Burden of Deaths and Disability-adjusted Life Years Attributable to Suboptimal High Temperature in India: Analysis of the Global Burden of Disease Estimates (1990-2021).

Abstract

Background: Rising ambient temperatures are an escalating health risk in India, yet long-term, disease-specific burdens are poorly quantified. The present study assessed national and subnational trends in mortality and disability-adjusted life years (DALYs) attributable to suboptimal high temperatures in India and quantify 1990-2021 trends in heat-attributable deaths and DALYs.

Methods: We conducted a secondary descriptive analysis of Global Burden of Disease 2021 estimates for India and all states/union territories (UTs) from 1990 to 2021. Outcomes were absolute deaths/DALYs and age-standardized rates per 100,000, stratified by sex and cause groups. Estimates with 95% uncertainty intervals were extracted from Global burden of disease (GBD) Compare; no additional modeling beyond GBD methods was performed.

Results: India's heat-attributable burden more than tripled in absolute terms between 1990 and 2021, while age-standardized death rates increased modestly (7.78 to 9.89 per 100,000). Males consistently had higher mortality and DALY rates than females. A marked shift from communicable, maternal, neonatal, and nutritional (CMNN) diseases to non-communicable diseases (NCDs) was observed. Among selected NCDs, ischemic heart disease and stroke showed increasing age-standardized DALY rates, whereas chronic kidney disease and chronic respiratory diseases showed slight declines. State-level heterogeneity was substantial, with Kerala, Tamil Nadu, and Delhi showing stable/declining rates, whereas Maharashtra, Chhattisgarh, Bihar, West Bengal, and several northeastern states recorded pronounced increases.

Conclusions: Heat-attributable deaths and DALYs in India have risen sharply with an epidemiological shift toward NCD-related vulnerability and subnational disparities. Findings underscore the urgent need to implement state-tailored heat action plans with health-system preparedness that integrate NCD risk management and prioritize high-risk populations and geographies.