A study published recently has looked at the morbidity transition across States from 1995 to 2018. The study examines self-reported morbidities in India by relying on the 1995, 2004, 2014, and 2018 data from the National Sample Survey Organisation (NSSO). A large number of households were included in each survey — 120,942 households in 1995, 73,868 households in 2004, 65,932 households in 2014, and 113,823 households in 2018. Multiple kinds of diseases and disabilities were collected in each NSSO survey, and the self-reported morbidities were classified into four broad categories — infectious and communicable diseases, non-communicable diseases, disability, and injury and other diseases. The study has been published in the journal PLOS ONE.
There has been a steady upsurge in morbidity prevalence — doubling from 56 per thousand population in 1995 to 106 per thousand population in 2014. However, there has been a considerable decline in 2018 — 79 per thousand population. Compared with 1995, the reported morbidity risk transition significantly increased over successive decades — 1.81 times in 2004, 2.16 times in 2014, and 1.44 times in 2018. Across India, non-communicable diseases gained a prominent share in morbidity trends from 1995 to 2018, with Kerala reporting the highest rates followed by Andhra Pradesh, Karnataka, West Bengal and Punjab.
The study found that while the prevalence of all types of morbidities not only increased but actually doubled from 56 per thousand population in 1995 to 106 per thousand population in 2014 (and 95 per thousand population in 2004), there has been a sharp dip in 2018 when the morbidity dropped to 79 per thousand from 106 per thousand population in 2014. In the case of infectious and communicable diseases, non-communicable diseases, disability except injury and other diseases the decline started in 2004. With a prevalence of 30 per thousand population in 2018, non-communicable diseases account for a major share of prevalence; it has increased more than three times from 8.6 per thousand population in 1995. In the case of infectious and communicable diseases, the prevalence has almost doubled from 8 to 15 per thousand population in the past two decades.
“Kerala consistently stands out with the highest reported morbidity rates, recording figures of 112 per 1,000 population in 1995, 266 per 1,000 population in 2004, 370 per 1,000 population in 2014, and 294 per 1,000 population in 2018. Other States like Andhra Pradesh, West Bengal, Punjab, and others also exhibit noteworthy prevalence rates,” the authors write. “Conversely, the northern and eastern states, particularly Manipur, exhibit the lowest prevalence of morbidity conditions. In 1995, Manipur reported a mere seven cases per 1,000 individuals, which increased to 28 per 1,000 individuals in 2004, 29 per 1,000 individuals in 2014, and declined to 19 per 1,000 individuals in 2018.”
Kerala has reported the highest prevalence of non-communicable diseases — 118 per thousand individuals in 2004, 185 per thousand individuals in 2014, and 177 per thousand individuals in 2018, followed by Pondicherry, Andhra Pradesh, Goa, Tamil Nadu, and Punjab. The north-eastern States have reported the lowest prevalence of non-communicable diseases. For instance, Meghalaya reported just 1.7 per thousand individuals in 1995, two per thousand individuals in 2004, 1.4 per thousand individuals in 2014 and 0.2 per thousand individuals in 2018, followed by Nagaland, Assam, Manipur, Mizoram, Tripura, Arunachal Pradesh and Bihar. “Prevalence of non-communicable diseases has declined in several States in less than half a decade (2014 to 2018), but it is still sizably higher in numbers,” they note.
Among the older adults (60 and above) reported the highest infectious, non-communicable diseases, disability and injuries. While the non-communicable diseases burden has been higher in women than in men, the burden of non-communicable diseases has tripled in both men and women between 1995 and 2014.
“As India undergoes concurrent demographic and epidemiological transitions, our study aligns with this dynamic shift. Notably, it highlights significant disparities in reporting morbidity burdens across different States from 1995 to 2018,” says Mahadev Bramhankar, a PhD scholar from the International Institute for Population Sciences (IIPS), Mumbai and the corresponding author of the paper. “These variations are attributed to distinct demographic, social, and economic determinants characterising each State, contributing to the nuanced landscape of health challenges across the nation.”
Many studies have discussed the epidemiological transition based on various aspects using demographic and morbidity data in India in the recent past. “But our study contributes additional insights by extending beyond a national perspective and conducting a meticulous analysis at the State level and determinants, especially in morbidity context,” Bramhankar says.
“The ageing population and rising life expectancy are concurrently fuelling the prevalence of non-communicable diseases without necessarily displacing existing infectious and communicable morbidities. Among all the morbidities over the period of disease transition from 1995 to 2018, non-communicable diseases are most predominantly gaining share,” he says.
