal disorders [0.9%] Neonatal haemolytic disease [0.4%] Measles [0.2%]
24
34
†
*Change not significant. The percent figure in brackets next to each cause is DALYs from that cause out of total DALYs.
COPD is chronic obstructive pulmonary disease. Sense organ diseases includes mainly hearing and vision loss. Self-harm refers to suicide and the nonfatal outcomes of self-harm.
‡
§
What caused the most death and disability combined across age groups in 2016?
What caused thebymost death both and disability combined across age groups in 2016? Percent of DALYs age group, sexes, 2016 Percent of DALYs by age group, both sexes, 2016 [1.75]
10 Percent of total DALYs
[2.07] [1.66]
[1.36] [0.8]
[0.68]
[0.61]
[2.59]
[1.1]
[0.92]
[3.11]
[0.55] 5
[0.46] [3.55] [0.31]
[0.3]
[4.04] [4.51]
) (< 1%
%)
85
84
+
(1
%) 80
to
79 75
to 70
to
74
(2
(1
%)
%) 69
to 65
to
64
(4
(3
%)
%) (4 60
59 to 55
to
54
(5
(6 50
49 to 45
44
%)
%)
%) (7
%) to 40
39
(8
%) to 35
to
34
(9 30
29 to
(9
%)
%) (9 25
to 20
19 to 15
14 to
24
(9
%) (8
%) (8 10
7%
)
o9 5t
5( de r Un
%)
0
Age Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
The number in the bracket on top of each vertical bar is the ratio of percent DALYs to population for that age group. The number in parentheses after each age group on the x-axis is the percent of population in that age group.
Injuries
Andhra Pradesh
81
What risk factors are driving the most death and disability combined? Contribution of top 10 risks to DALYs number, both sexes, ranked by number of DALYs, What risk factors are driving the most death and disability combined? What risk factors are driving the most death and disability combined?
Contribution ofoftop risks to to DALYs number, bothboth sexes, ranked by number of DALYs, 1990-2016 Contribution top1010 risks DALYs number, sexes, ranked by number of DALYs, 1990-2016 same or increase Behavioural Environmental/occupational Metabolic Behavioural
Environmental/occupational
same or increase
Metabolic
Risk factors 1990
Risk factors 1990
1 2 3 4 5 6 7 High fasting plasma glucose [2.2%] 8 Alcohol & drug use [1.4%] 10 Occupational risks [1.9%] High body-mass index [0.6%] 13 9 Alcohol & drug use [1.4%] 10 The percent figure in bracket next to each risk is DALYs from that risk out of total DALYs. High body-mass index [0.6%] 13 Malnutrition* [36.9%]
1 2 3 4 5 6 7 8 9 10 11
decrease
Risk factors 2016
Risk factors 2016
Malnutrition* [36.9%] 1 † [16.4%] [16.4%] WaSH†WaSH 2 Air pollution [9.5%] [9.5%] 3 Air pollution Dietary risks [5.1%] 4 Dietary risks [5.1%] High blood pressure [4.4%] 5 HighTobacco blooduse pressure [4.2%] [4.4%] 6 High total cholesterol [2.3%] 7 Tobacco use [4.2%] High fasting plasma glucose [2.2%] 8 High total cholesterol [2.3%] Occupational risks [1.9%] 9
1
Malnutrition* [11.7%]
Malnutrition* [11.7%] 2 Dietary risks [11.5%] Dietary risks [11.5%] High blood pressure [10.5%] 3 High blood pressure [10.5%] Air pollution [8.7%] 4 Air pollution [8.7%] High fasting plasma glucose [6.4%] 5 High fasting plasma glucose [6.4%] Tobacco use [6.0%] High total cholesterol [5.9%] 6 Tobacco use [6.0%] High body-mass index [5.4%] 7 High total cholesterol [5.9%] † WaSH [3.6%] Alcohol & drug use [3.3%]8 High body-mass index [5.4%] Occupational risks [3.2%]9 WaSH† [3.6%]
10 Alcohol & drug use [3.3%] [3.2%]
*Malnutrition is child and maternal malnutrition. † risks 11 Occupational WaSH is unsafe water, sanitation, and handwashing.
*Malnutrition is child and maternal malnutrition. † WaSH is unsafe water, sanitation, and handwashing.
The percent figure in bracket next to each risk is DALYs from that risk out of total DALYs.
How did the risk factors differ by sex in 2016? Percent of total DALYs attributable to top 10 risks, ranked by percent for both sexes combined, 2016 Females
Males Malnutrition* Dietary risks High blood pressure Air pollution High fasting plasma glucose Tobacco use High total cholesterol High body-mass index WaSH† Alcohol & drug use
12
8
4
0
Percent of years of life lost and years lived with disability Behavioural
0
4
*Malnutrition is child and maternal malnutrition. is unsafe water, sanitation, and handwashing.
82
Andhra Pradesh
8
12
Percent of years of life lost and years lived with disability Environmental/occupational
†WaSH
decrease
Metabolic
Arunachal Pradesh 1990 life expectancy Females: 60.8 years Males: 59.4 years
2016 life expectancy Females: 72.7 years Males: 68.2 years
How much did the under-5 mortality rate change from 1990 to 2016? How much did the under-5 mortality rate change from 1990 to 2016? Under-5 mortality rate, both sexes combined, Under-5 mortality rate, both 1990-2016 sexes combined, 1990-2016 Arunachal Pradesh under-5 rate
India under-5 rate
Comparative average rate globally for similar Socio-demographic Index as Arunachal Pradesh
Deaths per 1,000 live births
150
100
50 39.2 32.5 30.6
0 1990
1995
2000
2005
2010
The shaded bands indicate 95% uncertainty intervals around the estimates
2016
Year What caused the most deaths in different age groups in 2016? Percent top 10 causesdeaths of death byin agedifferent group, both sexes, Whatcontribution causedofthe most age 2016 groups
in 2016? Percent contribution of top 10 causes of death by age group, both sexes, 2016 0−14 years [14.4% of total deaths]
15−39 years [16.4% of total deaths]
1.8% 4.6%
HIV/AIDS & tuberculosis
1.3% 5.3% 6.6%
Diarrhoea/LRI*/other
12.4%
14.9%
NTDs† & malaria
1.6%
Maternal disorders
7.9%
35.1%
16.3%
4.2%
1.3%
4.6%
Neonatal disorders Nutritional deficiencies
7.6%
7.1%
Other communicable diseases Cancers
4.2%
7.6%
34%
8.7% 8.5%
Cardiovascular diseases
4.4%
Chronic respiratory diseases Cirrhosis Digestive diseases Neurological disorders
40−69 years [39.5% of total deaths]
70+ years [29.7% of total deaths]
Diabetes/urog‡/blood/endo§ Other non-communicable
2.9% 8.7%
4.9% 3.7%
8.4% 3.5%
7.7%
Transport injuries
4.1%
Unintentional injuries
9.1%
Suicide & violence
21.5%
7%
5.2% 2.6%
3.1%
2.7%
21.8% 9.7%
10.7%
11.1%
Other causes of death *LRI is lower respiratory infections. † NTDs are neglected tropical diseases. ‡ Urog is urogenital diseases. § Endo is endocrine diseases.
6.6% 20.5%
24.4%
Arunachal Pradesh
83
Proportion of total disease burden from: Premature death: 63.7% | Disability or morbidity: 36.3% What caused the most years of life lost, by sex, in 2016? Top 15 causes of YLLs, ranked by percent for both sexes combined, 2016 Females
Males Lower respiratory infections Diarrhoeal diseases Ischaemic heart disease Tuberculosis Suicide Preterm birth complications Stroke Road injuries HIV/AIDS Other neonatal disorders Hepatitis COPD* Neonatal encephalopathy Stomach cancer Cirrhosis due to hepatitis B
7.5
5
2.5
0
0
Percent of total years of life lost due to premature mortality
2.5
5
7.5
Percent of total years of life lost due to premature mortality
Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
Injuries
*COPD is chronic obstructive pulmonary disease. What caused the most years lived with disability, by sex, in 2016? Top 15 causes of YLDs, ranked by percent for both sexes combined, 2016
Females
Males Iron-deďŹ ciency anaemia Sense organ diseases* Migraine Low back & neck pain Skin diseases Depressive disorders Other musculoskeletal COPD* Anxiety disorders Preterm birth complications Diabetes Oral disorders Falls Schizophrenia Diarrhoeal diseases
15
10 5 Percent of total years lived with disability
0
Communicable, maternal, neonatal, and nutritional diseases
0
5 10 Percent of total years lived with disability
Non-communicable diseases
*COPD is chronic obstructive pulmonary disease. *Sense organ diseases includes mainly hearing and vision loss.
84
Arunachal Pradesh
Injuries
15
Proportion of total disease burden from: CMNNDs: 35.5% | NCDs: 52.9% | Injuries: 11.6% How leading causes causesofofdeath deathand anddisability disability combined changed from 1990 to 2016? How have have the leading combined changed from 1990 to 2016? Change causesof ofDALYs, DALYs,both bothsexes, sexes,ranked rankedbyby number DALYs, 1990–2016 Change in top 15 causes number of of DALYs, 1990–2016 Communicable, maternal, neonatal, and nutritional diseases
Injuries
Non-communicable diseases
Leading causes of DALYs 1990
same or increase
decrease
Leading causes of DALYs 2016
Diarrhoeal diseases [15.3%] Lower respiratory infections [9.2%] Malaria [6.8%] Tuberculosis [5.8%] Measles [4.0%] Preterm birth complications [3.7%] Hepatitis [2.8%] Other neonatal disorders [2.6%] Neonatal encephalopathy [2.2%] Iron-deficiency anaemia [1.6%] Self-harm§[1.5%] COPD† [1.5%] Meningitis [1.5%] Ischaemic heart disease [1.4%] Road injuries [1.4%] Stroke [1.4%] Sense organ diseases‡ [1.3%] Low back & neck pain [1.2%] Skin diseases [1.2%] Migraine [1.1%] Depressive disorders [1.0%]
1
1
2
2
3
3
4
4
5
5
6
6
7
7
8
8
9
9
10
10
11
11
12
12
13
13
14
14
15
15
16
17 18
17 19 20
23
23
36
26
54
Lower respiratory infections [4.3%] Diarrhoeal diseases [4.3%] Preterm birth complications [3.7%]* Ischaemic heart disease [3.4%] Tuberculosis [3.2%] Iron-deficiency anaemia [3.2%] Self-harm§ [2.9%] COPD† [2.8%] Sense organ diseases‡ [2.7%] Stroke [2.6%] Road injuries [2.6%] Skin diseases [2.5%] Migraine [2.5%] Low back & neck pain [2.4%] Depressive disorders [2.2%] Other neonatal disorders [1.9%]* Hepatitis [1.9%] Neonatal encephalopathy [1.6%]* Malaria [1.0%] Meningitis [0.8%]* Measles [0.4%]
29
†
*Change not significant. The percent figure in brackets next to each cause is DALYs from that cause out of total DALYs.
COPD is chronic obstructive pulmonary disease. Sense organ diseases includes mainly hearing and vision loss. § Self-harm refers to suicide and the nonfatal outcomes of self-harm. ‡
What caused death and disability combined across age groups in 2016? What causedthe themost most death and disability combined across age groups in 2016? Percent of DALYs by age group, both sexes, 2016 Percent of DALYs by age group, both sexes, 2016 20
[2.01]
10
[0.52] 5
[0.72]
[0.94]
[0.81]
[0.65]
[1.63]
[1.32]
[1.09]
[2.04] [2.49]
[0.36]
[0.35]
[3.11] [3.73]
[4.27]
[4.94]
[5.52]
) 1% (<
85
84 80
to
+
(< 1%
(1 79
75
to
74 to 70
to
%)
%) (1
%) (1 69
(2 65
64 to 60
to
59
(3
%)
%)
%) (4 55
to
54
(5 50
49 to 45
44 to 40
39
%)
%) (6
%) (7
%) to 35
34
(8
%) to 30
to
29
(9
(9 25
(1
24 to 20
to
19
(1 15
14 to
%)
) 1%
) 2%
1% (1 10
o9 5t
de
r5
(1
0%
)
)
)
0
Un
Percent of total DALYs
15
Age Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
Injuries
The number in the bracket on top of each vertical bar is the ratio of percent DALYs to population for that age group. The number in parentheses after each age group on the x-axis is the percent of population in that age group.
Arunachal Pradesh
85
What risk factors are driving the most death and disability combined? Contribution of top 10 risks to DALYs number, both sexes, ranked by number of DALYs, 19 What risk factors are driving the most death and disability combined? What risk factors are driving the most death and disability combined? Contribution DALYs number, bothboth sexes, ranked by number of DALYs, 1990-2016 Contribution oftop top10 10risks riskstoto DALYs number, sexes, ranked by number of DALYs, 1990-2016 same or increase Behaviouralof Environmental/occupational Metabolic Behavioural
Environmental/occupational
same or increase
Metabolic
Risk factors 1990
Risk factors 1990
1 2 3 4 5 6 7 Alcohol & drug use [1.6%] 8 Impaired kidney function [0.9%] 10 High fasting plasma glucose [1.4%] 9 The percent figure in bracket next to each risk is DALYs from that risk out of total DALYs. Impaired kidney function [0.9%] 10 Malnutrition* [32.2%]
1 2 3 4 5 6 7 8 9 10
decrease
Risk factors 2016
Risk factors 2016
Malnutrition* [32.2%] 1 † [15.2%] [15.2%] WaSH†WaSH 2 Air pollution [7.7%] [7.7%] 3 Air pollution Tobacco use [3.6%] 4 Tobacco use [3.6%] Dietary risks [2.3%] 5 Dietary[2.2%] risks [2.3%] High blood pressure 6 Occupational [1.9%] [2.2%] 7 High bloodrisks pressure Alcohol & drug use [1.6%] 8 Occupational risks [1.9%] High fasting plasma glucose [1.4%] 9
decrease
1
Malnutrition* [14.8%]
9
Occupational risks [2.6%]
Malnutrition* [14.8%] 2 Air pollution [5.1%] Air pollution [5.1%] High blood pressure [5.0%] 3 High blood pressure [5.0%] Tobacco use [4.9%] 4 Tobacco use [4.9%] Dietary risks [4.7%] Dietary risks [4.7%] 5 [4.0%] High fasting plasma glucose WaSH† [3.9%] 6 High fasting plasma glucose [4.0%] Alcohol & drug use [3.9%] 7 WaSH† [3.9%] Occupational risks [2.6%] Impaired kidney function8 [2.0%]Alcohol & drug use [3.9%] *Malnutrition is child and maternal malnutrition. kidney function 10 Impaired † WaSH is unsafe water, sanitation, and handwashing.
[2.0%]
*Malnutrition is child and maternal malnutrition. † WaSH is unsafe water, sanitation, and handwashing.
The percent figure in bracket next to each risk is DALYs from that risk out of total DALYs.
How did the risk factors differ by sex in 2016? Percent of total DALYs attributable to top 10 risks, ranked by percent for both sexes combined, 2016 Females
Males Malnutrition* Air pollution High blood pressure Tobacco use Dietary risks High fasting plasma glucose WaSH† Alcohol & drug use Occupational risks Impaired kidney function
15
10
5
0
Percent of years of life lost and years lived with disability Behavioural
0
5
Environmental/occupational *Malnutrition is child and maternal malnutrition. is unsafe water, sanitation, and handwashing.
†WaSH
86
Arunachal Pradesh
10
15
Percent of years of life lost and years lived with disability Metabolic
Assam 1990 life expectancy Females: 56.6 years Males: 55.6 years
2016 life expectancy Females: 66.9 years Males: 63.5 years
How much did the under-5 mortality rate change from 1990 to 2016? How much did the under-5 mortality rate change from 1990 to 2016? Under-5 mortality both sexes combined, 1990-2016 Under-5 mortality rate, bothrate, sexes combined, 1990-2016 Assam under-5 rate
India under-5 rate
Comparative average rate globally for similar Socio-demographic Index as Assam
Deaths per 1,000 live births
150
100
52.2
50
39.2 37.8
0 1990
1995
2000
2005
2010
The shaded bands indicate 95% uncertainty intervals around the estimates
2016
Year What caused the most deaths in different age groups in 2016?
Percent contribution of topmost 10 causes of death by group, bothage sexes, groups 2016 What caused the deaths inage different in 2016? Percent contribution of top 10 causes of death by age group, both sexes, 2016 0−14 years [13% of total deaths]
15−39 years [13.6% of total deaths]
1.1% HIV/AIDS & tuberculosis
3.8% 5.3%
2.9%
35%
12%
1.1% 0.9%
5.7%
1.8%
Diarrhoea/LRI*/other
15.7%
NTDs† & malaria
10.3%
Maternal disorders
12.6%
Neonatal disorders
5.6%
Nutritional deficiencies
5.1%
Other communicable diseases
8.4%
5.6%
4.1%
38.1%
Cancers
11%
5.2%
8.5%
Cardiovascular diseases Chronic respiratory diseases Cirrhosis Digestive diseases Neurological disorders
40−69 years [39.8% of total deaths]
70+ years [33.5% of total deaths]
3.1% 7.7%
Other non-communicable Transport injuries
3.8%
6.8%
9.2%
2.3%
Unintentional injuries
7.7%
7%
3.3% 3.2%
22.6%
4.3% 5.4% 15% 10.5%
28.7%
Diabetes/urog‡/blood/endo§
2.8% 2.6%
16.5%
6.9%
Suicide & violence
1.6%
Other causes of death *LRI is lower respiratory infections. † NTDs are neglected tropical diseases. ‡ Urog is urogenital diseases. § Endo is endocrine diseases.
28.9%
Assam
87
Proportion of total disease burden from: Premature death: 71.3% | Disability or morbidity: 28.7% What caused the most years of life lost, by sex, in 2016? Top 15 causes of YLLs, ranked by percent for both sexes combined, 2016 Females
Males Diarrhoeal diseases Stroke Lower respiratory infections Ischaemic heart disease Tuberculosis Preterm birth complications COPD* Other neonatal disorders Suicide Neonatal encephalopathy Hepatitis Road injuries Chronic kidney disease Congenital birth defects Diabetes
9
6
3
0
0
Percent of total years of life lost due to premature mortality
3
6
9
Percent of total years of life lost due to premature mortality
Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
Injuries
What caused the most years lived with disability, by sex, in 2016? *COPD is chronic obstructive pulmonary disease. Top 15 causes of YLDs, ranked by percent for both sexes combined, 2016 Females
Males Iron-deďŹ ciency anaemia Sense organ diseases* Migraine Low back & neck pain Skin diseases Other musculoskeletal Depressive disorders COPD* Anxiety disorders Diabetes Preterm birth complications Oral disorders Falls Osteoarthritis Schizophrenia
20
15 10 5 Percent of total years lived with disability
0
Communicable, maternal, neonatal, and nutritional diseases
0
5 10 15 Percent of total years lived with disability
Non-communicable diseases
*COPD is chronic obstructive pulmonary disease. *Sense organ diseases includes mainly hearing and vision loss.
88
Assam
Injuries
20
Proportion of total disease burden from: CMNNDs: 38.5% | NCDs: 51.2% | Injuries: 10.3% How leading causes causesofofdeath deathand anddisability disability combined changed from 1990 to 2016? How have have the leading combined changed from 1990 to 2016? Change causesof ofDALYs, DALYs,both bothsexes, sexes,ranked rankedbyby number DALYs, 1990–2016 Change in top 15 causes number of of DALYs, 1990–2016 Communicable, maternal, neonatal, and nutritional diseases
Injuries
Non-communicable diseases
Leading causes of DALYs 1990
same or increase
decrease
Leading causes of DALYs 2016
Diarrhoeal diseases [14.0%] Lower respiratory infections [7.9%] Tuberculosis [5.6%] Preterm birth complications [4.9%] Measles [4.7%] Other neonatal disorders [4.1%] COPD† [3.4%] Neonatal encephalopathy [3.2%] Stroke [3.0%] Iron-deficiency anaemia [2.4%] Ischaemic heart disease [1.7%] Self-harm§ [1.6%] Asthma [1.5%] Malaria [1.4%] Intestinal infectious diseases [1.4%] Hepatitis [1.3%] Sense organ diseases‡ [1.1%] Road injuries [1.1%] Diabetes [0.7%]
1
1
2
2
3
3
4
4
5
5
6
6
7
7
8
8
9
9
10
10
11
11
12
12
13
13
14
14
15
15
18 20
23 26
21
27
37
46 †
*Change not significant. The percent figure in brackets next to each cause is DALYs from that cause out of total DALYs.
Diarrhoeal diseases [5.8%] Stroke [5.6%] Lower respiratory infections [5.1%] COPD† [4.1%]* Ischaemic heart disease [4.1%] Preterm birth complications [3.8%]* Tuberculosis [3.8%] Iron-deficiency anaemia [3.7%] Other neonatal disorders [2.4%] Sense organ diseases‡ [2.3%] Road injuries [2.3%] Self-harm§ [2.2%]* Hepatitis [2.1%] Neonatal encephalopathy [2.1%] Diabetes [2.0%] Asthma [1.2%]* Malaria [1.2%]* Intestinal infectious diseases [0.9%] Measles [0.6%]
COPD is chronic obstructive pulmonary disease. Sense organ diseases includes mainly hearing and vision loss. Self-harm refers to suicide and the nonfatal outcomes of self-harm.
‡
§
What caused death and disability combined across age groups in 2016? What causedthe themost most death and disability combined across age groups in 2016? Percent of DALYs by age group, both sexes, 2016 Percent of DALYs by age group, both sexes, 2016 [2.4] 20
10
[0.61]
[0.57]
[0.8]
[0.68]
[1.41]
[1.13]
[0.93]
[1.75]
[2.16] [2.71]
[0.46]
5 [0.33]
[3.27]
[0.32]
[3.71] [4.13] [4.41]
) (< 1%
85
80
+
%) 84
(1
%) to
79 to
to 70
75
74
(1
(1
%)
%) 69
(2
%) to 65
64
(3
%) to 60
59
(4
%) to 55
54
(5
%) to 50
49
(6
%) to 45
to
44
(7 40
39 to 35
34
(6
%)
%) (8
%) to 30
29
(9
%) to 25
24 to 20
to
19
(9
(9
%)
) 0% (1 14
to
15
0% (1 10
o9 5t
de r
5(
9%
)
)
0
Un
Percent of total DALYs
15
Age Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
The number in the bracket on top of each vertical bar is the ratio of percent DALYs to population for that age group. The number in parentheses after each age group on the x-axis is the percent of population in that age group.
Injuries
Assam
89
What risk factors are driving the most death and disability combined? Contribution of top 10 risks to DALYs number, both sexes, ranked by number of DALYs, 19 What risk factors are driving the most death and disability combined? What risk factors are driving the most death and disability combined? Contribution DALYs number, bothboth sexes, ranked by number of DALYs, 1990-2016 Contribution oftop top10 10risks riskstoto DALYs number, sexes, ranked by number of DALYs, 1990-2016 same or increase Behaviouralof Environmental/occupational Metabolic Behavioural
Environmental/occupational
same or increase
Metabolic
Risk factors 1990
Risk factors 1990
1 2 3 4 5 6 7 Alcohol & drug use [2.0%] 8 Impaired kidney function [0.9%] 10 Occupational risks [1.9%] 9 The percent figure in bracket next to each risk is DALYs from that risk out of total DALYs. Impaired kidney function [1.3%] 10 High body-mass index [1.0%] 11 Malnutrition* [35.4%]
1 2 3 4 5 6 7 8 9 10
decrease
Risk factors 2016
Risk factors 2016
Malnutrition* [32.2%] 1 † [15.2%] [14.1%] WaSH†WaSH 2 Air pollution [7.7%] [9.3%] 3 Air pollution Tobacco use [3.6%] 4 Tobacco use [4.4%] Dietary risks [2.3%] 5 Dietary[2.2%] risks [3.7%] High blood pressure 6 Occupational [1.9%] [3.6%] 7 High bloodrisks pressure Alcohol & drug use [1.6%] 8 High fasting plasma glucose [2.1%] High fasting plasma glucose [1.4%] 9
decrease
1
Malnutrition* [17.4%]
Malnutrition* [14.8%] 2 Air pollution [8.7%] Air pollution [5.1%] High blood pressure [5.0%] 3 High blood pressure [7.6%] Tobacco use [4.9%] 4 Dietary risks [6.9%] Dietary risks [4.7%] Tobacco use [5.7%] 5 [4.0%] High fasting plasma glucose WaSH† [3.9%] 6 WaSH† [5.7%] Alcohol & drug use [3.9%] 7 High fasting plasma glucose [4.8%] Occupational risks [2.6%] Impaired kidney function8 [2.0%]Alcohol & drug use [3.9%]
9
High body-mass index [3.5%] [2.5%] 11 Impaired kidney function [2.5%]
*Malnutrition is child and maternal malnutrition. risks 10 Occupational † WaSH is unsafe water, sanitation, and handwashing.
*Malnutrition is child and maternal malnutrition. † WaSH is unsafe water, sanitation, and handwashing.
The percent figure in bracket next to each risk is DALYs from that risk out of total DALYs.
How did the risk factors differ by sex in 2016? Percent of total DALYs attributable to top 10 risks, ranked by percent for both sexes combined, 2016 Females
Males Malnutrition* Air pollution High blood pressure Dietary risks Tobacco use WaSH† High fasting plasma glucose Alcohol & drug use High body-mass index Occupational risks
20
15
10
5
0
Percent of years of life lost and years lived with disability Behavioural
0
5
Environmental/occupational *Malnutrition is child and maternal malnutrition. is unsafe water, sanitation, and handwashing.
†WaSH
90
Assam
10
15
Percent of years of life lost and years lived with disability Metabolic
20
Bihar 1990 life expectancy Females: 57.9 years Males: 58.9 years
2016 life expectancy Females: 67.7 years Males: 67.7 years
How much did the under-5 mortality rate change from 1990 to 2016? How much did the under-5 mortality rate change from 1990 to 2016? Under-5 mortality both sexes combined, 1990-2016 Under-5 mortality rate, bothrate, sexes combined, 1990-2016 Bihar under-5 rate
India under-5 rate
Comparative average rate globally for similar Socio-demographic Index as Bihar
Deaths per 1,000 live births
150
100
66.4
50
45.8 39.2
0 1990
1995
2000
2005
2010
The shaded bands indicate 95% uncertainty intervals around the estimates
2016
Year What caused the most deaths in different age groups in 2016? Percent top 10 causesdeaths of death byin agedifferent group, both sexes, Whatcontribution causedofthe most age 2016 groups
in 2016? Percent contribution of top 10 causes of death by age group, both sexes, 2016 0−14 years [18.6% of total deaths]
15−39 years [11.6% of total deaths]
0.9% 3.1% 5.5%
HIV/AIDS & tuberculosis
1.1% 11.8% 9.5%
39.5%
2.4%
13.5%
Diarrhoea/LRI*/other NTDs† & malaria
0.9%
8.2%
13.4%
Neonatal disorders
1.5% 10.4%
7.2%
3.9%
Nutritional deficiencies Other communicable diseases
5.7%
31.8%
Maternal disorders
Cancers
9% 12.8%
Cardiovascular diseases
3.9% 4.1%
Chronic respiratory diseases Cirrhosis Digestive diseases Neurological disorders
40−69 years [38.2% of total deaths]
70+ years [31.6% of total deaths]
Diabetes/urog‡/blood/endo§
2.5% 2.4%
11.9%
6.3% 5.5% 4.5%
2.5%
6.7%
Other non-communicable Transport injuries
3.6% 6.9% 3.6%
23.2%
Unintentional injuries
1.6% 1.4%
2.4% 3.9%
11%
16.4%
5.4% 12.1%
33.3%
Suicide & violence Other causes of death *LRI is lower respiratory infections. † NTDs are neglected tropical diseases. ‡ Urog is urogenital diseases. § Endo is endocrine diseases.
33.1%
Bihar
91
Proportion of total disease burden from: Premature death: 69.9% | Disability or morbidity: 30.1% What caused the most years of life lost, by sex, in 2016? Top 15 causes of YLLs, ranked by percent for both sexes combined, 2016 Females
Males Diarrhoeal diseases Ischaemic heart disease Lower respiratory infections Other neonatal disorders Congenital birth defects COPD* Preterm birth complications Stroke Neonatal encephalopathy Tuberculosis Road injuries HIV/AIDS Intestinal infectious diseases Diabetes Chronic kidney disease
15
10
5
0
0
Percent of total years of life lost due to premature mortality
5
10
15
Percent of total years of life lost due to premature mortality
Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
Injuries
*COPD is chronic obstructive pulmonary disease. What caused the most years lived with disability, by sex, in 2016? Top 15 causes of YLDs, ranked by percent for both sexes combined, 2016
Females
Males Iron-deďŹ ciency anaemia Sense organ diseases* Low back & neck pain Migraine Skin diseases Other musculoskeletal Depressive disorders COPD* Anxiety disorders Preterm birth complications Oral disorders Falls Diabetes Haemoglobinopathies Diarrhoeal diseases
20
15 10 5 Percent of total years lived with disability
0
Communicable, maternal, neonatal, and nutritional diseases
0
20 5 10 15 Percent of total years lived with disability
Non-communicable diseases
*COPD is chronic obstructive pulmonary disease. *Sense organ diseases includes mainly hearing and vision loss.
92
Bihar
Injuries
Proportion of total disease burden from: CMNNDs: 42.6% | NCDs: 47.6% | Injuries: 9.8% How leading causes causesofofdeath deathand anddisability disability combined changed from 1990 to 2016? How have have the leading combined changed from 1990 to 2016? Change causesof ofDALYs, DALYs,both bothsexes, sexes,ranked rankedbyby number DALYs, 1990–2016 Change in top 15 causes number of of DALYs, 1990–2016 Communicable, maternal, neonatal, and nutritional diseases
Injuries
Non-communicable diseases
Leading causes of DALYs 1990
same or increase
decrease
Leading causes of DALYs 2016
Diarrhoeal diseases [14.1%] Lower respiratory infections [12.3%] Measles [7.0%] Preterm birth complications [4.2%] Tuberculosis [3.8%] Other neonatal disorders [3.4%] Ischaemic heart disease [2.8%] COPD† [2.7%] Neonatal encephalopathy [2.6%] Leishmaniasis [2.5%] Iron-deficiency anaemia [2.5%] Congenital birth defects [2.1%] Tetanus [1.8%] Falls [1.3%] Stroke [1.3%] Sense organ diseases‡ [1.2%] Low back & neck pain [1.1%] Road injuries [1.1%] Skin diseases [1.0%]
1
1
2
2
3
3
4
4
5
5
6
6
7
7
8
8
9
9
10
10
11
11
12
12
13
13
14
14
15
15
17
18 35
20 22
41
25
101 †
*Change not significant. The percent figure in brackets next to each cause is DALYs from that cause out of total DALYs.
Diarrhoeal diseases [7.6%] Ischaemic heart disease [6.6%] Lower respiratory infections [6.4%] Iron-deficiency anaemia [4.3%] COPD† [3.9%] Preterm birth complications [3.5%]* Congenital birth defects [3.3%]* Other neonatal disorders [3.1%]* Stroke [2.8%] Neonatal encephalopathy [2.6%]* Sense organ diseases‡ [2.5%] Tuberculosis [2.4%] Road injuries [2.1%] Low back & neck pain [1.9%] Skin diseases [1.8%] Falls [1.6%]* Leishmaniasis [0.7%] Measles [0.6%] Tetanus [0.1%]
COPD is chronic obstructive pulmonary disease. Sense organ diseases includes mainly hearing and vision loss. Self-harm refers to suicide and the nonfatal outcomes of self-harm.
‡
§
What caused death and disability combined across age groups in 2016? What causedthe themost most death and disability combined across age groups in 2016? Percent of DALYs by age group, both sexes, 2016 Percent of DALYs by age group, both sexes, 2016 [2.41]
Percent of total DALYs
20
10
[0.35]
[0.33]
[0.6]
[0.54]
[0.45]
[0.66]
[0.76]
[1.05]
[0.87]
[2.03]
[1.61]
[1.3]
[2.56] [3.11] [3.54]
[4.05]
[4.43]
) 1% (<
85
84 80
to
+
(< 1%
%) 79
(1
%) to 75
74
(1
%) to 70
to
69
(3 65
64
(2
%)
%) to 60
to
59
(4 55
54 to 50
49
(3
%)
%) (4
%) to 45
44 to 40
39
(5
%) (6
%) to 35
34
(8
%) to 30
29
(8
%) 24
to
to 25
(9 20
(1
19 to 15
14 to
(8
%)
) 2%
3% (1 10
o9 5t
Un
de r5
(1
2%
)
)
)
0
Age Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
The number in the bracket on top of each vertical bar is the ratio of percent DALYs to population for that age group. The number in parentheses after each age group on the x-axis is the percent of population in that age group.
Injuries
Bihar
93
What risk factors are driving the most death and disability combined? Contribution of top 10 risks to DALYs number, both sexes, ranked by number of DALYs, 19 What risk factors are driving the most death and disability combined? What risk factors are driving the most death and disability combined? Contribution DALYs number, bothboth sexes, ranked by number of DALYs, 1990-2016 Contribution oftop top10 10risks riskstoto DALYs number, sexes, ranked by number of DALYs, 1990-2016 same or increase Behaviouralof Environmental/occupational Metabolic Behavioural
Environmental/occupational
same or increase
Metabolic
Risk factors 1990
Risk factors 1990
1 2 3 4 5 6 7 High fasting plasma glucose [1.5%] 8 Impaired kidney function [0.9%] 10 High total cholesterol [1.3%] 9 The percent figure in bracket next to each risk is DALYs from that risk out of total DALYs. Alcohol & drug use [1.2%] 10 Malnutrition* [39.7%]
1 2 3 4 5 6 7 8 9 10
decrease
Risk factors 2016
Risk factors 2016
Malnutrition* [32.2%] 1 † [15.2%] [14.9%] WaSH†WaSH 2 Air Air pollution [7.7%] [12.7%] 3 pollution Tobacco use [3.6%] 4 Tobacco use [3.8%] Dietary risks [2.3%] 5 Dietary[2.2%] risks [3.3%] High blood pressure 6 Occupational [1.9%] [2.8%] 7 High bloodrisks pressure Alcohol & drug use [1.6%] 8 Occupational risks [1.9%] High fasting plasma glucose [1.4%] 9
1
Malnutrition* [21.7%]
9
Occupational risks [2.7%] [2.3%]
Malnutrition* [14.8%] 2 Air pollution [11.6%] Air pollution [5.1%] High blood pressure [5.0%] 3 WaSH† [7.9%] Tobacco use [4.9%] 4 Dietary risks [7.0%] Dietary risks [4.7%] High blood pressure [6.4%] 5 [4.0%] High fasting plasma glucose WaSH† [3.9%] 6 Tobacco use [4.8%] Alcohol & drug use [3.9%] 7 High fasting plasma glucose [3.8%] Occupational risks [2.6%] Impaired kidney function8 [2.0%]High total cholesterol [2.7%] *Malnutrition is child and maternal malnutrition. 10 Alcohol & drug use † WaSH is unsafe water, sanitation, and handwashing.
*Malnutrition is child and maternal malnutrition. † WaSH is unsafe water, sanitation, and handwashing.
The percent figure in bracket next to each risk is DALYs from that risk out of total DALYs.
How did the risk factors differ by sex in 2016? Percent of total DALYs attributable to top 10 risks, ranked by percent for both sexes combined, 2016 Females
Males Malnutrition* Air pollution WaSH† Dietary risks High blood pressure Tobacco use High fasting plasma glucose High total cholesterol Occupational risks Alcohol & drug use
20
15
10
5
0
Percent of years of life lost and years lived with disability Behavioural
0
5
*Malnutrition is child and maternal malnutrition. is unsafe water, sanitation, and handwashing.
94
Bihar
10
15
20
Percent of years of life lost and years lived with disability Environmental/occupational
†WaSH
decrease
Metabolic
Chhattisgarh 1990 life expectancy Females: 58.9 years Males: 55.7 years
2016 life expectancy Females: 68.3 years Males: 64.6 years
How much did the under-5 mortality rate change from 1990 to 2016? How much did the under-5 mortality rate change from 1990 to 2016? Under-5 mortality both sexes combined, 1990-2016 Under-5 mortality rate, bothrate, sexes combined, 1990-2016 Chhattisgarh under-5 rate
India under-5 rate
Comparative average rate globally for similar Socio-demographic Index as Chhattisgarh
Deaths per 1,000 live births
150
100
50
46.9 39.2 37.8
0 1990
1995
2000
2005
2010
The shaded bands indicate 95% uncertainty intervals around the estimates
2016
Year What caused the most deaths in different age groups in 2016? Percent top 10 causesdeaths of death byin agedifferent group, both sexes, Whatcontribution causedofthe most age 2016 groups
in 2016? Percent contribution of top 10 causes of death by age group, both sexes, 2016 0−14 years [12% of total deaths]
15−39 years [12% of total deaths]
1.4% 3.2% 0.9% 4.8% 5.1% 32%
HIV/AIDS & tuberculosis
10.8%
1% 1.6%
2.9%
Diarrhoea/LRI*/other
12.8%
NTDs† & malaria
12%
Maternal disorders
16.1%
Neonatal disorders
3.3%
Nutritional deficiencies
5.6%
Other communicable diseases
9.9%
5.8%
Cancers
11.4%
41.3%
Cardiovascular diseases
9.8%
Chronic respiratory diseases
3.6%
4.7%
Cirrhosis Digestive diseases Neurological disorders
40−69 years [41.9% of total deaths]
70+ years [34.1% of total deaths]
Diabetes/urog‡/blood/endo§
3.2% 7.6%
7.5%
4.4%
4%
2.8%
Other non-communicable Transport injuries
4%
Unintentional injuries
8.1%
11.4% 7.3%
3.3% 2.8%
26.5%
4%
11.6%
9.7%
2.7% 7.2%
33.5%
6.1%
Suicide & violence
0.8%
Other causes of death *LRI is lower respiratory infections. † NTDs are neglected tropical diseases. ‡ Urog is urogenital diseases. § Endo is endocrine diseases.
31.4%
Chhattisgarh
95
Proportion of total disease burden from: Premature death: 70.1% | Disability or morbidity: 29.9% What caused the most years of life lost, by sex, in 2016? Top 15 causes of YLLs, ranked by percent for both sexes combined, 2016 Females
Males Ischaemic heart disease Stroke Diarrhoeal diseases Lower respiratory infections Preterm birth complications Tuberculosis Other neonatal disorders Suicide Road injuries COPD* Neonatal encephalopathy Malaria Intestinal infectious diseases Diabetes Chronic kidney disease
12
9
6
3
0
0
Percent of total years of life lost due to premature mortality
3
6
9
12
Percent of total years of life lost due to premature mortality
Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
Injuries
What caused the most years lived with disability, sex,obstructive in 2016? *COPD by is chronic pulmonary disease. Top 15 causes of YLDs, ranked by percent for both sexes combined, 2016 Females
Males Iron-deďŹ ciency anaemia Sense organ diseases* Low back & neck pain Migraine Skin diseases Other musculoskeletal Depressive disorders COPD* Diabetes Preterm birth complications Falls Anxiety disorders Oral disorders Intestinal nematodes Osteoarthritis
15
10 5 Percent of total years lived with disability
0
Communicable, maternal, neonatal, and nutritional diseases
0
5 10 Percent of total years lived with disability
Non-communicable diseases
*COPD is chronic obstructive pulmonary disease. *Sense organ diseases includes mainly hearing and vision loss.
96
Chhattisgarh
Injuries
15
Proportion of total disease burden from: CMNNDs: 37.7% | NCDs: 50.4% | Injuries: 11.9% How leading causes causesofofdeath deathand anddisability disability combined changed from 1990 to 2016? How have have the leading combined changed from 1990 to 2016? Change causesof ofDALYs, DALYs,both bothsexes, sexes,ranked rankedbyby number DALYs, 1990–2016 Change in top 15 causes number of of DALYs, 1990–2016 Communicable, maternal, neonatal, and nutritional diseases
Injuries
Non-communicable diseases
Leading causes of DALYs 1990
same or increase
decrease
Leading causes of DALYs 2016
Lower respiratory infections [11.5%] Diarrhoeal diseases [10.4%] Preterm birth complications [6.7%] Other neonatal disorders [5.2%] Malaria [4.8%] Tuberculosis [4.6%] Neonatal encephalopathy [3.8%] Measles [3.4%] Stroke [2.6%] Intestinal infectious diseases [2.2%] Ischaemic heart disease [2.1%] Iron-deficiency anaemia [1.8%] Protein-energy malnutrition [1.6%] Congenital birth defects [1.6%] COPD† [1.5%] Sense organ diseases‡ [1.3%] Self-harm§ [1.3%] Road injuries [1.2%] Low back & neck pain [1.0%] Migraine [0.9%] Diabetes [0.5%]
1
1
2
2
3
3
4
4
5
5
6
6
7
7
8
8
9
9
10
10
11
11
12
12
13
13
14
14
15
15
17
17 20
19 20
22
24 27
23 26
41
49 †
*Change not significant. The percent figure in brackets next to each cause is DALYs from that cause out of total DALYs.
Ischaemic heart disease [6.1%] Diarrhoeal diseases [5.7%] Stroke [5.5%] Lower respiratory infections [5.0%] Preterm birth complications [4.2%] Tuberculosis [3.5%] COPD† [3.1%] Iron-deficiency anaemia [3.1%] Other neonatal disorders [2.9%] Sense organ diseases‡ [2.8%] Self-harm§ [2.6%] Road injuries [2.4%] Low back & neck pain [2.0%] Diabetes [2.0%] Migraine [1.9%] Neonatal encephalopathy [1.7%] Malaria [1.5%] Intestinal infectious diseases [1.4%] Congenital birth defects [1.3%]* Protein-energy malnutrition [1.0%] Measles [0.5%]
COPD is chronic obstructive pulmonary disease. Sense organ diseases includes mainly hearing and vision loss. Self-harm refers to suicide and the nonfatal outcomes of self-harm.
