Tamil Nadu: Disease Burden Profile, 1990 to 2016 1990 life epectancy 2016 life epectancy emales 619 years ales 59 years emales 5 years ales 69 years How much did the under-5 mortality rate change from 1990 to 2016? How much did the under-5 mortality rate change from 1990 to 2016? Under-5Under-5 mortality mortality rate, both rate, sexes combined, both sexes 1990-2016 combined, 1990-2016

Tamil Nadu unde- ae India unde- ae Cmaaie aeae ae lall imila Si-demahi Inde a Tamil Nadu

150

100

Deaths per 1,000 lie births 50

9.2 The shaded 2. bands indicate 21. 95% uncertainty intervals around 0 the estimates 1990 1995 2000 2005 2010 2016 Year

What caused the most deaths in different age groups in 2016? PercentWhat contribution caused of the top 10 most causes deaths of death by in age different group, both sexes,age 2016groups in 2016? Percent contribution of top 10 causes of death by age group, both sexes, 2016

0−14 years [4.1% of total deaths] 15−39 years [9.7% of total deaths]

11 HIIDS ueuli 43 1 1 DiaheaRIhe 3 69 21 NTD malaia

46 Maenal dide 13 25 Nenaal dide

166 Nutritional deficiencies 2 12 11 he mmuniale dieae 1 6 Cane

5 Cadiaula dieae 39 25 13 1 Chni eia dieae

Cihi

Dieie dieae

Neulial dide 40−69 years [43.2% of total deaths] 70+ years [43% of total deaths] Diaeeuldend

26 25 he nn-mmuniale 1 Tan inuie 46 49 64 65 nineninal inuie 49 14 35 Suiide ilene 109 14 53 he aue deah 122 RI i lwe eia inein. 41 NTD ae neleed ial dieae. 23 i uenial dieae. 1 End i endine dieae. 64 3

404 396

India: Health of the Nation's States — The India State-Level Disease Burden Initiative. New Delhi: ICMR, PHFI, and IHME; 2017. ISBN 978-0-9976462-1-4. 1 roportion of total disease burden from Premature death 620 Disability or morbidity 0

What caused the most years of life lost by se in 2016? op 15 causes of YLLs, ranked by percent for both sexes combined, 2016

emales ales

Ischaemic heart disease Suicide Diabetes Road injuries Chronic kidney disease Stroke Diarrhoeal diseases COPD* Lower respiratory infections Tuberculosis Falls Preterm birth complications Congenital birth defects Hypertensive heart disease Neonatal encephalopathy

20 10 0 0 10 20 Percent of total years of life lost due to premature mortality Percent of total years of life lost due to premature mortality

Communicable, maternal, neonatal, and nutritional diseases on-communicable diseases nuries

What caused the most years lived with disability*COPD isby chronic se obstructive in 2016? pulmonary disease. op 15 causes of YLDs, ranked by percent for both sexes combined, 2016

emales ales

Iron-deficiency anaemia Sense organ diseases* Low back & neck pain Depressive disorders Migraine Diabetes Other musculoskeletal Skin diseases COPD* Anxiety disorders Falls Oral disorders Preterm birth complications Osteoarthritis Schizophrenia

15 10 5 0 0 5 10 15 Percent of total years lied ith disability Percent of total years lied ith disability Communicable, maternal, neonatal, and nutritional diseases on-communicable diseases nuries

*COPD is chronic obstructive pulmonary disease. *Sense organ diseases includes mainly hearing and vision loss.

2 Tamil Nadu roportion of total disease burden from CDs 20 CDs 65 nuries 1 HowHow havehave the leading causescauses of of death death and and disability disability combined combined changed changed from from 1990 1990 to 2016? to 2016? ChangeChange in top 15 causes of of DALYs, DALYs, both both sexes, sexes, ranked ranked by by number number of ofDALYs, DALYs, 1990 1990–2016–2016

Cmmuniale, maenal, Nn-mmuniale dieae Inuie ame ineae deeae nenaal, and nuiinal dieae

Leading causes of DALYs 1990 Leading causes of DALYs 2016

Diarrhoeal diseases [10.8%] 1 1 Ischaemic heart disease [14.3%] Lower respiratory infections [6.9%] 2 2 Diabetes [4.9%] Preterm birth complications [6.8%] Self-harm§ [4.3%]* Ischaemic heart disease [6.6%] 4 4 COPD† [3.7%]* Tuberculosis [4.9%] Iron-deficiency anaemia [3.6%] Neonatal encephalopathy [4.6%] 6 6 Sense organ diseases‡ [3.5%] Congenital birth defects [3.7%] 7 7 Road injuries [3.3%] Self-harm§ [3.6%] 8 8 Chronic kidney disease [3.1%] Measles [2.6%] 9 9 Low back & neck pain [2.8%] COPD† [2.5%] 10 10 Stroke [2.8%]* Iron-deficiency anaemia [2.4%] 11 11 Falls [2.7%]* Stroke [2.2%] 12 12 Diarrhoeal diseases [2.8%] Other neonatal disorders [2.2%] 1 1 Depressive disorders [2.5%] Road injuries [1.8%] 14 14 Migraine [2.3%] Chronic kidney disease [1.8%] 1 1 Tuberculosis [2.3%] Falls [1.7%] 16 16 Preterm birth complications [2.2%] Sense organ diseases‡ [1.6%] 17 17 Lower respiratory infections [2.1%] Low back & neck pain [1.4%] 18 20 Congenital birth defects [1.4%] Diabetes [1.4%] 20 22 Neonatal encephalopathy [1.0%] Depressive disorders [1.2%] 22 42 Other neonatal disorders [0.5%] Migraine [1.2%] 2 100 Measles [0.1%]

