Disease and Economic Burden of Stillbirths in India in 2019

Abstract

AbstractBackgroundIndia has the highest absolute number of stillbirths worldwide. Despite the high burden and preventable nature, stillbirth is not high on the health agenda including the absence of stillbirths in the Global Burden of Disease (GBD) study estimates. We assessed the disease and economic burden of stillbirth in India.MethodsIn this retrospective analysis, the number of stillbirths, live births, and life expectancy was derived from the Health Management Information System (HMIS) 2019 for India and its 21 states. Additionally, values from the civil and sample registration systems were used for secondary analysis. Two stillbirth rates were calculated-still live birth rate (SLBR) using live births and still total birth rate (STBR) using total births i.e., live and stillbirths. We calculated stillbirth-adjusted life expectancy (SALE). For disease burden, measured by disability-adjusted life-years (DALYs), we multiplied live births with the absolute difference of SALE and live-birth life expectancy. We calculated the stillbirth contribution of under-5 DALYs derived from GBD 2019. Economic burden was calculated under the value of life-year (VLY) approach by multiplying stillbirth DALYs with per capita domestic product. Three values were calculated based on different domestic product values from the Reserve Bank of India and National Health Accounts data for 2019.ResultsAs per HMIS, India had 263342 stillbirths. Nationally, the SLBR and STBR were 12.4 and 12.25, respectively. Stillbirths decreased the overall life expectancy at birth by 0.85 years. Stillbirths contributed to 18.1 million DALYs and the economic burden was INR 7.7 trillion in 2019. Stillbirths contributed 22% to under-5 DALYs. Eight states (30.9%) contribute to more than 50% of disease and economic burden.ConclusionThese findings suggest a high disease and economic burden of stillbirth in India with across-state variations. Incorporating burden metrics in child health policies could improve resource allocation.SynopsisStudy QuestionThis study estimates the disease and economic burden of stillbirth in India in 2019What’s already knownIndia has the highest absolute number of stillbirths. Despite the high burden and preventable nature, the stillbirth burden is not included in global or national estimates. No previous studies have looked at the disease burden of stillbirth. While previous studies have looked at the economic burden of stillbirth in the High-Income Countries, they present no value for India.What this study addsThis study looks at the stillbirth disease burden in terms of disability-adjusted life-years (DALYs) and the percentage contribution of stillbirth to under-5 DALYs. The economic burden of stillbirth was calculated by the value of life-years (VLYs) approach. The disease burden of stillbirth was 18 million DALYs, with stillbirth contributing 22% to the total under-5 DALYs. The economic burden was NR 7.7 trillion (USD 109.38 billion) for India in 2019.