‡
§
What caused death and disability combined across age groups in 2016? What causedthe themost most death and disability combined across age groups in 2016? Percent of DALYs by age group, both sexes, 2016 Percent of DALYs by age group, both sexes, 2016 [2.17]
20
10
[0.55] 5
[0.78]
[0.66]
[0.59]
[2.12]
[1.7]
[1.38]
[1.1]
[0.9]
[2.65] [3.2]
[0.45]
[3.63]
[0.31]
[0.31]
[4.09] [4.43]
) +
(<
1%
1%
to
85
84
(<
(1 79 to
80
70
75
74 to
69 to
%)
%) (1
%) (2
%) (3 65
to
64
(4 60
59 to 55
54
(5
%)
%)
%) to 50
49 to 45
44
(6
%) (7
%) to 40
39
(7
%) to 35
34
(8
%) to 30
29 to
24
(9 25
(1
(8
%)
) to 20
19 to 15
to
14
(1
0%
) 0%
0% (1 10
o9 5t
de
r5
(9
%)
)
)
0
Un
Percent of total DALYs
15
Age Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
The number in the bracket on top of each vertical bar is the ratio of percent DALYs to population for that age group. The number in parentheses after each age group on the x-axis is the percent of population in that age group.
Injuries
Chhattisgarh
97
What risk factors are driving the most death and disability combined? Contribution of top 10 risks to DALYs number, both sexes, ranked by number of DALYs, 19 What risk factors are driving the most death and disability combined? What risk factors are driving the most death and disability combined? Contribution DALYs number, bothboth sexes, ranked by number of DALYs, 1990-2016 Contribution oftop top10 10risks riskstoto DALYs number, sexes, ranked by number of DALYs, 1990-2016 same or increase Behaviouralof Environmental/occupational Metabolic Behavioural
Environmental/occupational
same or increase
Metabolic
Risk factors 1990
Risk factors 1990
1 2 3 4 5 6 7 Occupational risks [1.6%] 8 Impaired kidney function [0.9%] 10 Alcohol & drug use [1.2%] 9 The percent figure in bracket next to each risk is DALYs from that risk out of total DALYs. High total cholesterol [1.1%] 10 High body-mass index [0.6%] 12 Malnutrition* [37.6%]
1 2 3 4 5 6 7 8 9 10
decrease
Risk factors 2016
Risk factors 2016
Malnutrition* [32.2%] 1 † [15.2%] [11.4%] WaSH†WaSH 2 Air Air pollution [7.7%] [10.8%] 3 pollution Tobacco use [3.6%] 4 Tobacco use [3.6%] Dietary risks [2.3%] 5 Dietary[2.2%] risks [3.6%] High blood pressure 6 Occupational [1.9%] [3.6%] 7 High bloodrisks pressure Alcohol & drug use [1.6%] 8 High fasting plasma glucose [1.6%] High fasting plasma glucose [1.4%] 9
decrease
1
Malnutrition* [16.4%]
Malnutrition* [14.8%] 2 Air pollution [9.5%] Air pollution [5.1%] High blood pressure [5.0%] 3 High blood pressure [8.0%] Tobacco use [4.9%] 4 Dietary risks [7.9%] Dietary risks [4.7%] WaSH† [5.7%] 5 [4.0%] High fasting plasma glucose WaSH† [3.9%] 6 High fasting plasma glucose [5.4%] Alcohol & drug use [3.9%] 7 Tobacco use [4.5%] Occupational risks [2.6%] Impaired kidney function8 [2.0%]High total cholesterol [3.3%]
9
Alcohol & drug use [3.2%] [3.0%] 11 Occupational risks [2.5%]
*Malnutrition is child and maternal malnutrition. body-mass index 10 High † WaSH is unsafe water, sanitation, and handwashing.
*Malnutrition is child and maternal malnutrition. † WaSH is unsafe water, sanitation, and handwashing.
The percent figure in bracket next to each risk is DALYs from that risk out of total DALYs.
How did the risk factors differ by sex in 2016? Percent of total DALYs attributable to top 10 risks, ranked by percent for both sexes combined, 2016 Females
Males Malnutrition* Air pollution High blood pressure Dietary risks WaSH† High fasting plasma glucose Tobacco use High total cholesterol Alcohol & drug use High body-mass index
20
15
10
5
0
Percent of years of life lost and years lived with disability Behavioural
0
5
Environmental/occupational *Malnutrition is child and maternal malnutrition. is unsafe water, sanitation, and handwashing.
†WaSH
98
Chhattisgarh
10
15
20
Percent of years of life lost and years lived with disability Metabolic
Delhi 1990 life expectancy Females: 65.6 years Males: 63.5 years
2016 life expectancy Females: 74.7 years Males: 70.8 years
How much did the under-5 mortality rate change from 1990 to 2016? How much did the under-5 mortality rate change from 1990 to 2016? Under-5 mortality both sexes combined, 1990-2016 Under-5 mortality rate, bothrate, sexes combined, 1990-2016 Delhi under-5 rate
India under-5 rate
Comparative average rate globally for similar Socio-demographic Index as Delhi
Deaths per 1,000 live births
150
100
50 39.2 31.4 12.7
0 1990
1995
2000
2005
2010
The shaded bands indicate 95% uncertainty intervals around the estimates
2016
Year What caused the most deaths in different age groups in 2016? Percent top 10 causesdeaths of death byin agedifferent group, both sexes, Whatcontribution causedofthe most age 2016 groups
in 2016? Percent contribution of top 10 causes of death by age group, both sexes, 2016 0−14 years [10.8% of total deaths]
4%
15−39 years [14.8% of total deaths]
HIV/AIDS & tuberculosis
1.6% 4.3%
11.5% 8.2%
28.3%
2.3%
1.3% 0.9% 1.5%
Diarrhoea/LRI*/other
11.6%
NTDs† & malaria
8.4%
10.7%
Maternal disorders
2.5%
Neonatal disorders
8.1%
9.1%
Nutritional deficiencies
2.5%
Other communicable diseases
12.4%
14.9%
Cancers Cardiovascular diseases
5.2% 5.7%
45%
Chronic respiratory diseases Cirrhosis Digestive diseases Neurological disorders
40−69 years [41.2% of total deaths]
70+ years [33.2% of total deaths]
Diabetes/urog‡/blood/endo§
2.6% 2.6%
4.7%
6.1% 5.2% 3.4% 3.4%
9.4% 9%
19.8%
Other non-communicable Transport injuries
4.3%
Unintentional injuries
11.6%
Suicide & violence
9%
Other causes of death
4.8%
2.2%
1.9% 1.2%
4.2% 6.3%
9.5%
*LRI is lower respiratory infections. † NTDs are neglected tropical diseases. ‡ Urog is urogenital diseases. § Endo is endocrine diseases.
43.2% 35.6%
Delhi
99
Proportion of total disease burden from: Premature death: 59.2% | Disability or morbidity: 40.8% What caused the most years of life lost, by sex, in 2016? Top 15 causes of YLLs, ranked by percent for both sexes combined, 2016 Females
Males Ischaemic heart disease Lower respiratory infections Tuberculosis Other neonatal disorders Road injuries Preterm birth complications Stroke Chronic kidney disease Neonatal encephalopathy COPD* Intestinal infectious diseases Suicide Diarrhoeal diseases Diabetes Congenital birth defects
20
15
10
5
0
0
Percent of total years of life lost due to premature mortality
5
10
15
20
Percent of total years of life lost due to premature mortality
Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
Injuries
What caused the most years lived with disability, sex,obstructive in 2016? *COPDby is chronic pulmonary disease. Top 15 causes of YLDs, ranked by percent for both sexes combined, 2016 Females
Males Iron-deďŹ ciency anaemia Sense organ diseases* Migraine Low back & neck pain Skin diseases Other musculoskeletal Diabetes COPD* Depressive disorders Anxiety disorders Oral disorders Preterm birth complications Falls Schizophrenia Drug use disorders
12.5
10.0 7.5 5.0 2.5 Percent of total years lived with disability
0
Communicable, maternal, neonatal, and nutritional diseases
0
2.5 5.0 7.5 10.0 12.5 Percent of total years lived with disability
Non-communicable diseases
*COPD is chronic obstructive pulmonary disease. *Sense organ diseases includes mainly hearing and vision loss.
100 Delhi
Injuries
Proportion of total disease burden from: CMNNDs: 27.8% | NCDs: 61.2% | Injuries: 11.0% How leading causes causesofofdeath deathand anddisability disability combined changed from 1990 to 2016? How have have the leading combined changed from 1990 to 2016? Change causesof ofDALYs, DALYs,both bothsexes, sexes,ranked rankedbyby number DALYs, 1990–2016 Change in top 15 causes number of of DALYs, 1990–2016 Communicable, maternal, neonatal, and nutritional diseases
Injuries
Non-communicable diseases
Leading causes of DALYs 1990
Lower respiratory infections [7.4%] Diarrhoeal diseases [6.9%] Preterm birth complications [5.7%] Other neonatal disorders [5.4%] Ischaemic heart disease [5.3%] Tuberculosis [5.2%] Neonatal encephalopathy [3.8%] Meningitis [2.6%] Intestinal infectious diseases [2.5%] Congenital birth defects [2.3%] Iron-deficiency anaemia [2.3%] Road injuries [2.2%] COPD† [1.9%] Measles [1.8%] Sense organ diseases‡ [1.6%] Stroke [1.6%] Skin diseases [1.5%] Migraine [1.5%] Low back & neck pain [1.5%] Diabetes [1.3%] Other musculoskeletal disorders [1.2%]
same or increase
decrease
Leading causes of DALYs 2016
1
1
2
2
3
3
4
4
5
5
6
6
7
7
8
8
9
9
10
10
11
11
12
12
13
13
14
14
15
15
16
18 20
17 18
21
19 22
22 29
24
105
Ischaemic heart disease [9.6%] Iron-deficiency anaemia [3.4%] COPD† [3.4%] Preterm birth complications [3.4%]* Diabetes [3.2%] Tuberculosis [3.2%] Sense organ diseases‡ [3.1%] Road injuries [3.1%] Lower respiratory infections [3.0%] Migraine [2.8%] Low back & neck pain [2.7%] Other neonatal disorders [2.6%]* Skin diseases [2.6%] Other musculoskeletal disorders [2.1%] Stroke [2.1%] Diarrhoeal diseases [1.8%] Neonatal encephalopathy [1.7%] Congenital birth defects [1.6%]* Intestinal infectious diseases [1.6%] Meningitis [0.9%] Measles [0.1%]
†
*Change not significant. The percent figure in brackets next to each cause is DALYs from that cause out of total DALYs.
COPD is chronic obstructive pulmonary disease. Sense organ diseases includes mainly hearing and vision loss. § Self-harm refers to suicide and the nonfatal outcomes of self-harm. ‡
What caused death and disability combined across age groups in 2016? What causedthe themost most death and disability combined across age groups in 2016? Percent of DALYs by age group, both sexes, 2016 Percent of DALYs by age group, both sexes, 2016 16 [2.23]
8
[0.73]
[0.65]
[0.85]
[1.46]
[1.18]
[0.98]
[1.82] [2.25]
[0.59]
[2.8]
[0.49] 4
[3.35]
[0.36]
[0.37]
[3.84] [4.52]
[5.22]
) +
85
80
to
(< 1%
(< 1% 84
79
(1
%)
%) to 75
74 70
to
69
(1
%) (2
%) to 65
64
(3
%) to 60
59
(4
%) to 55
54
(5
%) to 50
49
(6
%) to 45
40
to
44
(8
(7
%)
)
39 to
(1 to
34
(1 30
35
1%
0%
)
) 29 to 25
24
(1
(9 to 20
19 to 15
14
0%
%)
%) (9
%) (9 to 10
o9 5t
de r
5(
7%
)
)
0
Un
Percent of total DALYs
12
Age Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
The number in the bracket on top of each vertical bar is the ratio of percent DALYs to population for that age group. The number in parentheses after each age group on the x-axis is the percent of population in that age group.
Injuries
Delhi 101
What risk factors are driving the most death and disability combined? Contribution of top 10 risks to DALYs number, both sexes, ranked by number of DALYs, 19 What risk factors are driving the most death and disability combined? What risk factors are driving the most death and disability combined? Contribution DALYs number, bothboth sexes, ranked by number of DALYs, 1990-2016 Contribution oftop top10 10risks riskstoto DALYs number, sexes, ranked by number of DALYs, 1990-2016 same or increase Behaviouralof Environmental/occupational Metabolic Behavioural
Environmental/occupational
same or increase
Metabolic
Risk factors 1990
Risk factors 1990
1 2 3 4 5 6 7 Alcohol & drug use [2.9%] 8 Impaired kidney function [0.9%] 10 High total cholesterol [2.7%] 9 The percent figure in bracket next to each risk is DALYs from that risk out of total DALYs. Occupational risks [2.0%] 10 High body-mass index [1.8%] 11 Malnutrition* [30.5%]
1 2 3 4 5 6 7 8 9 10
decrease
Risk factors 2016
Risk factors 2016
Malnutrition* [32.2%] 1 † Air pollution [15.2%] [7.4%] WaSH 2 Air pollutionWaSH [7.7%] † [6.2%] 3 Tobacco use [3.6%] 4 Dietary risks [5.5%] Dietary risks [2.3%] 5 High blood pressure High blood pressure [2.2%] [4.7%] 6 Occupational risks [1.9%] 7 Tobacco use [4.4%] Alcohol & drug use [1.6%] 8 High fasting plasma glucose [4.0%] High fasting plasma glucose [1.4%] 9
decrease
1
Malnutrition* [12.9%]
Malnutrition* [14.8%] 2 High fasting plasma glucose [8.5%] Air pollution [5.1%] High blood pressure [5.0%] 3 Dietary risks [8.4%] Tobacco use [4.9%] 4 High blood pressure [7.9%] Dietary risks [4.7%] Air pollution [7.0%] 5 [4.0%] High fasting plasma glucose WaSH† [3.9%] 6 Tobacco use [6.0%] Alcohol & drug use [3.9%] 7 High body-mass index [5.7%] Occupational risks [2.6%] Impaired kidney function8 [2.0%]High total cholesterol [5.1%]
9
Alcohol & drug use [4.6%] [3.3%] 12 WaSH† [1.4%]
*Malnutrition is child and maternal malnutrition. 10 Occupational risks † WaSH is unsafe water, sanitation, and handwashing.
*Malnutrition is child and maternal malnutrition. † WaSH is unsafe water, sanitation, and handwashing.
The percent figure in bracket next to each risk is DALYs from that risk out of total DALYs.
How did the risk factors differ by sex in 2016? Percent of total DALYs attributable to top 10 risks, ranked by percent for both sexes combined, 2016 Females
Males Malnutrition* High fasting plasma glucose Dietary risks High blood pressure Air pollution Tobacco use High body-mass index High total cholesterol Alcohol & drug use Occupational risks
16
12
8
4
0
Percent of years of life lost and years lived with disability Behavioural
0
4
Environmental/occupational *Malnutrition is child and maternal malnutrition.
102 Delhi
8
12
16
Percent of years of life lost and years lived with disability Metabolic
Goa 1990 life expectancy Females: 69.2 years Males: 66.1 years
2016 life expectancy Females: 78.4 years Males: 73.0 years
How much did the under-5 mortality rate change from 1990 to 2016? How much did the under-5 mortality rate change from 1990 to 2016? Under-5 mortality both sexes combined, 1990-2016 Under-5 mortality rate, bothrate, sexes combined, 1990-2016 Goa under-5 rate
India under-5 rate
Comparative average rate globally for similar Socio-demographic Index as Goa
Deaths per 1,000 live births
150
100
50 39.2
16 13.5
0 1990
1995
2000
2005
2010
The shaded bands indicate 95% uncertainty intervals around the estimates
2016
Year What caused the most deaths in different age groups in 2016? Percent top 10 causesdeaths of death byin agedifferent group, both sexes, Whatcontribution causedofthe most age 2016 groups
in 2016? Percent contribution of top 10 causes of death by age group, both sexes, 2016 0−14 years [4.7% of total deaths]
15−39 years [9.4% of total deaths]
2.9% HIV/AIDS & tuberculosis
5%
1.6%
6.6%
10.5%
8%
4.5%
22%
Diarrhoea/LRI*/other NTDs† & malaria
15.1%
Maternal disorders
7.7%
12.4%
Neonatal disorders
2.7% 2%
1.4% 1.2%
Nutritional deficiencies
8.3%
13.4%
Other communicable diseases Cancers
12.1% 12.7%
42.1%
Cardiovascular diseases
5.1%
Chronic respiratory diseases Cirrhosis
2.5%
Digestive diseases Neurological disorders
40−69 years [42.6% of total deaths] 3.6% 4.5%
70+ years [43.3% of total deaths] 1.4% 2.1%
1.9% 4.9%
Diabetes/urog‡/blood/endo§
Transport injuries
2.8%
9.6%
3.9% 7.5%
14.4%
Other non-communicable
5.3%
Unintentional injuries
12.3%
Suicide & violence
10.4%
Other causes of death
5.6% 2.4%
9.5%
9.5% 37.4%
6.6%
1.3%
*LRI is lower respiratory infections. † NTDs are neglected tropical diseases. ‡ Urog is urogenital diseases. § Endo is endocrine diseases.
42.8%
Goa 103
Proportion of total disease burden from: Premature death: 56.1% | Disability or morbidity: 43.9% What caused the most years of life lost, by sex, in 2016? Top 15 causes of YLLs, ranked by percent for both sexes combined, 2016 Females
Males Ischaemic heart disease Stroke Diabetes Lower respiratory infections Road injuries COPD* Suicide Chronic kidney disease Cirrhosis due to hepatitis B HIV/AIDS Falls Cirrhosis due to alcohol use Tuberculosis Preterm birth complications Cirrhosis due to hepatitis C
20
15
10
5
0
0
Percent of total years of life lost due to premature mortality
5
10
15
20
Percent of total years of life lost due to premature mortality
Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
Injuries
What caused the most years lived with disability, by sex, in 2016? *COPD is chronic obstructive pulmonary disease. Top 15 causes of YLDs, ranked by percent for both sexes combined, 2016 Females
Males Sense organ diseases* Low back & neck pain Migraine Iron-deďŹ ciency anaemia Other musculoskeletal Skin diseases Depressive disorders COPD* Diabetes Falls Oral disorders Anxiety disorders Osteoarthritis Preterm birth complications Schizophrenia
12
9 6 3 Percent of total years lived with disability
0
Communicable, maternal, neonatal, and nutritional diseases
0
3 6 9 Percent of total years lived with disability
Non-communicable diseases
*COPD is chronic obstructive pulmonary disease. *Sense organ diseases includes mainly hearing and vision loss.
104 Goa
Injuries
12
Proportion of total disease burden from: CMNNDs: 17.6% | NCDs: 70.9% | Injuries: 11.5% How have have the leading combined changed from 1990 to 2016? How leading causes causesofofdeath deathand anddisability disability combined changed from 1990 to 2016? Change in top 15 causes number of of DALYs, 1990–2016 Change causesof ofDALYs, DALYs,both bothsexes, sexes,ranked rankedbyby number DALYs, 1990–2016 Communicable, maternal, neonatal, and nutritional diseases
Injuries
Non-communicable diseases
Leading causes of DALYs 1990
same or increase
decrease
Leading causes of DALYs 2016
Lower respiratory infections [7.8%] Diarrhoeal diseases [7.0%] Preterm birth complications [6.0%] Ischaemic heart disease [5.6%] Congenital birth defects [4.0%] Other neonatal disorders [3.9%] Tuberculosis [3.8%] Neonatal haemolytic disease [2.8%] Stroke [2.8%] Neonatal encephalopathy [2.6%] COPD† [2.6%] Self-harm§ [2.2%] Sense organ diseases‡ [2.1%] Low back & neck pain [2.0%] Iron-deficiency anaemia [1.9%] Road injuries [1.8%] Migraine [1.8%] Skin diseases [1.8%] Falls [1.7%] Depressive disorders [1.4%] Chronic kidney disease [1.3%] Other musculoskeletal disorders [1.3%] Diabetes [1.2%]
1
1 Ischaemic heart disease [11.0%]
2
2 Sense organ diseases‡ [4.1%]
3
3 Diabetes [4.1%]
4
4 COPD† [4.1%]
5
5 Stroke [4.0%]*
6
6 Low back & neck pain [3.6%]
7
7 Migraine [3.0%]
8
8 Road injuries [2.8%]
9 10
9 Falls [2.7%] 10 Skin diseases [2.5%]
11
11 Iron-deficiency anaemia [2.4%]
12
12 Other musculoskeletal disorders [2.4%]
13
13 Lower respiratory infections [2.3%]
14
14 Depressive disorders [2.3%]
15
15 Chronic kidney disease [2.3%]
16
16 Self-harm§ [2.1%]* 17 Preterm birth complications [2.0%]
17 19 21
20 Diarrhoeal diseases [1.5%] 21 Congenital birth defects [1.4%] 22 Tuberculosis [1.3%]
22 24
26 Other neonatal disorders [1.1%] 31 Neonatal encephalopathy [0.9%]
25
60 Neonatal haemolytic disease [0.4%]
18
†
*Change not significant. The percent figure in brackets next to each cause is DALYs from that cause out of total DALYs.
COPD is chronic obstructive pulmonary disease. Sense organ diseases includes mainly hearing and vision loss. § Self-harm refers to suicide and the nonfatal outcomes of self-harm. ‡
What caused death and disability combined across age groups in 2016? What causedthe themost most death and disability combined across age groups in 2016? Percent of DALYs by age group, both sexes, 2016 Percent of DALYs by age group, both sexes, 2016 10.0 [1.62]
[1.11]
[2.01]
[1.3] 7.5 [0.89]
[0.78] [0.67]
[2.95]
[0.59]
[3.39]
5.0 [0.53]
[0.44] [4.05]
2.5
[4.81]
[0.3]
[0.27]
) (< 1%
85
(1 84
80
to
to
+
%)
%) 79
(1
%)
70
75
to
69
74
(3
(2
%)
%) to 65
64
(4
%) to 60
59 to 55
54
(6
(6
%)
%) to 50
49
(7
%) to 45
44
(7
%) to 40
39
(8
%) to 35
34
(9
%) to 30
to
29
(8 25
24
(9
%)
%) to 20
19 to 15
to
14
(6
(7
%)
%) (6 10
o9 5t
de
r5
(8
%)
0
Un
Percent of total DALYs
[2.49]
[1.07]
Age Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
The number in the bracket on top of each vertical bar is the ratio of percent DALYs to population for that age group. The number in parentheses after each age group on the x-axis is the percent of population in that age group.
Injuries
Goa 105
What risk factors are driving the most death and disability combined? Contribution of top 10 risks to DALYs number, both sexes, ranked by number of DALYs, 19 What risk factors are driving the most death and disability combined? What risk factors are driving the most death and disability combined? Contribution of toto DALYs number, bothboth sexes, ranked by number of DALYs, 1990-2016 Contribution oftop top1010risks risks DALYs number, sexes, ranked by number of DALYs, 1990-2016 same or increase Behavioural Environmental/occupational Metabolic Behavioural
Environmental/occupational
same or increase
Metabolic
Risk factors 1990
Risk factors 1990
1 2 3 4 5 6 7 High total cholesterol [2.8%] 8 Impaired kidney function [0.9%] 10 Alcohol & drug use [2.5%] 9 The percent figure in bracket next to each risk is DALYs from that risk out of total DALYs. Occupational risks [2.2%] 10 Impaired kidney function [2.1%] 11 High body-mass index [1.9%] 12 Malnutrition* [26.9%]
1 2 3 4 5 6 7 8 9 10
decrease
Risk factors 2016
Risk factors 2016
Malnutrition* [32.2%] 1 † Air pollution [15.2%] [8.1%] WaSH 2 Air pollutionWaSH [7.7%] † [7.0%] 3 Tobacco use [3.6%] 4 Dietary risks [6.6%] Dietary risks [2.3%] 5 High blood pressure High blood pressure [2.2%] [6.2%] 6 Occupational risks [1.9%] 7 Tobacco use [3.2%] Alcohol & drug use [1.6%] 8 High fasting plasma glucose [3.2%] High fasting plasma glucose [1.4%] 9
1
High blood pressure [11.0%]
Malnutrition* [14.8%] 2 Dietary risks [9.6%] Air pollution [5.1%] High blood pressure [5.0%] 3 High fasting plasma glucose [9.0%] Tobacco use [4.9%] 4 Malnutrition* [7.3%] Dietary risks [4.7%] High body-mass index [7.2%] 5 [4.0%] High fasting plasma glucose WaSH† [3.9%] 6 Air pollution [5.6%] Alcohol & drug use [3.9%] 7 High total cholesterol [5.4%] Occupational risks [2.6%] Impaired kidney function8 [2.0%]Alcohol & drug use [4.9%]
9
Impaired kidney function [3.7%] [3.5%] 11 Tobacco use [3.1%] † 14 WaSH [1.0%]
*Malnutrition is child and maternal malnutrition. 10 Occupational risks † WaSH is unsafe water, sanitation, and handwashing.
*Malnutrition is child and maternal malnutrition. † WaSH is unsafe water, sanitation, and handwashing.
The percent figure in bracket next to each risk is DALYs from that risk out of total DALYs.
How did the risk factors differ by sex in 2016? Percent of total DALYs attributable to top 10 risks, ranked by percent for both sexes combined, 2016 Females
Males High blood pressure Dietary risks High fasting plasma glucose Malnutrition* High body-mass index Air pollution High total cholesterol Alcohol & drug use Impaired kidney function Occupational risks
10
5
0
Percent of years of life lost and years lived with disability Behavioural
0
5
10
Percent of years of life lost and years lived with disability Environmental/occupational
*Malnutrition is child and maternal malnutrition.
106 Goa
decrease
Metabolic
Gujarat 1990 life expectancy Females: 62.2 years Males: 59.8 years
2016 life expectancy Females: 71.5 years Males: 67.3 years
How much did the under-5 mortality rate change from 1990 to 2016? How much did the under-5 mortality rate change from 1990 to 2016? Under-5 mortality both sexes combined, 1990-2016 Under-5 mortality rate, bothrate, sexes combined, 1990-2016 Gujarat under-5 rate
India under-5 rate
Comparative average rate globally for similar Socio-demographic Index as Gujarat
Deaths per 1,000 live births
150
100
50 39.2 37.1 28.5
0 1990
1995
2000
2005
2010
The shaded bands indicate 95% uncertainty intervals around the estimates
2016
Year What caused the most deaths in different age groups in 2016? Percent top 10 causesdeaths of death byin agedifferent group, both sexes, Whatcontribution causedofthe most age 2016 groups
in 2016? Percent contribution of top 10 causes of death by age group, both sexes, 2016 0−14 years [10.6% of total deaths]
15−39 years [11.9% of total deaths]
1.3%
15.1% 9.5%
28.9%
HIV/AIDS & tuberculosis
1.2%
3.9% 5.4%
Diarrhoea/LRI*/other
11.5%
NTDs† & malaria
1.2% 1.3% 1.4%
7.6%
Maternal disorders
15.4%
Neonatal disorders
5.7%
Nutritional deficiencies Other communicable diseases
9.8%
4.3% 14.7%
Cancers
10.6%
41.5%
Cardiovascular diseases
3% 4.1%
Chronic respiratory diseases
2.6%
Cirrhosis Digestive diseases Neurological disorders
40−69 years [40.2% of total deaths]
70+ years [37.3% of total deaths] 2.2%
2% 9.2%
5.4%
6.2%
4.5% 4.2% 2.6%
13.4%
2.7%
Transport injuries
4.6%
Unintentional injuries
7.9%
5.8%
12%
36.6%
Other non-communicable
4.3%
6.7% 12.5%
Diabetes/urog‡/blood/endo§
17.1%
1.5% 0.8%
Suicide & violence Other causes of death *LRI is lower respiratory infections. † NTDs are neglected tropical diseases. ‡ Urog is urogenital diseases. § Endo is endocrine diseases.
37.8%
Gujarat 107
Proportion of total disease burden from: Premature death: 66.2% | Disability or morbidity: 33.8% What caused the most years of life lost, by sex, in 2016? Top 15 causes of YLLs, ranked by percent for both sexes combined, 2016 Females
Males Ischaemic heart disease Tuberculosis Lower respiratory infections COPD* Preterm birth complications Suicide Diarrhoeal diseases Road injuries Stroke Other neonatal disorders Neonatal encephalopathy Congenital birth defects Chronic kidney disease Falls HIV/AIDS
20
15
10
5
0
0
Percent of total years of life lost due to premature mortality
5
10
15
20
Percent of total years of life lost due to premature mortality
Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
Injuries
What caused the most years lived with disability, by sex, in 2016? *COPD is chronic obstructive pulmonary disease. Top 15 causes of YLDs, ranked by percent for both sexes combined, 2016 Females
Males Iron-deďŹ ciency anaemia Sense organ diseases* Low back & neck pain Migraine Skin diseases Other musculoskeletal Depressive disorders COPD* Diabetes Anxiety disorders Falls Preterm birth complications Oral disorders Haemoglobinopathies Osteoarthritis
15
10 5 Percent of total years lived with disability
0
Communicable, maternal, neonatal, and nutritional diseases
0
5 10 Percent of total years lived with disability
Non-communicable diseases
*COPD is chronic obstructive pulmonary disease. *Sense organ diseases includes mainly hearing and vision loss.
108 Gujarat
Injuries
15
Proportion of total disease burden from: CMNNDs: 31.6% | NCDs: 56.7% | Injuries: 11.7% How leading causes causesofofdeath deathand anddisability disability combined changed from 1990 to 2016? How have have the leading combined changed from 1990 to 2016? Change causesof ofDALYs, DALYs,both bothsexes, sexes,ranked rankedbyby number DALYs, 1990–2016 Change in top 15 causes number of of DALYs, 1990–2016 Communicable, maternal, neonatal, and nutritional diseases
Injuries
Non-communicable diseases
Leading causes of DALYs 1990
same or increase
decrease
Leading causes of DALYs 2016
Diarrhoeal diseases [11.3%]
1
Lower respiratory infections [9.1%] Preterm birth complications [6.4%] Tuberculosis [5.9%] Ischaemic heart disease [4.6%] Other neonatal disorders [4.1%] Neonatal encephalopathy [4.0%] Measles [3.4%] COPD† [3.4%] Congenital birth defects [2.5%] Iron-deficiency anaemia [2.3%] Meningitis [1.8%] Asthma [1.5%] Self-harm§[1.5%] Sense organ diseases‡ [1.4%] Stroke [1.4%] Road injuries [1.4%] Low back & neck pain [1.3%] Migraine [1.2%] Diabetes [0.7%]
2
1 Ischaemic heart disease [10.9%] 2 COPD† [4.9%]
3
3 Tuberculosis [4.2%]
4 5
4 Preterm birth complications [4.1%] 5 Lower respiratory infections [3.7%]
6
6 Iron-deficiency anaemia [3.6%]
7
7 Sense organ diseases‡ [2.9%]
8
8 Diarrhoeal diseases [2.8%]
9 10
9 Road injuries [2.7%] 10 Self-harm§ [2.5%]
11
11 Low back & neck pain [2.4%]
12
12 Stroke [2.4%]
13
13 Migraine [2.2%]
14
14 Diabetes [2.1%]
15
15 Congenital birth defects [2.1%]*
17
18 Other neonatal disorders [2.0%] 19 Neonatal encephalopathy [1.9%]
19 23
24 Asthma [1.3%]* 25 Meningitis [1.0%]
37
64 Measles [0.3%]
20
†
*Change not significant. The percent figure in brackets next to each cause is DALYs from that cause out of total DALYs.
COPD is chronic obstructive pulmonary disease. Sense organ diseases includes mainly hearing and vision loss. Self-harm refers to suicide and the nonfatal outcomes of self-harm.
‡
§
What caused death and disability combined across age groups in 2016? What causedthe themost most death and disability combined across age groups in 2016? Percent of DALYs by age group, both sexes, 2016 Percent of DALYs by age group, both sexes, 2016 [2.07]
10
[1.69]
[1.36] [0.68]
[0.6]
[0.55]
5
[0.9]
[0.79]
[2.09]
[1.09]
[2.6] [3.12]
[0.45] [0.32]
[3.53]
[0.32]
[4.09] [4.55]
) (< 1% +
%) 84
to
79
80
85
(1
%) (1
%) to 75
70
to
74
(2 69 to
65
64
(1
%)
%) (3
%) to 60
to
59
(4
%) (5 55
to
54
(6 50
49 to 45
44
(7
%)
%)
%) to 40
39
(7
%) to 35
34
(9
%) to 30
to
29
(9
%) (9 25
to
24
(9 20
19 to 15
to
14
(9
%)
%)
%) (9 10
o9 5t
de r5
(9
%)
0
Un
Percent of total DALYs
15
Age Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
The number in the bracket on top of each vertical bar is the ratio of percent DALYs to population for that age group. The number in parentheses after each age group on the x-axis is the percent of population in that age group.
Injuries
Gujarat 109
What risk factors are driving the most death and disability combined? Contribution of top 10 risks to DALYs number, both sexes, ranked by number of DALYs, 19 What risk factors are driving the most death and disability combined? What risk factors are driving the most death and disability combined? Contribution of toto DALYs number, bothboth sexes, ranked by number of DALYs, 1990-2016 Contribution oftop top1010risks risks DALYs number, sexes, ranked by number of DALYs, 1990-2016 same or increase Behavioural Environmental/occupational Metabolic Behavioural
Environmental/occupational
same or increase
Metabolic
Risk factors 1990
Risk factors 1990
1 2 3 4 5 6 7 High fasting plasma glucose [2.1%] 8 Impaired kidney function [0.9%] 10 Alcohol & drug use [2.1%] 9 The percent figure in bracket next to each risk is DALYs from that risk out of total DALYs. Occupational risks [2.1%] 10 Impaired kidney function [1.3%] 11 Malnutrition* [36.1%]
1 2 3 4 5 6 7 8 9 10
decrease
Risk factors 2016
Risk factors 2016
Malnutrition* [32.2%] 1 † [15.2%] [11.3%] WaSH†WaSH 2 Air Air pollution [7.7%] [10.2%] 3 pollution Tobacco use [3.6%] 4 Dietary risks [4.7%] Dietary risks [2.3%] 5 Tobacco use [4.4%] High blood pressure [2.2%] 6 Occupational [1.9%] [4.0%] 7 High bloodrisks pressure Alcohol & drug use [1.6%] 8 High total cholesterol [2.2%] High fasting plasma glucose [1.4%] 9
1
Malnutrition* [14.6%]
9
Occupational risks [3.1%]
Malnutrition* [14.8%] 2 Dietary risks [10.4%] Air pollution [5.1%] High blood pressure [5.0%] 3 Air pollution [9.1%] Tobacco use [4.9%] 4 High blood pressure [9.0%] Dietary risks [4.7%] Tobacco use [6.2%] 5 [4.0%] High fasting plasma glucose WaSH† [3.9%] 6 High fasting plasma glucose [5.8%] Alcohol & drug use [3.9%] 7 High total cholesterol [5.4%] Occupational risks [2.6%] Impaired kidney function8 [2.0%]Alcohol & drug use [4.0%] *Malnutrition is child and maternal malnutrition. 10 Impaired kidney function † WaSH is unsafe water, sanitation, and handwashing.
[2.7%]
11 WaSH† [2.6%] *Malnutrition is child and maternal malnutrition. † WaSH is unsafe water, sanitation, and handwashing.
The percent figure in bracket next to each risk is DALYs from that risk out of total DALYs.
How did the risk factors differ by sex in 2016? Percent of total DALYs attributable to top 10 risks, ranked by percent for both sexes combined, 2016 Females
Males Malnutrition* Dietary risks Air pollution High blood pressure Tobacco use High fasting plasma glucose High total cholesterol Alcohol & drug use Occupational risks Impaired kidney function
15
10
5
0
Percent of years of life lost and years lived with disability Behavioural
5
0
10
15
Percent of years of life lost and years lived with disability Environmental/occupational
*Malnutrition is child and maternal malnutrition.
110 Gujarat
decrease
Metabolic
Haryana 1990 life expectancy Females: 62.1 years Males: 60.1 years
2016 life expectancy Females: 71.3 years Males: 65.0 years
How much did the under-5 mortality rate change from 1990 to 2016? How much did the under-5 mortality rate change from 1990 to 2016? Under-5 mortality both sexes combined, 1990-2016 Under-5 mortality rate, bothrate, sexes combined, 1990-2016 Haryana under-5 rate
India under-5 rate
Comparative average rate globally for similar Socio-demographic Index as Haryana
Deaths per 1,000 live births
150
100
50 39.2 34.6 22.9
0 1990
1995
2000
2005
2010
The shaded bands indicate 95% uncertainty intervals around the estimates
2016
Year What caused the most deaths in different age groups in 2016? Percent top 10 causesdeaths of death byin agedifferent group, both sexes, Whatcontribution causedofthe most age 2016 groups
in 2016? Percent contribution of top 10 causes of death by age group, both sexes, 2016 0−14 years [8.3% of total deaths]
15−39 years [12.5% of total deaths]
1.2% HIV/AIDS & tuberculosis
1.7%
4.1% 4.8%
9.5% 7.4%
35% 2.9%
1.1% 1.4%
11.1%
Diarrhoea/LRI*/other NTDs† & malaria
8.5% 13%
Maternal disorders
6.9%
Neonatal disorders Nutritional deficiencies
9.1%
Other communicable diseases
15.8%
Cancers
3.1%
37.3%
16.2% 2.6%
Cardiovascular diseases
4.3%
Chronic respiratory diseases
2.9%
Cirrhosis Digestive diseases Neurological disorders
40−69 years [40.7% of total deaths]
70+ years [38.5% of total deaths] 3.4% 2.5%
3.6% 6%
3.8%
14.6%
7.2% 2.2% 2.9%
Transport injuries Unintentional injuries
8.3% 4.2%
Suicide & violence
1.8%
Other causes of death
7.7% 18.9%
13.2%
35.3%
Other non-communicable
1.1%
3.6%
6.6% 5.1%
14.2%
Diabetes/urog‡/blood/endo§
*LRI is lower respiratory infections. † NTDs are neglected tropical diseases. ‡ Urog is urogenital diseases. § Endo is endocrine diseases.
34.1%
Haryana 111
Proportion of total disease burden from: Premature death: 67.3% | Disability or morbidity: 32.7% What caused the most years of life lost, by sex, in 2016? Top 15 causes of YLLs, ranked by percent for both sexes combined, 2016 Females
Males Ischaemic heart disease COPD* Lower respiratory infections Road injuries Tuberculosis Diarrhoeal diseases Suicide Stroke Other neonatal disorders Preterm birth complications Intestinal infectious diseases Diabetes Chronic kidney disease Neonatal encephalopathy Congenital birth defects
20
15
10
5
0
0
Percent of total years of life lost due to premature mortality
5
10
15
20
Percent of total years of life lost due to premature mortality
Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
Injuries
What caused the most years lived with disability, by sex, in 2016? *COPD is chronic obstructive pulmonary disease. Top 15 causes of YLDs, ranked by percent for both sexes combined, 2016 Females
Males Iron-deďŹ ciency anaemia Sense organ diseases* Low back & neck pain Migraine Other musculoskeletal Skin diseases COPD* Depressive disorders Diabetes Anxiety disorders Oral disorders Preterm birth complications Falls Osteoarthritis Road injuries
16
12 8 4 Percent of total years lived with disability
0
Communicable, maternal, neonatal, and nutritional diseases
0
4 8 12 Percent of total years lived with disability
Non-communicable diseases
*COPD is chronic obstructive pulmonary disease. *Sense organ diseases includes mainly hearing and vision loss.
112 Haryana
Injuries
16
Proportion of total disease burden from: CMNNDs: 28.5% | NCDs: 58.8% | Injuries: 12.7% How leading causes causesofofdeath deathand anddisability disability combined changed from 1990 to 2016? How have have the the leading combined changed from 1990 to 2016? Change top 15 15 causes causesof ofDALYs, DALYs,both bothsexes, sexes,ranked rankedbyby number DALYs, 1990–2016 Change in in top number of of DALYs, 1990–2016 Communicable, maternal, neonatal, and nutritional diseases
Injuries
Non-communicable diseases
Leading causes of DALYs 1990
Diarrhoeal diseases [15.0%] Lower respiratory infections [7.8%] COPD† [4.7%] Ischaemic heart disease [4.6%] Other neonatal disorders [4.4%] Preterm birth complications [4.4%] Tuberculosis [4.3%] Neonatal encephalopathy [2.8%] Iron-deficiency anaemia [2.5%] Measles [2.5%] Intestinal infectious diseases [2.5%] Road injuries [2.0%] Congenital birth defects [1.8%] Asthma [1.7%] Self-harm§ [1.6%] Sense organ diseases‡ [1.5%] Stroke [1.4%] Low back & neck pain [1.3%] Migraine [1.1%] Diabetes [0.7%]
same or increase
decrease
Leading causes of DALYs 2016
1
1
2
2 COPD† [5.8%]
3
3 Road injuries [4.1%]
4
4 Lower respiratory infections [3.6%]
5
5 Iron-deficiency anaemia [3.6%]
6
6
7
7
8
8
9
9
10
10
11
11
12
12
13
13
14
14
15
15
16
21 22
18 19
23
23
24
31
72
Ischaemic heart disease [11.7%]
Tuberculosis [3.2%]* Diarrhoeal diseases [3.1%] Sense organ diseases‡ [2.6%] Preterm birth complications [2.6%] Diabetes [2.3%] Stroke [2.3%] Low back & neck pain [2.2%] Self-harm§ [2.2%] Other neonatal disorders [2.1%] Migraine [2.0%] Intestinal infectious diseases [1.4%] Congenital birth defects [1.4%]* Asthma [1.3%]* Neonatal encephalopathy [1.2%] Measles [0.3%]
†
*Change not significant. The percent figure in brackets next to each cause is DALYs from that cause out of total DALYs.
