Reasons for premature deaths in India have seen a significant shift over the past two decades. In 1990, the top five reasons were communicable diseases. In 2010, two of the top five reasons for premature deaths are non-communicable diseases (NCDs). Diet-related risks are the leading risk factor in India.
These findings are a part of the report released by the World Bank and the Institute for Health Metrics and Evaluation (IHME), University of Washington. The report, "The Global Burden of Disease: Generating Evidence, Guiding Policy: South Asia Regional Edition", is based on the Global Burden of Diseases, Injuries, and Risk Factors Study of 2010 (GBD 2010), a collaborative effort of researchers from 50 countries.
The report explores changes in the leading causes of premature mortality and disability in South Asia and compares performance of countries.
In India in 1990, diarrheal diseases (12.4 per cent of total premature deaths), lower respiratory infections (10.3 per cent), pre-term birth complications (8.3 per cent), tuberculosis (4.4 per cent) and neonatal sepsis (4.6 per cent)—all communicable—were the top five causes for premature deaths. The data of 2010 suggests that while the first three remain among the top reasons, TB and sepsis have been replaced by ischemic heart disease (6.7 per cent) and chronic obstructive pulmonary disease (COPD) (4.7 per cent), which are NCDs. The total share of top three reasons now is 7.4 per cent for pre-term birth complications, 6.9 per cent for lower respiratory infections and 6.8 per cent for diarrheal diseases.
In the same duration, all-cause mortality has declined across all age groups, with maximum reduction in females aged 1-4 years (63 per cent) and least in males aged 35-39 (1 per cent). Of the 25 most important causes of disease burden, measles showed the largest decrease. Number of deaths due to measles fell by 63 per cent in 20 years. Among other reasons, self-harm (mostly suicide) and road injuries have seen a jump. While the increase in self-harm as the reason is 154 percent, for road injuries it is 63 per cent.
The condition in India conforms to the trend in the rest of South Asia where premature death and disability from communicable and nutritional diseases such as pneumonia, diarrheal diseases, and malnutrition have decreased. On the other hand early death and illness from NCDs and injuries has increased substantially.
People live longer but suffer more
According to the report, people are living longer in South Asian countries than ever before. However, quality of life has deteriorated because of NCDs. Major reasons of which the potential has increased are ischemic heart disease or coronary artery disease (up by 73 per cent), low back pain (up 63 per cent), and diabetes (up 104 per cent).
“The rapid shifts in disease burden place poor people in low- and middle-income countries at high risk of not having access to appropriate services and incurring payments for health care that push them deeper into poverty,” said Timothy Evans, Director of Health, Nutrition and Population at the World Bank Group.
Among the top five risk factors for disease burden in children, factors such as household air pollution and childhood underweight declined between 1990 and 2010. But premature death and disability from risk factors related to NCDs such as poor diet, smoking, and high blood pressure increased. Disease burden relating to dietary risks increased by 70 per cent, high blood pressure by 68 per cent and smoking by 21 per cent. On the other hand, burden due to household air pollution decreased by 27 per cent and childhood underweight by 69 per cent.
“South Asian countries have made great strides toward preventing child mortality related to hunger, and some improvements in indoor air pollution from use of solid fuels such as coal, wood, and dung for cooking, but these risk factors remain dominant causes of disease burden in the region,” said Lalit Dandona, professor at the Public Health Foundation of India in Delhi.
| Shift of mortality burden between 1990 and 2010 (in percentage)
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