Kumar G Anil, Pandey Anamika, Mohan Sailesh, Prabhakaran Dorairaj, Dandona Rakhi
Public Health Foundation of India, House No. 60, 4th Floor, Lane 2, Part of Saidulajab Extension, Near Saket Metro Station Gate No. 2, New Delhi, India.
Centre for Chronic Disease Control, C1/52, 2nd Floor, C1/52, New Delhi, Safdarjung Development Area, 110016, India.
BMC Geriatr. 2024 Dec 19;24(1):1019. doi: 10.1186/s12877-024-05614-w.
In the context of the increasing number and proportion of population aged 60 years or more in India, it is imperative to understand their health needs for ensuring healthy ageing.
Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we identified the top ten causes of disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs) disaggregated by sex and age groups (60-64 years, 65-69 years, 70-74 years, 75-79 years, and ≥ 80 years) for India in 2019. We analysed the proportional contribution of individual causes to the total DALYs due to communicable diseases (CMNNDs), non-communicable diseases (NCDs), and injuries disaggregated by age and sex. We report the state-level heterogeneity in the crude DALY rate for CMNNDs, NCDs, and injuries for older persons disaggregated by sex. Additionally, we reviewed if the data capture of service delivery indicators on older persons were age- and sex-disaggregated in the Health and Wellness Centres (HWCs), and in the National Programs aimed at the Health Care for the Elderly (NPHCE), Prevention and Control of Non-communicable Diseases (NP-NCD), Control of Blindness and Visual Impairment (NPCBVI), Prevention & Control of Deafness (NPPCD), the Mental Health Program (NMPH), and the AYUSH Musculoskeletal Disorders Program (MSDP) within the context of disease burden.
The older persons accounted for a total of 136.1 million DALYs (29.1% of the total DALYs) in 2019 of which 77.9% were from NCDs, 14.8% from CMNNDs, and 7.3% from injuries, and nearly two-thirds of DALYs were accounted by YLLs. In NCDs, cardiovascular diseases, chronic respiratory diseases, neoplasms, diabetes and kidney diseases, and musculoskeletal disorders accounted for nearly 80% of DALYs for both sexes. There were variations in the magnitude of disease burden by specific diseases and conditions between females and males, and by age groups within both sexes particularly for injuries and CMNNDs. Injuries accounted for more YLDs than YLLs, ranging between 5.9%-15.2% for females and 15.3%-17.3% for males, with the females having a higher contribution to total injury related DALYs due to falls as compared to the males (54.4% vs 36.6%), whereas the males had a higher contribution to total DALYs due to road injuries (33.8% vs 19.4%). There was substantial variation in the crude DALY rates of major disease groups by the two sexes across the states of India in 2019. The crude DALY rate for CMNNDs varied between 3.6 times -3.7 times between the states for females and males, respectively; NCDs varied between 1.3 times -1.9 times, and injuries varied 2.0 times -1.7 times. The capture of service utilisation indicators was not age- or sex-disaggregated in NPHCE, NPCBVI, NMHP, MSDP, and HWCs; sex-disaggregation was available in NP-NCD but not age-disaggregation; sex-disaggregated data was available for many service indicators in NPPCD but with no age disaggregation beyond 50 years and more. Only NP-NCD and NPPCD allowed for data capture by disease/condition or severity of disease/condition for the older persons whereas the other programs including NPHCE did not allow for much disaggregated understanding by the type of services availed.
This comprehensive assessment of the differentials in disease burden among older persons across age, sex and states of India, and the gaps identified in the service utilisation data capture by age and sex for the older persons in the national health programs can provide crucial inputs for strengthening the on-going public health policy and programmatic efforts aimed at improving the health and well-being of the growing older population in India.
在印度60岁及以上人口数量和比例不断增加的背景下，了解他们的健康需求对于确保健康老龄化至关重要。
利用《2019年全球疾病、伤害及风险因素负担研究》（GBD 2019）的数据，我们确定了2019年印度按性别和年龄组（60 - 64岁、65 - 69岁、70 - 74岁、75 - 79岁以及≥80岁）划分的残疾调整生命年（DALYs）、生命损失年数（YLLs）和残疾生存年数（YLDs）的十大原因。我们分析了各类原因对按年龄和性别划分的传染病（CMNNDs）、非传染病（NCDs）和伤害导致的总DALYs的比例贡献。我们报告了按性别划分的老年人中CMNNDs、NCDs和伤害的粗DALY率的州级异质性。此外，我们审查了健康与 wellness 中心（HWCs）以及针对老年人的医疗保健（NPHCE）、非传染病预防与控制（NP - NCD）、失明与视力损害控制（NPCBVI）、耳聋预防与控制（NPPCD）、心理健康项目（NMPH）以及阿育吠陀肌肉骨骼疾病项目（MSDP）等国家项目中关于老年人服务提供指标的数据是否按年龄和性别进行了分类。
2019年老年人的DALYs总数为1.361亿（占总DALYs的29.1%），其中77.9%来自非传染病，14.8%来自传染病，7.3%来自伤害，近三分之二的DALYs由YLLs构成。在非传染病中，心血管疾病、慢性呼吸道疾病、肿瘤、糖尿病和肾脏疾病以及肌肉骨骼疾病占两性DALYs的近80%。男女之间以及两性中不同年龄组之间，特定疾病和状况的疾病负担程度存在差异，特别是在伤害和传染病方面。伤害导致的YLDs多于YLLs，女性占5.9% - 15.2%，男性占15.3% - 17.3%，与男性相比，女性因跌倒导致的与伤害相关的总DALYs贡献更高（54.4%对36.6%），而男性因道路伤害导致的总DALYs贡献更高（33.8%对19.4%）。印度各邦2019年主要疾病组的粗DALY率在两性之间存在很大差异。女性和男性的CMNNDs粗DALY率在各邦之间分别相差3.6倍至3.7倍；非传染病相差1.3倍至1.9倍，伤害相差2.0倍至1.7倍。NPHCE、NPCBVI、NMHP、MSDP和HWCs中服务利用指标的数据未按年龄或性别分类；NP - NCD中有性别分类但无年龄分类；NPPCD中有许多服务指标的性别分类数据，但50岁及以上没有年龄分类。只有NP - NCD和NPPCD允许按疾病/状况或疾病/状况严重程度收集老年人的数据，而包括NPHCE在内的其他项目不太允许按所使用服务类型进行详细了解。
对印度老年人在年龄、性别和邦之间疾病负担差异的全面评估，以及在国家卫生项目中按年龄和性别收集老年人服务利用数据时发现的差距，可为加强旨在改善印度不断增长的老年人口健康和福祉的现行公共卫生政策和项目努力提供关键投入。