COPD is chronic obstructive pulmonary disease. Sense organ diseases includes mainly hearing and vision loss. § Self-harm refers to suicide and the nonfatal outcomes of self-harm. ‡
What caused death and disability combined across age groups in 2016? What causedthe themost most death and disability combined across age groups in 2016? Percent of DALYs by age group, both sexes, 2016 Percent of DALYs by age group, both sexes, 2016 16
[1.81]
8
[2.2]
[0.57]
[0.62]
[1.45]
[1.18]
[0.97]
[0.84]
[0.7]
[1.8] [2.75]
[0.46]
[3.29] [3.71]
4 [0.31]
[0.3]
[4.22] [4.58]
) (< 1% +
%)
85
80
to
to
79
84
(1
(1
%)
%)
70
75
to
69
74
(2
(1
%)
%) to 65
64
(3
%) to 60
to
59
(5 55
54 to 50
49
(4
%)
%) (5
%) to 45
44
(6
%) to 40
to
39
(7
%) (8 35
34 to 30
(1
29 to 25
24 to
(9
0%
%)
)
) (1 20
19 to 15
to
14
(9
0%
%)
%) (9 10
o9 5t
de r5
(8
%)
0
Un
Percent of total DALYs
12
Age
Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
The number in the bracket on top of each vertical bar is the ratio of percent DALYs to population for that age group. The number in parentheses after each age group on the x-axis is the percent of population in that age group.
Injuries
Haryana 113
What risk factors are driving the most death and disability combined? Contribution of top 10 risks to DALYs number, both sexes, ranked by number of DALYs, 19 What risk factors are driving the most death and disability combined? What risk factors are driving the most death and disability combined? Contribution of toto DALYs number, bothboth sexes, ranked by number of DALYs, 1990-2016 Contribution oftop top1010risks risks DALYs number, sexes, ranked by number of DALYs, 1990-2016 same or increase Behavioural Environmental/occupational Metabolic Behavioural
Environmental/occupational
same or increase
Metabolic
Risk factors 1990
Risk factors 1990
1 2 3 4 5 6 7 Occupational risks [2.2%] 8 Impaired kidney function [0.9%] 10 High fasting plasma glucose [2.1%] 9 The percent figure in bracket next to each risk is DALYs from that risk out of total DALYs. Alcohol & drug use [1.9%] 10 High body-mass index [1.0%] 12 Malnutrition* [33.8%]
1 2 3 4 5 6 7 8 9 10
decrease
Risk factors 2016
Risk factors 2016
Malnutrition* [32.2%] 1 † [15.2%] [15.0%] WaSH†WaSH 2 Air Air pollution [7.7%] [11.5%] 3 pollution Tobacco use [3.6%] 4 Tobacco use [5.1%] Dietary risks [2.3%] 5 Dietary[2.2%] risks [4.7%] High blood pressure 6 Occupational [1.9%] [3.3%] 7 High bloodrisks pressure Alcohol & drug use [1.6%] 8 High total cholesterol [2.2%] High fasting plasma glucose [1.4%] 9
1
Malnutrition* [12.7%]
Malnutrition* [14.8%] 2 Air pollution [10.9%] Air pollution [5.1%] High blood pressure [5.0%] 3 Dietary risks [9.9%] Tobacco use [4.9%] 4 High blood pressure [9.1%] Dietary risks [4.7%] Tobacco use [8.4%] 5 [4.0%] High fasting plasma glucose WaSH† [3.9%] 6 High total cholesterol [6.3%] Alcohol & drug use [3.9%] 7 High fasting plasma glucose [6.1%] Occupational risks [2.6%] Impaired kidney function8 [2.0%]High body-mass index [4.7%]
9
Alcohol & drug use [4.6%] [3.2%] 12 WaSH† [2.7%]
*Malnutrition is child and maternal malnutrition. 10 Occupational risks † WaSH is unsafe water, sanitation, and handwashing.
*Malnutrition is child and maternal malnutrition. † WaSH is unsafe water, sanitation, and handwashing.
The percent figure in bracket next to each risk is DALYs from that risk out of total DALYs.
How did the risk factors differ by sex in 2016? Percent of total DALYs attributable to top 10 risks, ranked by percent for both sexes combined, 2016 Females
Males Malnutrition* Air pollution Dietary risks High blood pressure Tobacco use High total cholesterol High fasting plasma glucose High body-mass index Alcohol & drug use Occupational risks
15
10
5
0
Percent of years of life lost and years lived with disability Behavioural
5
0
10
15
Percent of years of life lost and years lived with disability Environmental/occupational
*Malnutrition is child and maternal malnutrition.
114 Haryana
decrease
Metabolic
Himachal Pradesh 1990 life expectancy Females: 65.4 years Males: 64.2 years
2016 life expectancy Females: 76.9 years Males: 71.0 years
How much did the under-5 mortality rate change from 1990 to 2016? How much did the under-5 mortality rate change from 1990 to 2016? Under-5 mortality both sexes combined, 1990-2016 Under-5 mortality rate, bothrate, sexes combined, 1990-2016 Himachal Pradesh under-5 rate
India under-5 rate
Comparative average rate globally for similar Socio-demographic Index as Himachal Pradesh
Deaths per 1,000 live births
150
100
50 39.2 27.2 20.9
0 1990
1995
2000
2005
2010
The shaded bands indicate 95% uncertainty intervals around the estimates
2016
Year What caused the most deaths in different age groups in 2016? Percent top 10 causesdeaths of death byin agedifferent group, both sexes, Whatcontribution causedofthe most age 2016 groups
in 2016? Percent contribution of top 10 causes of death by age group, both sexes, 2016 0−14 years [6.1% of total deaths]
15−39 years [9.2% of total deaths]
1.2% 4.4%
HIV/AIDS & tuberculosis
1.8%
11.5%
6.3% 30.6%
NTDs† & malaria
8%
8.9% 0.9% 1.6% 1.4%
2.4%
Diarrhoea/LRI*/other
11.1%
15.4%
Maternal disorders Neonatal disorders
8.2%
Nutritional deficiencies
9.9%
11.8% 40.6%
Other communicable diseases Cancers
3% 3.9%
Cardiovascular diseases
14.4%
Chronic respiratory diseases
2.8%
Cirrhosis Digestive diseases Neurological disorders
40−69 years [35.5% of total deaths]
70+ years [49.3% of total deaths] 2.6% 2.1%
5.8% 5.5% 4.8% 6.1%
3.1% 13.4%
2.9% 2.7%
16.2%
Unintentional injuries
6.2% 6%
7.7%
28.4%
Other non-communicable Transport injuries
5%
6.1% 16.4%
0.8%
Diabetes/urog‡/blood/endo§
2.1%
25.8%
Suicide & violence Other causes of death *LRI is lower respiratory infections. † NTDs are neglected tropical diseases. ‡ Urog is urogenital diseases. § Endo is endocrine diseases.
30.4%
Himachal Pradesh 115
Proportion of total disease burden from: Premature death: 59.0% | Disability or morbidity: 41.0% What caused the most years of life lost, by sex, in 2016? Top 15 causes of YLLs, ranked by percent for both sexes combined, 2016 Females
Males Ischaemic heart disease COPD* Lower respiratory infections Road injuries Tuberculosis Suicide Diarrhoeal diseases Stroke Falls Preterm birth complications Chronic kidney disease Other neonatal disorders Neonatal encephalopathy Asthma HIV/AIDS
20
15
10
5
0
0
Percent of total years of life lost due to premature mortality
5
10
20
15
Percent of total years of life lost due to premature mortality
Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
Injuries
What caused the most years lived with disability, sex,obstructive in 2016? *COPDby is chronic pulmonary disease. Top 15 causes of YLDs, ranked by percent for both sexes combined, 2016 Females
Males Sense organ diseases* Low back & neck pain Iron-deďŹ ciency anaemia Migraine COPD* Skin diseases Other musculoskeletal Depressive disorders Falls Anxiety disorders Oral disorders Diabetes Preterm birth complications Osteoarthritis Schizophrenia
12
9 6 3 Percent of total years lived with disability
0
Communicable, maternal, neonatal, and nutritional diseases
0
3 6 9 Percent of total years lived with disability
Non-communicable diseases
*COPD is chronic obstructive pulmonary disease. *Sense organ diseases includes mainly hearing and vision loss.
116 Himachal Pradesh
Injuries
12
Proportion of total disease burden from: CMNNDs: 23.1% | NCDs: 64.5% | Injuries: 12.4% How leading causes causesofofdeath deathand anddisability disability combined changed from 1990 to 2016? How have have the the leading combined changed from 1990 to 2016? Change top 15 15 causes causesof ofDALYs, DALYs,both bothsexes, sexes,ranked rankedbyby number DALYs, 1990–2016 Change in in top number of of DALYs, 1990–2016 Communicable, maternal, neonatal, and nutritional diseases
Injuries
Non-communicable diseases
Leading causes of DALYs 1990
same or increase
decrease
Leading causes of DALYs 2016
Diarrhoeal diseases [15.0%] Lower respiratory infections [7.0%] COPD† [5.3%] Tuberculosis [4.8%] Ischaemic heart disease [4.3%] Preterm birth complications [4.1%] Neonatal encephalopathy [3.9%] Other neonatal disorders [3.2%] Iron-deficiency anaemia [2.0%] Sense organ diseases‡ [1.9%] Stroke [1.8%] Measles [1.8%] Congenital birth defects [1.8%] Asthma [1.7%] Low back & neck pain [1.7%] Falls [1.7%] Road injuries [1.6%] Self-harm§ [1.6%] Skin diseases [1.5%] Migraine [1.5%]
1
1
2
2
3
3
4
4
5
5
6
6
7
7
8
8
9
9
10
10
11
11
12
12
13
13
14
14
15
15
16
20 21
17 18
22
19
23
20
97
Ischaemic heart disease [8.7%] COPD† [7.7%] Sense organ diseases‡ [3.9%] Low back & neck pain [3.2%] Road injuries [3.2%] Lower respiratory infections [2.9%] Iron-deficiency anaemia [2.9%] Falls [2.8%] Migraine [2.7%] Diarrhoeal diseases [2.7%] Preterm birth complications [2.5%] Skin diseases [2.4%] Tuberculosis [2.4%] Stroke [2.3%]* Self-harm§ [2.2%]* Asthma [1.6%] Other neonatal disorders [1.4%] Congenital birth defects [1.4%] Neonatal encephalopathy [1.3%] Measles [0.1%]
†
*Change not significant. The percent figure in brackets next to each cause is DALYs from that cause out of total DALYs.
COPD is chronic obstructive pulmonary disease. Sense organ diseases includes mainly hearing and vision loss. § Self-harm refers to suicide and the nonfatal outcomes of self-harm. ‡
What caused death and disability combined across age groups in 2016? What causedthe themost most death and disability combined across age groups in 2016? Percent of DALYs by age group, both sexes, 2016
Percent of DALYs by age group, both sexes, 2016 12.5 [1.69]
10.0
7.5
[2.0]
[1.07]
[2.94]
[0.6]
[0.54]
5.0
[2.49]
[0.89]
[0.78]
[0.68]
[3.38]
[0.45]
[4.02] [4.67]
[0.32]
[0.32]
2.5
+
(1
%)
%)
to 80
85
84
(1
(1 79
75
to
74 to 70
to
%)
%) (2
%) (2 69
(4 65
64 to 60
to
59
(5
%)
%)
%) (6 55
54 to 50
49
(6
(7 to 45
44 to 40
39
%)
%)
%) (8
%) to 35
to
34
(9 30
29
(9
%)
%) to 25
24 to
19
(9 20
to 15
14 to
(9
%)
%) (8
%) (8 10
o9 5t
de r5
(6
%)
0
Un
Percent of total DALYs
[1.62] [1.3]
Age Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
The number in the bracket on top of each vertical bar is the ratio of percent DALYs to population for that age group. The number in parentheses after each age group on the x-axis is the percent of population in that age group.
Injuries
Himachal Pradesh 117
What risk factors are driving the most death and disability combined? Contribution of top 10 risks to DALYs number, both sexes, ranked by number of DALYs, 19 What risk factors are driving the most death and disability combined? What risk factors are driving the most death and disability combined? Contribution of toto DALYs number, bothboth sexes, ranked by number of DALYs, 1990-2016 Contribution oftop top1010risks risks DALYs number, sexes, ranked by number of DALYs, 1990-2016 same or increase Behavioural Environmental/occupational Metabolic Behavioural
Environmental/occupational
same or increase
Metabolic
Risk factors 1990
Risk factors 1990
1 2 3 4 5 6 7 High total cholesterol [2.0%] 8 Impaired kidney function [0.9%] 10 Alcohol & drug use [1.9%] 9 The percent figure in bracket next to each risk is DALYs from that risk out of total DALYs. High fasting plasma glucose [1.9%] 10 High body-mass index [0.8%] 12 Malnutrition* [30.0%]
1 2 3 4 5 6 7 8 9 10
decrease
Risk factors 2016
Risk factors 2016
Malnutrition* [32.2%] 1 † [15.2%] [14.9%] WaSH†WaSH 2 Air Air pollution [7.7%] [10.5%] 3 pollution Tobacco use [3.6%] 4 Dietary risks [4.9%] Dietary risks [2.3%] 5 Tobacco use [4.9%] High blood pressure [2.2%] 6 Occupational [1.9%] [4.7%] 7 High bloodrisks pressure Alcohol & drug use [1.6%] 8 Occupational risks [2.7%] High fasting plasma glucose [1.4%] 9
decrease
1
Malnutrition* [9.2%]
Malnutrition* [14.8%] 2 High blood pressure [8.7%] Air pollution [5.1%] High blood pressure [5.0%] 3 Air pollution [8.2%] Tobacco use [4.9%] 4 Dietary risks [8.0%] Dietary risks [4.7%] Tobacco use [6.5%] 5 [4.0%] High fasting plasma glucose WaSH† [3.9%] 6 High fasting plasma glucose [4.7%] Alcohol & drug use [3.9%] 7 High total cholesterol [4.4%] Occupational risks [2.6%] Impaired kidney function8 [2.0%]Alcohol & drug use [4.1%]
9
Occupational risks [4.0%] [3.4%] 12 WaSH† [2.4%]
*Malnutrition is child and maternal malnutrition. 10 High body-mass index † WaSH is unsafe water, sanitation, and handwashing.
*Malnutrition is child and maternal malnutrition. † WaSH is unsafe water, sanitation, and handwashing.
The percent figure in bracket next to each risk is DALYs from that risk out of total DALYs.
How did the risk factors differ by sex in 2016? Percent of total DALYs attributable to top 10 risks, ranked by percent for both sexes combined, 2016 Females
Males Malnutrition* High blood pressure Air pollution Dietary risks Tobacco use High fasting plasma glucose High total cholesterol Alcohol & drug use Occupational risks High body-mass index
12.5
10
7.5
5
2.5
0
Percent of years of life lost and years lived with disability Behavioural
2.5
0 Environmental/occupational
*Malnutrition is child and maternal malnutrition.
118 Himachal Pradesh
5
7.5
10
12.5
Percent of years of life lost and years lived with disability Metabolic
Jammu and Kashmir 1990 life expectancy Females: 60.9 years Males: 60.2 years
2016 life expectancy Females: 71.8 years Males: 68.3 years
How much did the under-5 mortality rate change from 1990 to 2016? How much did the under-5 mortality rate change from 1990 to 2016? Under-5 mortality both sexes combined, 1990-2016 Under-5 mortality rate, bothrate, sexes combined, 1990-2016 Jammu and Kashmir under-5 rate
India under-5 rate
Comparative average rate globally for similar Socio-demographic Index as Jammu and Kashmir
Deaths per 1,000 live births
150
100
50 39.2 32.1 31
0 1990
1995
2000
2005
2010
The shaded bands indicate 95% uncertainty intervals around the estimates
2016
Year What caused the most deaths in different age groups in 2016? Percent top 10 causesdeaths of death byin agedifferent group, both sexes, Whatcontribution causedofthe most age 2016 groups
in 2016? Percent contribution of top 10 causes of death by age group, both sexes, 2016 0−14 years [8% of total deaths]
15−39 years [12.1% of total deaths]
HIV/AIDS & tuberculosis
4.2%
2.8%
6.6%
6.5% 7.5%
32%
2.8%
1% 1.7% 1.2%
2.5%
NTDs† & malaria
3.2%
8.9%
Diarrhoea/LRI*/other
11.2% 10.2%
Maternal disorders
7.6%
Neonatal disorders
9.9%
Nutritional deficiencies Other communicable diseases
15.4%
Cancers
20.9%
4.9%
36.4%
Cardiovascular diseases Chronic respiratory diseases
2.6%
Cirrhosis Digestive diseases Neurological disorders
40−69 years [37.8% of total deaths] 3.9%
6.3%
70+ years [42.1% of total deaths] 2.3% 1.9%
3.8%
Other non-communicable
1.1%
Transport injuries
3.2%
4.5% 14.2%
4.9%
2% 2.2%
Unintentional injuries
7.6% 4.1%
7.3%
14.9%
1.5%
Suicide & violence Other causes of death
7.5%
19.2% 14.4%
36%
Diabetes/urog‡/blood/endo§
*LRI is lower respiratory infections. † NTDs are neglected tropical diseases. ‡ Urog is urogenital diseases. § Endo is endocrine diseases.
37.4%
Jammu and Kashmir 119
Proportion of total disease burden from: Premature death: 64.2% | Disability or morbidity: 35.8% What caused the most years of life lost, by sex, in 2016? Top 15 causes of YLLs, ranked by percent for both sexes combined, 2016 Females
Males Ischaemic heart disease Road injuries COPD* Lower respiratory infections Stroke Diarrhoeal diseases Chronic kidney disease Preterm birth complications Tuberculosis Other neonatal disorders Suicide Congenital birth defects Stomach cancer Diabetes Falls
20
15
10
5
0
0
Percent of total years of life lost due to premature mortality
5
10
15
20
Percent of total years of life lost due to premature mortality
Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
Injuries
*COPD is chronic obstructive pulmonary disease. What caused the most years lived with disability, by sex, in 2016? Top 15 causes of YLDs, ranked by percent for both sexes combined, 2016
Females
Males Iron-deďŹ ciency anaemia Sense organ diseases* Low back & neck pain Migraine Skin diseases COPD* Other musculoskeletal Depressive disorders Anxiety disorders Diabetes Preterm birth complications Oral disorders Falls Osteoarthritis Road injuries
15
10 5 Percent of total years lived with disability
0
Communicable, maternal, neonatal, and nutritional diseases
0
15 5 10 Percent of total years lived with disability
Non-communicable diseases
*COPD is chronic obstructive pulmonary disease. *Sense organ diseases includes mainly hearing and vision loss.
120 Jammu and Kashmir
Injuries
Proportion of total disease burden from: CMNNDs: 25.3% | NCDs: 61.3% | Injuries: 13.4% How leading causes causesofofdeath deathand anddisability disability combined changed from 1990 to 2016? How have have the the leading combined changed from 1990 to 2016? Change top 15 15 causes causesof ofDALYs, DALYs,both bothsexes, sexes,ranked rankedbyby number DALYs, 1990–2016 Change in in top number of of DALYs, 1990–2016 Communicable, maternal, neonatal, and nutritional diseases
Injuries
Non-communicable diseases
Leading causes of DALYs 1990
same or increase
decrease
Leading causes of DALYs 2016
Diarrhoeal diseases [11.3%] Lower respiratory infections [9.9%] Ischaemic heart disease [5.2%] Preterm birth complications [4.5%] COPD† [4.2%] Tuberculosis [4.0%] Road injuries [3.4%] Other neonatal disorders [3.0%] Measles [2.8%] Neonatal encephalopathy [2.6%] Stroke [2.2%] Congenital birth defects [2.1%] Iron-deficiency anaemia [2.0%] Neonatal haemolytic disease [1.6%] Sense organ diseases‡ [1.5%] Low back & neck pain [1.4%] Chronic kidney disease [1.3%] Skin diseases [1.2%] Migraine [1.2%] Diabetes [0.6%]
1
1
2
2
3
3
4
4
5
5
6
6
7
7
8
8
9
9
10
10
11
11
12
12
13
13
14
14
15
15
16 19
18 20
20 21
42
40
73
Ischaemic heart disease [10.7%] COPD† [6.5%] Road injuries [5.3%] Lower respiratory infections [4.2%] Iron-deficiency anaemia [3.1%] Sense organ diseases‡ [3.1%] Stroke [3.0%]* Diarrhoeal diseases [2.7%] Preterm birth complications [2.7%] Low back & neck pain [2.6%] Migraine [2.4%] Chronic kidney disease [2.3%] Skin diseases [2.2%] Diabetes [1.9%] Tuberculosis [1.9%] Congenital birth defects [1.7%] Other neonatal disorders [1.6%] Neonatal encephalopathy [1.0%] Neonatal haemolytic disease [0.5%] Measles [0.2%]
25
†
*Change not significant. The percent figure in brackets next to each cause is DALYs from that cause out of total DALYs.
COPD is chronic obstructive pulmonary disease. Sense organ diseases includes mainly hearing and vision loss. § Self-harm refers to suicide and the nonfatal outcomes of self-harm. ‡
What caused death and disability combined across age groups in 2016? What causedthe themost most death and disability combined across age groups in 2016? Percent of DALYs by age group, both sexes, 2016 Percent of DALYs by age group, both sexes, 2016 [1.88]
Percent of total DALYs
10
[1.5] [0.72]
[0.65]
[0.59]
[0.98]
[0.85]
[2.33]
[1.86]
[1.2]
[2.9]
[3.51]
[0.49]
5
[3.98]
[0.34]
[0.33]
[4.62] [5.15]
+
(<
1%
)
%) 85
84
(1
%) 80
to
79
(1
%) to 75
74
(1
%) 70
to
69
(2
%) to 65
64
(3
%) to 60
59
(4
%) to 55
54
(5
%) to 50
49
(5
%) to 45
44
(6
%) to 40
39 to 35
34
(8
(7
%)
%) to 30
25
to
29
(9
(9
%)
) (1
24 to 20
19 to 15
to
14
(1
0%
) 1%
1% (1 10
o9 5t
Un
de r
5(
7%
)
)
0
Age
Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
Injuries
The number in the bracket on top of each vertical bar is the ratio of percent DALYs to population for that age group. The number in parentheses after each age group on the x-axis is the percent of population in that age group.
Jammu and Kashmir 121
What risk factors are driving the most death and disability combined? Contribution of top 10 risks to DALYs number, both sexes, ranked by number of DALYs, 19 What risk factors are driving the most death and disability combined? What risk factors are driving the most death and disability combined? Contribution of toto DALYs number, bothboth sexes, ranked by number of DALYs, 1990-2016 Contribution oftop top1010risks risks DALYs number, sexes, ranked by number of DALYs, 1990-2016 same or increase Behavioural Environmental/occupational Metabolic Behavioural
Environmental/occupational
same or increase
Metabolic
Risk factors 1990
Risk factors 1990
1 2 3 4 5 6 7 High total cholesterol [2.3%] 8 Impaired kidney function [0.9%] 10 High fasting plasma glucose [2.1%] 9 The percent figure in bracket next to each risk is DALYs from that risk out of total DALYs. Impaired kidney function [2.0%] 10 High body-mass index [1.3%] 12 Malnutrition* [30.6%]
1 2 3 4 5 6 7 8 9 10
decrease
Risk factors 2016
Risk factors 2016
Malnutrition* [32.2%] 1 † Air pollution [15.2%] [12.4%] WaSH 2 † Air pollution [7.7%] 3 [11.7%] WaSH Tobacco use [3.6%] 4 Tobacco use [7.2%] Dietary risks [2.3%] 5 Dietary[2.2%] risks [6.0%] High blood pressure 6 Occupational [1.9%] [4.8%] 7 High bloodrisks pressure Alcohol & drug use [1.6%] 8 Occupational risks [2.4%] High fasting plasma glucose [1.4%] 9
1
Malnutrition* [10.9%]
9
Occupational risks [3.5%]
Malnutrition* [14.8%] 2 Dietary risks [10.4%] Air pollution [5.1%] High blood pressure [5.0%] 3 Tobacco use [10.0%] Tobacco use [4.9%] 4 Air pollution [10.0%] Dietary risks [4.7%] High blood pressure [9.9%] 5 [4.0%] High fasting plasma glucose WaSH† [3.9%] 6 High fasting plasma glucose [5.4%] Alcohol & drug use [3.9%] 7 High body-mass index [5.2%] Occupational risks [2.6%] Impaired kidney function8 [2.0%]High total cholesterol [5.1%] *Malnutrition is child and maternal malnutrition. 10 Impaired kidney function † WaSH is unsafe water, sanitation, and handwashing.
[3.5%]
12 WaSH† [2.6%] *Malnutrition is child and maternal malnutrition. † WaSH is unsafe water, sanitation, and handwashing.
The percent figure in bracket next to each risk is DALYs from that risk out of total DALYs.
How did the risk factors differ by sex in 2016? Percent of total DALYs attributable to top 10 risks, ranked by percent for both sexes combined, 2016 Females
Males Malnutrition* Dietary risks Tobacco use Air pollution High blood pressure High fasting plasma glucose High body-mass index High total cholesterol Occupational risks Impaired kidney function
10
5
0
Percent of years of life lost and years lived with disability Behavioural
5
0
10
Percent of years of life lost and years lived with disability Environmental/occupational
*Malnutrition is child and maternal malnutrition.
122 Jammu and Kashmir
decrease
Metabolic
Jharkhand 1990 life expectancy Females: 57.7 years Males: 57.2 years
2016 life expectancy Females: 67.8 years Males: 67.0 years
How much did the under-5 mortality rate change from 1990 to 2016? How much did the under-5 mortality rate change from 1990 to 2016? Under-5 mortality both sexes combined, 1990-2016 Under-5 mortality rate, bothrate, sexes combined, 1990-2016 Jharkhand under-5 rate
India under-5 rate
Comparative average rate globally for similar Socio-demographic Index as Jharkhand
Deaths per 1,000 live births
150
100
50
45 43.1 39.2
0 1990
1995
2000
2005
2010
The shaded bands indicate 95% uncertainty intervals around the estimates
2016
Year What caused the most deaths in different age groups in 2016? Percent top 10 causesdeaths of death byin agedifferent group, both sexes, Whatcontribution causedofthe most age 2016 groups
in 2016? Percent contribution of top 10 causes of death by age group, both sexes, 2016 0−14 years [13% of total deaths]
15−39 years [12.3% of total deaths]
1.3% 3.7% 6.2%
HIV/AIDS & tuberculosis
1.4% 14.1%
2%
39.4%
NTDs† & malaria
1% 1.6%
5.9%
Diarrhoea/LRI*/other
13.4% 9%
Maternal disorders
15%
Neonatal disorders Nutritional deficiencies
10.3%
Other communicable diseases
4.3% 5.4%
32.8% 4.8%
Cancers
11% 9.8%
Cardiovascular diseases
4.1%
Chronic respiratory diseases
3.7%
Cirrhosis Digestive diseases Neurological disorders
40−69 years [41.2% of total deaths]
70+ years [33.5% of total deaths]
Diabetes/urog‡/blood/endo§
2.4% 8.4% 5.3% 4.4%
2.9%
4.1%
6.5% 3.4%
10.1%
5.6%
Suicide & violence Other causes of death
33.2%
8.6%
28.9%
Unintentional injuries
2.7% 1.1%
3.9% 11%
Transport injuries
4.1% 3.6%
6.6%
16.1%
Other non-communicable
*LRI is lower respiratory infections. † NTDs are neglected tropical diseases. ‡ Urog is urogenital diseases. § Endo is endocrine diseases.
27.2%
Jharkhand 123
Proportion of total disease burden from: Premature death: 67.9% | Disability or morbidity: 32.1% What caused the most years of life lost, by sex, in 2016? Top 15 causes of YLLs, ranked by percent for both sexes combined, 2016 Females
Males Diarrhoeal diseases Ischaemic heart disease Lower respiratory infections Tuberculosis Road injuries Preterm birth complications Stroke Other neonatal disorders COPD* Neonatal encephalopathy Suicide Congenital birth defects HIV/AIDS Chronic kidney disease Drowning
16
12
8
4
0
0
Percent of total years of life lost due to premature mortality
4
8
12
16
Percent of total years of life lost due to premature mortality
Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
Injuries
What caused the most years lived with disability, sex,obstructive in 2016? *COPDby is chronic pulmonary disease. Top 15 causes of YLDs, ranked by percent for both sexes combined, 2016 Females
Males Iron-deďŹ ciency anaemia Sense organ diseases* Low back & neck pain Migraine Skin diseases Other musculoskeletal Depressive disorders COPD* Anxiety disorders Preterm birth complications Diabetes Oral disorders Falls Protein-energy malnutrition Diarrhoeal diseases
20
15 10 5 Percent of total years lived with disability
0
Communicable, maternal, neonatal, and nutritional diseases
0
5 10 15 Percent of total years lived with disability
Non-communicable diseases
*COPD is chronic obstructive pulmonary disease. *Sense organ diseases includes mainly hearing and vision loss.
124 Jharkhand
Injuries
20
Proportion of total disease burden from: CMNNDs: 40.8% | NCDs: 48.3% | Injuries: 10.9% How have have the the leading combined changed from 1990 to 2016? How leading causes causesofofdeath deathand anddisability disability combined changed from 1990 to 2016? Change in top 15 causes of DALYs, both sexes, ranked by number of DALYs, 1990–2016 Change in top 15 causes of DALYs, both sexes, ranked by number of DALYs, 1990–2016 Communicable, maternal, neonatal, and nutritional diseases
Injuries
Non-communicable diseases
Leading causes of DALYs 1990
same or increase
decrease
Leading causes of DALYs 2016
Diarrhoeal diseases [13.5%] Lower respiratory infections [10.5%] Measles [5.5%] Tuberculosis [5.2%] Preterm birth complications [4.8%] Other neonatal disorders [3.9%] Tetanus [3.1%] Neonatal encephalopathy [2.9%] Ischaemic heart disease [2.7%] Iron-deficiency anaemia [2.2%] Malaria [1.7%] Leishmaniasis [1.7%] Drowning [1.7%] Stroke [1.6%] Congenital birth defects [1.6%] Road injuries [1.5%] COPD† [1.5%] Sense organ diseases‡ [1.2%] Low back & neck pain [1.0%] Skin diseases [1.0%] Migraine [0.9%]
1
1
Diarrhoeal diseases [9.8%]
2
2
3
3
4
4
5
5
6
6
7
7
8
8
Ischaemic heart disease [6.6%] Lower respiratory infections [4.5%] Iron-deficiency anaemia [4.2%] Tuberculosis [3.8%] Preterm birth complications [3.3%] COPD† [3.3%] Road injuries [2.9%] Stroke [2.7%] Sense organ diseases‡ [2.6%] Other neonatal disorders [2.3%] Low back & neck pain [2.0%] Skin diseases [1.9%] Migraine [1.9%] Diabetes [1.8%] Neonatal encephalopathy [1.7%] Congenital birth defects [1.6%]* Drowning [1.1%] Malaria [0.9%]* Measles [0.5%] Leishmaniasis [0.4%] Tetanus [0.1%]
9
9
10
10
11
11
12
12
13
13
14
14
15
15
16 17
16 17
20 24
29
24
26 28
44 57
Diabetes [0.6%] 38
99 †
*Change not significant. The percent figure in brackets next to each cause is DALYs from that cause out of total DALYs.
COPD is chronic obstructive pulmonary disease. Sense organ diseases includes mainly hearing and vision loss. § Self-harm refers to suicide and the nonfatal outcomes of self-harm. ‡
What caused the most death and disability combined across age groups in 2016?
What caused thebymost death both and disability combined across age groups in 2016? Percent of DALYs age group, sexes, 2016 Percent of DALYs by age group, both sexes, 2016 [2.25]
20
10 [2.21]
[0.35]
5
[0.59]
[0.48]
[0.34]
[0.71]
[0.64]
[0.83]
[1.43]
[1.15]
[0.95]
[1.76]
[2.79] [3.38] [3.85] [4.38] [4.77]
) (< 1%
85
84 80
to
+
(< 1%
%) 79
(1
%) to 75
74
(1
%) 70
to
69
(2
%) to 65
64
(3
%) to 60
59
(4
%) to 55
54
(4
%) to 50
49 to 45
44
(5
%) (5
%) to 40
39
(7
%) to 35
34
(8
%) to 30
29
(8
%) to 25
to
24
(9 20
(1
19 to 15
14 to
(8
%)
) 2%
4% (1 10
o9 5t
de
r5
(9
%)
)
)
0
Un
Percent of total DALYs
15
Age Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
The number in the bracket on top of each vertical bar is the ratio of percent DALYs to population for that age group. The number in parentheses after each age group on the x-axis is the percent of population in that age group.
Injuries
Jharkhand 125
What risk factors are driving the most death and disability combined? Contribution of top 10 risks to DALYs number, both sexes, ranked by number of DALYs, 19 What risk factors are driving the most death and disability combined? What risk factors are driving the most death and disability combined? Contribution DALYs number, bothboth sexes, ranked by number of DALYs, 1990-2016 Contribution oftop top10 10risks riskstoto DALYs number, sexes, ranked by number of DALYs, 1990-2016 same or increase Behaviouralof Environmental/occupational Metabolic Behavioural
Environmental/occupational
same or increase
Metabolic
Risk factors 1990
Risk factors 1990
1 2 3 4 5 6 7 Occupational risks [1.6%] 8 Impaired kidney function [0.9%] 10 Alcohol & drug use [1.2%] 9 The percent figure in bracket next to each risk is DALYs from that risk out of total DALYs. Impaired kidney function [1.1%] 10 High body-mass index [0.5%] 12 Malnutrition* [37.7%]
1 2 3 4 5 6 7 8 9 10
decrease
Risk factors 2016
Risk factors 2016
Malnutrition* [32.2%] 1 † [15.2%] [14.1%] WaSH†WaSH 2 Air Air pollution [7.7%] [10.3%] 3 pollution Tobacco use [3.6%] 4 Dietary risks [3.5%] Dietary risks [2.3%] 5 High blood pressure High blood pressure [2.2%] [3.3%] 6 Occupational risks [1.9%] 7 Tobacco use [3.0%] Alcohol & drug use [1.6%] 8 High fasting plasma glucose [1.8%] High fasting plasma glucose [1.4%] 9
decrease
1
Malnutrition* [17.1%]
Malnutrition* [14.8%] 2 WaSH† [9.5%] Air pollution [5.1%] High blood pressure [5.0%] 3 Air pollution [8.9%] Tobacco use [4.9%] 4 Dietary risks [6.9%] Dietary risks [4.7%] High blood pressure [6.9%] 5 [4.0%] High fasting plasma glucose WaSH† [3.9%] 6 High fasting plasma glucose [4.5%] Alcohol & drug use [3.9%] 7 Tobacco use [2.9%] Occupational risks [2.6%] Impaired kidney function8 [2.0%]Occupational risks [2.6%]
9
Alcohol & drug use [2.6%] [2.4%] 12 Impaired kidney function [2.2%]
*Malnutrition is child and maternal malnutrition. 10 High body-mass index † WaSH is unsafe water, sanitation, and handwashing.
*Malnutrition is child and maternal malnutrition. † WaSH is unsafe water, sanitation, and handwashing.
The percent figure in bracket next to each risk is DALYs from that risk out of total DALYs.
How did the risk factors differ by sex in 2016? Percent of total DALYs attributable to top 10 risks, ranked by percent for both sexes combined, 2016 Females
Males Malnutrition* WaSH† Air pollution Dietary risks High blood pressure High fasting plasma glucose Tobacco use Occupational risks Alcohol & drug use High body-mass index
20
15
10
5
0
Percent of years of life lost and years lived with disability Behavioural
0
5
Environmental/occupational *Malnutrition is child and maternal malnutrition. is unsafe water, sanitation, and handwashing.
†WaSH
126 Jharkhand
10
15
Percent of years of life lost and years lived with disability Metabolic
20
Karnataka 1990 life expectancy Females: 62.5 years Males: 59.0 years
2016 life expectancy Females: 71.1 years Males: 67.1 years
How much did the under-5 mortality rate change from 1990 to 2016? How much did the under-5 mortality rate change from 1990 to 2016? Under-5 mortality both sexes combined, 1990-2016 Under-5 mortality rate, bothrate, sexes combined, 1990-2016 Karnataka under-5 rate
India under-5 rate
Comparative average rate globally for similar Socio-demographic Index as Karnataka
Deaths per 1,000 live births
150
100
50 39.2 32.2 28.5
0 1990
1995
2000
2005
2010
The shaded bands indicate 95% uncertainty intervals around the estimates
2016
Year What caused the most deaths in different age groups in 2016? Percent top 10 causesdeaths of death byin agedifferent group, both sexes, Whatcontribution causedofthe most age 2016 groups
in 2016? Percent contribution of top 10 causes of death by age group, both sexes, 2016 0−14 years [7% of total deaths]
15−39 years [11.4% of total deaths]
1.2% HIV/AIDS & tuberculosis
1.4%
4.6% 5.7%
9.9%
23.7%
2.3%
Diarrhoea/LRI*/other
9.8%
NTDs† & malaria
7.4%
12.3%
Maternal disorders
1.3% 1.2% 1.3%
2.2%
22.9%
6.5%
Neonatal disorders Nutritional deficiencies Other communicable diseases
13.9%
Cancers
8.2% 4.3% 10.1% 4.5%
44.9%
Cardiovascular diseases Chronic respiratory diseases Cirrhosis Digestive diseases Neurological disorders
40−69 years [41.6% of total deaths]
70+ years [40% of total deaths] 1.7% 2.3%
3.4% 4.8% 4.8% 6.7% 13.7%
3.5%
Other non-communicable Transport injuries
3.9%
2.5% 16.1%
8.8%
Unintentional injuries
11.9% 3.9%
7% 4%
13.9%
10.6%
37.2%
Diabetes/urog‡/blood/endo§
Suicide & violence
1.3% 1.1%
Other causes of death *LRI is lower respiratory infections. † NTDs are neglected tropical diseases. ‡ Urog is urogenital diseases. § Endo is endocrine diseases.
36.8%
Karnataka 127
Proportion of total disease burden from: Premature death: 65.9% | Disability or morbidity: 34.1% What caused the most years of life lost, by sex, in 2016? Top 15 causes of YLLs, ranked by percent for both sexes combined, 2016 Females
Males Ischaemic heart disease Suicide Stroke COPD* Diarrhoeal diseases Preterm birth complications Road injuries Lower respiratory infections Diabetes Tuberculosis Neonatal encephalopathy Congenital birth defects Chronic kidney disease Other neonatal disorders HIV/AIDS
20
15
10
5
0
0
Percent of total years of life lost due to premature mortality
5
10
15
20
Percent of total years of life lost due to premature mortality
Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
Injuries
*COPD by is chronic pulmonary disease. What caused the most years lived with disability, sex,obstructive in 2016? Top 15 causes of YLDs, ranked by percent for both sexes combined, 2016
Females
Males Sense organ diseases* Iron-deďŹ ciency anaemia Low back & neck pain Migraine Skin diseases Depressive disorders Other musculoskeletal COPD* Diabetes Anxiety disorders Falls Oral disorders Preterm birth complications Osteoarthritis Schizophrenia
15
10 5 Percent of total years lived with disability
0
Communicable, maternal, neonatal, and nutritional diseases
0
5 10 Percent of total years lived with disability
Non-communicable diseases
*COPD is chronic obstructive pulmonary disease. *Sense organ diseases includes mainly hearing and vision loss.
128 Karnataka
Injuries
15
Proportion of total disease burden from: CMNNDs: 25.1% | NCDs: 62.0% | Injuries: 12.9% How have have the the leading combined changed from 1990 to 2016? How leading causes causesofofdeath deathand anddisability disability combined changed from 1990 to 2016? Change in top 15 causes of DALYs, both sexes, ranked by number of DALYs, 1990–2016 Change in top 15 causes of DALYs, both sexes, ranked by number of DALYs, 1990–2016 Communicable, maternal, neonatal, and nutritional diseases
Injuries
Non-communicable diseases
Leading causes of DALYs 1990
Diarrhoeal diseases [11.7%] Preterm birth complications [7.9%] Lower respiratory infections [6.6%] Ischaemic heart disease [4.8%] Other neonatal disorders [4.0%] Tuberculosis [3.8%] Measles [3.8%] Neonatal encephalopathy [3.6%] COPD† [3.6%] Congenital birth defects [3.0%] Self-harm§[2.9%] Stroke [2.3%] Iron-deficiency anaemia [2.1%] Sense organ diseases‡ [1.6%] Asthma [1.5%] Low back & neck pain [1.4%] Road injuries [1.3%] Migraine [1.2%] Diabetes [1.1%]
same or increase
decrease
Leading causes of DALYs 2016
1
1
2
2
3
3
4
4
5
5
6
6
7
7
8
8
9
9
10
10
11
11
12
12
13
13
14
14
15
15
17 18
21 23
21 23
74
Ischaemic heart disease [11.0%] COPD† [4.9%] Self-harm§ [4.3%] Stroke [3.8%] Diarrhoeal diseases [3.5%] Preterm birth complications [3.4%] Diabetes [3.4%] Sense organ diseases‡ [3.2%] Iron-deficiency anaemia [3.1%] Road injuries [2.7%] Low back & neck pain [2.5%] Migraine [2.2%] Lower respiratory infections [2.2%] Tuberculosis [2.1%] Congenital birth defects [2.0%] Neonatal encephalopathy [1.7%] Other neonatal disorders [1.3%] Asthma [1.3%] Measles [0.2%]
24
†
*Change not significant. The percent figure in brackets next to each cause is DALYs from that cause out of total DALYs.
COPD is chronic obstructive pulmonary disease. Sense organ diseases includes mainly hearing and vision loss. Self-harm refers to suicide and the nonfatal outcomes of self-harm.
‡
§
What caused the most death and disability combined across age groups in 2016?
What caused thebymost death both and disability combined across age groups in 2016? Percent of DALYs age group, sexes, 2016 Percent of DALYs by age group, both sexes, 2016 [1.73]
Percent of total DALYs
10
[1.11] [0.8]
[0.6]
[2.1]
[1.7]
[1.36]
[2.65]
[0.92]
[0.68]
[3.17]
[0.54] 5
[3.6]
[0.44]
[4.12]
[0.3]
[0.29]
[4.58]
+
(<
1%
)
%) 85
80
to
84
(1 79
(1
%)
%) to 75
74
(2
%) to
69
70
to 65
64
(4
(3
%)
%) to 60
to
59
(5 55
54 to 50
49 to
(4
%)
%) (6
%) (7 45
to
44
(8 40
39 to 35
34
(8
%)
%)
) to 30
(1
0%
) to
29
(1 25
24
19
(9 to 20
to 15
14 to
0%
%)
%) (8
%) (8 10
o9 5t
Un
de r
5(
7%
)
0
Age Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
Injuries
The number in the bracket on top of each vertical bar is the ratio of percent DALYs to population for that age group. The number in parentheses after each age group on the x-axis is the percent of population in that age group.
