Air pollution attributed disease burden and economic growth in India: Estimating trends and inequality between states

Background Air pollution is one of the major contributors to the disease burden in India after malnutrition. We examined the relation, and state-wise disparities in air pollution attributed to disease burden (APADB) concerning gross state domestic product (GSDP) and growth in motor vehicles in India. Methods We retrieved disability-adjusted life year (DALY) estimates for India due to air pollution from the Global Burden of Disease Studies, injuries, and Risk Factors Study (GBD). We examined the association between APADB with GSDP and the growth in the number of registered motor vehicles in India during the 2011 to 2019 period. Concentration indices and Lorenz curves were used to explore the variation in APADB across individual states. Findings Except for a few states, APADB is inversely proportional to GSDP. Growth in motor vehicles was also negatively correlated with the APADB in n=19 states. The concentration index explained a 47% inequality in APADB between individual states and exhibited a decline (45%) during 2019 compared to 2011. The unevenness in APADB among Indian states is evident from the analysis as the states occupying the 6th or 7th decile and above in terms of GDP, urbanization and population contribute more than 60 per cent of the total APADB. Interpretation The APADB is inversely correlated with GSDP for most of the states, and the negative correlations were conspicuous when APADB per 100,000 population was analysed. The concentration index and Lorenz revealed the presence of APADB inequality between states in terms of GSDP, population, urbanisation, and total factories. Funding Not applicable. Copyright (c) 2022 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/) The Lancet Health 2022;7: https://doi.org/10.1016/j. lansea.2022.100069