Trends in Health-adjusted Life Expectancy Across Indian States and Union Territories, 1990-2021: An Ecological Analysis Using Data from the 2021 Global Burden of Disease Study.

BACKGROUND: India has undergone major demographic and epidemiological transitions over the past three decades. Although life expectancy has improved, conventional mortality indicators do not capture years lived with illness or disability. Health-adjusted life expectancy (HALE) offers a more comprehensive measure of population health by integrating mortality and morbidity. OBJECTIVE: The objective of this study was to assess trends in HALE in India from 1990 to 2021 by state, sex, and age group using estimates from the Global Burden of Disease (GBD) Study 2021. MATERIALS AND METHODS: This ecological analysis used publicly available HALE estimates from the GBD Study 2021 for all 28 states and 8 union territories of India. Percentage changes in HALE between 1990 and 2021 were analyzed by sex, age group, and geography. Estimates are presented with 95% uncertainty intervals (UI). RESULTS: National HALE increased from 15.20 years (95% UI: 13.95-16.33) in 1990-16.00 years (95% UI: 14.63-17.27) in 2021, representing a 5.25% increase. Female HALE improved slightly more than male HALE (5.36% vs. 5.28%). The largest gains were observed among individuals aged 20-24 years, whereas HALE declined among males aged ≥ 75 years. Goa recorded the highest HALE in 2021 (19.31 years), while Uttarakhand had the lowest (14.78 years). Jharkhand (22.15%), Andhra Pradesh (20.83%), Odisha (18.68%), and Telangana (18.54%) demonstrated the greatest relative increases, whereas Manipur showed minimal improvement (3.23%). Chhattisgarh exhibited the widest sex disparity in HALE change. CONCLUSION: HALE in India improved modestly between 1990 and 2021; however, substantial disparities persist across states, sexes, and age groups. Targeted public health interventions and healthy aging strategies are needed to reduce inequities and improve healthy longevity.