Trends and burden of diarrhoeal diseases across India, 1990 - 2023: A systematic analysis from the global burden of disease study 2023

Despite substantial progress, diarrhoeal diseases continue to pose a significant public health burden, with marked regional, age-specific, and pathogen-specific disparities. The persistence of high mortality in certain states, elevated vulnerability among young children and older adults, and the shifting dominance of diarrhoeal pathogens highlight gaps in prevention, sanitation, nutrition, and healthcare access. Objectives: To assess long-term trends in diarrhoeal disease burden in India from 1990 to 2023, including mortality, DALYs, YLLs, YLDs, associated risk factors and etiologies, and to examine age- and state-level variations. Methods: The analysis and findings presented in this article are based on data from the Global Burden of Disease (GBD) 2023 study. Trends were analysed using joinpoint regression to calculate annual percentage change (APC) and average annual percentage change (AAPC) by state and sex. Statistical significance was defined as a two-sided p-value of <0.05. Results: In 2023, an estimated 0.46 million deaths in India were attributable to diarrhoeal diseases across all age group, which showed a 68.3% reduction from 1.46 million in 1990. Age-standardised death and DALYs rates declined by 84.5% and 87.4%, respectively. Children under five showed the greatest improvement, with neonatal mortality falling by 94.1%, and the largest reduction (98.0%) among children aged 2-4 years. Conclusion: India has achieved a substantial decline in diarrhoeal mortality over the past three decades, particularly among children under 5 years. This progress may be attributed to initiatives like improved sanitation, safe drinking water, roll out of rotavirus vaccines and better healthcare access. Future efforts should prioritize strengthening WASH interventions, expanding vaccine coverage, and targeting high-burden populations, particularly children and older adults.