State-level retrospective analysis of the burden of emergency and operative conditions in India from 1980 to 2023.

INTRODUCTION: Disease burden is a crucial factor in determining healthcare policy and resource allocation. We analyzed the subnational burden of emergency and operative conditions in India from 1980 to 2023. MATERIALS AND METHODS: We 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. We conducted a post-hoc uncertainty analysis to calculate the mean and 95% uncertainty interval (UI) for each estimate. RESULTS: In 2023, emergency (mortality rate: 340 deaths per 100,000, 95% UI [282, 416]; DALY rate: 13,732 DALYs per 100,000 people, 95% UI [11,492, 16,277]), operative (mortality rate: 158 deaths per 100,000, 95% UI [123, 196]; DALY rate: 7284 DALYs per 100,000 people, 95% UI [5765, 9018]), and emergency-operative conditions (mortality rate: 70 deaths per 100,000, 95% UI [58, 83]; DALY rate: 3830 DALYs per 100,000 people, 95% UI [3229, 4396]) accounted for 49.76% (95% UI [43.44%, 58.14%]), 23.12% (95% UI [19.05%, 27.52%]), and 10.31% (95% UI [8.96%, 11.58%]) of all-cause mortality and 40.88% (95% UI [36.91%, 45.40%]), 21.66% (95% UI [18.69%, 24.85%]), and 11.41% (95% UI [10.22%, 12.60%]) of all-cause DALYs, respectively. Telangana, Chhattisgarh, and Uttarakhand had some of the highest mortality and DALY rates for all three condition groups. Mortality rates from 1980-2023 and DALY rates from 1990-2023 generally decreased across all conditions, with the largest decreases in emergency conditions. States such as Kerala and Goa did not show substantial decreases in their mortality and DALY rates between 1980 and 2023. CONCLUSION: Despite significant nationwide improvements in healthcare, 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 in all-cause mortality, surgical care should be a high priority in national and state-level cross-sectoral policymaking.