Abstract
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Background/Aims
- Inflammatory bowel disease (IBD) is increasing across the globe, more so in populous countries like India. We aimed to study the disease burden and epidemiological trends of IBD in India and look closer into the disease pattern across the country from 1990 to 2019.
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Methods
- The burden of IBD was estimated in India using the data from the Global Burden of Disease estimate for 2019, which is a comprehensive worldwide project. The analysis included various parameters like incidence, prevalence, mortality, disability-adjusted life years, years lived with disability, and years of life lost as age-adjusted rates (per 100,000 population). Using modeling, the prediction was also made for 2050 in India.
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Results
- The age-standardized incidence, prevalence, mortality, and disability rates of IBD in India for 2019 were 2.34, 20.34, 0.40, and 13.04, respectively. These are lower than the global incidence, prevalence, mortality, and disability rates of 4.97, 59.25, 0.54, and 20.15, respectively. The annual rates of change in incidence, prevalence, mortality, and disability rates in India from 1990 to 2019 were 0.05, –0.02, –0.36, and –0.35, respectively. The annual rates of change in incidence and prevalence are higher than the global rate of –0.18 and –0.19, while the annual rates of change in mortality and disability are lower than the global rate of –0.19 and –0.26.
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Conclusions
- The incidence and prevalence of IBD in India are lower compared to the global population but are increasing at a faster rate than the global population.
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Keywords: Crohn disease; Ulcerative colitis; Inflammatory bowel disease; Incidence; Prevalence
INTRODUCTION
Inflammatory bowel disease (IBD) has traditionally been considered as a disease of the developed countries. With time, IBD has become a truly global disease, with an increasing incidence being noted in some of the developing countries in Asia, Africa, and Eastern Europe [1]. It is a chronic relapsing illness with different therapeutic approaches offering response and remission but without any cure. This rising incidence, as well as prevalence, will likely be a burden on the health infrastructure of developing countries in the near future. The disability and morbidity associated with IBD will not only impact the quality of life of IBD patients but also have an impact on psycho-social health. Understanding the epidemiological trend and pattern will be important for the management of the disease. With the rise in incidence of IBD in populous Asian countries like India and China, the disease burden will likely surpass that of the West [2]. It is important for policymakers to be aware of the likely numbers to be witnessed so that the infrastructural and manpower-related parameters required to tackle the rising numbers can be organized.
The Global Burden of Diseases (GBD), injuries, and risk factors study is a compilation study of the quantification of the disease burden of 369 diseases and injuries in 204 countries and territories across the globe from 1990 to 2019 [3]. The project attempts to understand the true nature of diseases’ burden as well as descriptive trends with epidemiological statistics in a comprehensive way. The previous GBD study of 2017 showed a rise in the age-standardized prevalence of IBD rate from 79.5 (75.9–83.5) per 100,000 population in 1990 to 84.3 (79.2–89.9) per 100,000 population in 2017 across the globe [4]. India is the most populous country in the world, and the disease profile here would be decisive in the efforts to provide care to patients. These efforts include targeted interventions and health policies to provide holistic care to patients of IBD. We aimed to study the disease burden and epidemiological trends of IBD in India and look closer into the disease pattern across the country from 1990 to 2019.
METHODS
1. Data Source
This analysis estimated the burden of IBD in India using the data from GBD 2019, which is a comprehensive worldwide project associated with 369 illnesses and 87 risk variables across 204 territories and nations [3]. The information in this study about the mortality and non-mortality parameters of IBD in India between the years 1990 and 2019 was acquired using the Global Health Data Exchange query tool. The incidence and prevalence data for India were obtained from https://www.healthdata.org/research-analysis/gbd for the period from 1990 to 2019. This online data source is maintained by the Institute for Health Metrics and Evaluation, which is part of a global partnership that continues to offer extensive health-related data. This research was exempted from ethical approval as the research involved information freely available in the public domain. This is a review report derived from GBD 2019 database. Hence the patients were not directly involved. Appropriate consenting procedures were followed in the GBD 2019 study.