Karnataka 129
What risk factors are driving the most death and disability combined? Contribution of top 10 risks to DALYs number, both sexes, ranked by number of DALYs, 19 What risk factors are driving the most death and disability combined? What risk factors are driving the most death and disability combined? Contribution of toto DALYs number, bothboth sexes, ranked by number of DALYs, 1990-2016 Contribution oftop top1010risks risks DALYs number, sexes, ranked by number of DALYs, 1990-2016 same or increase Behavioural Environmental/occupational Metabolic Behavioural
Environmental/occupational
same or increase
Metabolic
Risk factors 1990
Risk factors 1990
1 2 3 4 5 6 7 Occupational risks [2.3%] 8 Impaired kidney function [0.9%] 10 High total cholesterol [2.2%] 9 The percent figure in bracket next to each risk is DALYs from that risk out of total DALYs. Alcohol & drug use [1.8%] 10 Impaired kidney function [1.6%] 11 Malnutrition* [34.3%]
1 2 3 4 5 6 7 8 9 10
decrease
Risk factors 2016
Risk factors 2016
Malnutrition* [32.2%] 1 † [15.2%] [11.7%] WaSH†WaSH 2 Air pollution [7.7%] [9.1%] 3 Air pollution Tobacco use [3.6%] 4 Dietary risks [5.2%] Dietary risks [2.3%] 5 High blood pressure High blood pressure [2.2%] [4.7%] 6 Occupational risks [1.9%] 7 Tobacco use [4.1%] Alcohol & drug use [1.6%] 8 High fasting plasma glucose [3.2%] High fasting plasma glucose [1.4%] 9
1
Malnutrition* [10.7%]
9
Occupational risks [3.3%]
Malnutrition* [14.8%] 2 High blood pressure [10.5%] Air pollution [5.1%] High blood pressure [5.0%] 3 Dietary risks [9.6%] Tobacco use [4.9%] 4 High fasting plasma glucose [8.3%] Dietary risks [4.7%] Air pollution [8.2%] 5 [4.0%] High fasting plasma glucose WaSH† [3.9%] 6 Tobacco use [5.5%] Alcohol & drug use [3.9%] 7 High total cholesterol [5.4%] Occupational risks [2.6%] Impaired kidney function8 [2.0%]Alcohol & drug use [4.1%] *Malnutrition is child and maternal malnutrition. 10 Impaired kidney function † WaSH is unsafe water, sanitation, and handwashing.
[3.3%]
11 WaSH† [3.3%] *Malnutrition is child and maternal malnutrition. † WaSH is unsafe water, sanitation, and handwashing.
The percent figure in brackets next to each risk is DALYs from that risk out of total DALYs.
How did the risk factors differ by sex in 2016? Percent of total DALYs attributable to top 10 risks, ranked by percent for both sexes combined, 2016 Females
Males Malnutrition* High blood pressure Dietary risks High fasting plasma glucose Air pollution Tobacco use High total cholesterol Alcohol & drug use Occupational risks Impaired kidney function
10
5
0
Percent of years of life lost and years lived with disability Behavioural
0
5
10
Percent of years of life lost and years lived with disability Environmental/occupational
*Malnutrition is child and maternal malnutrition.
130 Karnataka
decrease
Metabolic
Kerala 1990 life expectancy Females: 74.5 years Males: 67.6 years
2016 life expectancy Females: 78.7 years Males: 73.8 years
How much did the under-5 mortality rate change from 1990 to 2016? How much did the under-5 mortality rate change from 1990 to 2016? Under-5 mortality both sexes combined, 1990-2016 Under-5 mortality rate, bothrate, sexes combined, 1990-2016 Kerala under-5 rate
India under-5 rate
Comparative average rate globally for similar Socio-demographic Index as Kerala
Deaths per 1,000 live births
150
100
50 39.2
19.1 12.8
0 1990
1995
2000
2005
2010
The shaded bands indicate 95% uncertainty intervals around the estimates
2016
Year What caused the most deaths in different age groups in 2016? Percent top 10 causesdeaths of death byin agedifferent group, both sexes, Whatcontribution causedofthe most age 2016 groups
in 2016? Percent contribution of top 10 causes of death by age group, both sexes, 2016 0−14 years [2.7% of total deaths] 1.5%
1.4%
HIV/AIDS & tuberculosis
4.7%
2%
6.9%
18.4%
15−39 years [6.5% of total deaths]
4.6%
7.4%
Diarrhoea/LRI*/other
8.2%
NTDs† & malaria
9.7%
Maternal disorders
24.4%
2.5%
Neonatal disorders
21.2%
Nutritional deficiencies
14.8%
3.5%
36.2%
Other communicable diseases
7.3% 3.6% 5.5%
1.7%
Cancers
12.6%
Cardiovascular diseases Chronic respiratory diseases
1.8%
Cirrhosis Digestive diseases Neurological disorders
40−69 years [38.4% of total deaths]
70+ years [52.4% of total deaths]
2.6% 4.2%
4.2% 3.9%
0.9% 2.4% 3.3% 8.3% 3%
21.5%
Diabetes/urog‡/blood/endo§
8.6%
9.6%
Other non-communicable Transport injuries
4.5%
Unintentional injuries
11.4%
Suicide & violence Other causes of death
6.9% 0.9% 1%
3.6% 6.4%
9.3%
*LRI is lower respiratory infections. † NTDs are neglected tropical diseases. ‡ Urog is urogenital diseases. § Endo is endocrine diseases.
45.7% 37.8%
Kerala 131
Proportion of total disease burden from: Premature death: 54.8% | Disability or morbidity: 45.2% What caused the most years of life lost, by sex, in 2016? Top 15 causes of YLLs, ranked by percent for both sexes combined, 2016 Females
Males Ischaemic heart disease Stroke Suicide Chronic kidney disease COPD* Road injuries Diabetes Lower respiratory infections Congenital birth defects Falls Diarrhoeal diseases Other cancers Tracheal, bronchus, and lung cancer Preterm birth complications Hypertensive heart disease
25
20
15
10
5
0
0
Percent of total years of life lost due to premature mortality
5
10
15
20
25
Percent of total years of life lost due to premature mortality
Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
Injuries
*COPD is chronic obstructive pulmonary disease.
What caused the most years lived with disability, by sex, in 2016? Top 15 causes of YLDs, ranked by percent for both sexes combined, 2016 Females
Males Sense organ diseases* Low back & neck pain Migraine Depressive disorders Other musculoskeletal Diabetes Skin diseases COPD* Iron-deďŹ ciency anaemia Anxiety disorders Oral disorders Falls Preterm birth complications Osteoarthritis Schizophrenia
12
9 6 3 Percent of total years lived with disability
0
Communicable, maternal, neonatal, and nutritional diseases
0
3 6 9 Percent of total years lived with disability
Non-communicable diseases
*COPD is chronic obstructive pulmonary disease. *Sense organ diseases includes mainly hearing and vision loss.
132 Kerala
Injuries
12
Proportion of total disease burden from: CMNNDs: 13.6% | NCDs: 74.6% | Injuries: 11.8% How have have the the leading combined changed from 1990 to 2016? How leading causes causesofofdeath deathand anddisability disability combined changed from 1990 to 2016? Change in top 15 causes of DALYs, both sexes, ranked by number of DALYs, 1990–2016 Change in top 15 causes of DALYs, both sexes, ranked by number of DALYs, 1990–2016 Communicable, maternal, neonatal, and nutritional diseases
Injuries
Non-communicable diseases
Leading causes of DALYs 1990
same or increase
decrease
Leading causes of DALYs 2016
Ischaemic heart disease [7.1%] Congenital birth defects [6.1%] Preterm birth complications [6.1%] Lower respiratory infections [4.8%] Self-harm§ [3.7%] COPD† [3.7%] Stroke [3.5%] Diarrhoeal diseases [3.0%] Neonatal encephalopathy [2.8%] Sense organ diseases‡ [2.7%] Low back & neck pain [2.5%] Tuberculosis [2.4%] Migraine [2.1%] Skin diseases [2.0%] Road injuries [2.0%] Diabetes [1.8%] Depressive disorders [1.8%] Chronic kidney disease [1.8%] Falls [1.6%] Other musculoskeletal disorders [1.6%]
1
1
2
2
3
3
4
4
5
5
6
6
7
7
8
8
9
9
10
10
11
11
12
12
13
13
14
14
15
15
17 18
17 18
19 21
30
22
42
Ischaemic heart disease [12.2%] Sense organ diseases‡ [4.6%] COPD† [4.4%] Stroke [4.2%] Diabetes [4.0%] Low back & neck pain [3.8%] Self-harm§ [3.4%]* Chronic kidney disease [3.2%] Migraine [2.9%] Road injuries [2.6%] Depressive disorders [2.5%] Other musculoskeletal disorders [2.4%] Skin diseases [2.4%] Falls [2.3%] Preterm birth complications [2.0%] Congenital birth defects [1.7%] Diarrhoeal diseases [1.6%] Lower respiratory infections [1.4%] Tuberculosis [0.8%] Neonatal encephalopathy [0.5%]
20
†
*Change not significant. The percent figure in brackets next to each cause is DALYs from that cause out of total DALYs.
COPD is chronic obstructive pulmonary disease. Sense organ diseases includes mainly hearing and vision loss. § Self-harm refers to suicide and the nonfatal outcomes of self-harm. ‡
What causedthe themost most death and disability combined across age groups in 2016? What caused death and disability combined across age groups in 2016? Percent group, both both sexes, sexes,2016 2016 Percent of of DALYs by age group, 12
[1.56]
[1.94]
[1.25]
9
[2.39]
[0.85] 6
[3.24]
[2.84]
[0.74]
[0.91] [0.63] [0.56] [0.51]
[3.9]
[4.67]
[0.42]
3 [0.29]
[0.25]
(1 + 85
(1 84
80
to
to
%)
%)
%) 79
(2 75
74 70
to
to
(2
%)
%) 69
(5 65
64 to 60
59
(3
%)
%) (7
%) to 55
54
(7
%) to 50
to
49
(7
%) 45
44 to 40
39
(8
(7
%)
%) to 35
34
(8
%) to 30
to
29
(8 25
24 to 20
19
(8
%)
%) (7
%) to 15
to
14
(7
(7 10
o9 5t
de r
5(
6%
)
%)
0
Un
Percent of total DALYs
[1.02]
Age Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
The number in the bracket on top of each vertical bar is the ratio of percent DALYs to population for that age group. The number in parentheses after each age group on the x-axis is the percent of population in that age group.
Injuries
Kerala 133
What risk factors are driving the most death and disability combined? Contribution of top 10 risks to DALYs number, both sexes, ranked by number of DALYs, 19 What risk factors are driving the most death and disability combined? What risk factors are driving the most death and disability combined? Contribution of toto DALYs number, bothboth sexes, ranked by number of DALYs, 1990-2016 Contribution oftop top1010risks risks DALYs number, sexes, ranked by number of DALYs, 1990-2016 same or increase Behavioural Environmental/occupational Metabolic Behavioural
Environmental/occupational
same or increase
Metabolic
Risk factors 1990
Risk factors 1990
1 2 3 4 5 6 7 WaSH† [3.3%] 8 Impaired kidney function [0.9%] 10 Occupational risks [3.0%] 9 The percent figure in bracket next to each risk is DALYs from that risk out of total DALYs. Impaired kidney function [2.8%] 10 High body-mass index [1.7%] 12 Malnutrition* [17.4%]
1 2 3 4 5 6 7 8 9 10
decrease
Risk factors 2016
Risk factors 2016
Malnutrition* [32.2%] 1 † Air pollution [15.2%] [9.3%] WaSH 2 Air pollution 3 Dietary[7.7%] risks [8.1%] Tobacco use [3.6%] 4 High blood pressure [7.9%] Dietary risks [2.3%] 5 Tobacco use [6.5%] High blood pressure [2.2%] 6 Occupational risks [1.9%] [5.9%] 7 High fasting plasma glucose Alcohol & drug use [1.6%] 8 High total cholesterol [4.0%] High fasting plasma glucose [1.4%] 9
decrease
1
High blood pressure [13.4%]
Malnutrition* [14.8%] 2 Dietary risks [11.2%] Air pollution [5.1%] High blood pressure [5.0%] 3 High fasting plasma glucose [11.1%] Tobacco use [4.9%] 4 High body-mass index [7.6%] Dietary risks [4.7%] High total cholesterol [7.0%] 5 [4.0%] High fasting plasma glucose WaSH† [3.9%] 6 Tobacco use [6.9%] Alcohol & drug use [3.9%] 7 Air pollution [6.2%] Occupational risks [2.6%] Impaired kidney function8 [2.0%]Impaired kidney function [4.8%]
9
Malnutrition* [4.4%] [3.7%] 13 WaSH† [1.3%]
*Malnutrition is child and maternal malnutrition. 10 Occupational risks † WaSH is unsafe water, sanitation, and handwashing.
*Malnutrition is child and maternal malnutrition. † WaSH is unsafe water, sanitation, and handwashing.
The percent figure in bracket next to each risk is DALYs from that risk out of total DALYs.
How did the risk factors differ by sex in 2016? Percent of total DALYs attributable to top 10 risks, ranked by percent for both sexes combined, 2016 Females
Males High blood pressure Dietary risks High fasting plasma glucose High body-mass index High total cholesterol Tobacco use Air pollution Impaired kidney function Malnutrition* Occupational risks
16
12
8
4
0
Percent of years of life lost and years lived with disability Behavioural
0
4
Environmental/occupational *Malnutrition is child and maternal malnutrition.
134 Kerala
8
12
Percent of years of life lost and years lived with disability Metabolic
16
Madhya Pradesh 1990 life expectancy Females: 55.9 years Males: 55.6 years
2016 life expectancy Females: 69.3 years Males: 65.3 years
How much did the under-5 mortality rate change from 1990 to 2016? How much did the under-5 mortality rate change from 1990 to 2016? Under-5 mortality both sexes combined, 1990-2016 Under-5 mortality rate, bothrate, sexes combined, 1990-2016 Madhya Pradesh under-5 rate
India under-5 rate
Comparative average rate globally for similar Socio-demographic Index as Madhya Pradesh
Deaths per 1,000 live births
150
100
50
45.2 43.9 39.2
The shaded bands indicate 95% uncertainty intervals around the estimates
0 1990
1995
2000
2005
2010
2016
Year What caused the most deaths in different age groups in 2016? Percent top 10 causesdeaths of death byin agedifferent group, both sexes, Whatcontribution causedofthe most age 2016 groups
in 2016? Percent contribution of top 10 causes of death by age group, both sexes, 2016 0−14 years [13.2% of total deaths]
15−39 years [11.7% of total deaths]
1% 3.3% HIV/AIDS & tuberculosis
1% 5.4%
36.1%
3.4%
Diarrhoea/LRI*/other
10.8%
11.9% 0.8% 1.5%
7%
NTDs† & malaria
11.7%
Maternal disorders
15.6%
Neonatal disorders
3.4%
Nutritional deficiencies
5.9%
Other communicable diseases
11.2%
Cancers
3.7%
11.9%
37%
Cardiovascular diseases
11% 3%
Chronic respiratory diseases Cirrhosis
3.6%
Digestive diseases Neurological disorders
40−69 years [37.7% of total deaths]
70+ years [37.3% of total deaths]
Diabetes/urog‡/blood/endo§
2.7% 7.8% 5.9% 9.7%
3.6% 4.4% 3% 5.8%
Other non-communicable Transport injuries
3.8%
Unintentional injuries
6.9% 22.6%
3.7%
3.2% 2.5%
13.2%
11.5%
32.9%
14.3%
6.5%
2.3% 0.7%
Suicide & violence Other causes of death *LRI is lower respiratory infections. † NTDs are neglected tropical diseases. ‡ Urog is urogenital diseases. § Endo is endocrine diseases.
32.9%
Madhya Pradesh 135
Proportion of total disease burden from: Premature death: 69.9% | Disability or morbidity: 30.1% What caused the most years of life lost, by sex, in 2016? Top 15 causes of YLLs, ranked by percent for both sexes combined, 2016 Females
Males Ischaemic heart disease Lower respiratory infections Diarrhoeal diseases Preterm birth complications Stroke Tuberculosis Other neonatal disorders COPD* Suicide Road injuries Intestinal infectious diseases Congenital birth defects Neonatal encephalopathy Falls Diabetes
15
10
5
0
0
Percent of total years of life lost due to premature mortality
5
10
15
Percent of total years of life lost due to premature mortality
Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
Injuries
*COPD is chronic obstructive pulmonary disease.
What caused the most years lived with disability, by sex, in 2016? Top 15 causes of YLDs, ranked by percent for both sexes combined, 2016 Females
Males Iron-deďŹ ciency anaemia Sense organ diseases* Low back & neck pain Migraine Skin diseases Other musculoskeletal Depressive disorders COPD* Diabetes Anxiety disorders Oral disorders Preterm birth complications Falls Osteoarthritis Haemoglobinopathies
16
12 8 4 Percent of total years lived with disability
0
Communicable, maternal, neonatal, and nutritional diseases
0
4 8 12 Percent of total years lived with disability
Non-communicable diseases
*COPD is chronic obstructive pulmonary disease. *Sense organ diseases includes mainly hearing and vision loss.
136 Madhya Pradesh
Injuries
16
Proportion of total disease burden from: CMNNDs: 37.5% | NCDs: 50.5% | Injuries: 12.0% How have have the the leading combined changed from 1990 to 2016? How leading causes causesofofdeath deathand anddisability disability combined changed from 1990 to 2016? Change in top 15 causes of DALYs, both sexes, ranked by number of DALYs, 1990–2016 Change in top 15 causes of DALYs, both sexes, ranked by number of DALYs, 1990–2016 Communicable, maternal, neonatal, and nutritional diseases
Injuries
Non-communicable diseases
Leading causes of DALYs 1990
same or increase
decrease
Leading causes of DALYs 2016
Lower respiratory infections [14.2%] Diarrhoeal diseases [11.6%] Preterm birth complications [6.1%] Other neonatal disorders [5.3%] Tuberculosis [4.9%] Measles [4.8%] Ischaemic heart disease [2.6%] COPD† [2.6%] Intestinal infectious diseases [2.5%] Neonatal encephalopathy [2.1%] Protein-energy malnutrition [2.1%] Iron-deficiency anaemia [1.9%] Stroke [1.7%] Congenital birth defects [1.6%] Meningitis [1.6%] Self-harm§ [1.2%] Sense organ diseases‡ [1.1%] Road injuries [1.0%] Low back & neck pain [1.0%] Diabetes [0.5%]
1
1
2
2
3
3
4
4
5
5
6
6
7
7
8
8
9
9
10
10
11
11
12
12
13
13
14
14
15
15
19 20
16 24
22 24
27
37
48
25
Ischaemic heart disease [7.7%] Lower respiratory infections [5.6%] Diarrhoeal diseases [4.9%] COPD† [4.2%] Preterm birth complications [4.2%] Iron-deficiency anaemia [3.5%] Tuberculosis [3.4%] Stroke [3.4%] Other neonatal disorders [3.2%] Road injuries [2.6%] Sense organ diseases‡ [2.6%] Self-harm§ [2.4%] Low back & neck pain [2.0%] Diabetes [2.0%] Intestinal infectious diseases [1.9%] Congenital birth defects [1.9%]* Neonatal encephalopathy [1.1%] Protein-energy malnutrition [1.1%] Meningitis [1.0%] Measles [0.5%]
†
*Change not significant. The percent figure in brackets next to each cause is DALYs from that cause out of total DALYs.
COPD is chronic obstructive pulmonary disease. Sense organ diseases includes mainly hearing and vision loss. § Self-harm refers to suicide and the nonfatal outcomes of self-harm. ‡
What causedthe themost most death and disability combined across age groups in 2016? What caused death and disability combined across age groups in 2016? Percent group, both both sexes, sexes,2016 2016 Percent of of DALYs by age group, [2.24]
20
Percent of total DALYs
15
10
5
[0.54]
[0.44] [0.32]
[0.6]
[2.08]
[1.68]
[1.36]
[1.1]
[0.9]
[0.78]
[0.67]
[2.59]
[3.13] [3.54]
[0.31]
[4.03] [4.4]
)
85
+
(<
1%
%) 84
(1
%) 80
to
79
(1
%) 75
to
74
(2
%) 70
to
69
(2
%) to 65
64
(3
%) to 60
to
59
(4 55
54
(4
%)
%) to 50
49
(5
%) to 45
44
(6
%) to 40
to
39
(7
%) (8 35
34 to 30
25
to
29
(8
(9
%)
%)
)
24 to
(1 19 to
15
14 to
20
(1
0%
0%
) 0% (1 10
10
%)
o9 5t
5( de r Un
)
0
Age
Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
The number in the bracket on top of each vertical bar is the ratio of percent DALYs to population for that age group. The number in parentheses after each age group on the x-axis is the percent of population in that age group.
Injuries
Madhya Pradesh 137
What risk factors are driving the most death and disability combined? Contribution of top 10 risks to DALYs number, both sexes, ranked by number of DALYs, 19 What risk factors are driving the most death and disability combined? What risk factors are driving the most death and disability combined? Contribution of toto DALYs number, bothboth sexes, ranked by number of DALYs, 1990-2016 Contribution oftop top1010risks risks DALYs number, sexes, ranked by number of DALYs, 1990-2016 same or increase Behavioural Environmental/occupational Metabolic Behavioural
Environmental/occupational
same or increase
Metabolic
Risk factors 1990
Risk factors 1990
1 2 3 4 5 6 7 Occupational risks [1.7%] 8 Impaired kidney function [0.9%] 10 Alcohol & drug use [1.4%] 9 The percent figure in bracket next to each risk is DALYs from that risk out of total DALYs. High total cholesterol [1.2%] 10 Malnutrition* [42.1%]
1 2 3 4 5 6 7 8 9 10
decrease
Risk factors 2016
Risk factors 2016
Malnutrition* [32.2%] 1 † Air pollution [15.2%] [13.0%] WaSH 2 † Air pollution [7.7%] 3 [12.7%] WaSH Tobacco use [3.6%] 4 Tobacco use [4.6%] Dietary risks [2.3%] 5 Dietary[2.2%] risks [3.3%] High blood pressure 6 Occupational [1.9%] [3.0%] 7 High bloodrisks pressure Alcohol & drug use [1.6%] 8 High fasting plasma glucose [1.8%] High fasting plasma glucose [1.4%] 9
decrease
1
Malnutrition* [17.7%]
9
Alcohol & drug use [3.4%] [2.8%]
Malnutrition* [14.8%] 2 Air pollution [10.1%] Air pollution [5.1%] High blood pressure [5.0%] 3 Dietary risks [7.7%] Tobacco use [4.9%] 4 High blood pressure [7.3%] Dietary risks [4.7%] Tobacco use [5.9%] 5 [4.0%] High fasting plasma glucose WaSH† [3.9%] 6 High fasting plasma glucose [5.7%] Alcohol & drug use [3.9%] 7 WaSH† [5.0%] Occupational risks [2.6%] Impaired kidney function8 [2.0%]High total cholesterol [3.7%] *Malnutrition is child and maternal malnutrition. risks 10 Occupational † WaSH is unsafe water, sanitation, and handwashing.
*Malnutrition is child and maternal malnutrition. † WaSH is unsafe water, sanitation, and handwashing.
The percent figure in bracket next to each risk is DALYs from that risk out of total DALYs.
How did the risk factors differ by sex in 2016? Percent of total DALYs attributable to top 10 risks, ranked by percent for both sexes combined, 2016 Females
Males Malnutrition* Air pollution Dietary risks High blood pressure Tobacco use High fasting plasma glucose WaSH† High total cholesterol Alcohol & drug use Occupational risks
20
15
10
5
0
Percent of years of life lost and years lived with disability Behavioural
0
5
Environmental/occupational *Malnutrition is child and maternal malnutrition. is unsafe water, sanitation, and handwashing.
†WaSH
138 Madhya Pradesh
10
15
Percent of years of life lost and years lived with disability Metabolic
20
Maharashtra 1990 life expectancy Females: 55.9 years Males: 55.6 years
2016 life expectancy Females: 69.3 years Males: 65.3 years
How much did the under-5 mortality rate change from 1990 to 2016? How much did the under-5 mortality rate change from 1990 to 2016? Under-5 mortality both sexes combined, 1990-2016 Under-5 mortality rate, bothrate, sexes combined, 1990-2016 Maharashtra under-5 rate
India under-5 rate
Comparative average rate globally for similar Socio-demographic Index as Maharashtra
Deaths per 1,000 live births
150
100
50 39.2 27.5 21.6
0 1990
1995
2000
2005
2010
The shaded bands indicate 95% uncertainty intervals around the estimates
2016
Year What caused the most deaths in different age groups in 2016? Percent top 10 causesdeaths of death byin agedifferent group, both sexes, Whatcontribution causedofthe most age 2016 groups
in 2016? Percent contribution of top 10 causes of death by age group, both sexes, 2016 0−14 years [6% of total deaths]
4.2%
15−39 years [10.7% of total deaths]
HIV/AIDS & tuberculosis
1.5% 5.8%
26.1%
10.7% 8.8%
1.8%
Diarrhoea/LRI*/other
11%
NTDs† & malaria
7.6% 0.8% 1.4% 1.3%
Maternal disorders
16.2%
5.5%
Neonatal disorders Nutritional deficiencies
2.9% 13.9%
Other communicable diseases
10.2%
Cancers
45.4%
2.1%
6.1%
12.3%
Cardiovascular diseases
4.5%
Chronic respiratory diseases Cirrhosis Digestive diseases Neurological disorders
40−69 years [40.7% of total deaths]
70+ years [42.5% of total deaths] 2.2% 2.6%
2.4% 5.4% 5.8% 6.7% 11.5%
14.8%
7.5%
Other non-communicable Transport injuries
4.6%
2.9%
4.3%
4.3% 5.6%
15.4% 10%
Unintentional injuries
7.9%
5.7%
37.8%
Diabetes/urog‡/blood/endo§
Suicide & violence
1.5% 1.5%
Other causes of death *LRI is lower respiratory infections. † NTDs are neglected tropical diseases. ‡ Urog is urogenital diseases. § Endo is endocrine diseases.
39.7%
Maharashtra 139
Proportion of total disease burden from: Premature death: 63.7% | Disability or morbidity: 36.3% What caused the most years of life lost, by sex, in 2016? Top 15 causes of YLLs, ranked by percent for both sexes combined, 2016 Females
Males Ischaemic heart disease Stroke COPD* Lower respiratory infections Suicide Diarrhoeal diseases Preterm birth complications Road injuries Tuberculosis Chronic kidney disease Falls Diabetes Other neonatal disorders HIV/AIDS Neonatal encephalopathy
20
15
10
5
0
0
Percent of total years of life lost due to premature mortality
5
10
15
20
Percent of total years of life lost due to premature mortality
Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
Injuries
*COPD is chronic obstructive pulmonary disease.
What caused the most years lived with disability, by sex, in 2016? Top 15 causes of YLDs, ranked by percent for both sexes combined, 2016 Females
Males Iron-deďŹ ciency anaemia Sense organ diseases* Low back & neck pain Migraine Depressive disorders Other musculoskeletal Skin diseases COPD* Diabetes Anxiety disorders Oral disorders Preterm birth complications Falls Osteoarthritis Haemoglobinopathies
15
10 5 Percent of total years lived with disability
0
Communicable, maternal, neonatal, and nutritional diseases
0
5 10 Percent of total years lived with disability
Non-communicable diseases
*COPD is chronic obstructive pulmonary disease. *Sense organ diseases includes mainly hearing and vision loss.
140 Maharashtra
Injuries
15
Proportion of total disease burden from: CMNNDs: 24.6% | NCDs: 63.1% | Injuries: 12.3% How have have the the leading combined changed from 1990 to 2016? How leading causes causesofofdeath deathand anddisability disability combined changed from 1990 to 2016? Change in top 15 causes of DALYs, both sexes, ranked by number of DALYs, 1990–2016 Change in top 15 causes of DALYs, both sexes, ranked by number of DALYs, 1990–2016 Communicable, maternal, neonatal, and nutritional diseases
Injuries
Non-communicable diseases
Leading causes of DALYs 1990
Diarrhoeal diseases [8.9%] Preterm birth complications [7.3%] Lower respiratory infections [7.2%] Tuberculosis [6.4%] Ischaemic heart disease [5.2%] COPD† [4.1%] Other neonatal disorders [3.4%] Neonatal encephalopathy [2.6%] Measles [2.6%] Stroke [2.6%] Iron-deficiency anaemia [2.3%] Congenital birth defects [2.1%] Road injuries [2.0%] Self-harm§ [2.0%] Asthma [1.6%] Sense organ diseases‡ [1.6%] Low back & neck pain [1.4%] Migraine [1.3%] Depressive disorders [1.2%] Diabetes [0.9%]
same or increase
decrease
Leading causes of DALYs 2016
1
1
2
2
3
3
4
4
5
5
6
6
7
7
8
8
9
9
10
10
11
11
12
12
13
13
14
14
15
15
16
20
17
21
19 23
23 24
29
104
Ischaemic heart disease [11.2%] COPD† [5.0%]* Stroke [4.1%] Iron-deficiency anaemia [3.3%] Sense organ diseases‡ [3.3%] Preterm birth complications [3.2%] Lower respiratory infections [2.9%] Diarrhoeal diseases [2.8%] Self-harm§ [2.8%] Road injuries [2.8%] Low back & neck pain [2.7%] Tuberculosis [2.5%] Diabetes [2.4%] Migraine [2.3%] Depressive disorders [2.2%] Congenital birth defects [1.4%] Other neonatal disorders [1.3%] Asthma [1.2%] Neonatal encephalopathy [1.1%] Measles [0.1%]
†
*Change not significant. The percent figure in brackets next to each cause is DALYs from that cause out of total DALYs.
COPD is chronic obstructive pulmonary disease. Sense organ diseases includes mainly hearing and vision loss. § Self-harm refers to suicide and the nonfatal outcomes of self-harm. ‡
What causedthe themost most death and disability combined across age groups in 2016? What caused death and disability combined across age groups in 2016? Percent group, both both sexes, sexes,2016 2016 Percent of of DALYs by age group, 12.5 [1.6]
[1.69]
[1.36]
7.5
[0.6]
[0.54]
[1.11]
[0.92]
[0.81]
[0.68]
[2.61]
[2.08]
[3.14]
[3.61]
5.0 [0.45]
[4.15]
[0.31]
[0.29]
2.5
[4.66]
1% (< +
to 80
85
(1 84
79
)
%)
%) (1
%) to
to 70
75
74
(3 69 to
65
64
(2
%)
%) (4
%) to 60
59
(4
%) to 55
54
(5
%) to 50
49
(6
%) to 45
44 to 40
39
(7
(7
%)
%) to 35
30
to
34
(9
(9
%)
)
29
(1 24
to 25
(9 to 20
19 to 15
14 to
0%
%)
%) (8
%) (8 10
o9 5t
5(
7%
)
0
Un de r
Percent of total DALYs
10.0
Age
Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
Injuries
The number in the bracket on top of each vertical bar is the ratio of percent DALYs to population for that age group. The number in parentheses after each age group on the x-axis is the percent of population in that age group.
Maharashtra 141
What risk factors are driving the most death and disability combined? Contribution of top 10 risks to DALYs number, both sexes, ranked by number of DALYs, 19 What risk factors are driving the most death and disability combined? What risk factors are driving the most death and disability combined? Contribution of toto DALYs number, bothboth sexes, ranked by number of DALYs, 1990-2016 Contribution oftop top1010risks risks DALYs number, sexes, ranked by number of DALYs, 1990-2016 same or increase Behavioural Environmental/occupational Metabolic Behavioural
Environmental/occupational
same or increase
Metabolic
Risk factors 1990
Risk factors 1990
1 2 3 4 5 6 7 Alcohol & drug use [2.7%] 8 Impaired kidney function [0.9%] 10 High total cholesterol [2.4%] 9 The percent figure in bracket next to each risk is DALYs from that risk out of total DALYs. Occupational risks [2.2%] 10 Impaired kidney function [1.9%] 11 High body-mass index [0.9%] 12 Malnutrition* [30.1%]
1 2 3 4 5 6 7 8 9 10
decrease
Risk factors 2016
Risk factors 2016
Malnutrition* [32.2%] 1 † Air pollution [15.2%] [9.8%] WaSH 2 Air pollutionWaSH [7.7%] † [8.9%] 3 Tobacco use [3.6%] 4 Dietary risks [6.3%] Dietary risks [2.3%] 5 High blood pressure High blood pressure [2.2%] [5.1%] 6 Occupational risks [1.9%] 7 Tobacco use [4.6%] Alcohol & drug use [1.6%] 8 High fasting plasma glucose [3.2%] High fasting plasma glucose [1.4%] 9
decrease
1
Dietary risks [11.5%]
Malnutrition* [14.8%] 2 High blood pressure [10.4%] Air pollution [5.1%] High blood pressure [5.0%] 3 Malnutrition* [10.3%] Tobacco use [4.9%] 4 Air pollution [8.6%] Dietary risks [4.7%] High fasting plasma glucose [7.1%] 5 [4.0%] High fasting plasma glucose WaSH† [3.9%] 6 High total cholesterol [5.3%] Alcohol & drug use [3.9%] 7 Tobacco use [4.8%] Occupational risks [2.6%] Impaired kidney function8 [2.0%]Alcohol & drug use [4.6%]
9
High body-mass index [4.5%] [3.6%] 11 Occupational risks [3.2%] 12 WaSH† [2.6%]
*Malnutrition is child and maternal malnutrition. 10 Impaired kidney function † WaSH is unsafe water, sanitation, and handwashing.
*Malnutrition is child and maternal malnutrition. † WaSH is unsafe water, sanitation, and handwashing.
The percent figure in bracket next to each risk is DALYs from that risk out of total DALYs.
How did the risk factors differ by sex in 2016? Percent of total DALYs attributable to top 10 risks, ranked by percent for both sexes combined, 2016 Females
Males Dietary risks High blood pressure Malnutrition* Air pollution High fasting plasma glucose High total cholesterol Tobacco use Alcohol & drug use High body-mass index Impaired kidney function
15
10
5
0
Percent of years of life lost and years lived with disability Behavioural
0
5
Environmental/occupational *Malnutrition is child and maternal malnutrition.
142 Maharashtra
10
Percent of years of life lost and years lived with disability Metabolic
15
Manipur 1990 life expectancy Females: 65.0 years Males: 62.9 years
2016 life expectancy Females: 72.8 years Males: 68.0 years
How much did the under-5 mortality rate change from 1990 to 2016? How much did the under-5 mortality rate change from 1990 to 2016? Under-5 mortality both sexes combined, 1990-2016 Under-5 mortality rate, bothrate, sexes combined, 1990-2016 Manipur under-5 rate
India under-5 rate
Comparative average rate globally for similar Socio-demographic Index as Manipur
Deaths per 1,000 live births
150
100
50 39.2 29.3 24.8
0 1990
1995
2000
2005
2010
The shaded bands indicate 95% uncertainty intervals around the estimates
2016
Year What caused the most deaths in different age groups in 2016? Percent top 10 causesdeaths of death byin agedifferent group, both sexes, Whatcontribution causedofthe most age 2016 groups
in 2016? Percent contribution of top 10 causes of death by age group, both sexes, 2016 0−14 years [7.1% of total deaths] 2.2%
15−39 years [13.3% of total deaths]
0.9% HIV/AIDS & tuberculosis
4.2%
1.9%
5.7%
9.1%
18.1% 5.9%
37%
Diarrhoea/LRI*/other NTDs† & malaria
1.2% 1.5%
15.1%
Maternal disorders Neonatal disorders
10.8% 5.7% 1.9% 36.1%
Nutritional deficiencies Other communicable diseases
4.6%
12.2%
Cancers
9.6%
Cardiovascular diseases
8.2% 4.8%
Chronic respiratory diseases
3.3%
Cirrhosis Digestive diseases Neurological disorders
40−69 years [39.6% of total deaths] 2.7% 9.4%
70+ years [40% of total deaths] 2.8% 2.3%
Other non-communicable
2.4%
5.3%
Transport injuries
4.9%
10.1%
Unintentional injuries
11.9%
3.8%
9.5%
Diabetes/urog‡/blood/endo§
24.1%
Suicide & violence
4.7% 3%
12.3% 10.2%
9.2%
6.4%
1.5%
Other causes of death *LRI is lower respiratory infections. † NTDs are neglected tropical diseases. ‡ Urog is urogenital diseases. § Endo is endocrine diseases.
5.7% 28.7%
29.1%
Manipur 143
Proportion of total disease burden from: Premature death: 64.5% | Disability or morbidity: 35.5% What caused the most years of life lost, by sex, in 2016? Top 15 causes of YLLs, ranked by percent for both sexes combined, 2016 Females
Males Ischaemic heart disease Stroke Diarrhoeal diseases Lower respiratory infections Road injuries Tuberculosis HIV/AIDS Suicide Diabetes COPD* Chronic kidney disease Preterm birth complications Cirrhosis due to hepatitis B Interpersonal violence Intestinal infectious diseases
10
7.5
5
2.5
0
0
Percent of total years of life lost due to premature mortality
2.5
5
7.5
10
Percent of total years of life lost due to premature mortality
Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
Injuries
*COPD is chronic obstructive pulmonary disease.
What caused the most years lived with disability, by sex, in 2016? Top 15 causes of YLDs, ranked by percent for both sexes combined, 2016 Females
Males Sense organ diseases* Low back & neck pain Migraine Skin diseases Depressive disorders Other musculoskeletal Iron-deďŹ ciency anaemia COPD* Anxiety disorders Preterm birth complications Diabetes Oral disorders Falls Drug use disorders Osteoarthritis
10.0
7.5 5.0 2.5 Percent of total years lived with disability
0
Communicable, maternal, neonatal, and nutritional diseases
0
2.5 5.0 7.5 10.0 Percent of total years lived with disability
Non-communicable diseases
*COPD is chronic obstructive pulmonary disease. *Sense organ diseases includes mainly hearing and vision loss.
144 Manipur
Injuries
Proportion of total disease burden from: CMNNDs: 29.5% | NCDs: 58.5% | Injuries: 12.0% How have have the the leading combined changed from 1990 to 2016? How leading causes causesofofdeath deathand anddisability disability combined changed from 1990 to 2016? Change in top 15 causes of DALYs, both sexes, ranked by number of DALYs, 1990–2016 Change in top 15 causes of DALYs, both sexes, ranked by number of DALYs, 1990–2016 Communicable, maternal, neonatal, and nutritional diseases
Injuries
Non-communicable diseases
Leading causes of DALYs 1990
Diarrhoeal diseases [11.9%] Lower respiratory infections [9.6%] Tuberculosis [5.4%] Preterm birth complications [4.0%] Measles [3.7%] Stroke [2.7%] Other neonatal disorders [2.6%] Ischaemic heart disease [2.6%] Neonatal encephalopathy [2.6%] Tetanus [2.5%] COPD† [2.2%] Intestinal infectious diseases [2.1%] Road injuries [1.9%] Sense organ diseases‡ [1.7%] Whooping cough [1.6%] Low back & neck pain [1.5%] Skin diseases [1.4%] Migraine [1.4%] Self-harm§ [1.4%] Diabetes [1.2%] HIV/AIDS [0.1%]
same or increase
decrease
Leading causes of DALYs 2016
1
1
2
2
3
3
4
4
5
5
6
6
7
7
8
8
9
9
10
10
11
11
12
12
13
13
14
14
15
15
17
23
18
24
20 21
70
28
25
74
93
101
Ischaemic heart disease [5.2%] Stroke [5.0%] Diarrhoeal diseases [4.5%] Lower respiratory infections [3.9%] Road injuries [3.7%] Tuberculosis [3.4%] COPD† [3.4%] HIV/AIDS [3.4%] Sense organ diseases‡ [3.1%] Diabetes [3.1%] Preterm birth complications [2.8%]* Low back & neck pain [2.6%] Migraine [2.5%] Skin diseases [2.2%] Self-harm§ [2.2%] Intestinal infectious diseases [1.3%] Neonatal encephalopathy [1.2%] Other neonatal disorders [1.1%] Measles [0.3%] Whooping cough [0.2%]* Tetanus [0.1%]
†
*Change not significant. The percent figure in brackets next to each cause is DALYs from that cause out of total DALYs.
COPD is chronic obstructive pulmonary disease. Sense organ diseases includes mainly hearing and vision loss. § Self-harm refers to suicide and the nonfatal outcomes of self-harm. ‡
What caused the most death and disability combined across age groups in 2016?
What caused thebymost death both and disability combined across age groups in 2016? Percent of DALYs age group, sexes, 2016 Percent of DALYs by age group, both sexes, 2016 [1.53]
Percent of total DALYs
10
[1.52] [0.67]
[0.9]
[0.76]
[1.89]
[1.24]
[1.03]
[2.34]
[0.6]
[2.93]
[0.49]
5
[3.51]
[4.02]
[0.31] [0.28]
[4.64] [5.18]
+
(<
1%
)
%) 85
84
(1
%) to 80
to
79
(1
%) 75
74
(1
%) to 70
to
69
(3 65
64
(2
%)
%) to 60
59
(4
%) to 55
54
(5
%) to 50
49
(5
%) to 45
44
(6
%) to 40
35
to
39
(9
(7
%)
)
34
29
to 30
(1
0% to 25
to
24
(1
(1 20
19
0%
)
) 0%
) 0% to 15
to
14
(1
(9 10
o9 5t
Un
de r
5(
8%
)
%)
0
Age
Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
Injuries
The number in the bracket on top of each vertical bar is the ratio of percent DALYs to population for that age group. The number in parentheses after each age group on the x-axis is the percent of population in that age group.
