Burden of Emergency and Operative Conditions in India: A state-level retrospective analysis from 1981 to 2021

Abstract Introduction Disease burden is a crucial factor in determining healthcare policy and resource allocation. We analyzed the burden of emergency and operative conditions at the subnational level in India from 1981 to 2021. Material and Methods We extracted mortality and disability-adjusted life-year (DALY) estimates for 31 Indian states and Union Territories from 1981 to 2021 from the Global Burden of Disease 2021 Study. We used existing expert-consensus-based classifications for defining emergency (30 conditions), operative (57 conditions), and emergency-operative conditions (7 conditions). We investigated the rates per 100,000 people and proportion attributed to the above conditions out of total mortality and DALYs. Results In 2021, emergency (mortality rate: 345.82 per 100,000; DALY rate: 13,862 per 100,000), operative (mortality rate: 143.07 per 100,000; DALY rate: 6,448 per 100,000), and emergency-operative conditions (mortality rate: 70.69 per 100,000; DALY rate: 3,571 per 100,000) accounted for 41.65%, 17.23%, and 8.51% of all-cause mortality and 36.98%, 17.20%, and 9.53% of all-cause DALYs, respectively. Tamil Nadu, Chhattisgarh, and Uttarakhand had higher mortality and DALY rates for the three condition groups. From 1981 to 2021, mortality and DALY rates generally decreased for all conditions, with the largest decrease for emergency conditions. Mortality rates for Nagaland, Himachal Pradesh, and Punjab either decreased minimally or increased since 2001. States such as Kerala and Goa did not show significant decreases in their DALY rates from 2011 to 2021. Conclusion Despite significant improvements in healthcare nationally, the time trend of several states in India showed a consistent trend over time, reporting a persistently high burden of emergency and operative conditions. Given the relatively large share of emergency and operative conditions toward all-cause mortality, surgical care should be a high priority in national and state-level cross-sectoral policymaking.