Mortality from pneumonia falls in India, more lives are lost to hypertensive heart disease

Today, fewer people are dying from pneumonia and diarrheal diseases in India, according to a new, comprehensive analysis of trend data from 188 countries. Mortality from pneumonia dropped 50% between 1990 and 2013. 

At the same time, a number of diseases, including hypertensive heart disease and suicide, claimed more lives in India  in 2013 than in 1990. Life expectancy improved for both men and women in India, at an average of 8.6 years gained  since 1990. This was a larger increase than the global average, and one of the top 25 biggest gains in life expectancy  worldwide.

Published in The Lancet on December 18, “Global, regional, and national age-sex specific all-cause and cause-specific  mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013” was  conducted by an international consortium of researchers coordinated by the Institute for Health Metrics and Evaluation  (IHME) at the University of Washington.

The leading killers in India were ischemic heart disease, chronic obstructive pulmonary disease, and stroke, accounting  for 30% of all deaths in 2013. Tuberculosis and ischemic heart disease were the top two causes of death for people between  the ages of 15 and 49, resulting in 408,114 lives lost in 2013. Among individuals 70 and older, ischemic heart disease  claimed the most lives that year. The top cause of child mortality was neonatal encephalopathy in 2013, killing 212,686  children under the age of 5.

In India, hypertensive heart disease and suicide took more lives in 2013 than in 1990, with deaths increasing 138% and  129%, respectively. Mortality from road injuries also increased 88% between 1990 and 2013. Since 1990, India saw marked declines in mortality from a number of diseases that used to take a large toll on the  country. For instance, by 2013, mortality from pneumonia decreased 50%, and diarrheal diseases caused 42% fewer deaths.

 In 1990, these diseases killed 1,532,459 people. Twenty-three years later, they claimed 715,303 fewer lives. The study also revealed how some diseases and injuries cause different mortality patterns for males and females.

 For example, in India, ischemic heart disease took a greater toll on men, killing 962,686 males and 623,823 females  in 2013. By contrast, diarrheal diseases claimed 232,825 women’s lives and 180,401 men’s lives. "We have achieved great progress in reducing mortality from a number of diseases, reflecting our country’s investments  in improving health for its citizens," says Dr. Vivekanand  Jha, Director, George Institute for Global Health-India, one  of the co-authors of the study from India. "But we are still seeing children dying, and deaths from other conditions are  rising. These data are critical to understanding where we’ve been – and then where we need to go in order to save more  lives in the future."

The George Institute for Global Health, which has been working in India to reduce the burden of premature death and  disability,  feels that these new figures are alarming and once again underscore the urgency of giving more  importance to non-communicable   diseases in the entire health care delivery system.  "This is a wake-up call for more concerted and co-ordinated action to reduce the burden of NCDs in India,"  points out Dr.  Jha. 

Globally, people live an average of 6.2 years longer than they did in 1990, with a life expectancy rising to just under  72 years in 2013. Women showed a slightly larger average gain (an increase of 6.6 years) than men (a rise of 5.8 years).  Improvements in health, reduced fertility, and shifts in the world’s age patterns have driven these global gains in life  expectancy.

In India, the average life expectancy for women was 68.5 years in 2013, with men living an average of 64.2 years. By  contrast, women lived an average of 58.2 years and men had a life expectancy of 57.3 years in 1990. Out of the 188  countries included in the study, India ranked 133rd for women and 132nd for men for longest life expectancies. In 2013,  Andorra had the longest life expectancy for women (86.7 years) and Qatar had the longest for men (81.2 years).  Lesotho had the shortest life expectancy for both women (51.2 years) and men (45.6 years).

"The fact that people are living longer in most parts of the world is good news but we must do more to address health  disparities," said IHME Director Dr. Christopher Murray. "Only with the best available evidence can we develop policies  to improve health and save lives."

Worldwide, ischemic heart disease, stroke, and chronic obstructive pulmonary disease (COPD) claimed the most lives,  accounting for nearly 32% of all deaths. Much global progress has been made in reducing mortality from diseases such  as measles and diarrhea, with 83% and 51% declines, respectively, from 1990 to 2013.

The Global Burden of Disease (GBD) Study 2013 is part of an ongoing effort to produce the most timely and up-to-date  understanding of what kills and ails people worldwide. Thousands of collaborators worldwide work together to generate  annual estimates of deaths by cause, years of life lost to disability, and rates of premature mortality and illness.

 To make these data as useful and relevant to policymakers and country leaders as possible, findings from the GBD study  can be used at the global, regional, national, and even subnational levels to track trends in health over time.

 Researchers found a widening gap between countries with the lowest and highest death rates from a given disease – a  potential sign of increasing inequalities in health. They also emphasize the importance of measuring local disease  burdens, as the health challenges found in one corner of a country can widely vary from those experienced a few hours  away.

Globally, a number of diseases that have received less attention relative to others are some of the biggest causes of  premature death, particularly drug use disorders, diabetes, chronic kidney disease, and cirrhosis. The gender gap in  death rates for adults between the ages of 20 to 44 is widening and HIV/AIDS, interpersonal violence, road injuries, and  maternal mortality are some of the key conditions responsible.  For children under 5, diarrheal diseases, pneumonia,  neonatal disorders, and malaria are still among the leading causes of death.

Two diseases, HIV/AIDS and malaria, followed very different mortality trends from other diseases.  The global death toll from both diseases peaked around 2005 rather than 1990, with deaths from HIV/AIDS and malaria  declining 22% and 30%, respectively, from 2005 to 2013. For India, HIV/AIDS mortality peaked in 2002, claiming 286,602  lives. By 2013, deaths due to HIV/AIDS decreased 73%. Malaria mortality in India peaked in 1983, with 176,970 deaths,  but then fell 34% by 2013.

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The Institute for Health Metrics and Evaluation (IHME) is an independent global health research organization at the University of Washington that provides rigorous and comparable measurement of the world’s most important health problems and evaluates the strategies used to address them. IHME makes this information widely available so that policymakers  have the evidence they need to make informed decisions about how to allocate resources to best improve population  health.