2. Definitions and Measures
The definition of IBD in the GBD dataset was in agreement with the International Classification of Disease (ICD) definitions version 10 and included ICD-10 codes, K50 (Crohn’s disease), K51 (ulcerative colitis), and K52 (indeterminate colitis). The primary objective of this analysis is to quantify the disease burden of IBD in India. For every indicator of disease burden (incidence, prevalence, mortality, disability-adjusted life years [DALY], years lived with disability [YLD], and years of life lost [YLL]), data were recorded as both crude and age-adjusted rates (per 100,000 population). The incidence rate was defined as the number of newly diagnosed IBD cases each year per 100,000 people. The prevalence rate was defined as the total number of patients with IBD (new+old) each year per 100,000 people. DALY, a summary measure of total health loss, was calculated as a sum of YLL and YLD. Age adjustment is accomplished by first multiplying the age-specific rates of disease by age-specific weights (proportion of the population within each age group). The weighted rates are then summed across the age groups to give the age-adjusted rate.
3. Modeling
A linear regression model was employed to forecast future values. The decision to use this model was based on the graphical visualization of the data within the existing period. The dataset was pre-processed for consistency. No missing data were present, so no imputation was necessary. The model was trained using historical data from 1990 to 2019 from India and was used to predict the incidence and prevalence for the year 2050. Separate models were constructed for incidence and prevalence data. The year was considered the independent variable, while incidence and prevalence were considered dependent variables separately for each model (incidence model and prevalence model). The performance of the linear regression model was validated using the R-square metric (R²) [5].
RESULTS
1. Incidence of IBD in India
The expected number of new IBD cases in India in 2019 was 31,774 (95% confidence interval [CI], 26,432 to 38,972), contributing to approximately 8% of the global incidence. The age-standardized incidence rate (ASIR) of IBD in India for 2019 was 2.34 (95% CI, 1.95 to 2.86). This is lower than the global incidence rate of 4.97 (95% CI, 4.43 to 5.59)/100,000, as well as the rate in Asia of 2.94 (95% CI, 2.53 to 3.44)/100,000 (Fig. 1). The annual rate (1990–2019) of change in ASIR in India was 0.05 (95% CI, 0.02 to 0.08), higher than the global change rate of –0.18 (95% CI, –0.20 to –0.17) but lower than the rate change in Asia (0.26; 95% CI, 0.23 to 0.30).
Comparison of Sex and Age Groups
The ASIR of IBD in India was higher for males compared to females (2.59; 95% CI, 2.15 to 3.20 vs. 2.09; 95% CI, 1.75 to 2.53) (Fig. 2A), whereas the annual rate of change in ASIR was higher in females (0.08; 95% CI, 0.06 to 0.11 vs. 0.03; 95% CI, 0.00 to 0.06) (Table 1). The incidence rate in the year 2019 was highest in the age group of 50 to 74 years (4.67; 95% CI, 3.57 to 6.15) (specifically highest in the age group of 50–54 years with a rate of 4.91; 95% CI, 3.58 to 6.60), followed by the age group of > 75 years (3.68; 95% CI, 2.62 to 5.15), and 25–49 years (3.41; 95% CI, 2.66 to 4.29) (Fig. 2B). The annual rate of change in incidence rate (1990–2019) is highest in the age group of > 75 years (0.27; 95% CI, 0.23 to 0.33), followed by the age group of 50–74 years (0.17; 95% CI, 0.14–0.21). On the other hand, the annual rate of change in incidence rate in the age group of 25–49 years was –0.01 (95% CI, –0.04 to 0.02).
2. Prevalence of IBD in India
The expected number of IBD cases in India in 2019 was 270,719 (95% CI, 219,873 to 332,264). The age-standardized prevalence rate (ASPR) of IBD in India in 2019 was 20.34 (95% CI, 16.57 to 24.97). This is compared to 39.37 (95% CI, 33.70 to 45.81)/100,000 in Asia and 59.25 (95% CI, 52.78 to 66.47)/100,000 in the global population (Fig. 1). The annual rate (1990–2019) of change in prevalence in India was –0.02 (95% CI, –0.04 to 0.01), higher than the global change rate of –0.19 (95% CI, –0.21 to –0.17) but lower than the rate change in Asia (0.32; 95% CI, 0.27 to 0.37).