*Change not significant. COPD is chronic obstructive pulmonary disease. The percent figure in brackets next to each cause is Sense organ diseases includes mainly hearing and vision loss. DALYs from that cause out of total DALYs. Sel-ham refers to suicide and the nonfatal outcomes of self-harm. What caused the most death and disability combined across age groups in 2016? WhatPercent caused of DALYs the by most age group,death bothand disabilitysexes, 2016 combined across age groups in 2016? Percent of DALYs by age group, both sexes, 2016

10.0

[1.68] [2.08] [1.35] [1.2] [1.1] 7.5 [2.59]

[0.91] [0.78] [3.12] [0.66] [0.58] [3.58] 5.0 [0.53] Percent of total DALYs Percent

[0.44]

[4.14]

2.5 [0.29] [0.27] [4.64]

0

5 to 9 (7%) 85+ (<1%) Under 5 (7%) 10 to 14 (7%) 15 to 19 (8%) 20 to 24 (8%) 25 to 29 (9%) 30 to 34 (9%) 35 to 39 (8%) 40 to 44 (7%) 45 to 49 (7%) 50 to 54 (6%) 55 to 59 (5%) 60 to 64 (4%) 65 to 69 (3%) 70 to 74 (2%) 75 to 79 (1%) 80 to 84 (1%) Age Communicable, maternal, neonatal, and nutritional diseases on-communicable diseases nuries

The number in the bracket on top of each vertical bar is the ratio of percent DALYs to population for that age group. The number in parentheses after each age group on the x-axis is the percent of population in that age group. Tamil Nadu 3 What risk factors are driving the most death and disability combined? Contribution of top 10 risks to DALYs number, both sexes, ranked by number of DALYs, 1990-2016 What riskrisk factors factors are are driving driving the the most most death death and and disability disability combined? combined? ContributionBehavioural of of top top 10 10 risksEnvironmental/occupational risks to to DALYs DALYs number, number, both both sexes, sexes, rankedMetabolic ranked by number by number of DALYs,same of DALYs, 1990-2016 or increase 1990-2016 decrease

Behavioural Environmental/occupational Metabolic same or increase decrease

Risk factors 1990 Risk factors 2016 Risk factors 1990 Risk factors 2016

Malnutrition*Malnutrition* [32.2%] [31.0%]1 1 1 Malnutrition* [14.8%] 1 Dietary risks [14.4%] WaSHWaSH [15.2%] [10.9%]2 2 2 Air pollution [5.1%] 2 High fasting plasma glucose [12.9%] Air pollutionAir pollution [7.7%] [9.6%] High blood pressure [5.0%] High blood pressure [12.3%] Tobacco use [3.6%] 4 4 Tobacco use [4.9%] Dietary risks [7.7%] 4 4 High body-mass index [8.1%] Dietary risks [2.3%] Dietary risks [4.7%] HighHigh blood blood pressure pressure [2.2%] [5.9%]6 6 High fasting plasma glucose [4.0%]Malnutrition* [8.0%] OccupationalTobacco risks [1.9%] use [4.9%]7 6 7 WaSH [3.9%] 6 Air pollution [7.2%] High fastingAlcohol plasma & drug use glucose [1.6%] [4.9%]8 7 8 Alcohol & drug use [3.9%]7 High total cholesterol [7.2%] High fasting plasma glucose [1.4%] 9 9 Occupational risks [2.6%] ImpairedHigh kidney total function cholesterol [0.9%] [3.2%]10 8 10 Impaired kidney function8 [2.0%]Tobacco use [5.6%] Impaired kidney function [2.6%] 9 9 Impaired kidney function [4.7%] The percent figure in bracket next to each risk is DALYs from that risk out of total DALYs. *Malnutrition is child and maternal malnutrition. Occupational risks [2.0%] 10 WaSH is unsafe water, sanitation,10 Alcohol and handwashing. & drug use [3.8%] Alcohol & drug use [1.8%] 11 11 Occupational risks [3.2%] High body-mass index [1.5%] 12 12 WaSH [2.6%]

The percent figure in bracket next to each risk is DALYs from that risk out of total DALYs. *Malnutrition is child and maternal malnutrition. WaSH is unsafe water, sanitation, and handwashing.

How did the risk factors differ by se in 2016? Percent of total DALYs attributable to top 10 risks, ranked by percent for both sexes combined, 2016

emales ales

Dietary risks High fasting plasma glucose High blood pressure High body-mass index Malnutrition* Air pollution High total cholesterol Tobacco use Impaired kidney function Alcohol & drug use

15 10 5 0 0 5 10 15 Percent of years of life lost and years lied ith disability Percent of years of life lost and years lied ith disability

ehaioural nironmentaloccupational etabolic

*Malnutrition is child and maternal malnutrition.

4 Tamil Nadu