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

IntroductionDisease 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 1980 to 2023. Material and MethodsWe extracted mortality and disability-adjusted life-year (DALY) estimates for 31 Indian states and Union Territories from 1980 to 2023 from the Global Burden of Disease 2023 Study. We used existing expert-consensus-based classifications for defining emergency (30 conditions), operative (57 conditions), and emergency-operative conditions (7 conditions). We investigated rates per 100,000 people and proportions attributable to the above conditions, expressed as percentages of total mortality and DALYs. ResultsIn 2023, emergency (mortality rate: 339 deaths per 100,000; DALY rate: 13,699 DALYs per 100,000), operative (mortality rate: 158 deaths per 100,000; DALY rate: 7,259 DALYs per 100,000), and emergency-operative conditions (mortality rate: 70 deaths per 100,000; DALY rate: 3,823 DALYs per 100,000) accounted for 49.75%, 23.11%, and 10.31% of all-cause mortality and 40.82%, 21.63%, and 11.39% of all-cause DALYs, respectively. Telangana, Chhattisgarh, and Uttarakhand had high mortality and DALY rates for all three condition groups. From 1980 to 2023, mortality and DALY rates generally decreased across all conditions, with the largest decreases in emergency conditions. States such as Kerala and Goa did not show significant decreases in their mortality and DALY rates between 1980 and 2023. ConclusionDespite significant improvements in healthcare nationwide, several states in India have shown a consistent trend over time, reporting a persistently high burden of emergency, operative, and emergency-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.