Comparison of Sex and Age Groups
The ASPR was comparable between males (20.63; 95% CI, 16.73 to 25.66) and females (20.09; 95% CI, 16.45 to 24.62) in India (Fig. 2A), which is similar to the global trend (Table 1). On the contrary, the annual rate of change in ASPR was higher in females (0.01; 95% CI, –0.02 to 0.04 vs. –0.03; 95% CI, –0.06 to 0.00). The prevalence rate in the year 2019 was highest in the age group of 50–74 years (48.88; 95% CI, 38.39 to 63.50) (specifically highest in the age group of 55–59 years with a rate of 53.1; 95% CI, 40.49 to 69.88), followed by the age group of > 75 years (32.43; 95% CI, 23.62 to 42.70), and 25–49 years (27.66; 95% CI, 21.16 to 34.85) (Fig. 2B). The annual rate of change in prevalence rate (1990–2019) is highest in the age group of > 75 years (0.19; 95% CI, 0.14 to 0.24), followed by the age group of 50–74 years (0.03; 95% CI, 0.00 to 0.07).
3. Mortality-Related to IBD in India
The expected number of deaths related to IBD in India for the year 2019 was 4,214 (95% CI, 2,950 to 5,531). The age-standardized mortality rate (ASMR) for IBD in India in 2019 was 0.40 (95% CI, 0.29 to 0.53). This is in comparison to 0.33 (95% CI, 0.28 to 0.37) in Asia and 0.54 (95% CI, 0.46 to 0.59) in the global population. The annual rate (1990–2019) of change in ASMR in India was –0.36 (95% CI, –0.50 to –0.17), and this decline was more than the global change rate of –0.19 (95% CI, –0.09 to –0.29), but higher than the rate change in Asia (–0.52; 95% CI, –0.62 to –0.34) (Fig. 1).
Comparison of Sex and Age Groups
The ASMR of IBD in India was higher for males compared to females (0.44; 95% CI, 0.31 to 0.68 vs. 0.37; 95% CI, 0.24 to 0.49), whereas the annual rate of change in ASMR was higher in females (–0.31; 95% CI, –0.52 to 0.01 vs. –0.39; 95% CI, –0.55 to –0.12) (Table 1). The mortality rate in the year 2019 was highest in the age group of > 75 years (4.30; 95% CI, 3.21 to 5.67) (specifically highest in the age group of more than 95 years with a rate of 14.53; 95% CI, 7.54 to 27.13), followed by the age group of 50–74 years (0.82; 95% CI, 0.57 to 1.08), and 25–49 years (0.17; 95% CI, 0.11 to 0.23). The annual rate of change (reduction) in mortality was highest in the age group of 25–49 years (–0.41; 95% CI, –0.55 to –0.18), followed by 10–24 years (–0.38; 95% CI, –0.54 to –0.02).
4. Disability-Adjusted Life Years
The age-standardized disability rate (ASDR) for Indian patients with IBD in 2019 was 13.04 (95% CI, 9.44 to 16.50). This ASDR in Indian patients with IBD was comparable to the Asians with a rate of 13.51 (95% CI, 11.08 to 16.21) but lower than the global rate of 20.15 (95% CI, 16.86 to 23.71). The annual rates of change in DALY related to IBD in India, Asia, and the global population were –0.35 (–0.47 to –0.19), –0.36 (–0.46 to –0.19), and –0.26 (–0.32 to –0.17), respectively (Fig. 1).
Comparison of Sex and Age Groups
While the ASDR for 2019 was slightly lower in Indian females than males (12.40; 95% CI, 8.31 to 15.98 vs. 13.74; 95% CI, 9.99 to 19.39), the annual rate of change in DALY was lower in males compared to females (–0.37; 95% CI, –0.52 to –0.16 vs. –0.32; 95% CI, –0.47 to 0.01) (Table 1). The DALY rate in the year 2019 was highest in the age group of > 75 years (38.36; 95% CI, 29.37 to 49.38) (specifically highest in the age group of more than 95 years with a rate of 80.03; 95% CI, 44.00 to 145.33), followed by the age group of 50–74 years (15.25; 95% CI, 11.35 to 19.20), and 25–49 years (12.81; 95% CI, 9.17 to 16.45). The annual rate of change in DALY was highest in the age group of 50–74 years (–0.28; 95% CI, –0.43 to –0.09), followed by 25–49 years (–0.33; 95% CI, –0.46 to –0.15).