Manipur 145
What risk factors are driving the most death and disability combined? Contribution of top 10 risks to DALYs number, both sexes, ranked by number of DALYs, 19 What risk factors are driving the most death and disability combined? What risk factors are driving the most death and disability combined? Contribution of toto DALYs number, bothboth sexes, ranked by number of DALYs, 1990-2016 Contribution oftop top1010risks risks DALYs number, sexes, ranked by number of DALYs, 1990-2016 same or increase Behavioural Environmental/occupational Metabolic Behavioural
Environmental/occupational
same or increase
Metabolic
Risk factors 1990
Risk factors 1990
1 2 3 4 5 6 7 Alcohol & drug use [2.2%] 8 Impaired kidney function [0.9%] 10 Occupational risks [2.1%] 9 The percent figure in bracket next to each risk is DALYs from that risk out of total DALYs. Impaired kidney function [1.7%] 10 High body-mass index [0.9%] 12 Malnutrition* [27.4%]
1 2 3 4 5 6 7 8 9 10
decrease
Risk factors 2016
Risk factors 2016
Malnutrition* [32.2%] 1 † [15.2%] [12.1%] WaSH†WaSH 2 Air pollution [7.7%] [9.1%] 3 Air pollution Tobacco use [3.6%] 4 Tobacco use [5.5%] Dietary risks [2.3%] 5 Dietary[2.2%] risks [4.4%] High blood pressure 6 Occupational [1.9%] [4.0%] 7 High bloodrisks pressure Alcohol & drug use [1.6%] 8 High fasting plasma glucose [2.9%] High fasting plasma glucose [1.4%] 9
decrease
1
Malnutrition* [8.3%]
Malnutrition* [14.8%] 2 High blood pressure [7.9%] Air pollution [5.1%] High blood pressure [5.0%] 3 Tobacco use [7.7%] Tobacco use [4.9%] 4 Dietary risks [7.5%] Dietary risks [4.7%] High fasting plasma glucose [6.6%] 5 [4.0%] High fasting plasma glucose WaSH† [3.9%] 6 Air pollution [6.1%] Alcohol & drug use [3.9%] 7 Alcohol & drug use [4.9%] Occupational risks [2.6%] † Impaired kidney function8 [2.0%]WaSH [4.3%]
9
Impaired kidney function [3.0%] [3.0%] 11 Occupational risks [3.0%]
*Malnutrition is child and maternal malnutrition. body-mass index 10 High † WaSH is unsafe water, sanitation, and handwashing.
*Malnutrition is child and maternal malnutrition. † WaSH is unsafe water, sanitation, and handwashing.
The percent figure in bracket next to each risk is DALYs from that risk out of total DALYs.
How did the risk factors differ by sex in 2016? Percent of total DALYs attributable to top 10 risks, ranked by percent for both sexes combined, 2016 Females
Males Malnutrition* High blood pressure Tobacco use Dietary risks High fasting plasma glucose Air pollution Alcohol & drug use WaSH† Impaired kidney function High body-mass index
10
7.5
5
2.5
0
Percent of years of life lost and years lived with disability Behavioural
0
2.5
Environmental/occupational *Malnutrition is child and maternal malnutrition. is unsafe water, sanitation, and handwashing.
†WaSH
146 Manipur
5
7.5
Percent of years of life lost and years lived with disability Metabolic
10
Meghalaya 1990 life expectancy Females: 63.1 years Males: 59.8 years
2016 life expectancy Females: 72.4 years Males: 66.8 years
How much did the under-5 mortality rate change from 1990 to 2016? How much did the under-5 mortality rate change from 1990 to 2016? Under-5 mortality both sexes combined, 1990-2016 Under-5 mortality rate, bothrate, sexes combined, 1990-2016 Meghalaya under-5 rate
India under-5 rate
Comparative average rate globally for similar Socio-demographic Index as Meghalaya
Deaths per 1,000 live births
150
100
50 39.2 36.3 33.3
0 1990
1995
2000
2005
2010
The shaded bands indicate 95% uncertainty intervals around the estimates
2016
Year What caused the most deaths in different age groups in 2016? Percent top 10 causesdeaths of death byin agedifferent group, both sexes, Whatcontribution causedofthe most age 2016 groups
in 2016? Percent contribution of top 10 causes of death by age group, both sexes, 2016 0−14 years [15.3% of total deaths] 1.5%
15−39 years [15.7% of total deaths]
3.5%
HIV/AIDS & tuberculosis
3.8% 1.2% 1% 1.7% 0.9%
6.4%
12.8%
Diarrhoea/LRI*/other
14.1%
NTDs† & malaria
10.1%
13.5%
38.4%
Maternal disorders Neonatal disorders
7.3%
4.7% 30.4%
Other communicable diseases
7.7%
7% 8.8%
11.2%
Nutritional deficiencies
9%
5%
Cancers Cardiovascular diseases Chronic respiratory diseases Cirrhosis Digestive diseases Neurological disorders
40−69 years [37.6% of total deaths] 2.7% 9.4%
70+ years [31.5% of total deaths] 2.3% 2.9%
Other non-communicable
1.7%
Transport injuries
5.5%
6.1%
5%
Unintentional injuries
8.3%
6.5%
9.4%
5.1%
23.4%
3.9% 2.5%
8.2%
9.6%
24.9%
6.1%
20.6%
Diabetes/urog‡/blood/endo§
Suicide & violence Other causes of death *LRI is lower respiratory infections. † NTDs are neglected tropical diseases. ‡ Urog is urogenital diseases. § Endo is endocrine diseases.
10.3% 25.7%
Meghalaya 147
Proportion of total disease burden from: Premature death: 64.1% | Disability or morbidity: 35.9% What caused the most years of life lost, by sex, in 2016? Top 15 causes of YLLs, ranked by percent for both sexes combined, 2016 Females
Males Lower respiratory infections Diarrhoeal diseases Tuberculosis Ischaemic heart disease Malaria Stroke Preterm birth complications Intestinal infectious diseases Neonatal encephalopathy Oesophageal cancer Road injuries Suicide Other neonatal disorders COPD* Congenital birth defects
10
7.5
5
2.5
0
0
Percent of total years of life lost due to premature mortality
2.5
5
7.5
10
Percent of total years of life lost due to premature mortality
Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
Injuries
*COPD is chronic obstructive pulmonary disease.
What caused the most years lived with disability, by sex, in 2016? Top 15 causes of YLDs, ranked by percent for both sexes combined, 2016 Females
Males Iron-deďŹ ciency anaemia Sense organ diseases* Migraine Skin diseases Low back & neck pain Depressive disorders Other musculoskeletal COPD* Anxiety disorders Preterm birth complications Oral disorders Diabetes Falls Protein-energy malnutrition Asthma
16
12 8 4 Percent of total years lived with disability
0
Communicable, maternal, neonatal, and nutritional diseases
0
4 8 12 Percent of total years lived with disability
Non-communicable diseases
*COPD is chronic obstructive pulmonary disease. *Sense organ diseases includes mainly hearing and vision loss.
148 Meghalaya
Injuries
16
Proportion of total disease burden from: CMNNDs: 39.1% | NCDs: 52.3% | Injuries: 8.6% How leading causes causesofofdeath deathand anddisability disability combined changed from 1990 to 2016? How have have the leading combined changed from 1990 to 2016? Change causesof ofDALYs, DALYs,both bothsexes, sexes,ranked rankedbyby number DALYs, 1990–2016 Change in top 15 causes number of of DALYs, 1990–2016 Communicable, maternal, neonatal, and nutritional diseases
Injuries
Non-communicable diseases
Leading causes of DALYs 1990
Diarrhoeal diseases [12.6%] Lower respiratory infections [10.5%] Malaria [7.3%] Tuberculosis [5.9%] Preterm birth complications [4.4%] Neonatal encephalopathy [3.5%] Measles [3.1%] Intestinal infectious diseases [2.7%] Iron-deficiency anaemia [2.4%] Other neonatal disorders [2.1%] COPD† [1.8%] Congenital birth defects [1.6%] Tetanus [1.5%] Stroke [1.5%] Neonatal sepsis [1.4%] Ischaemic heart disease [1.4%] Sense organ diseases‡ [1.4%] Skin diseases [1.3%] Low back & neck pain [1.2%] Migraine [1.2%]
same or increase
decrease
Leading causes of DALYs 2016
1
1
2
2
3
3
4
4
5
5
6
6
7
7
8
8
9
9
10
10
11
11
12
12
13
13
14
14
15
15
17
19
18
24
19 21
56
22
118
31
†
*Change not significant. The percent figure in brackets next to each cause is DALYs from that cause out of total DALYs.
Lower respiratory infections [5.1%] Diarrhoeal diseases [4.6%] Tuberculosis [4.3%] Iron-deficiency anaemia [4.1%] Preterm birth complications [3.3%]* Ischaemic heart disease [3.3%] Malaria [2.8%] Stroke [2.7%] Sense organ diseases‡ [2.6%] COPD† [2.6%] Skin diseases [2.4%] Migraine [2.4%] Low back & neck pain [2.2%] Neonatal encephalopathy [2.2%]* Intestinal infectious diseases [2.2%] Congenital birth defects [1.8%]* Other neonatal disorders [1.5%]* Neonatal sepsis [0.9%]* Measles [0.4%] Tetanus [0.1%]
COPD is chronic obstructive pulmonary disease. Sense organ diseases includes mainly hearing and vision loss. Self-harm refers to suicide and the nonfatal outcomes of self-harm.
‡
§
What caused death and disability combined across age groups in 2016? What causedthe themost most death and disability combined across age groups in 2016? Percent of of DALYs DALYs by by age Percent age group, group, both both sexes, sexes,2016 2016 [2.27] 20
10
[0.65]
[0.54] [0.38]
5
[0.69]
[0.91]
[0.77]
[1.28]
[1.04]
[1.58]
[1.98]
[0.37]
[2.44]
[3.05] [3.63]
[4.14] [4.75]
[5.32]
) (< 1%
85
84 80
to
to
+
(< 1%
)
%) 79
(1
%)
70
Non-communicable diseases
75
74 to
69
Age
Communicable, maternal, neonatal, and nutritional diseases
(1
%) (1
%) to 65
64
(2
%) to 60
59
(3
%) to 55
54
(4
%) to 50
49
(5
%) to 45
44
(5
%) to 40
39
(6
%) to 35
to
34
(9 30
(1
29 to 25
(8
%)
) 0%
)
24 to 20
19 to 15
14 to
(1
(1
1%
2%
) 3% (1 10
(9
%)
o9 5t
de r5
)
0
Un
Percent of total DALYs
15
Injuries
The number in the bracket on top of each vertical bar is the ratio of percent DALYs to population for that age group. The number in parentheses after each age group on the x-axis is the percent of population in that age group.
Meghalaya 149
What risk factors are driving the most death and disability combined? Contribution of top 10 risks to DALYs number, both sexes, ranked by number of DALYs, 19 What risk factors are driving the most death and disability combined? What risk factors are driving the most death and disability combined? Contribution of toto DALYs number, bothboth sexes, ranked by number of DALYs, 1990-2016 Contribution oftop top1010risks risks DALYs number, sexes, ranked by number of DALYs, 1990-2016 same or increase Behavioural Environmental/occupational Metabolic Behavioural
Environmental/occupational
same or increase
Metabolic
Risk factors 1990
Risk factors 1990
1 2 3 4 5 6 7 Occupational risks [1.7%] 8 Impaired kidney function [0.9%] 10 High fasting plasma glucose [1.5%] 9 The percent figure in bracket next to each risk is DALYs from that risk out of total DALYs. Impaired kidney function [1.0%] 10 Malnutrition* [31.9%]
1 2 3 4 5 6 7 8 9 10
decrease
Risk factors 2016
Risk factors 2016
Malnutrition* [32.2%] 1 † [15.2%] [12.9%] WaSH†WaSH 2 Air pollution [7.7%] [8.9%] 3 Air pollution Tobacco use [3.6%] 4 Tobacco use [4.4%] Dietary risks [2.3%] 5 Dietary[2.2%] risks [2.6%] High blood pressure 6 Occupational [1.9%] [2.2%] 7 High bloodrisks pressure Alcohol & drug use [1.6%] 8 Alcohol & drug use [1.9%] High fasting plasma glucose [1.4%] 9
1
Malnutrition* [16.0%]
9
Occupational risks [2.5%]
Malnutrition* [14.8%] 2 Tobacco use [6.4%] Air pollution [5.1%] High blood pressure [5.0%] 3 Air pollution [6.1%] Tobacco use [4.9%] 4 High blood pressure [4.9%] Dietary risks [4.7%] Dietary risks [4.8%] 5 [4.0%] High fasting plasma glucose WaSH† [3.9%] 6 Alcohol & drug use [4.5%] Alcohol & drug use [3.9%] 7 WaSH† [4.4%] Occupational risks [2.6%] Impaired kidney function8 [2.0%]High fasting plasma glucose [3.6%] *Malnutrition is child and maternal malnutrition. kidney function 10 Impaired † WaSH is unsafe water, sanitation, and handwashing.
[2.0%]
*Malnutrition is child and maternal malnutrition. † WaSH is unsafe water, sanitation, and handwashing.
The percent figure in bracket next to each risk is DALYs from that risk out of total DALYs.
How did the risk factors differ by sex in 2016? Percent of total DALYs attributable to top 10 risks, ranked by percent for both sexes combined, 2016 Females
Males Malnutrition* Tobacco use Air pollution High blood pressure Dietary risks Alcohol & drug use WaSH† High fasting plasma glucose Occupational risks Impaired kidney function
15
10
5
0
Percent of years of life lost and years lived with disability Behavioural
0
5
*Malnutrition is child and maternal malnutrition. is unsafe water, sanitation, and handwashing.
150 Meghalaya
10
15
Percent of years of life lost and years lived with disability Environmental/occupational
†WaSH
decrease
Metabolic
Mizoram 1990 life expectancy Females: 66.7 years Males: 64.0 years
2016 life expectancy Females: 73.8 years Males: 68.3 years
How much did the under-5 mortality rate change from 1990 to 2016? How much did the under-5 mortality rate change from 1990 to 2016? Under-5 mortality both sexes combined, 1990-2016 Under-5 mortality rate, bothrate, sexes combined, 1990-2016 Mizoram under-5 rate
India under-5 rate
Comparative average rate globally for similar Socio-demographic Index as Mizoram
Deaths per 1,000 live births
150
100
50 39.2 30.6 26.2
0 1990
1995
2000
2005
2010
The shaded bands indicate 95% uncertainty intervals around the estimates
2016
Year What caused the most deaths in different age groups in 2016? Percent top 10 causesdeaths of death byin agedifferent group, both sexes, Whatcontribution causedofthe most age 2016 groups
in 2016? Percent contribution of top 10 causes of death by age group, both sexes, 2016 0−14 years [12% of total deaths]
3.7% 3.8%
15−39 years [13.7% of total deaths]
1% 6.6%
30.6%
HIV/AIDS & tuberculosis
13.8%
0.9% 1.3% 1.3% 0.9%
Diarrhoea/LRI*/other
15.7% NTDs† & malaria
7.8%
13.8%
Neonatal disorders
6.7% 5.5% 34%
15.8%
Maternal disorders
Nutritional deficiencies Other communicable diseases
11.7%
10.3%
Cancers Cardiovascular diseases
4.6% 5.7% 4.4%
Chronic respiratory diseases Cirrhosis Digestive diseases Neurological disorders
40−69 years [37.8% of total deaths]
70+ years [36.6% of total deaths]
Diabetes/urog‡/blood/endo§
2.9% 3.6% 5.9% 7.3%
3.2% 3.3%
8.9% 6.6%
Suicide & violence Other causes of death
3.9% 2% 15%
12.3% 11.8%
Unintentional injuries
8.2% 5.3%
4.7% 5.9%
Transport injuries
4% 19.9%
30%
Other non-communicable
*LRI is lower respiratory infections. † NTDs are neglected tropical diseases. ‡ Urog is urogenital diseases. § Endo is endocrine diseases.
21% 14.1%
Mizoram 151
Proportion of total disease burden from: Premature death: 64.6% | Disability or morbidity: 35.4% What caused the most years of life lost, by sex, in 2016? Top 15 causes of YLLs, ranked by percent for both sexes combined, 2016 Females
Males Malaria Lower respiratory infections COPD* Road injuries Intestinal infectious diseases Diarrhoeal diseases Preterm birth complications Other neonatal disorders Ischaemic heart disease Tuberculosis HIV/AIDS Stomach cancer Tracheal, bronchus, and lung cancer Neonatal encephalopathy Stroke
10
7.5
5
2.5
0
0
Percent of total years of life lost due to premature mortality
2.5
5
7.5
10
Percent of total years of life lost due to premature mortality
Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
Injuries
*COPD is chronic obstructive pulmonary disease.
What caused the most years lived with disability, by sex, in 2016? Top 15 causes of YLDs, ranked by percent for both sexes combined, 2016 Females
Males Sense organ diseases* Low back & neck pain Migraine Iron-deďŹ ciency anaemia Skin diseases COPD* Other musculoskeletal Depressive disorders Anxiety disorders Preterm birth complications Diabetes Oral disorders Falls Drug use disorders Schizophrenia
10.0
7.5 5.0 2.5 Percent of total years lived with disability
0
Communicable, maternal, neonatal, and nutritional diseases
0
2.5 5.0 7.5 10.0 Percent of total years lived with disability
Non-communicable diseases
*COPD is chronic obstructive pulmonary disease. *Sense organ diseases includes mainly hearing and vision loss.
152 Mizoram
Injuries
Proportion of total disease burden from: CMNNDs: 34.6% | NCDs: 55.5% | Injuries: 9.8% How leading causes causesofofdeath deathand anddisability disability combined changed from 1990 to 2016? How have have the leading combined changed from 1990 to 2016? Change causesof ofDALYs, DALYs,both bothsexes, sexes,ranked rankedbyby number DALYs, 1990–2016 Change in top 15 causes number of of DALYs, 1990–2016 Communicable, maternal, neonatal, and nutritional diseases
Injuries
Non-communicable diseases
Leading causes of DALYs 1990
Lower respiratory infections [9.9%] Diarrhoeal diseases [6.7%] Malaria [5.1%] Intestinal infectious diseases [4.6%] Tuberculosis [4.1%] Preterm birth complications [3.7%] COPD† [3.2%] Other neonatal disorders [3.1%] Neonatal encephalopathy [2.6%] Road injuries [2.2%] Congenital birth defects [2.1%] Sense organ diseases‡ [1.8%] Skin diseases [1.8%] Low back & neck pain [1.7%] Iron-deficiency anaemia [1.7%] Migraine [1.7%] Ischaemic heart disease [1.3%]
same or increase
decrease
Leading causes of DALYs 2016
1
1
2
2
3
3
4
4
5
5
6
6
7
7
8
8
9
9
10
10
11
11
12
12
13
13
14
14
15
15
16
22
20
23 †
*Change not significant. The percent figure in brackets next to each cause is DALYs from that cause out of total DALYs.
COPD† [5.5%] Malaria [4.7%]* Lower respiratory infections [4.4%] Preterm birth complications [3.2%]* Diarrhoeal diseases [3.1%] Road injuries [3.0%] Sense organ diseases‡ [3.0%] Intestinal infectious diseases [2.6%] Low back & neck pain [2.6%] Migraine [2.5%] Skin diseases [2.3%] Iron-deficiency anaemia [2.3%] Ischaemic heart disease [2.2%] Tuberculosis [2.2%] Other neonatal disorders [2.1%]* Congenital birth defects [1.7%]* Neonatal encephalopathy [1.6%]*
COPD is chronic obstructive pulmonary disease. Sense organ diseases includes mainly hearing and vision loss. Self-harm refers to suicide and the nonfatal outcomes of self-harm.
‡
§
What causedthe themost most death and disability combined across age groups in 2016? What caused death and disability combined across age groups in 2016? Percent group, both both sexes, sexes,2016 2016 Percent of of DALYs by age group, 20 [1.95]
10
[1.45] [0.73]
[0.65]
[0.58]
[0.86]
[1.83]
[1.18]
[0.97]
[2.25]
[0.48]
5
[2.81] [3.37]
[0.32]
[3.85]
[0.33] [4.46] [5.02]
(<
1%
)
) 85
84 80
to
+
(< 1%
%) (1 79
to
to 70
Non-communicable diseases
75
74
(1
(2 69 to
65
64
Age
Communicable, maternal, neonatal, and nutritional diseases
%)
%)
%) (2
%) to 60
59
(4
%) to 55
54
(5
%) to 50
49
(5
%) to 45
to
44
(6
%) 40
to
39
(7
%) (9 35
34 to 30
29
(9
0% to
(1 24 to
25
(1 20
19
%)
)
) 0%
%) (9 to 15
14
(1
0% to 10
o9 5t
de
r5
(9
%)
)
0
Un
Percent of total DALYs
15
Injuries
The number in the bracket on top of each vertical bar is the ratio of percent DALYs to population for that age group. The number in parentheses after each age group on the x-axis is the percent of population in that age group.
Mizoram 153
What risk factors are driving the most death and disability combined? Contribution of top 10 risks to DALYs number, both sexes, ranked by number of DALYs, 19 What risk factors are driving the most death and disability combined? What risk factors are driving the most death and disability combined? Contribution of toto DALYs number, bothboth sexes, ranked by number of DALYs, 1990-2016 Contribution oftop top1010risks risks DALYs number, sexes, ranked by number of DALYs, 1990-2016 same or increase Behavioural Environmental/occupational Metabolic Behavioural
Environmental/occupational
same or increase
Metabolic
Risk factors 1990
Risk factors 1990
1 2 3 4 5 6 7 High blood pressure [2.2%] 8 Impaired kidney function [0.9%] 10 High fasting plasma glucose [1.8%] 9 The percent figure in bracket next to each risk is DALYs from that risk out of total DALYs. Impaired kidney function [1.3%] 10 Malnutrition* [22.4%]
1 2 3 4 5 6 7 8 9 10
decrease
Risk factors 2016
Risk factors 2016
Malnutrition* [32.2%] 1 † Air pollution [15.2%] [8.3%] WaSH 2 Air pollution [7.7%] 3 Tobacco use [7.3%] Tobacco use [3.6%] † 4 WaSH [7.3%] Dietary risks [2.3%] 5 Dietary[2.2%] risks [2.5%] High blood pressure 6 Occupational [1.9%] 7 Alcohol &risks drug use [2.4%] Alcohol & drug use [1.6%] 8 Occupational risks [2.4%] High fasting plasma glucose [1.4%] 9
decrease
1
Malnutrition* [11.5%]
9
WaSH† [2.9%]
Malnutrition* [14.8%] 2 Tobacco use [11.0%] Air pollution [5.1%] High blood pressure [5.0%] 3 Air pollution [5.4%] Tobacco use [4.9%] 4 Alcohol & drug use [4.1%] Dietary risks [4.7%] Dietary risks [3.6%] 5 [4.0%] High fasting plasma glucose WaSH† [3.9%] 6 High fasting plasma glucose [3.5%] Alcohol & drug use [3.9%] 7 High blood pressure [3.3%] Occupational risks [2.6%] Impaired kidney function8 [2.0%]Occupational risks [3.0%] *Malnutrition is child and maternal malnutrition. kidney function 10 Impaired † WaSH is unsafe water, sanitation, and handwashing.
[1.9%]
*Malnutrition is child and maternal malnutrition. † WaSH is unsafe water, sanitation, and handwashing.
The percent figure in bracket next to each risk is DALYs from that risk out of total DALYs.
How did the risk factors differ by sex in 2016? Percent of total DALYs attributable to top 10 risks, ranked by percent for both sexes combined, 2016 Females
Males Malnutrition* Tobacco use Air pollution Alcohol & drug use Dietary risks High fasting plasma glucose High blood pressure Occupational risks WaSH† Unsafe sex
15
10
5
0
Percent of years of life lost and years lived with disability Behavioural
0
5
Environmental/occupational
*Malnutrition is child and maternal malnutrition. † WaSH is unsafe water, sanitation, and handwashing.
154 Mizoram
10
Percent of years of life lost and years lived with disability Metabolic
15
Nagaland 1990 life expectancy Females: 64.9 years Males: 63.1 years
2016 life expectancy Females: 74.5 years Males: 69.1 years
How much did the under-5 mortality rate change from 1990 to 2016? How much did the under-5 mortality rate change from 1990 to 2016? Under-5 mortality both sexes combined, 1990-2016 Under-5 mortality rate, bothrate, sexes combined, 1990-2016 Nagaland under-5 rate
India under-5 rate
Comparative average rate globally for similar Socio-demographic Index as Nagaland
Deaths per 1,000 live births
150
100
50 39.2 28.9 22.1
0 1990
1995
2000
2005
2010
The shaded bands indicate 95% uncertainty intervals around the estimates
2016
Year What caused the most deaths in different age groups in 2016? Percent top 10 causesdeaths of death byin agedifferent group, both sexes, Whatcontribution causedofthe most age 2016 groups
in 2016? Percent contribution of top 10 causes of death by age group, both sexes, 2016 0−14 years [11% of total deaths]
15−39 years [16.4% of total deaths]
3.8% 4.2%
5.4% 5.4% 3.6%
36.5%
HIV/AIDS & tuberculosis
1.3%
Diarrhoea/LRI*/other
13.8%
17.1%
1% 1.3%
NTDs† & malaria
7.7% 10%
Neonatal disorders
9.1% 4%
Nutritional deficiencies Other communicable diseases
6.8%
31.8%
Maternal disorders
5.7%
9.2% 10%
8%
Cancers Cardiovascular diseases
4.3%
Chronic respiratory diseases Cirrhosis Digestive diseases Neurological disorders
40−69 years [37.8% of total deaths]
70+ years [34.8% of total deaths] 3.9% 3.3%
Diabetes/urog‡/blood/endo§ Other non-communicable Transport injuries
8.8% 6.5%
6.7% 3.8% 2.9% 6.8% 3.5%
18.9%
4%
Unintentional injuries
8.5%
16.2%
Suicide & violence
5.7% 3% 2.5%
9.2%
9.2%
8.8%
Other causes of death *LRI is lower respiratory infections. † NTDs are neglected tropical diseases. ‡ Urog is urogenital diseases. § Endo is endocrine diseases.
5.1% 27.9%
34.9%
Nagaland 155
Proportion of total disease burden from: Premature death: 61.0% | Disability or morbidity: 39.0% What caused the most years of life lost, by sex, in 2016? Top 15 causes of YLLs, ranked by percent for both sexes combined, 2016 Females
Males Ischaemic heart disease Lower respiratory infections Stroke HIV/AIDS Tuberculosis Road injuries Intestinal infectious diseases Preterm birth complications Diarrhoeal diseases Hepatitis Chronic kidney disease COPD* Cirrhosis due to hepatitis B Malaria Neonatal encephalopathy
10
7.5
5
2.5
0
0
Percent of total years of life lost due to premature mortality
2.5
5
7.5
10
Percent of total years of life lost due to premature mortality
Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
Injuries
*COPD is chronic pulmonary disease. What caused the most years lived with disability, by sex,obstructive in 2016? Top 15 causes of YLDs, ranked by percent for both sexes combined, 2016
Females
Males Sense organ diseases* Migraine Skin diseases Low back & neck pain Iron-deďŹ ciency anaemia Other musculoskeletal Depressive disorders COPD* Anxiety disorders Preterm birth complications Diabetes Falls Oral disorders Drug use disorders Iodine deďŹ ciency
10.0
7.5 5.0 2.5 Percent of total years lived with disability
0
Communicable, maternal, neonatal, and nutritional diseases
0
2.5 5.0 7.5 10.0 Percent of total years lived with disability
Non-communicable diseases
*COPD is chronic obstructive pulmonary disease. *Sense organ diseases includes mainly hearing and vision loss.
156 Nagaland
Injuries
Proportion of total disease burden from: CMNNDs: 32.2% | NCDs: 57.2% | Injuries: 10.6%
How have the leading causes of death and disability combined changed from 1990 to 2016? How have the leading causes of death and disability combined changed from 1990 to 2016? Change in top 15 causes of DALYs, both sexes, ranked by number of DALYs, 1990–2016 Change in top 15 causes of DALYs, both sexes, ranked by number of DALYs, 1990–2016 Communicable, maternal, neonatal, and nutritional diseases
Injuries
Non-communicable diseases
Leading causes of DALYs 1990
Lower respiratory infections [11.3%] Diarrhoeal diseases [7.9%] Tuberculosis [4.8%] Preterm birth complications [4.1%] Measles [3.7%] Intestinal infectious diseases [2.9%] Hepatitis [2.6%] Stroke [2.5%] Ischaemic heart disease [2.5%] Malaria [2.4%] Neonatal encephalopathy [2.4%] Tetanus [2.4%] Neonatal haemolytic disease [1.9%] COPD† [1.8%] Other neonatal disorders [1.7%] Road injuries [1.7%] Sense organ diseases‡ [1.6%] Skin diseases [1.5%] Low back & neck pain [1.5%] Migraine [1.4%] Iron-deficiency anaemia [1.2%] HIV/AIDS [0.1%]
same or increase
decrease
Leading causes of DALYs 2016
1
1
2
2
3
3
4
4
5
5
6
6
7
7
8
8
9
9
10
10
11
11
12
12
13
13
14
14
15
15
16
21
17 21
22 24
22
30
24
44
26
59
94
103 †
*Change not significant. The percent figure in brackets next to each cause is DALYs from that cause out of total DALYs.
Ischaemic heart disease [4.6%] Lower respiratory infections [4.3%] Stroke [3.9%] HIV/AIDS [3.1%] Sense organ diseases‡ [3.0%] Tuberculosis [3.0%] Preterm birth complications [2.9%]* Skin diseases [2.9%] Migraine [2.8%] Road injuries [2.8%] Low back & neck pain [2.7%] COPD† [2.6%] Iron-deficiency anaemia [2.1%] Intestinal infectious diseases [2.1%] Diarrhoeal diseases [2.1%] Hepatitis [1.5%] Neonatal encephalopathy [1.4%]* Malaria [1.3%]* Other neonatal disorders [1.0%]* Neonatal haemolytic disease [0.6%] Measles [0.5%] Tetanus [0.1%]
COPD is chronic obstructive pulmonary disease. Sense organ diseases includes mainly hearing and vision loss. Self-harm refers to suicide and the nonfatal outcomes of self-harm.
‡
§
What causedthe themost most death and disability combined across age groups in 2016? What caused death and disability combined across age groups in 2016? Percent of of DALYs by age group, Percent group, both both sexes, sexes,2016 2016 16 [2.16]
8
[0.66]
[0.55]
[0.74]
[0.84]
[0.98]
[1.34]
[1.11]
[1.65] [2.07] [2.55]
[0.37]
[0.35]
[3.17]
4
[4.35]
[3.81]
[5.12] [5.8]
(<
1%
)
) 85
84 80
to
+
(< 1%
%) 79
(1
%) to 75
74
(1
%) 70
to
69
(1
%) to 65
64
(2
%) to 60
59
(3
%) to 55
54
(4
%) to 50
49
(5
%) to 45
to
44
(6
%) (7 40
39 to 35
to
34
(8
(9 30
29 to 25
(1
%)
%)
) 1%
) to
24
(1 20
19 to 15
10
to
14
(1
(1
2%
2%
) 2%
)
o9
6%
5t
5( de r
)
0
Un
Percent of total DALYs
12
Age Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
The number in the bracket on top of each vertical bar is the ratio of percent DALYs to population for that age group. The number in parentheses after each age group on the x-axis is the percent of population in that age group.
Injuries
Nagaland 157
What risk factors are driving the most death and disability combined? Contribution of top 10 risks to DALYs number, both sexes, ranked by number of DALYs, 19 What risk factors are driving the most death and disability combined? What risk factors are driving the most death and disability combined? Contribution of toto DALYs number, bothboth sexes, ranked by number of DALYs, 1990-2016 Contribution oftop top1010risks risks DALYs number, sexes, ranked by number of DALYs, 1990-2016 same or increase Behavioural Environmental/occupational Metabolic Behavioural
Environmental/occupational
same or increase
Metabolic
Risk factors 1990
Risk factors 1990
1 2 3 4 5 6 7 Occupational risks [2.0%] 8 Impaired kidney function [0.9%] 10 High fasting plasma glucose [1.6%] 9 The percent figure in bracket next to each risk is DALYs from that risk out of total DALYs. Impaired kidney function [1.4%] 10 High total cholesterol [1.3%] 11 Malnutrition* [27.3%]
1 2 3 4 5 6 7 8 9 10
decrease
Risk factors 2016
Risk factors 2016
Malnutrition* [32.2%] 1 † Air pollution [15.2%] [10.0%] WaSH 2 Air pollutionWaSH [7.7%] † [8.1%] 3 Tobacco use [3.6%] 4 High blood pressure [4.1%] Dietary risks [2.3%] 5 Dietary[2.2%] risks [3.9%] High blood pressure 6 Occupational risks [1.9%] 7 Tobacco use [3.7%] Alcohol & drug use [1.6%] 8 Alcohol & drug use [2.3%] High fasting plasma glucose [1.4%] 9
1
Malnutrition* [10.2%]
Malnutrition* [14.8%] 2 High blood pressure [7.5%] Air pollution [5.1%] High blood pressure [5.0%] 3 Dietary risks [6.1%] Tobacco use [4.9%] 4 Air pollution [5.6%] Dietary risks [4.7%] Alcohol & drug use [5.3%] 5 [4.0%] High fasting plasma glucose WaSH† [3.9%] 6 Tobacco use [4.4%] Alcohol & drug use [3.9%] 7 High fasting plasma glucose [4.2%] Occupational risks [2.6%] Impaired kidney function8 [2.0%]Occupational risks [2.7%]
9
High total cholesterol [2.6%] [2.6%] 12 WaSH† [9.5%]
*Malnutrition is child and maternal malnutrition. 10 Impaired kidney function † WaSH is unsafe water, sanitation, and handwashing.
*Malnutrition is child and maternal malnutrition. † WaSH is unsafe water, sanitation, and handwashing.
The percent figure in bracket next to each risk is DALYs from that risk out of total DALYs.
How did the risk factors differ by sex in 2016? Percent of total DALYs attributable to top 10 risks, ranked by percent for both sexes combined, 2016 Females
Males Malnutrition* High blood pressure Dietary risks Air pollution Alcohol & drug use Tobacco use High fasting plasma glucose Occupational risks High total cholesterol Impaired kidney function
10
5
0
Percent of years of life lost and years lived with disability Behavioural
0
5
10
Percent of years of life lost and years lived with disability Environmental/occupational
*Malnutrition is child and maternal malnutrition.
158 Nagaland
decrease
Metabolic
Odisha 1990 life expectancy Females: 55.3 years Males: 53.7 years
2016 life expectancy Females: 68.6 years Males: 66.1 years
How much did the under-5 mortality rate change from 1990 to 2016? How much did the under-5 mortality rate change from 1990 to 2016? Under-5 mortality both sexes combined, 1990-2016 Under-5 mortality rate, bothrate, sexes combined, 1990-2016 Odisha under-5 rate
India under-5 rate
Comparative average rate globally for similar Socio-demographic Index as Odisha
Deaths per 1,000 live births
150
100
50
40.8 39.2 38.5
0 1990
1995
2000
2005
2010
The shaded bands indicate 95% uncertainty intervals around the estimates
2016
Year What caused the most deaths in different age groups in 2016? Percent top 10 causesdeaths of death byin agedifferent group, both sexes, Whatcontribution causedofthe most age 2016 groups
in 2016? Percent contribution of top 10 causes of death by age group, both sexes, 2016 0−14 years [9% of total deaths]
15−39 years [10.8% of total deaths]
1.4% 3.5% 5%
0.8%
HIV/AIDS & tuberculosis
27.9%
13%
1.1% 1.8% 1.9%
5.7%
Diarrhoea/LRI*/other
14.9%
NTDs† & malaria Maternal disorders
12.4%
12.3%
Nutritional deficiencies
3.8% 3.8% 12.7%
9.5%
5.9%
38.1%
Neonatal disorders
Other communicable diseases Cancers
9.9%
9%
Cardiovascular diseases
5.4%
Chronic respiratory diseases Cirrhosis Digestive diseases Neurological disorders
40−69 years [41.3% of total deaths]
70+ years [38.9% of total deaths] 3.6% 3.4%
Diabetes/urog‡/blood/endo§ Other non-communicable Transport injuries
8.3%
7.8%
2.6%
5.1%
5%
Unintentional injuries
7.7%
14.6%
3.7%
31.5%
8.2%
3.5%
5% 12.3%
8.1%
2.4% 5.6%
Suicide & violence Other causes of death *LRI is lower respiratory infections. † NTDs are neglected tropical diseases. ‡ Urog is urogenital diseases. § Endo is endocrine diseases.
6.3% 27.9%
0.8%
26.5%
Odisha 159
Proportion of total disease burden from: Premature death: 69.0% | Disability or morbidity: 31.0% What caused the most years of life lost, by sex, in 2016? Top 15 causes of YLLs, ranked by percent for both sexes combined, 2016 Females
Males Diarrhoeal diseases Stroke Ischaemic heart disease Lower respiratory infections Tuberculosis Malaria Preterm birth complications Road injuries Other neonatal disorders Suicide COPD* Neonatal encephalopathy Chronic kidney disease HIV/AIDS Falls
15
10
5
0
0
Percent of total years of life lost due to premature mortality
5
10
15
Percent of total years of life lost due to premature mortality
Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
Injuries
What caused the most years lived with disability, by sex, in 2016? *COPD is chronic obstructive pulmonary disease. Top 15 causes of YLDs, ranked by percent for both sexes combined, 2016 Females
Males Iron-deďŹ ciency anaemia Sense organ diseases* Low back & neck pain Depressive disorders Migraine Skin diseases Other musculoskeletal COPD* Anxiety disorders Diabetes Falls Oral disorders Preterm birth complications Diarrhoeal diseases Osteoarthritis
15
10 5 Percent of total years lived with disability
0
Communicable, maternal, neonatal, and nutritional diseases
0
5 10 Percent of total years lived with disability
Non-communicable diseases
*COPD is chronic obstructive pulmonary disease. *Sense organ diseases includes mainly hearing and vision loss.
160 Odisha
Injuries
15
Proportion of total disease burden from: CMNNDs: 36.9% | NCDs: 52.1% | Injuries: 11.1% How have have the leading combined changed from 1990 to 2016? How leading causes causesofofdeath deathand anddisability disability combined changed from 1990 to 2016? Change in top 15 causes of DALYs, both sexes, ranked by number of DALYs, 1990–2016 Change in top 15 causes of DALYs, both sexes, ranked by number of DALYs, 1990–2016 Communicable, maternal, neonatal, and nutritional diseases
Injuries
Non-communicable diseases
Leading causes of DALYs 1990
same or increase
decrease
Leading causes of DALYs 2016
Diarrhoeal diseases [13.1%] Lower respiratory infections [10.0%] Tuberculosis [5.9%] Measles [5.2%] Malaria [4.4%] Other neonatal disorders [4.2%] Preterm birth complications [4.1%] Neonatal encephalopathy [3.6%] Stroke [2.7%] COPD† [2.2%] Tetanus [1.8%] Congenital birth defects [1.7%] Iron-deficiency anaemia [1.7%] Ischaemic heart disease [1.5%] Hepatitis [1.4%] Sense organ diseases‡ [1.1%] Falls [1.0%] Low back & neck pain [1.0%] Road injuries [0.9%] Chronic kidney disease [0.9%]
1
1
2
2
3
3
4
4
5
5
6
6
7
7
8
8
9
9
10
10
11
11
12
12
13
13
14
14
15
15
20
21
23 24
24 25
28
83
30
131
Diarrhoeal diseases [7.6%] Stroke [5.8%] Ischaemic heart disease [4.5%] Lower respiratory infections [4.0%] Tuberculosis [3.5%] Iron-deficiency anaemia [3.2%] Malaria [3.1%]* COPD† [3.0%]* Sense organ diseases‡ [2.8%] Preterm birth complications [2.5%] Road injuries [2.3%] Low back & neck pain [2.2%] Falls [2.1%] Chronic kidney disease [2.0%] Other neonatal disorders [2.0%] Neonatal encephalopathy [1.8%] Congenital birth defects [1.2%] Hepatitis [1.0%] Measles [0.2%] Tetanus [0.1%]
†
*Change not significant. The percent figure in brackets next to each cause is DALYs from that cause out of total DALYs.
COPD is chronic obstructive pulmonary disease. Sense organ diseases includes mainly hearing and vision loss. § Self-harm refers to suicide and the nonfatal outcomes of self-harm. ‡
What caused death and disability combined across age groups in 2016? What causedthe themost most death and disability combined across age groups in 2016? Percent of of DALYs DALYs by by age Percent age group, group, both both sexes, sexes,2016 2016 [1.8]
Percent of total DALYs
15
10
[0.54]
5
[0.65]
[0.59]
[1.08]
[0.89]
[0.78]
[2.05]
[1.65]
[1.33]
[2.58] [3.13] [3.55]
[0.44] [0.3]
[0.3]
[4.03] [4.37]
) (< 1% +
%)
80
85
84
(1
%) to
79
(1
%) to
to 70
75
74
(2
%) 69
(2
%) to 65
64
(4
%) to 60
59
(4
%) to 55
54
(5
%) to 50
49
(6
%) to 45
to
44
(7
%) 40
39
(7
%) to 35
34
(8
%) to 30
29
(9
%) to 25
24
(9
%) to 20
19
(9
%) to 15
to
14
(9
(9 10
o9 5t
Un de r
5(
9%
)
%)
0
Age Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
Injuries
The number in the bracket on top of each vertical bar is the ratio of percent DALYs to population for that age group. The number in parentheses after each age group on the x-axis is the percent of population in that age group.
