Disability-adjusted life years (DALYs) due to the direct health impact of COVID-19 in India, 2020

Balbir B Singh,Brecht Devleesschauwer,Mehar S Khatkar,Herman W Barkema,Baljit Singh,Navneet K Dhand,Mark Lowerison

doi:10.1038/s41598-022-06505-z

Abstract

COVID-19 has affected all countries. Its containment represents a unique challenge for India due to a large population (> 1.38 billion) across a wide range of population densities. Assessment of the COVID-19 disease burden is required to put the disease impact into context and support future pandemic policy development. Here, we present the national-level burden of COVID-19 in India in 2020 that accounts for differences across urban and rural regions and across age groups. Input data were collected from official records or published literature. The proportion of excess COVID-19 deaths was estimated using the Institute for Health Metrics and Evaluation, Washington data. Disability-adjusted life years (DALY) due to COVID-19 were estimated in the Indian population in 2020, comprised of years of life lost (YLL) and years lived with disability (YLD). YLL was estimated by multiplying the number of deaths due to COVID-19 by the residual standard life expectancy at the age of death due to the disease. YLD was calculated as a product of the number of incident cases of COVID-19, disease duration and disability weight. Scenario analyses were conducted to account for excess deaths not recorded in the official data and for reported COVID-19 deaths. The direct impact of COVID-19 in 2020 in India was responsible for 14,100,422 (95% uncertainty interval [UI] 14,030,129–14,213,231) DALYs, consisting of 99.2% (95% UI 98.47–99.64%) YLLs and 0.80% (95% UI 0.36–1.53) YLDs. DALYs were higher in urban (56%; 95% UI 56–57%) than rural areas (44%; 95% UI 43.4–43.6) and in men (64%) than women (36%). In absolute terms, the highest DALYs occurred in the 51–60-year-old age group (28%) but the highest DALYs per 100,000 persons were estimated for the 71–80 years old age group (5481; 95% UI 5464–5500 years). There were 4,815,908 (95% UI 4,760,908–4,924,307) DALYs after considering reported COVID-19 deaths only. The DALY estimations have direct and immediate implications not only for public policy in India, but also internationally given that India represents one sixth of the world’s population.

Highlights

The coronavirus disease 2019 (COVID-19) p andemic[1] originated in Wuhan, China in December 2 0192 and eventually worldwide
The direct impact of COVID-19 was responsible for 14,100,422 Disability-adjusted life years (DALY) consisting of 13,992,709 (99.2%; 95% uncertainty interval (UI) 98.47–99.64%) years of life lost (YLL) and 105,784 (0.80%; 95% UI 0.36–1.53%) years lived with disability (YLD) in 2020 in India (Table 1)
post-acute COVID-19 syndrome (PCS) contributed towards 89.61% (95% UI 79.1–95.62%) of the YLDs

Summary

Introduction

The coronavirus disease 2019 (COVID-19) p andemic[1] originated in Wuhan, China in December 2 0192 and eventually worldwide. The disease is caused by the severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) virus that infects h umans[3]. The first case of COVID-19 in India was reported on 30 January 2020. The adjusted case fatality risk (aCFR) due to COVID-19 in India has been reported to be 1.4 and 3.0% using random- and fixed-effects models, r espectively[12]. The aCFR in India was associated with co-morbidities such as the incidence of diabetes, cardiovascular diseases, hypertension, and acute respiratory infections[12]. We estimated DALYs due to the direct health impact of COVID-19 in India from January 2020 (the first case reported) to December 2020. Gender, and age-specific DALY estimates are provided to understand health impacts of COVID-19 in India

Methods

Results

Conclusion