5. Impairment: Anemia in IBD
The ASPR of IBD patients with anemia in India in 2019 was 9.70 (95% CI, 7.98 to 11.79). This is in comparison to 13.09 (95% CI, 11.29 to 14.99) in Asia and 18.43 (95% CI, 16.36 to 20.59) in the global population. Despite a lower ASPR of IBD patients with anemia in India, the proportion of IBD patients with anemia is higher in India (47.72; 95% CI, 46.83% to 48.83%) than in Asia (33.25; 95% CI, 32.31% to 34.29%) or global population (31.11; 95% CI, 30.30% to 31.97%) (Fig. 3A). The annual rate (1990–2019) of change in the prevalence rate of IBD with anemia in India was –0.01 (95% CI, –0.04 to 0.02), higher than the global change rate of –0.23 (95% CI, –0.25 to –0.20), but lower than the rate change in Asia (0.09; 95% CI, 0.04 to 0.15).
Comparison of Sex and Age Groups
The prevalence of anemia in IBD patients in India was significantly higher for females compared to males (60.38; 95% CI, 58.69% to 61.97% vs. 35.88; 95% CI, 35.04 to 36.85) (Fig. 3B). The annual rate of change in ASPR for IBD patients with anemia was higher in females (0.00; 95% CI, –0.03 to 0.04 vs. –0.04; 95% CI, –0.08 to 0.01). The prevalence of anemia in the year 2019 was highest in the age group of < 20 years (53.04; 95% CI, 51.79 to 54.30) (specifically highest in the age group of 15–19 years with a rate of 56.58; 95% CI, 55.17 to 57.92), followed by the age group of 25–49 years (51.68; 95% CI, 50.32 to 53.01), and > 75 years (46.46; 95% CI, 45.26 to 47.66).
6. State-Wise Data Analysis
Among the Southern states, Kerala had the highest ASPR and YLD for 2019, whereas Telangana, followed by Andhra Pradesh, had the highest rate of change in ASPR and YLD. Among the Eastern states, Odisha had the highest ASMR and DALY rate for 2019. Among the Northern states, Himachal Pradesh had the highest ASIR for 2019, along with the highest rate of change in ASIR, Delhi had the highest ASPR, and Uttar Pradesh had the highest ASMR, DALY, and YLL. Among the Central states, Chhattisgarh had the highest ASMR and DALY rate for 2019. Among the Western states, Goa had the highest ASIR, ASPR, and YLD for 2019, Maharashtra had the highest rate of change in ASIR, while Rajasthan had the highest rate of change in ASPR and YLD. All the Northeastern states showed an increased burden, with Nagaland and Manipur showing the highest ASIR for 2019, Assam and Manipur showing the highest ASMR for 2019, Nagaland and Mizoram showing the highest rate of change in ASIR, and Assam showing high rates of DALY and YLL (Table 2). Figs. 4 and 5 show the ASIR and ASPR for various states in India with annual rate of change.
7. Prediction for Future
The predicted ASMR from GBD data in 2040, using better or worse scenarios, will be 0.69 (95% CI, 0.45 to 1.08)/100,000 and 0.70 (95% CI, 0.46 to 1.09)/100,000, respectively. The R² metric for the developed model was 0.965 for incidence and 0.960 for prevalence, both indicating a strong relationship. Based on the existing data for India in 2050, the forecasted incidence and prevalence are 53,913 cases and 456,921 cases, respectively (Fig. 6).
DISCUSSION
There is a rapidly changing epidemiological pattern in IBD in India. The incidence rate for 2019 in India is lower than in both Asia and the world, while the annual rate of change in incidence is highest in Asia, India, and the world. The changing epidemiological pattern includes higher incidence in males, a higher rate of change in females, the highest incidence rate in 50–74 years, and a higher rate of change in ages > 75 years. The prevalence rate for 2019 in India is lower than in both Asia and the world, while the annual rate of change in incidence is highest in Asia, India, and the world. The prevalence is comparable between males and females, but the rate of change is higher in females. The incidence rate is highest in 50–74 years, but the rate of change is highest in age > 75 years. The mortality rate for 2019 in India is higher than in Asia but lower than in the world, while the annual rate of change in mortality is highest in the world, India, and Asia. The mortality is higher in males, but the rate of change is higher in females. DALY rates for 2019 are the same in India and Asia and higher in the world. Also, annual rates of change in DALY are the same in India and Asia and higher in the world. The DALY rate is higher in females, but the rate of change is higher in males.