Odisha 161
What risk factors are driving the most death and disability combined? Contribution of top 10 risks to DALYs number, both sexes, ranked by number of DALYs, 19 What risk factors are driving the most death and disability combined? What risk factors are driving the most death and disability combined? Contribution of toto DALYs number, bothboth sexes, ranked by number of DALYs, 1990-2016 Contribution oftop top1010risks risks DALYs number, sexes, ranked by number of DALYs, 1990-2016 same or increase Behavioural Environmental/occupational Metabolic Behavioural
Environmental/occupational
same or increase
Metabolic
Risk factors 1990
Risk factors 1990
1 2 3 4 5 6 7 High fasting plasma glucose [1.6%] 8 Impaired kidney function [0.9%] 10 Occupational risks [1.6%] 9 The percent figure in bracket next to each risk is DALYs from that risk out of total DALYs. Impaired kidney function [1.3%] 10 High body-mass index [0.5%] 12 Malnutrition* [35.5%]
1 2 3 4 5 6 7 8 9 10
decrease
Risk factors 2016
Risk factors 2016
Malnutrition* [32.2%] 1 † [15.2%] [13.7%] WaSH†WaSH 2 Air Air pollution [7.7%] [10.0%] 3 pollution Tobacco use [3.6%] 4 Tobacco use [3.6%] Dietary risks [2.3%] 5 High blood pressure High blood pressure [2.2%] [3.2%] 6 Occupational risks [1.9%] 7 Dietary risks [3.2%] Alcohol & drug use [1.6%] 8 Alcohol & drug use [1.7%] High fasting plasma glucose [1.4%] 9
1
Malnutrition* [12.7%]
Malnutrition* [14.8%] 2 Air pollution [8.2%] Air pollution [5.1%] High blood pressure [5.0%] 3 High blood pressure [7.6%] Tobacco use [4.9%] 4 WaSH† [7.4%] Dietary risks [4.7%] Dietary risks [7.0%] 5 [4.0%] High fasting plasma glucose WaSH† [3.9%] 6 High fasting plasma glucose [5.2%] Alcohol & drug use [3.9%] 7 Tobacco use [4.0%] Occupational risks [2.6%] Impaired kidney function8 [2.0%]Alcohol & drug use [3.8%]
9
High body-mass index [3.2%] [3.0%] 11 Occupational risks [2.5%]
*Malnutrition is child and maternal malnutrition. kidney function 10 Impaired † WaSH is unsafe water, sanitation, and handwashing.
*Malnutrition is child and maternal malnutrition. † WaSH is unsafe water, sanitation, and handwashing.
The percent figure in bracket next to each risk is DALYs from that risk out of total DALYs.
How did the risk factors differ by sex in 2016? Percent of total DALYs attributable to top 10 risks, ranked by percent for both sexes combined, 2016 Females
Males Malnutrition* Air pollution High blood pressure WaSH† Dietary risks High fasting plasma glucose Tobacco use Alcohol & drug use High body-mass index Impaired kidney function
12
8
4
0
Percent of years of life lost and years lived with disability Behavioural
0
4
*Malnutrition is child and maternal malnutrition. is unsafe water, sanitation, and handwashing.
162 Odisha
8
12
Percent of years of life lost and years lived with disability Environmental/occupational
†WaSH
decrease
Metabolic
Punjab 1990 life expectancy Females: 64.2 years Males: 62.2 years
2016 life expectancy Females: 72.2 years Males: 68.0 years
How much did the under-5 mortality rate change from 1990 to 2016? How much did the under-5 mortality rate change from 1990 to 2016? Under-5 mortality both sexes combined, 1990-2016 Under-5 mortality rate, bothrate, sexes combined, 1990-2016 Punjab under-5 rate
India under-5 rate
Comparative average rate globally for similar Socio-demographic Index as Punjab
Deaths per 1,000 live births
150
100
50 39.2 29.4 23.6
0 1990
1995
2000
2005
2010
The shaded bands indicate 95% uncertainty intervals around the estimates
2016
Year What caused the most deaths in different age groups in 2016? Percent top 10 causesdeaths of death byin agedifferent group, both sexes, Whatcontribution causedofthe most age 2016 groups
in 2016? Percent contribution of top 10 causes of death by age group, both sexes, 2016 0−14 years [5.2% of total deaths]
4.7%
15−39 years [10.3% of total deaths]
HIV/AIDS & tuberculosis
2.1% 8.5%
5.1%
Diarrhoea/LRI*/other
9.9%
8.2% 32.7%
9.4% 1.2% 1.6% 1.4% 1.6%
NTDs† & malaria
9.3%
2.7%
Maternal disorders
5.7%
Neonatal disorders
9.2%
Nutritional deficiencies Other communicable diseases
21.7%
2%
Cancers
16.2%
Cardiovascular diseases
38.2%
5.5%
Chronic respiratory diseases Cirrhosis
3.1%
Digestive diseases Neurological disorders
40−69 years [39.1% of total deaths]
70+ years [45.4% of total deaths] 2.3% 2.1%
3.6% 4.2% 4.4% 5.5% 11.5%
Other non-communicable
1%
3.5%
Transport injuries
12.2%
4.1%
Unintentional injuries
11.6%
10.9%
Suicide & violence
5.5% 4.4%
1.8% 3% 9.4%
6.9%
44.2%
Diabetes/urog‡/blood/endo§
Other causes of death
1.3% *LRI is lower respiratory infections. † NTDs are neglected tropical diseases. ‡ Urog is urogenital diseases. § Endo is endocrine diseases.
46.6%
Punjab 163
Proportion of total disease burden from: Premature death: 64.9% | Disability or morbidity: 35.1% What caused the most years of life lost, by sex, in 2016? Top 15 causes of YLLs, ranked by percent for both sexes combined, 2016 Females
Males Ischaemic heart disease Road injuries Stroke Lower respiratory infections Diabetes COPD* Diarrhoeal diseases Chronic kidney disease Tuberculosis Suicide Intestinal infectious diseases Other neonatal disorders Preterm birth complications HIV/AIDS Neonatal encephalopathy
30
20
10
0
0
Percent of total years of life lost due to premature mortality
10
20
30
Percent of total years of life lost due to premature mortality
Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
Injuries
What caused the most years lived with disability, sex,obstructive in 2016? *COPD by is chronic pulmonary disease. Top 15 causes of YLDs, ranked by percent for both sexes combined, 2016 Females
Males Iron-deďŹ ciency anaemia Sense organ diseases* Low back & neck pain Migraine Skin diseases Other musculoskeletal COPD* Depressive disorders Diabetes Anxiety disorders Oral disorders Preterm birth complications Falls Osteoarthritis Road injuries
15
10 5 Percent of total years lived with disability
0
Communicable, maternal, neonatal, and nutritional diseases
0
5 10 Percent of total years lived with disability
Non-communicable diseases
*COPD is chronic obstructive pulmonary disease. *Sense organ diseases includes mainly hearing and vision loss.
164 Punjab
Injuries
15
Proportion of total disease burden from: CMNNDs: 22.4% | NCDs: 66.0% | Injuries: 11.6% How have have the leading combined changed from 1990 to 2016? How leading causes causesofofdeath deathand anddisability disability combined changed from 1990 to 2016? Change in top 15 causes of DALYs, both sexes, ranked by number of DALYs, 1990–2016 Change in top 15 causes of DALYs, both sexes, ranked by number of DALYs, 1990–2016 Communicable, maternal, neonatal, and nutritional diseases
Injuries
Non-communicable diseases
Leading causes of DALYs 1990
Diarrhoeal diseases [12.9%] Ischaemic heart disease [8.2%] Lower respiratory infections [6.5%] Preterm birth complications [4.1%] Tuberculosis [3.9%] Neonatal encephalopathy [3.8%] Other neonatal disorders [3.5%] COPD† [3.4%] Congenital birth defects [2.7%] Iron-deficiency anaemia [2.5%] Intestinal infectious diseases [2.4%] Road injuries [2.3%] Stroke [2.1%] Sense organ diseases‡ [1.7%] Meningitis [1.7%] Low back & neck pain [1.6%] Chronic kidney disease [1.4%] Skin diseases [1.4%] Migraine [1.3%] Diabetes [1.3%]
same or increase
decrease
Leading causes of DALYs 2016
1
1
2
2
3
3
4
4
5
5
6
6
7
7
8
8
9
9
10
10
11
11
12
12
13
13
14
14
15
15
16
20
18 19
21 22
20
24
21
35 †
*Change not significant. The percent figure in brackets next to each cause is DALYs from that cause out of total DALYs.
Ischaemic heart disease [17.1%] Road injuries [4.2%] COPD† [4.0%]* Diabetes [3.9%] Iron-deficiency anaemia [3.2%] Sense organ diseases‡ [3.2%] Stroke [2.9%] Low back & neck pain [2.7%] Lower respiratory infections [2.6%] Diarrhoeal diseases [2.6%] Chronic kidney disease [2.5%] Migraine [2.3%] Skin diseases [2.0%] Tuberculosis [1.9%] Preterm birth complications [1.9%] Congenital birth defects [1.4%] Intestinal infectious diseases [1.3%] Other neonatal disorders [1.3%] Neonatal encephalopathy [1.1%] Meningitis [0.7%]
COPD is chronic obstructive pulmonary disease. Sense organ diseases includes mainly hearing and vision loss. Self-harm refers to suicide and the nonfatal outcomes of self-harm.
‡
§
What caused the most death and disability combined across age groups in 2016? Percent of DALYs age group, sexes, 2016 What caused thebymost death both and disability combined across age groups in 2016? Percent of DALYs by age group, both sexes, 2016 [1.58] 9 [2.08] [1.68]
Percent of total DALYs
[1.36]
[2.61]
[1.1] 6
[0.55]
[0.9]
[0.79]
[0.68]
[0.6]
[3.15]
[3.57] [0.44] [4.12] 3
[0.3]
[0.29]
[4.61]
+
(1
%)
%) 85
84
(1
%) 80
to
79
(1
%) to 75
74
(2
%) 70
to
69
(3
%) to 65
64
(4
%) to 60
59
(4
%) to 55
54
(5
%) to 50
49
(6
%) to 45
44
(7
%) to 40
39
(7
%) to 35
34
(8
%) to 30
(1
29 to 25
24
(9
0%
)
%) to 20
19
(9
%) to 15
to
14
(8
(8 10
o9 5t
Un
de r
5(
6%
)
%)
0
Age Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
Injuries
The number in the bracket on top of each vertical bar is the ratio of percent DALYs to population for that age group. The number in parentheses after each age group on the x-axis is the percent of population in that age group.
Punjab 165
What risk factors are driving the most death and disability combined? Contribution of top 10 risks to DALYs number, both sexes, ranked by number of DALYs, 19 What risk factors are driving the most death and disability combined? What risk factors are driving the most death and disability combined? Contribution of toto DALYs number, bothboth sexes, ranked by number of DALYs, 1990-2016 Contribution oftop top1010risks risks DALYs number, sexes, ranked by number of DALYs, 1990-2016 same or increase Behavioural Environmental/occupational Metabolic Behavioural
Environmental/occupational
same or increase
Metabolic
Risk factors 1990
Risk factors 1990
1 2 3 4 5 6 7 High total cholesterol [3.4%] 8 Impaired kidney function [0.9%] 10 Occupational risks [2.4%] 9 The percent figure in bracket next to each risk is DALYs from that risk out of total DALYs. High body-mass index [2.4%] 10 Impaired kidney function [2.3%] 11 Alcohol & drug use [1.8%] 12 Malnutrition* [29.7%]
1 2 3 4 5 6 7 8 9 10
decrease
Risk factors 2016
Risk factors 2016
Malnutrition* [32.2%] 1 † [15.2%] [12.8%] WaSH†WaSH 2 Air Air pollution [7.7%] [11.5%] 3 pollution Tobacco use [3.6%] 4 Dietary risks [8.3%] Dietary risks [2.3%] 5 High blood pressure High blood pressure [2.2%] [7.3%] 6 Occupational risks [1.9%] 7 Tobacco use [4.0%] Alcohol & drug use [1.6%] 8 High fasting plasma glucose [4.0%] High fasting plasma glucose [1.4%] 9
1
High blood pressure [15.3%]
Malnutrition* [14.8%] 2 Dietary risks [14.6%] Air pollution [5.1%] High blood pressure [5.0%] 3 Air pollution [10.4%] Tobacco use [4.9%] 4 High fasting plasma glucose [10.0%] Dietary risks [4.7%] Malnutrition* [8.9%] 5 [4.0%] High fasting plasma glucose WaSH† [3.9%] 6 High body-mass index [8.8%] Alcohol & drug use [3.9%] 7 High total cholesterol [6.6%] Occupational risks [2.6%] Impaired kidney function8 [2.0%]Tobacco use [4.8%]
9
Impaired kidney function [4.4%] [3.6%] 11 Occupational risks [3.6%] † 12 WaSH [2.4%]
*Malnutrition is child and maternal malnutrition. 10 Alcohol & drug use † WaSH is unsafe water, sanitation, and handwashing.
*Malnutrition is child and maternal malnutrition. † WaSH is unsafe water, sanitation, and handwashing.
The percent figure in bracket next to each risk is DALYs from that risk out of total DALYs.
How did the risk factors differ by sex in 2016? Percent of total DALYs attributable to top 10 risks, ranked by percent for both sexes combined, 2016 Females
Males High blood pressure Dietary risks Air pollution High fasting plasma glucose Malnutrition* High body-mass index High total cholesterol Tobacco use Impaired kidney function Alcohol & drug use
15
10
5
0
Percent of years of life lost and years lived with disability Behavioural
0
5
10
15
Percent of years of life lost and years lived with disability Environmental/occupational
*Malnutrition is child and maternal malnutrition.
166 Punjab
decrease
Metabolic
Rajasthan 1990 life expectancy Females: 59.4 years Males: 57.2 years
2016 life expectancy Females: 70.1 years Males: 65.5 years
How much did the under-5 mortality rate change from 1990 to 2016? How much did the under-5 mortality rate change from 1990 to 2016? Under-5 mortality both sexes combined, 1990-2016 Under-5 mortality rate, bothrate, sexes combined, 1990-2016 Rajasthan under-5 rate
India under-5 rate
Comparative average rate globally for similar Socio-demographic Index as Rajasthan
Deaths per 1,000 live births
150
100
50
45 44 39.2
0 1990
1995
2000
2005
2010
The shaded bands indicate 95% uncertainty intervals around the estimates
2016
Year What caused the most deaths in different age groups in 2016? Percent top 10 causesdeaths of death byin agedifferent group, both sexes, Whatcontribution causedofthe most age 2016 groups
in 2016? Percent contribution of top 10 causes of death by age group, both sexes, 2016 0−14 years [14.9% of total deaths]
15−39 years [11.6% of total deaths]
1.1% 2.9% 1.1% 4.8% 4.7%
HIV/AIDS & tuberculosis
0.7% 1.2% 2.3%
12.4%
Diarrhoea/LRI*/other
10.7%
NTDs† & malaria
10.9%
12.4%
Maternal disorders
41.7%
Neonatal disorders
9.8%
6.1%
Nutritional deficiencies Other communicable diseases
6.4%
36.6%
Cancers
14.2%
10.6%
Cardiovascular diseases Chronic respiratory diseases
2.9%
3.6% 2.9%
Cirrhosis Digestive diseases Neurological disorders
40−69 years [36.9% of total deaths]
70+ years [36.6% of total deaths] 2.1% 3.3% 0.8% 3.9% 4.6%
3.8% 8.8% 8.8%
5.1%
3.4%
4.2%
13.5%
2.1% 2.2%
18.4%
4%
Other non-communicable Transport injuries
1.6%
Unintentional injuries Suicide & violence Other causes of death
6.7% 20.4%
27.5%
Diabetes/urog‡/blood/endo§
30.4%
*LRI is lower respiratory infections. † NTDs are neglected tropical diseases. ‡ Urog is urogenital diseases. § Endo is endocrine diseases.
24.1%
Rajasthan 167
Proportion of total disease burden from: Premature death: 69.7% | Disability or morbidity: 30.3% What caused the most years of life lost, by sex, in 2016? Top 15 causes of YLLs, ranked by percent for both sexes combined, 2016 Females
Males Lower respiratory infections Ischaemic heart disease COPD* Preterm birth complications Diarrhoeal diseases Tuberculosis Other neonatal disorders Road injuries Intestinal infectious diseases Stroke Suicide Asthma Neonatal encephalopathy Congenital birth defects Falls
15
10
5
0
0
Percent of total years of life lost due to premature mortality
5
10
15
Percent of total years of life lost due to premature mortality
Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
Injuries
What caused the most years lived with disability, by sex, in 2016? *COPD is chronic obstructive pulmonary disease. Top 15 causes of YLDs, ranked by percent for both sexes combined, 2016 Females
Males Iron-deďŹ ciency anaemia Sense organ diseases* Migraine Low back & neck pain Skin diseases Other musculoskeletal COPD* Depressive disorders Anxiety disorders Diabetes Oral disorders Preterm birth complications Falls Protein-energy malnutrition Osteoarthritis
16
12 8 4 Percent of total years lived with disability
0
Communicable, maternal, neonatal, and nutritional diseases
0
4 8 12 Percent of total years lived with disability
Non-communicable diseases
*COPD is chronic obstructive pulmonary disease. *Sense organ diseases includes mainly hearing and vision loss.
168 Rajasthan
Injuries
16
Proportion of total disease burden from: CMNNDs: 39.9% | NCDs: 49.3% | Injuries: 10.8% How have have the the leading combined changed from 1990 to 2016? How leading causes causesofofdeath deathand anddisability disability combined changed from 1990 to 2016? Change in top 15 causes of DALYs, both sexes, ranked by number of DALYs, 1990–2016 Change in top 15 causes of DALYs, both sexes, ranked by number of DALYs, 1990–2016 Communicable, maternal, neonatal, and nutritional diseases
Injuries
Non-communicable diseases
Leading causes of DALYs 1990
Lower respiratory infections [14.0%] Diarrhoeal diseases [13.0%] Tuberculosis [6.2%] Preterm birth complications [5.0%] Other neonatal disorders [4.0%] Measles [3.5%] COPD† [3.4%] Intestinal infectious diseases [3.1%] Ischaemic heart disease [2.7%] Iron-deficiency anaemia [2.3%] Tetanus [2.2%] Neonatal encephalopathy [2.0%] Asthma [1.6%] Road injuries [1.5%] Meningitis [1.4%] Sense organ diseases‡ [1.3%] Stroke [1.2%] Skin diseases [1.0%] Migraine [1.0%]
same or increase
decrease
Leading causes of DALYs 2016
1
1
2
2
3
3
4
4
5
5
6
6
7
7
8
8
9
9
10
10
11
11
12
12
13
13
14
14
15
15
16
19
18 21
28 55
22
109
Lower respiratory infections [7.4%] COPD† [7.0%] Ischaemic heart disease [6.4%] Preterm birth complications [4.5%]* Diarrhoeal diseases [4.1%] Tuberculosis [3.8%] Iron-deficiency anaemia [3.8%] Road injuries [3.2%] Other neonatal disorders [3.2%]* Sense organ diseases‡ [2.6%] Intestinal infectious diseases [2.3%] Stroke [2.1%] Migraine [1.9%] Skin diseases [1.9%] Asthma [1.9%]* Neonatal encephalopathy [1.4%]* Meningitis [0.9%]* Measles [0.3%] Tetanus [0.1%]
†
*Change not significant. The percent figure in brackets next to each cause is DALYs from that cause out of total DALYs.
COPD is chronic obstructive pulmonary disease. Sense organ diseases includes mainly hearing and vision loss. § Self-harm refers to suicide and the nonfatal outcomes of self-harm. ‡
What caused death and disability combined across age groups in 2016? What causedthe themost most death and disability combined across age groups in 2016? Percent of of DALYs by age group, Percent group, both both sexes, sexes,2016 2016 25
[2.34]
Percent of total DALYs
20
15
10
[0.54]
[0.45]
5
[0.33]
[0.66]
[0.59]
[2.09]
[1.68]
[1.36]
[1.09]
[0.89]
[0.77]
[2.59]
[3.11]
[0.32]
[3.51] [4.0]
[4.38]
+
(<
1%
)
%) 85
84
(1
%) 80
to
79
(1
%) to 75
74
(1
%) 70
to
69
(2
%) to 65
64
(3
%) to 60
59 to 55
54
(4
%) (4
%) to 50
49
(5
%) to 45
to
44
(6 40
39
(6
%)
%) to 35
to
34
(8
%) (8 30
to
29
(9 25
(1
24 to 20
to
19
(1 15
14 to
%)
) 0%
) 1%
1% (1 10
o9 5t
Un
de r5
(1
0%
)
)
0
Age Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
Injuries
The number in the bracket on top of each vertical bar is the ratio of percent DALYs to population for that age group. .0The number in parentheses after each age group on the x-axis is the percent of population in that age group.
Rajasthan 169
What risk factors are driving the most death and disability combined? Contribution of top 10 risks to DALYs number, both sexes, ranked by number of DALYs, 19 What risk factors are driving the most death and disability combined? What risk factors are driving the most death and disability combined? Contribution of toto DALYs number, bothboth sexes, ranked by number of DALYs, 1990-2016 Contribution oftop top1010risks risks DALYs number, sexes, ranked by number of DALYs, 1990-2016 same or increase Behavioural Environmental/occupational Metabolic Behavioural
Environmental/occupational
same or increase
Metabolic
Risk factors 1990
Risk factors 1990
1 2 3 4 5 6 7 Alcohol & drug use [1.6%] 8 Impaired kidney function [0.9%] 10 High total cholesterol [1.5%] 9 The percent figure in bracket next to each risk is DALYs from that risk out of total DALYs. High fasting plasma glucose [1.5%] 10 Malnutrition* [38.7%]
1 2 3 4 5 6 7 8 9 10
decrease
Risk factors 2016
Risk factors 2016
Malnutrition* [32.2%] 1 † [15.2%] [13.8%] WaSH†WaSH 2 Air Air pollution [7.7%] [13.7%] 3 pollution Tobacco use [3.6%] 4 Tobacco use [4.9%] Dietary risks [2.3%] 5 Dietary[2.2%] risks [3.2%] High blood pressure 6 Occupational [1.9%] [2.7%] 7 High bloodrisks pressure Alcohol & drug use [1.6%] 8 Occupational risks [2.0%] High fasting plasma glucose [1.4%] 9
decrease
1
Malnutrition* [20.1%]
9
Alcohol & drug use [3.2%] [3.1%]
Malnutrition* [14.8%] 2 Air pollution [12.4%] Air pollution [5.1%] High blood pressure [5.0%] 3 Tobacco use [6.3%] Tobacco use [4.9%] 4 Dietary risks [6.3%] Dietary risks [4.7%] High blood pressure [5.6%] 5 [4.0%] High fasting plasma glucose WaSH† [3.9%] 6 WaSH† [4.3%] Alcohol & drug use [3.9%] 7 High total cholesterol [3.6% Occupational risks [2.6%] Impaired kidney function8 [2.0%]High fasting plasma glucose [3.5%] *Malnutrition is child and maternal malnutrition. risks 10 Occupational † WaSH is unsafe water, sanitation, and handwashing.
*Malnutrition is child and maternal malnutrition. † WaSH is unsafe water, sanitation, and handwashing.
The percent figure in bracket next to each risk is DALYs from that risk out of total DALYs.
How did the risk factors differ by sex in 2016? Percent of total DALYs attributable to top 10 risks, ranked by percent for both sexes combined, 2016 Females
Males Malnutrition* Air pollution Tobacco use Dietary risks High blood pressure WaSH† High total cholesterol High fasting plasma glucose Alcohol & drug use Occupational risks
25
20
15
10
5
0
Percent of years of life lost and years lived with disability Behavioural
0
5
Environmental/occupational *Malnutrition is child and maternal malnutrition. is unsafe water, sanitation, and handwashing.
†WaSH
170 Rajasthan
10
15
20
Percent of years of life lost and years lived with disability Metabolic
25
Sikkim 1990 life expectancy Females: 63.5 years Males: 61.9 years
2016 life expectancy Females: 75.8 years Males: 70.5 years
How much did the under-5 mortality rate change from 1990 to 2016? How much did the under-5 mortality rate change from 1990 to 2016? Under-5 mortality both sexes combined, 1990-2016 Under-5 mortality rate, bothrate, sexes combined, 1990-2016 Sikkim under-5 rate
India under-5 rate
Comparative average rate globally for similar Socio-demographic Index as Sikkim
Deaths per 1,000 live births
150
100
50 39.2 26.2 22.5
0 1990
1995
2000
2005
2010
The shaded bands indicate 95% uncertainty intervals around the estimates
2016
Year What caused the most deaths in different age groups in 2016? Percent top 10 causesdeaths of death byin agedifferent group, both sexes, Whatcontribution causedofthe most age 2016 groups
in 2016? Percent contribution of top 10 causes of death by age group, both sexes, 2016 0−14 years [11.9% of total deaths]
15−39 years [14.4% of total deaths]
1.3% HIV/AIDS & tuberculosis
1%
4.2% 4.8%
9% 1.6% 1.8% 1%
5.7% 38.9%
Diarrhoea/LRI*/other
11.5%
NTDs† & malaria
9.7% 14.6% 7.8%
Maternal disorders Neonatal disorders Nutritional deficiencies
8.7%
9.8% 36.9%
Cancers
10.5%
10.9%
Cardiovascular diseases
4.4%
2.7%
Other communicable diseases
Chronic respiratory diseases Cirrhosis
3.1%
Digestive diseases Neurological disorders
40−69 years [38.1% of total deaths]
70+ years [35.7% of total deaths] 3.4% 2.6%
5.7% 6% 7.1%
5.2% 15.9%
7.4% 3.2%
Other non-communicable Transport injuries
2.6% 4.4%
18.9%
Unintentional injuries
9.1%
Suicide & violence
5.4% 2.7% 3.3%
9.7%
11.5% 13.6% 7.8% 25.4%
Diabetes/urog‡/blood/endo§
Other causes of death *LRI is lower respiratory infections. † NTDs are neglected tropical diseases. ‡ Urog is urogenital diseases. § Endo is endocrine diseases.
29.1%
Sikkim 171
Proportion of total disease burden from: Premature death: 60.2% | Disability or morbidity: 39.8% What caused the most years of life lost, by sex, in 2016? Top 15 causes of YLLs, ranked by percent for both sexes combined, 2016 Females
Males Lower respiratory infections Ischaemic heart disease Preterm birth complications Suicide Tuberculosis Road injuries COPD* Other neonatal disorders Diarrhoeal diseases Stroke Falls Cirrhosis due to hepatitis B Intestinal infectious diseases Chronic kidney disease Cirrhosis due to hepatitis C
12.5
10
7.5
5
2.5
0
0
Percent of total years of life lost due to premature mortality
2.5
5
7.5
10
12.5
Percent of total years of life lost due to premature mortality
Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
Injuries
*COPD by is chronic pulmonary disease. What caused the most years lived with disability, sex,obstructive in 2016? Top 15 causes of YLDs, ranked by percent for both sexes combined, 2016
Females
Males Iron-deďŹ ciency anaemia Sense organ diseases* Low back & neck pain Migraine Skin diseases Other musculoskeletal Depressive disorders COPD* Anxiety disorders Diabetes Falls Preterm birth complications Oral disorders Asthma Schizophrenia
15
10 5 Percent of total years lived with disability
0
Communicable, maternal, neonatal, and nutritional diseases
0
5 10 Percent of total years lived with disability
Non-communicable diseases
*COPD is chronic obstructive pulmonary disease. *Sense organ diseases includes mainly hearing and vision loss.
172 Sikkim
Injuries
15
Proportion of total disease burden from: CMNNDs: 30.9% | NCDs: 57.5% | Injuries: 11.6% How have have the the leading combined changed from 1990 to 2016? How leading causes causesofofdeath deathand anddisability disability combined changed from 1990 to 2016? Change in top 15 causes of DALYs, both sexes, ranked by number of DALYs, 1990–2016 Change in top 15 causes of DALYs, both sexes, ranked by number of DALYs, 1990–2016 Communicable, maternal, neonatal, and nutritional diseases
Injuries
Non-communicable diseases
Leading causes of DALYs 1990
Diarrhoeal diseases [12.2%] Lower respiratory infections [11.7%] Tuberculosis [5.6%] Preterm birth complications [4.9%] Other neonatal disorders [4.3%] Ischaemic heart disease [3.0%] COPD† [2.3%] Neonatal encephalopathy [2.2%] Iron-deficiency anaemia [2.2%] Hepatitis [2.0%] Measles [1.8%] Intestinal infectious diseases [1.8%] Falls [1.6%] Self-harm§ [1.5%] Sense organ diseases‡ [1.5%] Low back & neck pain [1.4%] Skin diseases [1.3%] Migraine [1.3%] Road injuries [1.3%] Diabetes [0.6%]
same or increase
decrease
Leading causes of DALYs 2016
1
1
2
2
3
3
4
4
5
5
6
6
7
7
8
8
9
9
10
10
11
11
12
12
13
13
14
14
15
15
17
18
19 20
22 25
21
30
36
76 †
*Change not significant. The percent figure in brackets next to each cause is DALYs from that cause out of total DALYs.
Lower respiratory infections [5.8%] Ischaemic heart disease [5.8%] COPD† [3.7%] Iron-deficiency anaemia [3.6%] Preterm birth complications [3.4%] Sense organ diseases‡ [3.1%] Low back & neck pain [2.7%] Road injuries [2.7%] Migraine [2.7%] Falls [2.6%] Skin diseases [2.6%] Tuberculosis [2.5%] Self-harm§ [2.4%]* Diarrhoeal diseases [2.3%] Diabetes [2.1%] Other neonatal disorders [1.9%] Intestinal infectious diseases [1.5%] Neonatal encephalopathy [1.2%] Hepatitis [1.0%] Measles [0.2%]
COPD is chronic obstructive pulmonary disease. Sense organ diseases includes mainly hearing and vision loss. Self-harm refers to suicide and the nonfatal outcomes of self-harm.
‡
§
What caused the most death and disability combined across age groups in 2016?
What caused thebymost death both and disability combined across age groups in 2016? Percent of DALYs age group, sexes, 2016 Percent of DALYs by age group, both sexes, 2016 [1.65]
Percent of total DALYs
15
10
[0.67]
[0.62]
[0.76]
[0.89]
[1.03]
[0.52]
[1.54]
[1.25]
[1.94] [2.4]
[2.99]
5
[3.58]
[0.36]
[0.34]
[4.1] [4.85]
[5.5]
1%
)
) (< +
84 to 80
85
(< 1%
%) 79
(1
%) to 75
74
(1
%) 70
to
69 to 65
64
(2
(2
%)
%) to 60
59 to 55
54
(3
%) (4
%) to 50
49
(5
%) to 45
44
(6
%) to 40
to
39
(9 35
(1
34 to 30
29 to
(7
%)
) 0%
) 0% (1 25
to
24
(1 20
19 to 15
14
(1
1%
0%
)
)
%) (9 o9
5t
to 10
Un
de r5
(1
1%
)
0
Age Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
Injuries
The number in the bracket on top of each vertical bar is the ratio of percent DALYs to population for that age group. The number in parentheses after each age group on the x-axis is the percent of population in that age group.
Sikkim 173
What risk factors are driving the most death and disability combined? Contribution of top 10 risks to DALYs number, both sexes, ranked by number of DALYs, 19 What risk factors are driving the most death and disability combined? What risk factors are driving the most death and disability combined? Contribution of toto DALYs number, bothboth sexes, ranked by number of DALYs, 1990-2016 Contribution oftop top1010risks risks DALYs number, sexes, ranked by number of DALYs, 1990-2016 same or increase Behavioural Environmental/occupational Metabolic Behavioural
Environmental/occupational
same or increase
Metabolic
Risk factors 1990
Risk factors 1990
1 2 3 4 5 6 7 Alcohol & drug use [1.9%] 8 Impaired kidney function [0.9%] 10 High fasting plasma glucose [1.8%] 9 The percent figure in bracket next to each risk is DALYs from that risk out of total DALYs. High total cholesterol [1.4%] 10 High body-mass index [0.8%] 12 Malnutrition* [33.9%]
1 2 3 4 5 6 7 8 9 10
decrease
Risk factors 2016
Risk factors 2016
Malnutrition* [32.2%] 1 † [15.2%] [12.0%] WaSH†WaSH 2 Air Air pollution [7.7%] [10.1%] 3 pollution Tobacco use [3.6%] 4 Tobacco use [5.0%] Dietary risks [2.3%] 5 High blood pressure High blood pressure [2.2%] [3.9%] 6 Occupational risks [1.9%] 7 Dietary risks [3.7%] Alcohol & drug use [1.6%] 8 Occupational risks [2.3%] High fasting plasma glucose [1.4%] 9
1
Malnutrition* [14.1%]
Malnutrition* [14.8%] 2 High blood pressure [6.9%] Air pollution [5.1%] High blood pressure [5.0%] 3 Air pollution [6.2%] Tobacco use [4.9%] 4 Dietary risks [5.6%] Dietary risks [4.7%] Tobacco use [5.6%] 5 [4.0%] High fasting plasma glucose WaSH† [3.9%] 6 High fasting plasma glucose [4.7%] Alcohol & drug use [3.9%] 7 Alcohol & drug use [4.2%] Occupational risks [2.6%] Impaired kidney function8 [2.0%]High body-mass index [3.8%]
9
Occupational risks [3.2%] [2.8%] 12 WaSH† [1.8%]
*Malnutrition is child and maternal malnutrition. 10 High total cholesterol † WaSH is unsafe water, sanitation, and handwashing.
*Malnutrition is child and maternal malnutrition. † WaSH is unsafe water, sanitation, and handwashing.
The percent figure in bracket next to each risk is DALYs from that risk out of total DALYs.
How did the risk factors differ by sex in 2016? Percent of total DALYs attributable to top 10 risks, ranked by percent for both sexes combined, 2016 Females
Males Malnutrition* High blood pressure Air pollution Dietary risks Tobacco use High fasting plasma glucose Alcohol & drug use High body-mass index Occupational risks High total cholesterol
15
10
5
0
Percent of years of life lost and years lived with disability Behavioural
5
0
10
15
Percent of years of life lost and years lived with disability Environmental/occupational
*Malnutrition is child and maternal malnutrition.
174 Sikkim
decrease
Metabolic
Tamil Nadu 1990 life expectancy Females: 61.9 years Males: 59.4 years
2016 life expectancy Females: 73.5 years Males: 68.9 years
How much did the under-5 mortality rate change from 1990 to 2016? How much did the under-5 mortality rate change from 1990 to 2016? Under-5 mortality both sexes combined, 1990-2016 Under-5 mortality rate, bothrate, sexes combined, 1990-2016 Tamil Nadu under-5 rate
India under-5 rate
Comparative average rate globally for similar Socio-demographic Index as Tamil Nadu
Deaths per 1,000 live births
150
100
50 39.2 23.5 21.3
0 1990
1995
2000
2005
2010
The shaded bands indicate 95% uncertainty intervals around the estimates
2016
Year What caused the most deaths in different age groups in 2016? Percent top 10 causesdeaths of death byin agedifferent group, both sexes, Whatcontribution causedofthe most age 2016 groups
in 2016? Percent contribution of top 10 causes of death by age group, both sexes, 2016 0−14 years [4.1% of total deaths]
15−39 years [9.7% of total deaths]
1.1% HIV/AIDS & tuberculosis
4.3%
1.7%
7%
7.1%
Diarrhoea/LRI*/other
8.3%
6.9%
27.1%
NTDs† & malaria
4.6%
Maternal disorders
13%
25% 1.2% 1.1% 1%
2.8%
Neonatal disorders
16.6%
Nutritional deficiencies Other communicable diseases Cancers
8.6% 2.5% 1.8%
39.7%
5.7%
Cardiovascular diseases
13%
Chronic respiratory diseases Cirrhosis Digestive diseases Neurological disorders
40−69 years [43.2% of total deaths]
70+ years [43% of total deaths] 2.6% 2.5%
3.4% 6.4%
Other non-communicable
1%
4.6% 4.9%
10.9%
Diabetes/urog‡/blood/endo§
14%
4.9% 3.5%
Transport injuries
6.5%
Unintentional injuries Suicide & violence
14.8%
5.3%
Other causes of death
12.2% 4.1% 2.3% 8.3%
6.4% 40.4%
1.4%
*LRI is lower respiratory infections. † NTDs are neglected tropical diseases. ‡ Urog is urogenital diseases. § Endo is endocrine diseases.
39.6%
Tamil Nadu 175
Proportion of total disease burden from: Premature death: 62.0% | Disability or morbidity: 38.0% What caused the most years of life lost, by sex, in 2016? Top 15 causes of YLLs, ranked by percent for both sexes combined, 2016 Females
Males Ischaemic heart disease Suicide Diabetes Road injuries Chronic kidney disease Stroke Diarrhoeal diseases COPD* Lower respiratory infections Tuberculosis Falls Preterm birth complications Congenital birth defects Hypertensive heart disease Neonatal encephalopathy
20
10
0
0
Percent of total years of life lost due to premature mortality
10
20
Percent of total years of life lost due to premature mortality
Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
Injuries
What caused the most years lived with disability, by sex, in 2016? *COPD is chronic obstructive pulmonary disease. Top 15 causes of YLDs, ranked by percent for both sexes combined, 2016 Females
Males Iron-deďŹ ciency anaemia Sense organ diseases* Low back & neck pain Depressive disorders Migraine Diabetes Other musculoskeletal Skin diseases COPD* Anxiety disorders Falls Oral disorders Preterm birth complications Osteoarthritis Schizophrenia
15
10 5 Percent of total years lived with disability
0
Communicable, maternal, neonatal, and nutritional diseases
0
5 10 Percent of total years lived with disability Non-communicable diseases
*COPD is chronic obstructive pulmonary disease. *Sense organ diseases includes mainly hearing and vision loss.
176 Tamil Nadu
Injuries
15
Proportion of total disease burden from: CMNNDs: 20.4% | NCDs: 65.3% | Injuries: 14.3% How have have the the leading combined changed from 1990 to 2016? How leading causes causesofofdeath deathand anddisability disability combined changed from 1990 to 2016? Change in top 15 causes of DALYs, both sexes, ranked by number of DALYs, 1990–2016 Change in top 15 causes of DALYs, both sexes, ranked by number of DALYs, 1990–2016 Communicable, maternal, neonatal, and nutritional diseases
Injuries
Non-communicable diseases
Leading causes of DALYs 1990
Diarrhoeal diseases [10.8%] Lower respiratory infections [6.9%] Preterm birth complications [6.8%] Ischaemic heart disease [6.6%] Tuberculosis [4.9%] Neonatal encephalopathy [4.6%] Congenital birth defects [3.7%] Self-harm§ [3.6%] Measles [2.6%] COPD† [2.5%] Iron-deficiency anaemia [2.4%] Stroke [2.2%] Other neonatal disorders [2.2%] Road injuries [1.8%] Chronic kidney disease [1.8%] Falls [1.7%] Sense organ diseases‡ [1.6%] Low back & neck pain [1.4%] Diabetes [1.4%] Depressive disorders [1.2%] Migraine [1.2%]
same or increase
decrease
Leading causes of DALYs 2016
1
1
2
2
3
3
4
4
5
5
6
6
7
7
8
8
9
9
10
10
11
11
12
12
13
13
14
14
15
15
16
16
17 18
17 20
20
22
22
42
23
100 †
*Change not significant. The percent figure in brackets next to each cause is DALYs from that cause out of total DALYs.
Ischaemic heart disease [14.3%] Diabetes [4.9%] Self-harm§ [4.3%]* COPD† [3.7%]* Iron-deficiency anaemia [3.6%] Sense organ diseases‡ [3.5%] Road injuries [3.3%] Chronic kidney disease [3.1%] Low back & neck pain [2.8%] Stroke [2.8%]* Falls [2.7%]* Diarrhoeal diseases [2.8%] Depressive disorders [2.5%] Migraine [2.3%] Tuberculosis [2.3%] Preterm birth complications [2.2%] Lower respiratory infections [2.1%] Congenital birth defects [1.4%] Neonatal encephalopathy [1.0%] Other neonatal disorders [0.5%] Measles [0.1%]
COPD is chronic obstructive pulmonary disease. Sense organ diseases includes mainly hearing and vision loss. Self-harm refers to suicide and the nonfatal outcomes of self-harm.
‡
§
What caused the most death and disability combined across age groups in 2016?
What caused the most death and disability combined across age groups in 2016? Percent of DALYs by age group, both sexes, 2016 Percent of DALYs by age group, both sexes, 2016 10.0 [1.68] [2.08] [1.35]
[1.2]
[1.1]
[2.59]
Percent of total DALYs
7.5 [0.91]
[0.78]
[3.12]
[0.66]
[0.58]
[3.58]
5.0
[0.53] [0.44] [4.14]
2.5
[0.29]
[0.27]
[4.64]
) (< 1% +
%)
80
85
84
(1
%) to
79
(1
%) to 75
70
to
74
(2
%) 69
(3
%) to 65
64
(4
%) to 60
59
(5
%) to 55
54
(6
%) to 50
49
(7
%) to 45
44
(7
%) to 40
39
(8
%) to 35
34
(9
%) to 30
29
(9
%) to 25
24
(8
%) to 20
19 to 15
14 to
(8
%) (7
%) (7 10
o9 5t
Un
de r5
(7
%)
0
Age Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
Injuries
The number in the bracket on top of each vertical bar is the ratio of percent DALYs to population for that age group. The number in parentheses after each age group on the x-axis is the percent of population in that age group.
