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Lens on states' disease burden

New Delhi, Oct. 12: A consortium of government and academic institutions has launched India's first-ever exercise to estimate the burden of each of over 130 causes of ill-health and premature deaths in states, an initiative that experts say will help guide state-specific health policies.

The Indian Council of Medical Research and the Public Health Foundation of India, collaborating with the University of Washington, plan to generate state-level estimates of ill-health and premature deaths from a range of causes - from cancers to cirrhosis-linked to alcohol abuse, and infections to suicides.

"State-level estimates are important because national-level data are unable to capture nuances needed for state-specific actions," said Lalit Dandona, professor at the Delhi-based Public Health Foundation of India and director of the exercise.

The researchers will rely on multiple sources of data - research studies, state-level health surveys and, wherever available, hospital-based and community-based analysis of disease burden - and a modelling tool to generate estimates for as many states as possible.

Preliminary results for states' disease burden are expected by end-2016, the researchers said. "This will be a continuous exercise. We expect the estimates to improve over time," said Dandona.

A similar exercise at the national level has already revealed changing patterns in disease burdens - for instance, in 2013, coronary heart disease had taken over as the leading cause of ill-health in India from lower respiratory infections in 1990.

Chronic obstructive pulmonary disease - an illness linked to smoking and exposure to air pollution - had emerged the second leading cause of ill-health in 2013, moving up from eighth position two decades ago.

At the national level, high blood pressure, abnormal blood sugar levels and air pollution have emerged the top three risk factors for ill-health in 2013, compared to childhood under-nutrition, unsafe drinking water and poor sanitation two decades ago.

"But there is a substantial variation in disease burden trends that we need to understand at the state level to plan responses specific to local situations," said Soumya Swaminathan, director-general of the Indian Council of Medical Research.

The researchers say reliable estimates will allow financial and health policy makers to judiciously target resources to deliver "what needs to be done where". The absence of state-specific estimates could lead to a mismatch between disease burden and allocation of resources.

The India exercise is part of the so-called Global Burden of Disease study initiated by scientists at the University of Washington."This project could generate some meaningful information but only through adequate caution that the data used in the analysis is statistically reliable," said a senior health statistician who requested not to be named. "Finding reliable data in India is a difficult issue and sample size is important."

The statistician cited an independent study that had picked too small a sample and had portrayed the number of stillbirths in a community as misleadingly high.


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