The ASIR of IBD in India for 2019 was lower compared to the global data (2.94/100,000 vs. 4.97/100,000). However, the annual rate (1990–2019) of change in ASIR in India was higher than the global trend (0.05/100,000 vs. –0.18/100,000). Despite having a lower incidence rate compared to the global population, the annual rate of change is higher in the Indian population. Thus, while the ASPR of IBD in India is lower compared to Asia, the ASMR remains higher in India. This may be because of the poor access to healthcare and the lack of dedicated centers for the management of such patients. Despite the increased incidence and prevalence of IBD in India, there has been a reduction in DALY. This may be due to early diagnosis and the availability of better treatment options for the management of IBD.
The annual rates of change in ASIR and ASPR were both higher in females than males. Thus, there is a rise in the incidence and prevalence of IBD among the female population. The annual rate of change in incidence and prevalence rates (1990–2019) were both highest in the age group of > 75 years, followed by the age group of 50–74 years. Previous studies have reported that the peak age of IBD incidence ranges from the second to third decades of life. However, this data is based on older studies conducted in the 19th century [6]. There is emerging data from studies done after 2000, which show that there is a second peak in the higher age group, which is emerging as the peak age of presentation [7-9]. The incidence of IBD was highest in the age group of 50–74 years for India, similar to the global GBD data reporting peak incidence in 50–54 years and 60–64 years, respectively, among females and males [10]. Thus, there is a rise in the prevalence of IBD among the older population in India. This is possibly due to changes in the environment and dietary factors, along with an increase in life expectancy in the general population in India, leading to prolonged life of already diagnosed cases of IBD [11].
There were only 2 prevalence studies from India. The first was done by Khosla et al. [12] 1986 which showed that the prevalence of ulcerative colitis was 42.8/100,000 persons in Haryana, India. The other study was conducted by Sood et al. in 2003 [13], which showed a prevalence of 44.3/100,000 in Punjab, India. It has been over a decade since the last community prevalence study in India. The GBD data showed that the rise in incidence in cases was more seen in Maharashtra, while Rajasthan had the highest rate of change in prevalence. There was an increasing burden of disease in the Northeastern states, especially Nagaland and Manipur, showing rising incidence, while Assam and Manipur showed increasing mortality. A study from North India revealed an increasing prevalence of Crohn’s disease with younger age at diagnosis [14]. These numbers should raise concern regarding the need for more studies especially from these regions.
The delay in diagnosis plays a crucial role in the understanding of the incidence and prevalence of IBD [15]. A study showed that the time to diagnosis was longer in patients of IBD from low and middle-income countries as compared to high-income countries [16]. The time to diagnosis was approximately 11.7 months in Crohn’s disease and 7.8 months in ulcerative colitis. Quick diagnosis and better access to health care in suburbs and rural areas could rapidly increase the numbers of IBD in India. This will also increase the disease burden of more complicated diseases in IBD.
There is a previous study on GBD of IBD, which has limited information focusing on India [17]. We provide a detailed analysis of GBD data in India with a focus on geographic distribution. Despite this, there are a number of limitations, just as with any prediction model. First, the quality and availability of data collected have a significant impact on the accuracy of the estimated GBD data. India does not have IBD-related registries, disease-specific censuses, civil registration, or IBD-related notifications [18]. A national IBD registry was started in 2014–2015, but it had limited centers from Eastern and Western India with a lack of follow-up [19]. In the absence of accurate data, estimations might only be based on global trends or predictive variables from surrounding countries. Hence, the GBD information might underestimate India’s true picture of disease, and the prediction for 2050 might be lower than the actual scenario. Second, we cannot establish the causality of population data with the rising incidence and prevalence of IBD as there are mere statistical associations. Third, good quality studies on epidemiology with data on various risk factors are required. Fourth, the long-term data follow-up of patients of IBD is lacking. Lastly, stratified data of patients with ulcerative colitis and Crohn’s disease were unavailable.