Tamil Nadu 177
What risk factors are driving the most death and disability combined? Contribution of top 10 risks to DALYs number, both sexes, ranked by number of DALYs, 19 What risk factors are driving the most death and disability combined? What risk factors are driving the most death and disability combined? Contribution of toto DALYs number, bothboth sexes, ranked by number of DALYs, 1990-2016 Contribution oftop top1010risks risks DALYs number, sexes, ranked by number of DALYs, 1990-2016 same or increase Behavioural Environmental/occupational Metabolic Behavioural
Environmental/occupational
same or increase
Metabolic
Risk factors 1990
Risk factors 1990
1 2 3 4 5 6 7 High total cholesterol [3.2%] 8 Impaired kidney function [0.9%] 10 Impaired kidney function [2.6%] 9 The percent figure in bracket next to each risk is DALYs from that risk out of total DALYs. Occupational risks [2.0%] 10 Alcohol & drug use [1.8%] 11 High body-mass index [1.5%] 12 Malnutrition* [31.0%]
1 2 3 4 5 6 7 8 9 10
decrease
Risk factors 2016
Risk factors 2016
Malnutrition* [32.2%] 1 † [15.2%] [10.9%] WaSH†WaSH 2 Air pollution [7.7%] [9.6%] 3 Air pollution Tobacco use [3.6%] 4 Dietary risks [7.7%] Dietary risks [2.3%] 5 High blood pressure High blood pressure [2.2%] [5.9%] 6 Occupational risks [1.9%] 7 Tobacco use [4.9%] Alcohol & drug use [1.6%] 8 High fasting plasma glucose [4.9%] High fasting plasma glucose [1.4%] 9
1
Dietary risks [14.4%]
Malnutrition* [14.8%] 2 High fasting plasma glucose [12.9%] Air pollution [5.1%] High blood pressure [5.0%] 3 High blood pressure [12.3%] Tobacco use [4.9%] 4 High body-mass index [8.1%] Dietary risks [4.7%] Malnutrition* [8.0%] 5 [4.0%] High fasting plasma glucose WaSH† [3.9%] 6 Air pollution [7.2%] Alcohol & drug use [3.9%] 7 High total cholesterol [7.2%] Occupational risks [2.6%] Impaired kidney function8 [2.0%]Tobacco use [5.6%]
9
Impaired kidney function [4.7%] [3.8%] 11 Occupational risks [3.2%] † 12 WaSH [2.6%]
*Malnutrition is child and maternal malnutrition. 10 Alcohol & drug use † WaSH is unsafe water, sanitation, and handwashing.
*Malnutrition is child and maternal malnutrition. † WaSH is unsafe water, sanitation, and handwashing.
The percent figure in bracket next to each risk is DALYs from that risk out of total DALYs.
How did the risk factors differ by sex in 2016? Percent of total DALYs attributable to top 10 risks, ranked by percent for both sexes combined, 2016 Females
Males Dietary risks High fasting plasma glucose High blood pressure High body-mass index Malnutrition* Air pollution High total cholesterol Tobacco use Impaired kidney function Alcohol & drug use
15
10
5
0
Percent of years of life lost and years lived with disability Behavioural
5
0
10
15
Percent of years of life lost and years lived with disability Environmental/occupational
*Malnutrition is child and maternal malnutrition.
178 Tamil Nadu
decrease
Metabolic
Telangana 1990 life expectancy Females: 61.8 years Males: 60.2 years
2016 life expectancy Females: 73.2 years Males: 69.4 years
How much did the under-5 mortality rate change from 1990 to 2016? How much did the under-5 mortality rate change from 1990 to 2016? Under-5 mortality both sexes combined, 1990-2016 Under-5 mortality rate, bothrate, sexes combined, 1990-2016 Telangana under-5 rate
India under-5 rate
Comparative average rate globally for similar Socio-demographic Index as Telangana
Deaths per 1,000 live births
150
100
50 39.2 30.6 29.3
0 1990
1995
2000
2005
2010
The shaded bands indicate 95% uncertainty intervals around the estimates
2016
Year What caused the most deaths in different age groups in 2016? Percent top 10 causesdeaths of death byin agedifferent group, both sexes, Whatcontribution causedofthe most age 2016 groups
in 2016? Percent contribution of top 10 causes of death by age group, both sexes, 2016 0−14 years [7.6% of total deaths]
15−39 years [11.4% of total deaths]
2.4% 3.4% 1.2%
HIV/AIDS & tuberculosis
5.1% 8.7%
1% 1.6% 1.2%
30.5%
Diarrhoea/LRI*/other
10%
13%
NTDs† & malaria
8.9%
Maternal disorders
20.5%
Neonatal disorders
2.5%
Nutritional deficiencies
5.9%
Other communicable diseases
9.1%
13.5%
2.4%
42.5%
Cancers
10.4%
Cardiovascular diseases Chronic respiratory diseases
2.8%
Cirrhosis
3.3%
Digestive diseases Neurological disorders
40−69 years [43.1% of total deaths]
70+ years [37.9% of total deaths]
Diabetes/urog‡/blood/endo§
2.3% 2.9% 5.5% 5.8% 8.5%
3% 4.8%
2.8%
Suicide & violence
4.6% 6.6% 14.3%
10%
38.1%
Unintentional injuries
7.3%
19%
2.9%
Transport injuries
5.2%
6.5%
12.2%
Other non-communicable
1.5% 1%
Other causes of death *LRI is lower respiratory infections. † NTDs are neglected tropical diseases. ‡ Urog is urogenital diseases. § Endo is endocrine diseases.
35.3%
Telangana 179
Proportion of total disease burden from: Premature death: 61.6% | Disability or morbidity: 38.4% What caused the most years of life lost, by sex, in 2016? Top 15 causes of YLLs, ranked by percent for both sexes combined, 2016 Females
Males Ischaemic heart disease Diarrhoeal diseases Suicide Stroke COPD* Preterm birth complications Lower respiratory infections Road injuries HIV/AIDS Tuberculosis Neonatal encephalopathy Falls Diabetes Chronic kidney disease Congenital birth defects
20
15
10
5
0
0
Percent of total years of life lost due to premature mortality
5
10
15
20
Percent of total years of life lost due to premature mortality
Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
Injuries
*COPD is chronic obstructive pulmonary disease.
What caused the most years lived with disability, by sex, in 2016? Top 15 causes of YLDs, ranked by percent for both sexes combined, 2016 Females
Males Sense organ diseases* Iron-deďŹ ciency anaemia Low back & neck pain Depressive disorders Migraine Skin diseases Other musculoskeletal COPD* Diabetes Falls Anxiety disorders Oral disorders Preterm birth complications Road injuries Osteoarthritis
15
10 5 Percent of total years lived with disability
0
Communicable, maternal, neonatal, and nutritional diseases
0
5 10 Percent of total years lived with disability Non-communicable diseases
*COPD is chronic obstructive pulmonary disease. *Sense organ diseases includes mainly hearing and vision loss.
180 Telangana
Injuries
15
Proportion of total disease burden from: CMNNDs: 27.6% | NCDs: 59.2% | Injuries: 13.2% How have have the the leading combined changed from 1990 to 2016? How leading causes causesofofdeath deathand anddisability disability combined changed from 1990 to 2016? Change in top 15 causes of DALYs, both sexes, ranked by number of DALYs, 1990–2016 Change in top 15 causes of DALYs, both sexes, ranked by number of DALYs, 1990–2016 Communicable, maternal, neonatal, and nutritional diseases
Injuries
Non-communicable diseases
Leading causes of DALYs 1990
Diarrhoeal diseases [13.2%] Lower respiratory infections [7.5%] Preterm birth complications [7.2%] Ischaemic heart disease [4.9%] Measles [4.4%] Neonatal encephalopathy [3.7%] Tuberculosis [3.2%] COPD† [2.8%] Self-harm§ [2.6%] Iron-deficiency anaemia [2.2%] Other neonatal disorders [2.2%] Stroke [2.2%] Congenital birth defects [2.1%] Neonatal haemolytic disease [1.6%] Sense organ diseases‡ [1.5%] Road injuries [1.5%] Low back & neck pain [1.4%] Falls [1.3%] Migraine [1.2%] Depressive disorders [1.2%] Diabetes [0.8%]
same or increase
decrease
Leading causes of DALYs 2016
1
1
2
2
3
3
4
4
5
5
6
6
7
7
8
8
9
9
10
10
11
11
12
12
13
13
14
14
15
15
17
19
18 19
21 22
22
26
23
52
36
75
Ischaemic heart disease [10.3%] COPD† [4.6%] Diarrhoeal diseases [4.4%] Preterm birth complications [3.6%] Self-harm§ [3.5%]* Sense organ diseases‡ [3.4%] Iron-deficiency anaemia [3.3%] Stroke [3.3%]* Road injuries [2.9%] Low back & neck pain [2.8%] Depressive disorders [2.5%] Lower respiratory infections [2.5%] Migraine [2.4%] Diabetes [2.3%] Falls [2.3%] Tuberculosis [1.9%] Congenital birth defects [1.5%] Neonatal encephalopathy [1.4%] Other neonatal disorders [0.9%] Neonatal haemolytic disease [0.4%] Measles [0.2%]
†
*Change not significant. The percent figure in brackets next to each cause is DALYs from that cause out of total DALYs.
COPD is chronic obstructive pulmonary disease. Sense organ diseases includes mainly hearing and vision loss. § Self-harm refers to suicide and the nonfatal outcomes of self-harm. ‡
What caused the most death and disability combined across age groups in 2016? Percent of DALYs age group, sexes, 2016 What caused thebymost death both and disability combined across age groups in 2016? Percent of DALYs by age group, both sexes, 2016 [1.69]
10 Percent of total DALYs
[2.07] [1.66]
[1.35] [0.8]
[0.69]
[0.61]
[2.6]
[1.1]
[0.92]
[3.12]
[0.55] 5 [0.46]
[3.57] [0.32]
[0.31]
[4.14] [4.7]
) +
(<
1%
%) 85
(1 to
84
(1 79 to
80
70
75
74 to
69
%)
%) (2
%) (3
%) to 65
64
(4
%) to 60
59
(4
%) to 55
54
(5
%) to 50
49
(6
%) to 45
44
(7
%) to 40
39
(8
%) to 35
34
(9
%) to 30
29
(9
%) to 25
24
(9
%) to 20
19 to 15
14 to
(9
%) (8
%) (8 10
o9 5t
Un
de
r5
(7
%)
0
Age Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
Injuries
The number in the bracket on top of each vertical bar is the ratio of percent DALYs to population for that age group. The number in parentheses after each age group on the x-axis is the percent of population in that age group.
Telangana 181
What risk factors are driving the most death and disability combined? Contribution of top 10 risks to DALYs number, both sexes, ranked by number of DALYs, 19 What risk factors are driving the most death and disability combined? What risk factors are driving the most death and disability combined? Contribution of toto DALYs number, bothboth sexes, ranked by number of DALYs, 1990-2016 Contribution oftop top1010risks risks DALYs number, sexes, ranked by number of DALYs, 1990-2016 same or increase Behavioural Environmental/occupational Metabolic Behavioural
Environmental/occupational
same or increase
Metabolic
Risk factors 1990
Risk factors 1990
1 2 3 4 5 6 7 Occupational risks [2.3%] 8 Impaired kidney function [0.9%] 10 High total cholesterol [2.3%] 9 The percent figure in bracket next to each risk is DALYs from that risk out of total DALYs. High body-mass index [1.8%] 10 Malnutrition* [35.1%]
1 2 3 4 5 6 7 8 9 10
decrease
Risk factors 2016
Risk factors 2016
Malnutrition* [32.2%] 1 † [15.2%] [13.5%] WaSH†WaSH 2 Air Air pollution [7.7%] [10.1%] 3 pollution Tobacco use [3.6%] 4 Dietary risks [5.7%] Dietary risks [2.3%] 5 High blood pressure High blood pressure [2.2%] [4.2%] 6 Occupational risks [1.9%] 7 Tobacco use [4.0%] Alcohol & drug use [1.6%] 8 High fasting plasma glucose [2.4%] High fasting plasma glucose [1.4%] 9
1
Malnutrition* [11.4%]
9
WaSH† [4.2%]
Malnutrition* [14.8%] 2 Dietary risks [9.9%] Air pollution [5.1%] High blood pressure [5.0%] 3 High blood pressure [8.7%] Tobacco use [4.9%] 4 Air pollution [8.6%] Dietary risks [4.7%] High fasting plasma glucose [5.9%] 5 [4.0%] High fasting plasma glucose WaSH† [3.9%] 6 High total cholesterol [5.1%] Alcohol & drug use [3.9%] 7 Tobacco use [5.0%] Occupational risks [2.6%] Impaired kidney function8 [2.0%]High body-mass index [4.6%] *Malnutrition is child and maternal malnutrition. risks 10 Occupational † WaSH is unsafe water, sanitation, and handwashing.
[3.4%]
*Malnutrition is child and maternal malnutrition. † WaSH is unsafe water, sanitation, and handwashing.
The percent figure in bracket next to each risk is DALYs from that risk out of total DALYs.
How did the risk factors differ by sex in 2016? Percent of total DALYs attributable to top 10 risks, ranked by percent for both sexes combined, 2016 Females
Males Malnutrition* Dietary risks High blood pressure Air pollution High fasting plasma glucose High total cholesterol Tobacco use High body-mass index WaSH† Occupational risks
10
5
0
Percent of years of life lost and years lived with disability Behavioural
5
0
*Malnutrition is child and maternal malnutrition. is unsafe water, sanitation, and handwashing.
182 Telangana
10
Percent of years of life lost and years lived with disability Environmental/occupational
†WaSH
decrease
Metabolic
Tripura 1990 life expectancy Females: 61.6years Males: 58.9 years
2016 life expectancy Females: 71.5 years Males: 66.3 years
How much did the under-5 mortality rate change from 1990 to 2016? How much did the under-5 mortality rate change from 1990 to 2016? Under-5 mortality both sexes combined, 1990-2016 Under-5 mortality rate, bothrate, sexes combined, 1990-2016 Tripura under-5 rate
India under-5 rate
Comparative average rate globally for similar Socio-demographic Index as Tripura
Deaths per 1,000 live births
150
100
50
40.4 39.2 35.1
0 1990
1995
2000
2005
2010
The shaded bands indicate 95% uncertainty intervals around the estimates
2016
Year What caused the most deaths in different age groups in 2016? Percent top 10 causesdeaths of death byin agedifferent group, both sexes, Whatcontribution causedofthe most age 2016 groups
in 2016? Percent contribution of top 10 causes of death by age group, both sexes, 2016 0−14 years [10.1% of total deaths]
15−39 years [11.7% of total deaths]
1.1% 4.2% 4.9%
HIV/AIDS & tuberculosis
0.9% 6.7% 6.1%
33.2%
0.9% 1.9% 1.5%
Diarrhoea/LRI*/other
13%
8.7%
NTDs† & malaria
3.6%
Maternal disorders
4.4%
Neonatal disorders
25.2%
Nutritional deficiencies
14% 6.7%
Other communicable diseases Cancers
38.4%
4.6% 4.2% 8.7%
7%
Cardiovascular diseases Chronic respiratory diseases Cirrhosis Digestive diseases Neurological disorders
40−69 years [35.8% of total deaths] 3.7%
8.4%
6%
70+ years [42.4% of total deaths] 1.6% 2.4%
3.7% 2.5%
Other non-communicable
2%
Transport injuries
7.1%
20.1%
Unintentional injuries
4% 2.7%
7%
12.5%
5.2% 16.7%
11.2% 36.6%
1.2%
Suicide & violence Other causes of death
3.9% 4.6%
Diabetes/urog‡/blood/endo§
*LRI is lower respiratory infections. † NTDs are neglected tropical diseases. ‡ Urog is urogenital diseases. § Endo is endocrine diseases.
37%
Tripura 183
Proportion of total disease burden from: Premature death: 66.7% | Disability or morbidity: 33.3% What caused the most years of life lost, by sex, in 2016? Top 15 causes of YLLs, ranked by percent for both sexes combined, 2016 Females
Males Ischaemic heart disease Stroke Lower respiratory infections Suicide Diarrhoeal diseases COPD* Preterm birth complications Road injuries Other neonatal disorders Chronic kidney disease Malaria Tuberculosis Neonatal encephalopathy Congenital birth defects Asthma
12
9
6
3
0
0
Percent of total years of life lost due to premature mortality
3
6
9
12
Percent of total years of life lost due to premature mortality
Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
Injuries
*COPD is chronic obstructive pulmonary disease.
What caused the most years lived with disability, by sex, in 2016? Top 15 causes of YLDs, ranked by percent for both sexes combined, 2016 Females
Males Iron-deďŹ ciency anaemia Sense organ diseases* Low back & neck pain Migraine Skin diseases Other musculoskeletal Depressive disorders COPD* Diabetes Anxiety disorders Preterm birth complications Oral disorders Falls Asthma Osteoarthritis
15
10 5 Percent of total years lived with disability
0
Communicable, maternal, neonatal, and nutritional diseases
0
5 10 Percent of total years lived with disability Non-communicable diseases
*COPD is chronic obstructive pulmonary disease. *Sense organ diseases includes mainly hearing and vision loss.
184 Tripura
Injuries
15
Proportion of total disease burden from: CMNNDs: 31.1% | NCDs: 57.0% | Injuries: 12.0% How have have the the leading combined changed from 1990 to 2016? How leading causes causesofofdeath deathand anddisability disability combined changed from 1990 to 2016? Change in top 15 causes of DALYs, both sexes, ranked by number of DALYs, 1990–2016 Change in top 15 causes of DALYs, both sexes, ranked by number of DALYs, 1990–2016 Communicable, maternal, neonatal, and nutritional diseases
Injuries
Non-communicable diseases
Leading causes of DALYs 1990
Lower respiratory infections [11.2%] Diarrhoeal diseases [10.7%] Preterm birth complications [7.0%] COPD† [3.8%] Stroke [3.5%] Ischaemic heart disease [3.3%] Other neonatal disorders [3.2%] Measles [2.9%] Self-harm§ [2.8%] Neonatal encephalopathy [2.8%] Tuberculosis [2.7%] Malaria [2.5%] Iron-deficiency anaemia [2.2%] Asthma [1.7%] Neonatal sepsis [1.7%] Sense organ diseases‡ [1.5%] Low back & neck pain [1.3%] Road injuries [1.3%] Skin diseases [1.2%] Migraine [1.2%] Chronic kidney disease [0.9%] Diabetes [0.7%]
same or increase
decrease
Leading causes of DALYs 2016
1
1
2
2
3
3
4
4
5
5
6
6
7
7
8
8
9
9
10
10
11
11
12
12
13
13
14
14
15
15
18
17
20 21
18 19
22
20
23
23
28
25
33
66 †
*Change not significant. The percent figure in brackets next to each cause is DALYs from that cause out of total DALYs.
Ischaemic heart disease [6.7%] Stroke [6.5%] Lower respiratory infections [5.3%] COPD† [4.8%] Self-harm§ [4.5%] Diarrhoeal diseases [4.2%] Preterm birth complications [4.1%] Iron-deficiency anaemia [3.4%] Sense organ diseases‡ [2.9%] Road injuries [2.4%] Low back & neck pain [2.3%] Migraine [2.1%] Diabetes [2.1%] Skin diseases [1.9%] Chronic kidney disease [1.9%] Other neonatal disorders [1.7%] Tuberculosis [1.6%] Malaria [1.5%]* Asthma [1.5%]* Neonatal encephalopathy [1.3%] Neonatal sepsis [1.0%]* Measles [0.3%]
COPD is chronic obstructive pulmonary disease. Sense organ diseases includes mainly hearing and vision loss. Self-harm refers to suicide and the nonfatal outcomes of self-harm.
‡
§
What caused the most death and disability combined across age groups in 2016?
What caused thebymost death both and disability combined across age groups in 2016? Percent of DALYs age group, sexes, 2016 Percent of DALYs by age group, both sexes, 2016 [2.15]
Percent of total DALYs
15
10
[0.54] 5
[0.78]
[0.67]
[0.59]
[1.37]
[1.1]
[0.9]
[1.71] [2.1]
[2.63] [3.16]
[0.45]
[3.59] [4.11]
[0.32]
[0.33]
[4.56]
1% (< + 85
(1 84 to
80
)
%)
%) 79
(1
%) to 75
74
(1
%) 70
to
69
(2
%) to 65
64
(3
%) to 60
59
(4
%) to 55
54
(5
%) to 50
49
(6
%) to 45
44
(6
%) to 40
39
(8
%) to 35
30
to
34
(9
(9
%)
) (1
29 to 25
24 to
19
(9 20
to 15
14 to
0%
%)
%) (9
%) (9 10
o9 5t
Un
de r5
(8
%)
0
Age Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
Injuries
The number in the bracket on top of each vertical bar is the ratio of percent DALYs to population for that age group. The number in parentheses after each age group on the x-axis is the percent of population in that age group.
Tripura 185
What risk factors are driving the most death and disability combined? Contribution of top 10 risks to DALYs number, both sexes, ranked by number of DALYs, 19 What risk factors are driving the most death and disability combined? What risk factors are driving the most death and disability combined? Contribution of toto DALYs number, bothboth sexes, ranked by number of DALYs, 1990-2016 Contribution oftop top1010risks risks DALYs number, sexes, ranked by number of DALYs, 1990-2016 same or increase Behavioural Environmental/occupational Metabolic Behavioural
Environmental/occupational
same or increase
Metabolic
Risk factors 1990
Risk factors 1990
1 2 3 4 5 6 7 Occupational risks [2.2%] 8 Impaired kidney function [0.9%] 10 Alcohol & drug use [1.6%] 9 The percent figure in bracket next to each risk is DALYs from that risk out of total DALYs. Impaired kidney function [1.5%] 10 High total cholesterol [1.5%] 11 Malnutrition* [33.9%]
1 2 3 4 5 6 7 8 9 10
decrease
Risk factors 2016
Risk factors 2016
Malnutrition* [32.2%] 1 † Air pollution [15.2%] [12.3%] WaSH 2 † Air pollution [7.7%] 3 [11.3%] WaSH Tobacco use [3.6%] 4 Tobacco use [5.7%] Dietary risks [2.3%] 5 Dietary[2.2%] risks [5.1%] High blood pressure 6 Occupational [1.9%] [4.8%] 7 High bloodrisks pressure Alcohol & drug use [1.6%] 8 High fasting plasma glucose [2.4%] High fasting plasma glucose [1.4%] 9
1
Malnutrition* [14.8%]
Malnutrition* [14.8%] 2 Air pollution [10.4%] Air pollution [5.1%] High blood pressure [5.0%] 3 High blood pressure [9.7%] Tobacco use [4.9%] 4 Dietary risks [8.8%] Dietary risks [4.7%] Tobacco use [7.9%] 5 [4.0%] High fasting plasma glucose WaSH† [3.9%] 6 High fasting plasma glucose [6.6%] Alcohol & drug use [3.9%] 7 WaSH† [4.3%] Occupational risks [2.6%] Impaired kidney function8 [2.0%]Alcohol & drug use [3.6%]
9
High total cholesterol [3.3%] [3.1%] 11 Impaired kidney function [3.1%]
*Malnutrition is child and maternal malnutrition. risks 10 Occupational † WaSH is unsafe water, sanitation, and handwashing.
*Malnutrition is child and maternal malnutrition. † WaSH is unsafe water, sanitation, and handwashing.
The percent figure in bracket next to each risk is DALYs from that risk out of total DALYs.
How did the risk factors differ by sex in 2016? Percent of total DALYs attributable to top 10 risks, ranked by percent for both sexes combined, 2016 Females
Males Malnutrition* Air pollution High blood pressure Dietary risks Tobacco use High fasting plasma glucose WaSH† Alcohol & drug use High total cholesterol Occupational risks
15
10
0
5
Percent of years of life lost and years lived with disability Behavioural
0
5
*Malnutrition is child and maternal malnutrition. is unsafe water, sanitation, and handwashing.
186 Tripura
10
15
Percent of years of life lost and years lived with disability Environmental/occupational
†WaSH
decrease
Metabolic
Uttar Pradesh 1990 life expectancy Females: 53.5 years Males: 54.9 years
2016 life expectancy Females: 66.8 years Males: 64.6 years
How much did the under-5 mortality rate change from 1990 to 2016? How much did the under-5 mortality rate change from 1990 to 2016? Under-5 mortality both sexes combined, 1990-2016 Under-5 mortality rate, bothrate, sexes combined, 1990-2016 Uttar Pradesh under-5 rate
India under-5 rate
Comparative average rate globally for similar Socio-demographic Index as Uttar Pradesh
Deaths per 1,000 live births
150
100
50
48.7 48.3 39.2
0 1990
1995
2000
2005
2010
The shaded bands indicate 95% uncertainty intervals around the estimates
2016
Year What caused the most deaths in different age groups in 2016? Percent top 10 causesdeaths of death byin agedifferent group, both sexes, Whatcontribution causedofthe most age 2016 groups
in 2016? Percent contribution of top 10 causes of death by age group, both sexes, 2016 0−14 years [14.1% of total deaths]
15−39 years [11.9% of total deaths]
1% 3.3% 1.2%
HIV/AIDS & tuberculosis
11.4%
13.5%
5% 7.4% 40.1%
3%
0.8% 1.5%
Diarrhoea/LRI*/other NTDs† & malaria
13.6%
12.5%
Neonatal disorders Nutritional deficiencies
4.9%
33.7%
Maternal disorders
9.6%
Other communicable diseases
6.4%
Cancers
12.4%
9%
3%
Cardiovascular diseases Chronic respiratory diseases
3.3%
Cirrhosis
3.5%
Digestive diseases Neurological disorders
40−69 years [38.1% of total deaths]
70+ years [35.9% of total deaths] 2.3%
10.3% 5.1% 4.5% 3.2% 10.5%
5.6% 3.5% 2.2%
5.1%
Transport injuries
4.1%
Unintentional injuries
3.5%
21.1%
23.7%
2.3%
Suicide & violence Other causes of death
12.7% 18.8%
Other non-communicable
0.7%
6.2% 24.5%
Diabetes/urog‡/blood/endo§
6.2%
*LRI is lower respiratory infections. † NTDs are neglected tropical diseases. ‡ Urog is urogenital diseases. § Endo is endocrine diseases.
24%
Uttar Pradesh 187
Proportion of total disease burden from: Premature death: 71.6% | Disability or morbidity: 28.4% What caused the most years of life lost, by sex, in 2016? Top 15 causes of YLLs, ranked by percent for both sexes combined, 2016 Females
Males Ischaemic heart disease Lower respiratory infections Diarrhoeal diseases COPD* Tuberculosis Preterm birth complications Other neonatal disorders Road injuries Suicide Intestinal infectious diseases Congenital birth defects Stroke Neonatal encephalopathy Asthma Falls
12
9
6
3
0
0
Percent of total years of life lost due to premature mortality
3
6
9
12
Percent of total years of life lost due to premature mortality
Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
Injuries
*COPD is chronic obstructive pulmonary disease.
What caused the most years lived with disability, by sex, in 2016? Top 15 causes of YLDs, ranked by percent for both sexes combined, 2016 Females
Males Iron-deďŹ ciency anaemia Sense organ diseases* Low back & neck pain Migraine Skin diseases Other musculoskeletal COPD* Depressive disorders Anxiety disorders Diabetes Falls Preterm birth complications Oral disorders Protein-energy malnutrition Haemoglobinopathies
16
12 8 4 Percent of total years lived with disability
0
Communicable, maternal, neonatal, and nutritional diseases
0
4 8 12 Percent of total years lived with disability
Non-communicable diseases
*COPD is chronic obstructive pulmonary disease. *Sense organ diseases includes mainly hearing and vision loss.
188 Uttar Pradesh
Injuries
16
Proportion of total disease burden from: CMNNDs: 40.5% | NCDs: 47.9% | Injuries: 11.6% How have have the the leading combined changed from 1990 to 2016? How leading causes causesofofdeath deathand anddisability disability combined changed from 1990 to 2016? Change in top 15 causes of DALYs, both sexes, ranked by number of DALYs, 1990–2016 Change in top 15 causes of DALYs, both sexes, ranked by number of DALYs, 1990–2016 Communicable, maternal, neonatal, and nutritional diseases
Injuries
Non-communicable diseases
Leading causes of DALYs 1990
Diarrhoeal diseases [15.7%] Lower respiratory infections [11.2%] Tuberculosis [5.5%] Tetanus [4.6%] Measles [4.5%] Preterm birth complications [3.7%] Other neonatal disorders [3.6%] COPD† [3.6%] Neonatal encephalopathy [2.5%] Intestinal infectious diseases [2.3%] Ischaemic heart disease [2.2%] Iron-deficiency anaemia [1.8%] Protein-energy malnutrition [1.7%] Asthma [1.6%] Congenital birth defects [1.5%] Road injuries [1.5%] Sense organ diseases‡ [1.1%] Self-harm§ [1.1%] Falls [1.0%] Stroke [1.0%]
same or increase
decrease
Leading causes of DALYs 2016
1
1
2
2
3
3
4
4
5
5
6
6
7
7
8
8
9
9
10
10
11
11
12
12
13
13
14
14
15
15
16
19
18 19
21 24
21
33
22
68 †
*Change not significant. The percent figure in brackets next to each cause is DALYs from that cause out of total DALYs.
COPD† [6.1%] Diarrhoeal diseases [6.0%] Ischaemic heart disease [5.8%] Lower respiratory infections [5.7%] Tuberculosis [5.0%] Preterm birth complications [3.7%]* Iron-deficiency anaemia [3.3%] Road injuries [3.0%] Other neonatal disorders [2.9%]* Sense organ diseases‡ [2.4%] Congenital birth defects [2.1%]* Self-harm§ [2.0%] Stroke [1.9%] Falls [1.8%] Intestinal infectious diseases [1.8%] Asthma [1.7%]* Neonatal encephalopathy [1.5%] Protein-energy malnutrition [1.1%] Measles [0.7%] Tetanus [0.3%]
COPD is chronic obstructive pulmonary disease. Sense organ diseases includes mainly hearing and vision loss. Self-harm refers to suicide and the nonfatal outcomes of self-harm.
‡
§
What caused death and disability combined across age groups in 2016? What causedthe themost most death and disability combined across age groups in 2016? Percent of of DALYs DALYs by by age Percent age group, group, both both sexes, sexes,2016 2016 25
[2.26]
Percent of total DALYs
20
15
10
[0.46] 5
[0.32]
[0.56]
[0.79]
[0.67]
[0.6]
[1.12]
[0.92]
[2.17]
[1.74]
[1.41]
[2.71] [3.28]
[0.31]
[3.71]
[4.15] [4.44]
) (< 1% + 85
%) 84
(1
%) to 80
to
79
(1
%)
70
75
74
(1
%) to
69
(2
%) to 65
to
64
(3
%) (3 60
59 to 55
54 to 50
49
(4
%)
%) (5
%) to 45
44
(5
%) to 40
39
(6
%) to 35
34
(7
%) to 30
to
29
(9 25
24 to
(8
%)
) 1% (1
to
19
(1 15
14 to
o9
(1 10
20
1%
) 1%
%) 5t
10 5( de r Un
)
0
Age Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
Injuries
The number in the bracket on top of each vertical bar is the ratio of percent DALYs to population for that age group. The number in parentheses after each age group on the x-axis is the percent of population in that age group.
Uttar Pradesh 189
What risk factors are driving the most death and disability combined? Contribution of top 10 risks to DALYs number, both sexes, ranked by number of DALYs, 19 What risk factors are driving the most death and disability combined? What risk factors are driving the most death and disability combined? Contribution of toto DALYs number, bothboth sexes, ranked by number of DALYs, 1990-2016 Contribution oftop top1010risks risks DALYs number, sexes, ranked by number of DALYs, 1990-2016 same or increase Behavioural Environmental/occupational Metabolic Behavioural
Environmental/occupational
same or increase
Metabolic
Risk factors 1990
Risk factors 1990
1 2 3 4 5 6 7 Alcohol & drug use [1.5%] 8 Impaired kidney function [0.9%] 10 High fasting plasma glucose [1.4%] 9 The percent figure in bracket next to each risk is DALYs from that risk out of total DALYs. High total cholesterol [0.9%] 10 High body-mass index [0.7%] 12 Malnutrition* [38.0%]
1 2 3 4 5 6 7 8 9 10
decrease
Risk factors 2016
Risk factors 2016
Malnutrition* [32.2%] 1 † [15.2%] [16.2%] WaSH†WaSH 2 Air Air pollution [7.7%] [12.2%] 3 pollution Tobacco use [3.6%] 4 Tobacco use [4.1%] Dietary risks [2.3%] 5 Dietary[2.2%] risks [2.8%] High blood pressure 6 Occupational [1.9%] [2.1%] 7 High bloodrisks pressure Alcohol & drug use [1.6%] 8 Occupational risks [1.8%] High fasting plasma glucose [1.4%] 9
decrease
1
Malnutrition* [18.2%]
Malnutrition* [14.8%] 2 Air pollution [11.1%] Air pollution [5.1%] High blood pressure [5.0%] 3 Tobacco use [6.2%] Tobacco use [4.9%] 4 WaSH† [6.1%] Dietary risks [4.7%] Dietary risks [5.7%] 5 [4.0%] High fasting plasma glucose WaSH† [3.9%] 6 High blood pressure [5.1%] Alcohol & drug use [3.9%] 7 High fasting plasma glucose [4.1%] Occupational risks [2.6%] Impaired kidney function8 [2.0%]Alcohol & drug use [3.3%]
9
Occupational risks [2.9%] [2.5%] 11 High total cholesterol [2.4%]
*Malnutrition is child and maternal malnutrition. body-mass index 10 High † WaSH is unsafe water, sanitation, and handwashing.
*Malnutrition is child and maternal malnutrition. † WaSH is unsafe water, sanitation, and handwashing.
The percent figure in bracket next to each risk is DALYs from that risk out of total DALYs.
How did the risk factors differ by sex in 2016? Percent of total DALYs attributable to top 10 risks, ranked by percent for both sexes combined, 2016 Females
Males Malnutrition* Air pollution Tobacco use WaSH† Dietary risks High blood pressure High fasting plasma glucose Alcohol & drug use Occupational risks High body-mass index
20
15
10
0
5
Percent of years of life lost and years lived with disability Behavioural
0
5
Environmental/occupational *Malnutrition is child and maternal malnutrition. is unsafe water, sanitation, and handwashing.
†WaSH
190 Uttar Pradesh
10
15
20
Percent of years of life lost and years lived with disability Metabolic
Uttarakhand 1990 life expectancy Females: 60.5 years Males: 57.8 years
2016 life expectancy Females: 71.1 years Males: 65.3 years
How much did the under-5 mortality rate change from 1990 to 2016? How much did the under-5 mortality rate change from 1990 to 2016? Under-5 mortality both sexes combined, 1990-2016 Under-5 mortality rate, bothrate, sexes combined, 1990-2016 Uttarakhand under-5 rate
India under-5 rate
Comparative average rate globally for similar Socio-demographic Index as Uttarakhand
Deaths per 1,000 live births
150
100
50
46.2 39.2 24.9
0 1990
1995
2000
2005
2010
The shaded bands indicate 95% uncertainty intervals around the estimates
2016
Year What caused the most deaths in different age groups in 2016? Percent top 10 causesdeaths of death byin agedifferent group, both sexes, Whatcontribution causedofthe most age 2016 groups
in 2016? Percent contribution of top 10 causes of death by age group, both sexes, 2016 0−14 years [10.3% of total deaths]
15−39 years [10.9% of total deaths]
1.2% 4.3%
HIV/AIDS & tuberculosis
2.3%
6.2%
12.4%
Diarrhoea/LRI*/other
11.6%
NTDs† & malaria
6.7% 38.9%
2% 2.3%
1.1%
10%
12.6%
Neonatal disorders
6.7% 9.5% 10.4%
4% 2.6%
Nutritional deficiencies Other communicable diseases Cancers
32.2% 2.9%
Maternal disorders
17.7%
Cardiovascular diseases Chronic respiratory diseases
2.6%
Cirrhosis Digestive diseases Neurological disorders
40−69 years [38.7% of total deaths]
70+ years [40% of total deaths] 2.4%
8.1% 7.1%
5.4%
3.8% 4.3% 4.2%
2.8% 2.5%
Transport injuries
4.6% 8%
Suicide & violence
4.6% 2.2%
7.3%
23.1%
16.6% 28.2%
Other non-communicable
1.1%
Unintentional injuries
15.9%
6.8% 14%
Diabetes/urog‡/blood/endo§
Other causes of death *LRI is lower respiratory infections. † NTDs are neglected tropical diseases. ‡ Urog is urogenital diseases. § Endo is endocrine diseases.
27%
Uttarakhand 191
Proportion of total disease burden from: Premature death: 68.0% | Disability or morbidity: 32.0% What caused the most years of life lost, by sex, in 2016? Top 15 causes of YLLs, ranked by percent for both sexes combined, 2016 Females
Males Ischaemic heart disease Lower respiratory infections COPD* Road injuries Tuberculosis Diarrhoeal diseases Preterm birth complications Stroke Suicide Intestinal infectious diseases Other neonatal disorders Falls Diabetes Neonatal encephalopathy Congenital birth defects
15
10
5
0
0
Percent of total years of life lost due to premature mortality
5
10
15
Percent of total years of life lost due to premature mortality
Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
Injuries
*COPD is chronic obstructive pulmonary disease.
What caused the most years lived with disability, by sex, in 2016? Top 15 causes of YLDs, ranked by percent for both sexes combined, 2016 Females
Males Iron-deďŹ ciency anemia Sense organ diseases* Low back & neck pain Migraine Skin diseases COPD* Other musculoskeletal Depressive disorders Diabetes Anxiety disorders Preterm birth complications Oral disorders Falls Osteoarthritis Schizophrenia
12.5
10.0 7.5 5.0 2.5 Percent of total years lived with disability
0
Communicable, maternal, neonatal, and nutritional diseases
0
2.5 5.0 7.5 10.0 12.5 Percent of total years lived with disability Non-communicable diseases
*COPD is chronic obstructive pulmonary disease. *Sense organ diseases includes mainly hearing and vision loss.
192 Uttarakhand
Injuries
Proportion of total disease burden from: CMNNDs: 31.7% | NCDs: 55.5% | Injuries: 12.9% How have have the the leading combined changed from 1990 to 2016? How leading causes causesofofdeath deathand anddisability disability combined changed from 1990 to 2016? Change in top 15 causes of DALYs, both sexes, ranked by number of DALYs, 1990–2016 Change in top 15 causes of DALYs, both sexes, ranked by number of DALYs, 1990–2016 Communicable, maternal, neonatal, and nutritional diseases
Injuries
Non-communicable diseases
Leading causes of DALYs 1990
Diarrhoeal diseases [12.7%] Lower respiratory infections [8.3%] Tuberculosis [7.1%] COPD† [4.2%] Preterm birth complications [3.9%] Ischaemic heart disease [3.7%] Tetanus [3.5%] Other neonatal disorders [2.8%] Intestinal infectious diseases [2.7%] Road injuries [2.5%] Neonatal encephalopathy [2.4%] Measles [2.2%] Iron-deficiency anaemia [2.1%] Stroke [1.6%] Asthma [1.5%] Sense organ diseases‡ [1.4%] Skin diseases [1.3%] Falls [1.2%] Low back & neck pain [1.2%] Migraine [1.1%] Diabetes [0.7%]
same or increase
decrease
Leading causes of DALYs 2016
1
1
2
2
3
3
4
4
5
5
6
6
7
7
8
8
9
9
10
10
11
11
12
12
13
13
14
14
15
15
17
17
19 21
18 21
23
24
25
73
37
82
Ischaemic heart disease [7.8%] COPD† [6.8%] Lower respiratory infections [5.5%] Road injuries [4.2%] Tuberculosis [3.6%] Diarrhoeal diseases [3.0%] Preterm birth complications [3.0%]* Iron-deficiency anaemia [2.8%] Sense organ diseases‡ [2.8%] Low back & neck pain [2.3%] Diabetes [2.2%] Stroke [2.2%] Skin diseases [2.1%] Migraine [2.1%] Falls [2.0%] Intestinal infectious diseases [1.7%] Other neonatal disorders [1.7%] Asthma [1.6%]* Neonatal encephalopathy [1.3%] Tetanus [0.3%] Measles [0.2%]
†
*Change not significant. The percent figure in brackets next to each cause is DALYs from that cause out of total DALYs.
COPD is chronic obstructive pulmonary disease. Sense organ diseases includes mainly hearing and vision loss. § Self-harm refers to suicide and the nonfatal outcomes of self-harm. ‡
What caused the most death and disability combined across age groups in 2016?
What caused thebymost death both and disability combined across age groups in 2016? Percent of DALYs age group, sexes, 2016 Percent of DALYs by age group, both sexes, 2016 [2.21]
Percent of total DALYs
15
10 [2.08] [1.67]
[1.34] [0.54]
[0.45]
5
[0.59]
[0.89]
[0.78]
[0.66]
[2.6]
[1.09]
[3.11] [3.53]
[0.31]
[0.33]
[4.02] [4.45]
) +
(<
1%
%) 85
84
(1
%) 80
to
79
(1
%) to 75
74
(2
%) 70
to
69
(2
%) to 65
64
(4
%) to 60
59
(4
%) to 55
54
(5
%) to 50
49
(5
%) to 45
44
(6
%) to 40
39
(7
%) to 35
to
34
(8 30
29 to 25
(1 24
(8
%)
) 0%
) 1% to 20
to
19
(1 15
to
14
(1 10
(1
0%
) 0%
)
o9
8%
5t
5( de r Un
)
0
Age Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
Injuries
The number in the bracket on top of each vertical bar is the ratio of percent DALYs to population for that age group. The number in parentheses after each age group on the x-axis is the percent of population in that age group.
Uttarakhand 193
What risk factors are driving the most death and disability combined? Contribution of top 10 risks to DALYs number, both sexes, ranked by number of DALYs, 19 What risk factors are driving the most death and disability combined? What risk factors are driving the most death and disability combined? Contribution of toto DALYs number, bothboth sexes, ranked by number of DALYs, 1990-2016 Contribution oftop top1010risks risks DALYs number, sexes, ranked by number of DALYs, 1990-2016 same or increase Behavioural Environmental/occupational Metabolic Behavioural
Environmental/occupational
same or increase
Metabolic
Risk factors 1990
Risk factors 1990
1 2 3 4 5 6 7 Occupational risks [2.1%] 8 Impaired kidney function [0.9%] 10 Alcohol & drug use [1.8%] 9 The percent figure in bracket next to each risk is DALYs from that risk out of total DALYs. High total cholesterol [1.7%] 10 High body-mass index [1.0%] 12 Malnutrition* [29.2%]
1 2 3 4 5 6 7 8 9 10
decrease
Risk factors 2016
Risk factors 2016
Malnutrition* [32.2%] 1 † [15.2%] [12.9%] WaSH†WaSH 2 Air Air pollution [7.7%] [10.8%] 3 pollution Tobacco use [3.6%] 4 Tobacco use [6.4%] Dietary risks [2.3%] 5 Dietary[2.2%] risks [4.4%] High blood pressure 6 Occupational [1.9%] [4.0%] 7 High bloodrisks pressure Alcohol & drug use [1.6%] 8 High fasting plasma glucose [2.1%] High fasting plasma glucose [1.4%] 9
decrease
1
Malnutrition* [13.5%]
Malnutrition* [14.8%] 2 Air pollution [9.3%] Air pollution [5.1%] High blood pressure [5.0%] 3 Tobacco use [8.8%] Tobacco use [4.9%] 4 High blood pressure [7.5%] Dietary risks [4.7%] Dietary risks [7.4%] 5 [4.0%] High fasting plasma glucose WaSH† [3.9%] 6 High fasting plasma glucose [5.5%] Alcohol & drug use [3.9%] 7 High body-mass index [4.7%] Occupational risks [2.6%] Impaired kidney function8 [2.0%]High total cholesterol [3.9%]
9
Alcohol & drug use [3.7%] [3.2%] 11 WaSH† [2.7%]
*Malnutrition is child and maternal malnutrition. 10 Occupational risks † WaSH is unsafe water, sanitation, and handwashing.