To conclude, the incidence and prevalence of IBD is rising in India at a rate more than that of the global population. With industrialization, the numbers in India could reach new peaks, which could be troubling for healthcare providers. There is a higher rate of change in incidence and prevalence in the females and older population. There is a higher prevalence of anemia in Indian patients with IBD, which requires attention. With more patients being diagnosed and increasing survival, the 2050 scenario could be much worse than the actual predictions.
NOTES
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Funding Source
The authors received no financial support for the research, authorship, and/or publication of this article.
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Conflict of Interest
No potential conflict of interest relevant to this article was reported.
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Data Availability Statement
Data sharing is not relevant because no dataset was generated for this study.
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Author Contributions
Conceptualization: Giri S, Jena A. Methodology: Giri S, Jena A, Kumar-M P, Sharma V. Formal analysis: Giri S, Kumar-M P, Muniswany JR. Project administration: Nath P, Sharma V. Visualization: Giri S, Kumar-M P, Muniswany JR. Writing-original draft: Giri S, Jena A. Writing-review & editing: Giri S, Jena A, Kumar-M P, Muniswany JR, Nath P, Sharma V. Approval of final manuscript: all authors.
Fig. 1.Comparison of trend of age-standardized (A) incidence, (B) prevalence, (C) mortality, and (D) disability-adjusted life year (DALY) rates between India, Asia, and the Global population.
Fig. 2.Age-standardized incidence and prevalence rates of inflammatory bowel disease in India according to (A) sex and (B) age groups.
Fig. 3.Comparison of the trend of prevalence of anemia among patients with inflammatory bowel disease between (A) India, Asia, and the global population, and (B) Indian females and males.
Fig. 4.Age-standardized (A) incidence rate for the year 2019 and (B) annual rate of change (1990–2019) in incidence in various states of India. The image was created by MapChart.
Fig. 5.Age-standardized (A) prevalence rate for the year 2019 and (B) annual rate of change (1990–2019) in prevalence in various states of India. The image was created by MapChart.
Fig. 6.Predicted (A) incidence and (B) prevalence of inflammatory bowel disease in India for the year 2050 based on the existing data.
Table 1.Non-Mortality and Mortality Measures of Burden on Inflammatory Bowel Disease in India with Subgroup Analysis Based on Sex
|
Parameters |
Sex |
1990 |
2019 |
Annual rate of change |
|
Incidence |
Overall |
2.23 (1.85 to 2.73) |
2.34 (1.95 to 2.86) |
0.05 (0.02 to 0.08) |
|
Male |
2.51 (2.07 to 3.08) |
2.59 (2.15 to 3.20) |
0.03 (0.00 to 0.06) |
|
Female |
1.93 (1.61 to 2.35) |
2.09 (1.75 to 2.53) |
0.08 (0.06 to 0.11) |
|
Prevalence |
Overall |
20.68 (16.76 to 25.67) |
20.34 (16.57 to 24.97) |
–0.02 (–0.04 to 0.01) |
|
Male |
21.36 (17.21 to 26.70) |
20.63 (16.73 to 25.66) |
–0.03 (–0.06 to 0.00) |
|
Female |
19.93 (16.19 to 24.47) |
20.09 (16.45 to 24.62) |
0.01 (–0.02 to 0.04) |
|
Deaths |
Overall |
0.63 (0.43 to 0.91) |
0.40 (0.29 to 0.53) |
–0.36 (–0.50 to –0.17) |
|
Male |
0.72 (0.45 to 1.19) |
0.44 (0.31 to 0.68) |
–0.39 (–0.55 to –0.12) |
|
Female |
0.53 (0.29 to 0.80) |
0.37 (0.24 to 0.49) |
–0.31 (–0.52 to 0.01) |
|
Disability-adjusted life years (DALY) |
Overall |
20.11 (13.58 to 26.72) |
13.04 (9.44 to 16.50) |
–0.35 (–0.47 to –0.19) |
|
Male |
21.89 (15.01 to 32.56) |
13.74 (9.99 to 19.39) |
–0.37 (–0.52 to –0.16) |
|
Female |
18.19 (9.75 to 24.03) |
12.40 (8.31 to 15.98) |
–0.32 (–0.47 to 0.01) |
|
Years lived with disability (YLD) |
Overall |
3.17 (2.07 to 4.59) |
3.11 (2.03 to 4.56) |
–0.02 (–0.06 to 0.03) |
|
Male |
3.18 (2.04 to 4.63) |
3.07 (2.00 to 4.49) |
–0.03 (–0.09 to 0.03) |
|
Female |
3.15 (2.05 to 4.54) |
3.16 (2.06 to 4.57) |
0.00 (–0.06 to 0.06) |
|
Years of life lost (YLL) |
Overall |
16.95 (10.70 to 23.19) |
9.93 (6.68 to 13.18) |
–0.41 (–0.54 to –0.24) |
|
Male |
18.71 (11.96 to 29.41) |
10.67 (7.23 to 16.42) |
–0.43 (–0.57 to –0.20) |
|
Female |
15.04 (6.75 to 20.66) |
9.24 (5.47 to 12.45) |
–0.39 (–0.54 to 0.02) |
Table 2.State-Wise Data of Various Parameters for Burden of Inflammatory Bowel Disease in India
|
Location |
Area |
ASIR
|
ASPR
|
ASMR
|
DALY
|
YLD
|
YLL
|
|
2019 |
∆1990–2019 |
2019 |
∆1990–2019 |
2019 |
∆1990–2019 |
2019 |
∆1990–2019 |
2019 |
∆1990–2019 |
2019 |
∆1990–2019 |
|
Andhra Pradesh |
South |
2.19 |
0.01 |
20.34 |
0.24 |
0.38 |
–2.07 |
11.73 |
–2.01 |
3.11 |
0.23 |
8.62 |
–2.56 |
|
Arunachal Pradesh |
Northeast |
2.26 |
0.03 |
21.02 |
0.11 |
0.44 |
–0.55 |
12.69 |
–0.75 |
3.21 |
0.12 |
9.48 |
–1.00 |
|
Assam |
Northeast |
2.44 |
0.06 |
18.65 |
–0.24 |
0.54 |
–0.96 |
17.07 |
–1.10 |
2.89 |
–0.22 |
14.18 |
–1.25 |
|
Bihar |
East |
2.16 |
–0.07 |
17.85 |
–0.34 |
0.35 |
–2.51 |
12.08 |
–2.38 |
2.76 |
–0.32 |
9.33 |
–2.81 |
|
Chhattisgarh |
Central |
2.39 |
0.08 |
18.61 |
0.05 |
0.54 |
–0.45 |
16.08 |
–0.63 |
2.87 |
0.05 |
13.21 |
–0.76 |
|
Delhi |
North |
2.50 |
0.09 |
25.18 |
–0.23 |
0.34 |
–2.06 |
11.43 |
–1.65 |
3.78 |
–0.23 |
7.65 |
–2.18 |
|
Goa |
West |
2.60 |
0.25 |
25.79 |
–0.14 |
0.32 |
–2.00 |
10.70 |
–1.59 |
3.89 |
–0.12 |
6.81 |
–2.22 |
|
Gujarat |
West |
2.44 |
0.13 |
21.31 |
0.12 |
0.39 |
–2.28 |
12.94 |