*Malnutrition is child and maternal malnutrition. † WaSH is unsafe water, sanitation, and handwashing.
The percent figure in bracket next to each risk is DALYs from that risk out of total DALYs.
How did the risk factors differ by sex in 2016? Percent of total DALYs attributable to top 10 risks, ranked by percent for both sexes combined, 2016 Females
Males Malnutrition* Air pollution Tobacco use High blood pressure Dietary risks High fasting plasma glucose High body-mass index High total cholesterol Alcohol & drug use Occupational risks
16
12
8
0
4
Percent of years of life lost and years lived with disability Behavioural
0
4
Environmental/occupational *Malnutrition is child and maternal malnutrition.
194 Uttarakhand
8
12
16
Percent of years of life lost and years lived with disability Metabolic
West Bengal 1990 life expectancy Females: 59.6 years Males: 58.4 years
2016 life expectancy Females: 71.3 years Males: 68.1 years
How much did the under-5 mortality rate change from 1990 to 2016? How much did the under-5 mortality rate change from 1990 to 2016? Under-5 mortality both sexes combined, 1990-2016 Under-5 mortality rate, bothrate, sexes combined, 1990-2016 West Bengal under-5 rate
India under-5 rate
Comparative average rate globally for similar Socio-demographic Index as West Bengal
Deaths per 1,000 live births
150
100
50 39.2 34.2 30.4
0 1990
1995
2000
2005
2010
The shaded bands indicate 95% uncertainty intervals around the estimates
2016
Year What caused the most deaths in different age groups in 2016? Percent top 10 causesdeaths of death byin agedifferent group, both sexes, Whatcontribution causedofthe most age 2016 groups
in 2016? Percent contribution of top 10 causes of death by age group, both sexes, 2016 0−14 years [6.4% of total deaths]
15−39 years [11.4% of total deaths]
1.3% HIV/AIDS & tuberculosis
4.6%
1.4%
7.5%
9.7%
9.8%
Diarrhoea/LRI*/other
7.3%
30.6%
7.1% 1.5% 1.9% 1.8%
NTDs† & malaria
2.3%
Maternal disorders
20.6%
6.5%
Neonatal disorders Nutritional deficiencies Other communicable diseases
15.7%
3.7% 38.6%
8.9% 4.3% 4.7%
Cancers Cardiovascular diseases
10.2%
Chronic respiratory diseases Cirrhosis Digestive diseases Neurological disorders
40−69 years [42% of total deaths]
70+ years [40.1% of total deaths] 1.7% 2.4% 3.1%
2.7% 6.1%
4.5% 5.5%
3.3%
Other non-communicable Transport injuries
2.6% 14%
Unintentional injuries
7.3% 3.8%
12.9%
Diabetes/urog‡/blood/endo§
6.5%
1.7% 1%
5.9%
Suicide & violence Other causes of death
3.4% 12.1% 8%
44.6%
*LRI is lower respiratory infections. † NTDs are neglected tropical diseases. ‡ Urog is urogenital diseases. § Endo is endocrine diseases.
47.2%
West Bengal 195
Proportion of total disease burden from: Premature death: 64.7% | Disability or morbidity: 35.3% What caused the most years of life lost, by sex, in 2016? Top 15 causes of YLLs, ranked by percent for both sexes combined, 2016 Females
Males Ischaemic heart disease Stroke Suicide Lower respiratory infections Diarrhoeal diseases COPD* Road injuries Preterm birth complications Tuberculosis Chronic kidney disease HIV/AIDS Other neonatal disorders Diabetes Drowning Neonatal encephalopathy
15
10
5
0
0
Percent of total years of life lost due to premature mortality
5
10
15
Percent of total years of life lost due to premature mortality
Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
Injuries
*COPD is chronic obstructive pulmonary disease.
What caused the most years lived with disability, by sex, in 2016? Top 15 causes of YLDs, ranked by percent for both sexes combined, 2016 Females
Males Iron-deďŹ ciency anaemia Sense organ diseases* Low back & neck pain Migraine Skin diseases Other musculoskeletal Depressive disorders COPD* Anxiety disorders Diabetes Oral disorders Preterm birth complications Falls Osteoarthritis Schizophrenia
15
10 5 Percent of total years lived with disability
0
Communicable, maternal, neonatal, and nutritional diseases
0
5 10 Percent of total years lived with disability Non-communicable diseases
*COPD is chronic obstructive pulmonary disease. *Sense organ diseases includes mainly hearing and vision loss.
196 West Bengal
Injuries
15
Proportion of total disease burden from: CMNNDs: 24.8% | NCDs: 62.7% | Injuries: 12.6% How have have the the leading combined changed from 1990 to 2016? How leading causes causesofofdeath deathand anddisability disability combined changed from 1990 to 2016? Change in top 15 causes of DALYs, both sexes, ranked by number of DALYs, 1990–2016 Change in top 15 causes of DALYs, both sexes, ranked by number of DALYs, 1990–2016 Communicable, maternal, neonatal, and nutritional diseases
Injuries
Non-communicable diseases
Leading causes of DALYs 1990
Lower respiratory infections [9.8%] Diarrhoeal diseases [7.7%] Preterm birth complications [6.2%] Measles [5.9%] Tuberculosis [4.4%] Ischaemic heart disease [4.2%] Stroke [4.0%] Other neonatal disorders [3.7%] Self-harm§ [2.8%] COPD† [2.5%] Neonatal encephalopathy [2.5%] Iron-deficiency anaemia [2.2%] Congenital birth defects [1.6%] Road injuries [1.5%] Tetanus [1.5%] Sense organ diseases‡ [1.4%] Low back & neck pain [1.3%] Chronic kidney disease [1.2%] Skin diseases [1.2%] Migraine [1.1%]
same or increase
decrease
Leading causes of DALYs 2016
1
1
2
2
3
3
4
4
5
5
6
6
7
7
8
8
9
9
10
10
11
11
12
12
13
13
14
14
15
15
18
21
21 22
22 25
23
86
24
131 †
*Change not significant. The percent figure in brackets next to each cause is DALYs from that cause out of total DALYs.
Ischaemic heart disease [9.7%] Stroke [8.5%] COPD† [4.2%] Self-harm§ [3.7%]* Iron-deficiency anaemia [3.5%] Lower respiratory infections [3.3%] Sense organ diseases‡ [3.2%] Diarrhoeal diseases [3.0%] Preterm birth complications [2.7%] Low back & neck pain [2.6%] Road injuries [2.6%] Migraine [2.3%] Chronic kidney disease [2.2%] Skin diseases [2.1%] Tuberculosis [2.0%] Other neonatal disorders [1.3%] Congenital birth defects [1.2%] Neonatal encephalopathy [0.9%] Measles [0.2%] Tetanus [0.0%]
COPD is chronic obstructive pulmonary disease. Sense organ diseases includes mainly hearing and vision loss. Self-harm refers to suicide and the nonfatal outcomes of self-harm.
‡
§
What caused death and disability combined across age groups in 2016? What causedthe themost most death and disability combined across age groups in 2016? Percent of of DALYs DALYs by by age Percent age group, group, both both sexes, sexes,2016 2016 12.5 [1.75]
10.0
[1.74]
Percent of total DALYs
[1.39]
[2.16]
[1.12]
7.5 [0.93]
[0.8] [0.61]
[0.56] 2.5
[2.73]
[0.69] [3.29]
[0.46]
[3.76]
[0.32]
[0.32]
[4.31]
2.5
[4.81]
(<
1%
)
) + 85
84
(1 %
) to 80
75
to
79
(1 %
) (2 %
) 70
to
74
(2 %
) to 65
64
69
(3 %
%) to 60
to
59
(6 55
54 to 50
(5
%)
) (6 %
) 45
to
49
(7 %
) 44 to 40
35
to
39
(8 %
) (8 %
) 30
to
34
(9 %
) 25
to
29
(9 %
) 24 to 20
19 to 15
14 to
(9 %
) (9 %
%) (8 10
o9 5t
Un
de
r5
(6
%)
0.0
Age Communicable, maternal, neonatal, and nutritional diseases
Non-communicable diseases
The number in the bracket on top of each vertical bar is the ratio of percent DALYs to population for that age group. The number in parentheses after each age group on the x-axis is the percent of population in that age group.
Injuries
West Bengal 197
What risk factors are driving the most death and disability combined? Contribution of top 10 risks to DALYs number, both sexes, ranked by number of DALYs, 19 What risk factors are driving the most death and disability combined? What risk factors are driving the most death and disability combined? Contribution of toto DALYs number, bothboth sexes, ranked by number of DALYs, 1990-2016 Contribution oftop top1010risks risks DALYs number, sexes, ranked by number of DALYs, 1990-2016 same or increase Behavioural Environmental/occupational Metabolic Behavioural
Environmental/occupational
same or increase
Metabolic
Risk factors 1990
Risk factors 1990
1 2 3 4 5 6 7 High fasting plasma glucose [2.1%] 8 Impaired kidney function [0.9%] 10 Impaired kidney function [2.0%] 9 The percent figure in bracket next to each risk is DALYs from that risk out of total DALYs. Occupational risks [2.0%] 10 Alcohol & drug use [1.9%] 11 Malnutrition* [32.9%]
1 2 3 4 5 6 7 8 9 10
decrease
Risk factors 2016
Risk factors 2016
Malnutrition* [32.2%] 1 † Air pollution [15.2%] [12.0%] WaSH 2 Air pollutionWaSH [7.7%] † [8.5%] 3 Tobacco use [3.6%] 4 Dietary risks [6.2%] Dietary risks [2.3%] 5 High blood pressure High blood pressure [2.2%] [5.7%] 6 Occupational risks [1.9%] 7 Tobacco use [5.5%] Alcohol & drug use [1.6%] 8 High total cholesterol [2.3%] High fasting plasma glucose [1.4%] 9
decrease
1
Dietary risks [13.1%]
Malnutrition* [14.8%] 2 High blood pressure [12.9%] Air pollution [5.1%] High blood pressure [5.0%] 3 Air pollution [11.4%] Tobacco use [4.9%] 4 Malnutrition* [10.4%] Dietary risks [4.7%] Tobacco use [8.6%] 5 [4.0%] High fasting plasma glucose WaSH† [3.9%] 6 High fasting plasma glucose [5.9%] Alcohol & drug use [3.9%] 7 High total cholesterol [5.2%] Occupational risks [2.6%] Impaired kidney function8 [2.0%]Impaired kidney function [4.0%]
9
Alcohol & drug use [3.8%] [3.3%] 12 WaSH† [3.1%]
*Malnutrition is child and maternal malnutrition. 10 Occupational risks † WaSH is unsafe water, sanitation, and handwashing.
*Malnutrition is child and maternal malnutrition. † WaSH is unsafe water, sanitation, and handwashing.
The percent figure in bracket next to each risk is DALYs from that risk out of total DALYs.
How did the risk factors differ by sex in 2016? Percent of total DALYs attributable to top 10 risks, ranked by percent for both sexes combined, 2016 Females
Males Dietary risks High blood pressure Air pollution Malnutrition* Tobacco use High fasting plasma glucose High total cholesterol Impaired kidney function Alcohol & drug use Occupational risks
16
12
8
0
4
Percent of years of life lost and years lived with disability Behavioural
0
4
Environmental/occupational *Malnutrition is child and maternal malnutrition.
198 West Bengal
8
12
Percent of years of life lost and years lived with disability Metabolic
16
Policy implications of the findings India has been able to achieve a 36% reduction in per capita disease burden from 1990 to 2016, measured as DALY rate per person after adjusting for the changes in age structure during this period. However, there was an almost two-fold range of per capita disease burden across the states of India in 2016, adjusting for differences in age structure between the states, with Kerala and Goa having the lowest rates and Assam, Uttar Pradesh, and Chhattisgarh having the highest rates. India's age-standardised DALY rate was 72% higher and Kerala's was 12% higher than in either Sri Lanka or China in GBD 2016. These findings highlight major inequalities in disease burden across the states of India, and that neighbouring Sri Lanka, with population 21 million, as well as China, with population 1.4 billion, have been able to achieve a much lower disease burden level than India. In 2016, 55% of the total disease burden in India was caused by NCDs, 33% by CMNNDs, and 12% by injuries. The burden of CMNNDs has decreased and that of NCDs increased across all states in India from 1990 to 2016. However, there are wide variations between the states, with the contribution of NCDs to the total disease burden ranging from 48% to 75%, CMNNDs ranging from 14% to 43%, and injuries ranging from 9% to 14% across the states in 2016. Even with a decreasing burden of CMNNDs, it is important to note that for diarrhoeal diseases, iron-deficiency anaemia, and tuberculosis, the DALY rates are higher than would be expected in most states for their development level (Socio-demographic Index). The per capita health loss from the individual diseases varies widely between states, with a range of over 5-fold for five of the 10 leading individual causes, i.e., ischaemic heart disease, diarrhoeal diseases, lower respiratory infections, stroke, and tuberculosis. The striking health status and disease inequalities between the states of India documented in this report are driven by variations in the exposure to major risk factors as well as broader development factors. The key to reducing these inequalities, and thereby the overall disease burden in India, is to successfully address these risks and determinants in each state of the country in accordance with their magnitude and trajectory. The findings presented in this report provide a useful reference for the distribution of diseases and risk factors in each state of the country, which can be an important aid in the data-driven and decentralised health planning recommended by two important recent policy documents in India, the NITI Aayog Action Agenda 2017â&#x20AC;&#x201C;2020 and the National Health Policy 2017. The following major policy-relevant issues arise from the findings presented in this report. These include issues related to specific risks and disease conditions, as well as broader cross-cutting policy action required to reduce health inequalities between the states. The following sections highlight key issues but are not comprehensive descriptions of each issue. The latter would be more suitable for detailed topic-specific reports and publications that will be produced subsequently.
Addressing the major risk factors Child and maternal malnutrition
The very high burden of child and maternal malnutrition in many states of India should be considered an emergency situation, as this is not commensurate with Indiaâ&#x20AC;&#x2122;s aspirations for further rapid social and economic
India: Health of the Nationâ&#x20AC;&#x2122;s States
199
progress. Besides causing considerable disease burden, malnutrition blunts intellectual growth in children, thereby robbing the country of its future brain power. Several major nutritional enhancement programmes have been in place in India for a long time. These include the Integrated Child Development Services since 1975 and the Mid Day Meal Scheme for schoolchildren since 1995. The National Food Security Act was enacted in 2013 for nutritional security of the population. The fact that child and maternal malnutrition continues to be the single largest risk factor for health loss in India in 2016 points to the need for drastic and rapid action on this front. Several EAG states and Assam face the highest burden due to child and maternal malnutrition. There is a 7-fold range in the per capita DALYs due to child and maternal malnutrition among the states of India, highlighting the huge variations across the country. For India as a whole, the per capita disease burden due to child and maternal malnutrition is a striking 12 times higher than in China. Interestingly, even the lowest per capita burden in the Indian state of Kerala is 2.7 times higher than in China and 1.7 times higher than in Sri Lanka.
Unsafe water and sanitation
The disease burden from unsafe water and sanitation dropped from 13% of the total burden in 1990 to 5% of the total in 2016, but this too is unacceptably high. The EAG states and Assam again have the highest disease burden from this risk factor. The Swachh Bharat Abhiyan, launched in India in 2014 with very large investments, could improve this situation. Combining infrastructure development to address this risk with behaviour change would increase the likelihood of benefits, and close monitoring of the impact of the Swachh Bharat Abhiyan versus the disease burden trends in each state over the next few years would enable increasing efforts where they are most needed. Again, for reference the per capita disease burden due to unsafe water and sanitation in India is a massive 40 times higher than in China and 12 times higher than in Sri Lanka. Within India there is a wide variation as well, with the per capita burden ranging 12-fold across the states. The lowest burden is in Goa, although it is seven times higher than in China as a whole, suggesting that huge improvements should be possible across the states of India.
Air pollution
People living in India have one of the highest levels of exposure to air pollution globally. Progress has been made in India in reducing household air pollution from solid fuels, yet this remains a significant problem, particularly in the EAG states and Assam. Continuing efforts to reduce the use of solid fuels, as is being done through the Pradhan Mantri Ujjwala Yojna to enhance access to cooking gas for the poor, will be needed for some time to come. Outdoor air pollution, on the other hand, has increased across all of India. Concerted efforts are needed to curb the sources of this pollution, including power production, industry, vehicles, construction, and open burning. These efforts are needed across all states through strategic long-term planning involving the relevant sectors. Several EAG states have quite high levels of both household and outdoor air pollution, and a corresponding high burden of chronic obstructive pulmonary disease as well. Controlling air pollution has to be one of the highest priorities for improving the health of Indiaâ&#x20AC;&#x2122;s population that would impact generations to come. Improved and more detailed monitoring of the ambient air pollution levels would be important in monitoring progress.
200
India: Health of the Nationâ&#x20AC;&#x2122;s States
Risk factors for cardiovascular disease and diabetes
Unhealthy diet, high blood pressure, high blood sugar, high cholesterol, and overweight together contribute about a quarter of the total disease burden in India presently, as compared with a little over a tenth of the total disease burden in 1990. This phenomenal increase is responsible for the increasing dominance of NCDs in every state of the country, particularly ischaemic heart disease, stroke, and diabetes, though to a variable extent. All of these risks are already very high in Punjab and Tamil Nadu, and most of these risks are high in Kerala, Andhra Pradesh, and Karnataka. The per capita burden of ischaemic heart disease and diabetes is relatively lower in the EAG and North-East states than in the Other states group at present, but the per capita burden of stroke is a mixed situation, with some of these states having a high burden. In any case, the increasing trajectory of these risks across all states of India is ominous. If effective interventions to blunt this trajectory are not taken quickly, the EAG states in particular will be faced with relatively high burden from communicable and childhood diseases on the one hand due to a continuing momentum, and from these non-communicable diseases on the other hand due to increasing risk exposure. Tobacco use is also a major risk factor for cardiovascular disease, causing 6% of the total disease burden in India in 2016. Policy action commensurate with a potential explosion of ischaemic heart disease, diabetes, and stroke is needed without delay across all states of the country.
Addressing persistent and increasing disease conditions Under-5 disease burden
The under-5-year age group in India presently suffers 18% of the total disease burden across all ages, measured as DALYs. This proportion is even higher in the EAG states group (23%), which is over two times the contribution of this age group to the total population, indicating the unreasonably high disease burden in this age group. Deaths and ill-health in neonates in the first month of life make up about half of the total under-5 disease burden in India. In comparison, both the neonatal death rate and the under-5 death rate in India are about six times higher than in Sri Lanka. There is wide variation among the Indian states as well, with the under-5 mortality rate ranging 4-fold between the highest in Assam and Uttar Pradesh versus the lowest in Kerala. Reduction in the under-5 disease burden in India has to be unambiguously one of the highest health priorities through focussed action in each state, especially those where this continues to be high.
Tuberculosis
India has an exceptionally high burden of tuberculosis, contributing the largest number of new cases annually of any country in the world. For almost all states of India, the burden of tuberculosis is much higher than the average burden for the similar socio-demographic level globally. The range of per capita disease burden due to tuberculosis among the states of India is 9-fold. The state with the lowest burden, Kerala, has twice the per capita burden as Sri Lanka and China, and India as a whole has about 10 times the per capita burden from tuberculosis as either of these two countries. A National Strategic Plan for Tuberculosis Elimination has been announced recently by the Revised National Control Programme of India. Effective implementation and assessing progress against evolving tuberculosis burden trends are needed to curtail the continuing very high suffering from this disease across India.
India: Health of the Nationâ&#x20AC;&#x2122;s States
201
Other communicable diseases
Several other communicable diseases have reduction targets mentioned in the National Health Policy 2017 and the NITI Aayog Action Agenda 2017â&#x20AC;&#x201C; 2020, which include HIV/AIDS, malaria, kala azar (visceral leishmaniasis), leprosy, and lymphatic filariasis. Estimates for each of these are produced by the India State-Level Disease Burden Initiative for 1990 to 2016. These are available in an online open-access visualisation tool at vizhub.healthdata. org/gbd-compare/india. Estimates of these diseases over the next few years in each state would help monitor the progress in reducing their burden.
Other non-communicable diseases
Besides cardiovascular disease and diabetes, referred to above, the other major NCDs that need particular attention are chronic respiratory disorders, mental health disorders, and cancers. The relative contribution of all of these conditions to the disease burden in India has increased substantially since 1990. This increase has occurred across all three state groups but varies considerably between the states. Each of these groups of conditions requires systematic and large-scale interventions to be put in place, which are currently far from adequate in most states of India. Specific estimates for these diseases and their risk factors, which are provided for each state in this report and the open-access online visualisation tool, can be useful in planning for their control.
Injuries
The control of injuries has not been a high priority in India. The incidence of road injuries has increased by about half since 1990 in India, leading to its higher ranking in the contribution to disease burden. The relative contribution of road injuries to the disease burden has increased across all three groups of states. The contribution of suicide to the disease burden in India has also gone up in the ranking during this period. There is a 6-fold variation between the states in the DALY rate from self-harm, and for India as a whole this rate is about two times higher than the global level for a similar level of sociodemographic development. Reduction in the burden due to both road injuries and suicide requires effective multi-sectoral interventions that need to be developed in each state of the country. The state-specific estimates for these and other injuries could be used for planning their control and monitoring progress over time.
Inter-sectoral collaborations A major issue with interventions to improve population health in India has been the relative deficiency of the necessary inter-sectoral collaborations. Most of the leading risk factors contributing to the disease burden in India can be addressed fully only through inter-sectoral collaborations. For example, child and maternal malnutrition has to be dealt with through linkages between a number of efforts being made by the Ministry of Women and Child Development, Ministry of Consumer Affairs, Food, and Public Distribution, Ministry of Agriculture and Farmers Welfare, Ministry of Health and Family Welfare, as well as a variety of non-governmental players. Similarly, air pollution can be effectively dealt with only if the efforts of the Ministry of Environment, Forest and Climate Change, Ministry of Power, Ministry of New and Renewable Energy, Ministry of Road Transport and Highways, Ministry of Housing and Urban Affairs, Ministry of Health and Family Welfare, and a variety of non-governmental partners come together. The group of risk factors that influence the increasing burden of cardiovascular disease and diabetes have to be dealt with through collaborative efforts between the Ministry of Health and Family Welfare, Ministry of Consumer 202
India: Health of the Nationâ&#x20AC;&#x2122;s States
Affairs, Food, and Public Distribution, Ministry of Agriculture and Farmers Welfare, Ministry of Housing and Urban Affairs, and a range of non-governmental partners. Besides the sectors noted above, several others impact health as well. These include education, working conditions, and social protection. Improved understanding of the influence of the variety of sectors on health would help achieve better population health levels in India. Given the social, cultural, and economic diversity between the states of India, these linkages should ideally be understood and addressed in the context of each state. These broader determinants would also have to be taken into account when the findings of the India State-Level Disease Burden Initiative are utilised in attempts to improve population health in each state.
Universal coverage and health assurance The National Health Policy 2017 and the NITI Aayog Action Agenda 2017â&#x20AC;&#x201C; 2020 have emphasised that India must achieve universal health coverage and assure health care for all. Achievement of this highly desirable goal requires a variety of actions articulated in these two policy documents. Of these, the following two major cross-cutting actions could be informed by the statelevel findings presented in this report.
Increasing health financing
The National Health Policy has recommended increasing public spending on health in the states to more than 8% of the state government budget by 2020. Health is a state subject in India, and states contribute a larger proportion of the public spending on health than the centre. The aspiration of increasing state spending on health is a good investment in human capital. The magnitude of health spending and how this is utilised could benefit from the specific disease burden and risk profile of each state. For example, the annual Project Implementation Plan of each state could be informed by the findings presented in this report.
Improving human resources for health
Suitable human resources for addressing the evolving disease burden through more emphasis on public and preventive health, and through improved linkages between the primary and higher care levels, have been emphasised in the above two 2017 policy documents of the government. Within this broader goal, titration of a suitable balance between the various types and levels of health personnel can be informed by the specific disease and risk factors profile of each state.
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Strengthening the health information system Better cause of death data
Of the total disease burden in India in 2016, two-thirds was due to premature death and one-third due to disability. A robust cause of death reporting system is needed for disease burden estimates. Only 22% of the deaths in India in 2015 had their cause reported in the Medical Certification of Cause of Death (MCCD) system, overseen by the Office of the Registrar General of India, the majority of which were from urban public sector hosptials. This proportion varies widely between the states. The Sample Registration System (SRS) has been providing cause of death data from representative samples of the population in each state, using the verbal autopsy approach in which the cause of death is inferred from information obtained from someone close to the deceased. Verbal autopsy in general can provide reasonable cause of death distribution data at the population level. The cause of death data from the last SRS sampling cycle, 2004–2013, were provided by the Office of the Registrar General of India for utilisation in the India State-Level Disease Burden Initiative. This has made the disease burden estimates in this report stronger. However, it is essential to improve the scope of the MCCD system to cover the majority of deaths in India in the long run. The SRS was introduced in India some four decades ago as an interim arrangement until the Civil Registration and Vital Statistics (CRVS) system covering birth and death registration as well as medically certified causes of death got more established. While the SRS continues to provide quite useful data from a representative sample of about 0.7% of the country’s population, it should not be considered a substitute for a fully functional CRVS system. India needs to effectively plan and invest to make the CRVS system much stronger in all states of the country, including good-quality cause of death data for the majoirty of deaths, as a very high priority.
Improved surveillance
Disease surveillance is the cornerstone of tracking evolution of the trends of disease conditions and risk factors in populations. It is needed to monitor established diseases as well as emerging diseases and risk factors. An adequate health system response to both acute and chronic diseases is generally not possible without an adequate disease surveillance system including disease registeries. Disease surveillance has typically been weak in India. Exceptions in recent times include polio and HIV, and cancer registeries have provided crucial data from parts of the country. The Integrated Disease Surveillance Programme was started in India over a decade ago with much hope, but it did not reach the level of functioning needed to significantly uplift disease surveillance systematically across India. The importance of disease surveillance has been reiterated in both the National Health Policy 2017 and the NITI Action Agenda 2017–2020. What is needed as one of the highest priorities in health in India currently is development of a scientifically sound surveillance system covering all disease conditions and risk factors of interest, as well as a practically feasibile implementation plan backed by financial and human resources. The success of this seems likely only if planning for this is done for every state of the country, taking into account the specific disease and risk factor profile and context of each state. The findings of the India State-Level Disease Burden Initiative could be a useful guide for such planning.
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Another important aspect of the health information system that needs significant improvement in India is better documentation in health facility records and utilisation of these data to understand health outcomes. This requires enhancement of information technology infrastructure across all states of India for more systematic documentation of health services provision, as well as corresponding training of health personnel, both in the public and private sectors. The data gaps related to disease sequelae and outcomes identified through the work of the India State-Level Disease Burden Initiative could inform enhancement of this aspect of the health information system of India.
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Conclusion The India State-Level Disease Burden Initiative findings in this report are the most detailed mapping of the magnitude, age and sex distribution, and trends since 1990 for the whole range of diseases and risk factors in every state of the country. These findings are based on all available data obtained through extensive efforts of a large network of collaborators, and use of the standardised methods of the Global Burden of Disease study that enable comparisons across diseases, risk factors, age, sex, time, and geographies. Although variations in diseases and risk factors have been anticipated between the states of India, this is the first time that a comprehensive compilation of all estimates in a single standardised framework has been made possible for every state in India. Besides presenting the findings in this report, the technical details are presented in a scientific paper published in the journal The Lancet, and visual graphics of the findings are available in an online open-access interactive visualisation tool at vizhub.healthdata.org/gbd-compare/india. All three outputs – the report, the technical paper, and the visualisation tool – are being released on the same day in November 2017. Together, these outputs provide a valuable resource for policymakers, health managers, academics, health providers, agencies supporting health, other stakeholders, and the public at large to understand the heterogeneity of disease burden and risk factors across the states of India, which can be utilised in a variety of ways in the effort to improve the health of people living in each state and union territory of the country. The major areas in which policy utilisation of the India State-Level Disease Burden Initiative findings could be useful include planning of state health budgets, prioritisation of interventions relevant to each state, informing the government’s Health Assurance Mission in each state, monitoring of health-related Sustainable Development Goals targets in each state, assessing impact of large-scale interventions based on time trends of disease burden, and forecasting population health under various scenarios in each state. The 1990 to 2016 state-level disease burden findings, and the subsequent annual updates in the trends by the India State-Level Disease Burden Initiative, as well as availability of more disaggregated findings such as rural-urban estimates planned for next year, can be crucial contributors to the data-driven and decentralised health planning and monitoring recommended by the National Health Policy 2017 and the NITI Aayog Action Agenda 2017–2020. The availability of detailed and comprehensive estimates for disease burden and risk factors for every state of the country is a major advancement which would enable the planning of specific action needed to reduce health inequalities and inequities between the states, as well as between the sexes and age-groups within each state.
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India State-Level Disease Burden Initiative Advisory Board Members J.V.R. Prasada Rao (Chair), Former Secretary, Ministry of Health and Family Welfare, Government of India C.K. Mishra, Secretary, Ministry of Health and Family Welfare, Government of India Manoj Jhalani, Additional Secretary & Managing Director National Health Mission, Ministry of Health and Family Welfare, Government of India Sanjeeva Kumar, Additional Secretary, National AIDS Control Organisation, Ministry of Health and Family Welfare, Government of India N.S. Dharmshaktu, Principal Advisor, Directorate General of Health Services, Government of India Alok Kumar, Adviser, NITI Aayog, Government of India Rajani R. Ved, Executive Director, National Health Systems Resource Centre Hendrik J. Bekedam, World Health Organization Representative to India Bilali Camara, India Country Director, Joint United Nations Programme on HIV/AIDS Swarup K. Sarkar, Director, Department of Communicable Diseases, World Health Organization Regional Office for South-East Asia R.O. Budnah, Director, Health Services â&#x20AC;&#x201C; Medical Institutions, Government of Meghalaya P.V. Dave, Additional Director, Public Health, Government of Gujarat S. Aruna Kumari, Director, Health Services, Government of Andhra Pradesh K. Kolandaswamy, Director, Public Health and Preventive Medicine, Government of Tamil Nadu Padmakar Singh, Director General, Medical and Health, Government of Uttar Pradesh Gyanendra K. Tripathy, Director, Public Health, Government of Odisha Lalit Dandona (Member Secretary), Director, India State-Level Disease Burden Initiative
Heads of the institutions leading this Initiative Soumya Swaminathan, Director General, Indian Council of Medical Research, New Delhi, India K. Srinath Reddy, President, Public Health Foundation of India, Gurugram, National Capital Region, India Christopher Murray, Director, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
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India State-Level Disease Burden Initiative Contributors Contributors listed in alphabetical order by last name Rizwan S. Abdulkader, Tirunelveli, India Ashkan Afshin, Seattle, USA Sanjay K. Agarwal, New Delhi, India Ashutosh N. Aggarwal, Chandigarh, India Rakesh Aggarwal, Lucknow, India Anurag Agrawal, New Delhi, India Sandra Albert, Shillong, India Atul Ambekar, New Delhi, India Ranjit M. Anjana, Chennai, India Monika Arora, Gurugram, India Narendra K. Arora, New Delhi, India Rashmi Arora, New Delhi, India Shally Awasthi, Lucknow, India Damodar Bachani, Gurugram, India Kalpana Balakrishnan, Chennai, India Anup Barman, Guwahati, India Kalpana Baruah, New Delhi, India Ashish Bavdekar, Pune, India Shahina Begum, Mumbai, India Gufran Beig, Pune, India Anil Bhansali, Chandigarh, India Deeksha Bhardwaj, Gurugram, India Anurag Bhargava, Mangalore, India Eesh Bhatia, Lucknow, India Kelly Bienhoff, Seattle, USA Simon Brooker, Seattle, USA Vineet Chadha, Bengaluru, India Joy Kumar Chakma, New Delhi, India H.K. Chaturvedi, New Delhi, India Pankaj Chaturvedi, Mumbai, India Arvind Chopra, Pune, India D.J. Christopher, Vellore, India Lalit Dandona, Gurugram, India Rakhi Dandona, Gurugram, India Shyamashree Das, New Delhi, India Siddharth K. Das, Lucknow, India A.P. Dash, Thiruvarur, India Puneet Dewan, New Delhi, India Sagnik Dey, New Delhi, India Subhojit Dey, Gurugram, India R.S. Dhaliwal, New Delhi, India A.C. Dhariwal, New Delhi, India Preet K. Dhillon, Gurugram, India Neeraj Dhingra, New Delhi, India Rajesh Dikshit, Mumbai, India Eliza Dutta, Gurugram, India Christina Fitzmaurice, Seattle, USA Melissa Furtado, Gurugram, India Emmanuela Gakidou, Seattle, USA P. Gangadharan, Cochin, India Parthasarathi Ganguly, Gandhinagar, India Peter Gething, Oxford, UK Alakendu Ghosh, Kolkata, India Raj S. Ghosh, New Delhi, India
Aloke G. Ghoshal, Kolkata, India Scott Glenn, Seattle, USA Saurabh Goel, New Delhi, India N. Gopalakrishnan, Chennai, India Randeep Guleria, New Delhi, India Prakash C. Gupta, Mumbai, India Rajeev Gupta, Jaipur, India R.K. Das Gupta, New Delhi, India Subodh S. Gupta, Wardha, India Tarun Gupta, Kanpur, India M.D. Gupte, Pune, India G. Gururaj, Bengaluru, India S. Harikrishnan, Trivandrum, India N.K. Hase, Mumbai, India Simon I. Hay, Seattle, USA Manoranjan Hota, New Delhi, India Harish Iyer, New Delhi, India Veena Iyer, Gandhinagar, India Saurabh Jain, New Delhi, India Sudhir K. Jain, New Delhi, India P. Jambulingam, Puducherry, India K.S. James, New Delhi, India M.S. Jawahar, Chennai, India P. Jeemon, Trivandrum, India Jacob Jose, Vellore, India P.L. Joshi, New Delhi, India Tushar K. Joshi, New Delhi, India Vasna Joshua, Chennai, India Atul Juneja, New Delhi, India Ravi Kannan, Silchar, India Lalit Kant, New Delhi, India Rajni Kant, New Delhi, India Umesh Kapil, New Delhi, India Anita Kar, Pune, India Chittaranjan Kar, Cuttack, India Nicholas J. Kassebaum, Seattle, USA Amal C. Kataki, Guwahati, India Kiran Katoch, Agra, India Tanvir Kaur, New Delhi, India Tripti Khanna, New Delhi, India Sunil D. Khaparde, New Delhi, India Pradeep Khasnobis, New Delhi, India Ajay Khera, New Delhi, India Sanjay Kinra, London, UK Parvaiz A. Koul, Srinagar, India Anand Krishnan, New Delhi, India Anil Kumar, New Delhi, India Avdhesh Kumar, New Delhi, India G. Anil Kumar, Gurugram, India Raman K. Kumar, Cochin, India Rashmi Kumar, Lucknow, India R. Vijai Kumar, Hyderabad, India Sanjiv Kumar, New Delhi, India Sathish Kumar, Bengaluru, India India: Health of the Nationâ&#x20AC;&#x2122;s States
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Sunil Kumar, Ahmedabad, India Anura V. Kurpad, Bengaluru, India Hmwe H. Kyu, Seattle, USA Laishram Ladusingh, Mumbai, India Shiv Lal, New Delhi, India Avula Laxmaiah, Hyderabad, India Stephen S. Lim, Seattle, USA Derek Lobo, Manipal, India Rakesh Lodha, New Delhi, India Thingnganing Longvah, Hyderabad, India Jayaram Madala, Hyderabad, India P.A. Mahesh, Mysore, India Rajesh Malhotra, New Delhi, India Matthews Mathai, Liverpool, UK Ashish J. Mathew, Vellore, India Joseph L. Mathew, Chandigarh, India Manu R. Mathur, Gurugram, India Prashant Mathur, Bengaluru, India Dileep Mavalankar, Gandhinagar, India Sanjay Mehendale, New Delhi, India Ravi Mehrotra, Noida, India Geetha R. Menon, New Delhi, India Ahmed J. Mohamed, New Delhi, India B.V. Murali Mohan, Bengaluru, India Dinesh Mohan, New Delhi, India Viswanathan Mohan, Chennai, India Ajit Mukherjee, New Delhi, India Satinath Mukhopadhyay, Kolkata, India Pallavi Muraleedharan, Gurugram, India Manoj Murhekar, Chennai, India Christopher J.L. Murray, Seattle, USA G.V.S. Murthy, Hyderabad, India Parul Mutreja, Gurugram, India Mohsen Naghavi, Seattle, USA Nitish Naik, New Delhi, India Sanjeev Nair, Trivandrum, India Saritha Nair, New Delhi, India Sreenivas A. Nair, New Delhi, India Lipika Nanda, Bhubaneswar, India A. Nandakumar, Bengaluru, India Romi S. Nongmaithem, Imphal, India Anu M. Oommen, Vellore, India Arvind Pandey, New Delhi, India Rajendra Pandey, Kolkata, India Jeyaraj D. Pandian, Ludhiana, India Sapan Pandya, Ahmedabad, India Sreejith Parameswaran, Puducherry, India Vikram Patel, Gurugram, India Sanghamitra Pati, Bhubaneswar, India Vinod K. Paul, New Delhi, India C. Ponnuraja, Chennai, India Dorairaj Prabhakaran, Gurugram, India Kameshwar Prasad, New Delhi, India Narayan Prasad, Lucknow, India Manorama Purwar, Nagpur, India Kirankumar Rade, New Delhi, India Manju Rahi, New Delhi, India 212
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Asma Rahim, Kozhikode, India Neena Raina, New Delhi, India Sreebhushan Raju, Hyderabad, India Siddarth Ramji, New Delhi, India Thara Rangaswamy, Chennai, India Paturi V. Rao, Hyderabad, India Raghuram Rao, New Delhi, India Reeta Rasaily, New Delhi, India Goura K. Rath, New Delhi, India H.K.T. Raza, Jabalpur, India K. Srinath Reddy, Gurugram, India Robert C. Reiner, Seattle, USA C.R. Revankar, Mumbai, India Gregory A. Roth, Seattle, USA Sarit K. Rout, Bhubaneswar, India Ambuj Roy, New Delhi, India Nupur Roy, New Delhi, India Yogesh Sabde, Bhopal, India K.S. Sachdeva, New Delhi, India Harsiddha Sadhu, Ahmedabad, India Rajesh Sagar, New Delhi, India Damodar Sahu, New Delhi, India Sundeep Salvi, Pune, India Parag Sancheti, Pune, India Mari J. Sankar, New Delhi, India Dipika Saraf, New Delhi, India Sanjeev B. Sarmukaddam, Pune, India Sakthivel Selvaraj, Gurugram, India P.K. Sen, New Delhi, India Suresh Seshadri, New Delhi, India B. Sesikeran, Hyderabad, India Meenakshi Sharma, New Delhi, India Rajendra Sharma, Mumbai, India Ravendra K. Sharma, Jabalpur, India R.S. Sharma, New Delhi, India Chander Shekhar, New Delhi, India Anita Shet, Baltimore, USA D.K. Shukla, New Delhi, India Rajan Shukla, Hyderabad, India Sharvari R. Shukla, Pune, India Gagandeep Singh, Ludhiana, India Jitenkumar Singh, New Delhi, India Lucky Singh, New Delhi, India Manjula Singh, New Delhi, India Narinder P. Singh, New Delhi, India Neeru Singh, Jabalpur, India Shalini Singh, New Delhi, India Virendra Singh, Jaipur, India Anju Sinha, New Delhi, India Dhirendra N. Sinha, Patna, India V. Sreenivas, New Delhi, India R.K. Srivastava, New Delhi, India P.K. Srivastava, New Delhi, India A. Srividya, Puducherry, India Jeffrey D. Stanaway, Seattle, USA R. Sujatha, Chennai, India Dipika Sur, Kolkata, India
Vanita Suri, Chandigarh, India Rajaraman Swaminathan, Chennai, India Soumya Swaminathan, New Delhi, India L. Swasticharan, New Delhi, India P.N. Sylaja, Trivandrum, India Babasaheb Tandale, Pune, India Nikhil Tandon, New Delhi India J.S. Thakur, Chandigarh, India Kavumpurathu R. Thankappan, Trivandrum, India Nihal Thomas, Vellore, India G.S. Toteja, New Delhi, India Suryakant Tripathi, Lucknow, India Srikanth Tripathy, Chennai, India K. Vaitheeswaran, Bengaluru, India Neena Valecha, New Delhi, India Chris M. Varghese, Gurugram, India Mathew Varghese, Bengaluru, India Santosh Varughese, Vellore, India S. Venkatesh, New Delhi, India K. Venugopal, Thiruvalla, India Lakshmi Vijayakumar, Chennai, India R.N. Visweswara, Bengaluru, India Theo Vos, Seattle, WA, USA Haidong Wang, Seattle, USA Harvey Whiteford, Brisbane, Australia Joan E. Williams, Seattle, USA Denis Xavier, Bengaluru, India Geetika Yadav, New Delhi, India Chittaranjan S. Yajnik, Pune, India Geevar Zachariah, Thrissur, India Sanjay Zodpey, Gurugram, India
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