–1.97 |
3.27 |
0.11 |
9.67 |
–2.47 |
|
Haryana |
North |
2.39 |
0.41 |
21.82 |
–0.13 |
0.35 |
–1.83 |
12.28 |
–1.61 |
3.32 |
–0.10 |
8.96 |
–2.03 |
|
Himachal Pradesh |
North |
2.36 |
0.28 |
22.77 |
0.12 |
0.34 |
–1.83 |
11.61 |
–1.77 |
3.44 |
0.09 |
8.17 |
–2.33 |
|
Jammu & Kashmir and Ladakh |
North |
2.36 |
0.21 |
22.52 |
0.08 |
0.36 |
–1.01 |
11.67 |
–0.98 |
3.43 |
0.07 |
8.24 |
–1.34 |
|
Jharkhand |
East |
2.21 |
0.17 |
19.22 |
–0.12 |
0.42 |
–1.16 |
12.63 |
–1.38 |
2.96 |
–0.12 |
9.67 |
–1.69 |
|
Karnataka |
South |
2.31 |
0.02 |
20.60 |
0.11 |
0.34 |
–1.34 |
11.61 |
–1.25 |
3.13 |
0.09 |
8.48 |
–1.64 |
|
Kerala |
South |
2.40 |
0.25 |
25.04 |
–0.12 |
0.23 |
–2.53 |
8.84 |
–1.73 |
3.80 |
–0.15 |
5.04 |
–2.57 |
|
Madhya Pradesh |
Central |
2.32 |
0.28 |
18.25 |
–0.32 |
0.44 |
–1.05 |
13.90 |
–1.36 |
2.82 |
–0.30 |
11.08 |
–1.58 |
|
Maharashtra |
West |
2.41 |
0.56 |
22.36 |
–0.18 |
0.34 |
–1.60 |
11.45 |
–1.32 |
3.38 |
–0.18 |
8.07 |
–1.70 |
|
Manipur |
Northeast |
2.49 |
0.04 |
20.15 |
–0.26 |
0.46 |
–1.31 |
12.74 |
–1.39 |
3.07 |
–0.27 |
9.68 |
–1.68 |
|
Meghalaya |
Northeast |
2.42 |
0.23 |
19.86 |
–0.21 |
0.44 |
–0.50 |
13.12 |
–0.77 |
3.06 |
–0.21 |
10.05 |
–0.92 |
|
Mizoram |
Northeast |
2.33 |
0.30 |
22.33 |
–0.32 |
0.40 |
–1.15 |
12.34 |
–1.16 |
3.39 |
–0.31 |
8.95 |
–1.43 |
|
Nagaland |
Northeast |
2.54 |
0.39 |
20.74 |
–0.47 |
0.42 |
–0.76 |
12.45 |
–0.82 |
3.17 |
–0.44 |
9.28 |
–0.94 |
|
Odisha |
East |
2.41 |
0.22 |
18.76 |
–0.12 |
0.46 |
–0.72 |
14.81 |
–0.84 |
2.90 |
–0.09 |
11.91 |
–1.00 |
|
Punjab |
North |
2.43 |
0.20 |
22.24 |
–0.16 |
0.35 |
–2.69 |
12.02 |
–2.28 |
3.38 |
–0.16 |
8.64 |
–2.85 |
|
Rajasthan |
West |
2.25 |
0.12 |
19.40 |
0.16 |
0.39 |
–1.37 |
13.13 |
–1.24 |
2.97 |
0.14 |
10.16 |
–1.55 |
|
Sikkim |
Northeast |
2.27 |
0.16 |
23.37 |
0.07 |
0.42 |
–1.75 |
12.25 |
–1.62 |
3.53 |
0.06 |
8.72 |
–2.12 |
|
Tamil Nadu |
South |
2.49 |
0.17 |
21.23 |
0.06 |
0.37 |
–1.97 |
11.59 |
–1.76 |
3.21 |
0.03 |
8.37 |
–2.26 |
|
Telangana |
South |
2.15 |
–0.08 |
21.83 |
0.34 |
0.36 |
–1.94 |
10.97 |
–1.86 |
3.33 |
0.32 |
7.64 |
–2.51 |
|
Tripura |
Northeast |
2.30 |
–0.09 |
20.33 |
0.01 |
0.43 |
–0.55 |
12.82 |
–0.78 |
3.11 |
–0.01 |
9.70 |
–0.99 |
|
Uttarakhand |
North |
2.67 |
0.45 |
19.83 |
0.07 |
0.44 |
–1.40 |
13.19 |
–1.33 |
3.06 |
0.09 |
10.12 |
–1.67 |
|
Uttar Pradesh |
North |
2.36 |
0.19 |
18.25 |
–0.10 |
0.59 |
–0.89 |
17.48 |
–1.20 |
2.82 |
–0.09 |
14.65 |
–1.38 |
|
West Bengal |
East |
2.27 |
0.04 |
21.38 |
–0.03 |
0.32 |
–1.58 |
10.81 |
–1.27 |
3.28 |
–0.03 |
7.53 |
–1.69 |
|
Other Union Territories |
|
2.39 |
0.16 |
25.19 |
0.02 |
0.35 |
–1.40 |
11.27 |
–1.29 |
3.79 |
–0.01 |
7.48 |
–1.79 |
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