{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T14:00:06Z","timestamp":1789999206049,"version":"4.0.1"},"reference-count":29,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>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\u20132021 trends in heat-attributable deaths and DALYs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>India\u2019s 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/ijcm.ijcm_706_25","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T17:02:34Z","timestamp":1789750954000},"page":"801-809","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Burden of Deaths and Disability-adjusted Life Years Attributable to Suboptimal High Temperature in India: Analysis of the Global Burden of Disease Estimates (1990\u20132021)"],"prefix":"10.4103","volume":"51","author":[{"given":"Sonia","family":"Kochhar","sequence":"first","affiliation":[{"name":"Department of Physiology, All India Institute of Medical Sciences, Bathinda, Punjab, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deepak","family":"Chaudhary","sequence":"additional","affiliation":[{"name":"Department of Medicine, All India Institute of Medical Sciences, Bathinda, Punjab, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashwani","family":"Ummat","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Adesh Institute of Medical Sciences (AIMSR), Bathinda, Punjab, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenisha","family":"Ummat","sequence":"additional","affiliation":[{"name":"GGS Medical College Faridkot, Punjab, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moonis","family":"Mirza","sequence":"additional","affiliation":[{"name":"Department of Hospital Administration, All India Institute of Medical Sciences, Bathinda, Punjab, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madhur","family":"Verma","sequence":"additional","affiliation":[{"name":"Department of Community and Family Medicine, All India Institute of Medical Sciences, Bathinda, Punjab, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,9,18]]},"reference":[{"key":"R1-20260921","doi-asserted-by":"crossref","first-page":"102615","DOI":"10.1016\/j.jiph.2024.102615","article-title":"Transforming global public health: Climate collaboration, political challenges, and systemic change","volume":"18","author":"Goniewicz","year":"2025","journal-title":"J Infect Public Health"},{"key":"R2-20260921","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1146\/annurev-publhealth-012420-105026","article-title":"Extreme weather and climate change: Population health and health system implications","volume":"42","author":"Ebi","year":"2021","journal-title":"Annu Rev Public Health"},{"key":"R3-20260921","doi-asserted-by":"crossref","first-page":"100203","DOI":"10.1016\/j.dialog.2024.100203","article-title":"Impact of heat on human and animal health in India: A landscape review","volume":"6","author":"Yasobant","year":"2025","journal-title":"Dialogues Health"},{"key":"R4-20260921","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1016\/S0140-6736(21)01208-3","article-title":"Hot weather and heat extremes: Health risks","volume":"398","author":"Ebi","year":"2021","journal-title":"Lancet"},{"key":"R5-20260921","doi-asserted-by":"crossref","first-page":"101392","DOI":"10.1016\/j.uclim.2022.101392","article-title":"Urban extreme heat, climate change, and saving lives: Lessons from Washington state","volume":"47","author":"Kearl","year":"2023","journal-title":"Urban Clim"},{"key":"R6-20260921","doi-asserted-by":"crossref","first-page":"e26431","DOI":"10.1016\/j.heliyon.2024.e26431","article-title":"Temperature projections and heatwave attribution scenarios over India: A systematic review","volume":"10","author":"Ravindra","year":"2024","journal-title":"Heliyon"},{"key":"R7-20260921","doi-asserted-by":"crossref","first-page":"124446","DOI":"10.1016\/j.jenvman.2025.124446","article-title":"Green infrastructure and its influence on urban heat island, heat risk, and air pollution: A case study of Porto (Portugal)","volume":"376","author":"Lopes","year":"2025","journal-title":"J Environ Manage"},{"key":"R8-20260921","doi-asserted-by":"crossref","first-page":"108461","DOI":"10.1016\/j.envint.2024.108461","article-title":"Impact of heatwaves on all-cause mortality in India: A comprehensive multi-city study","volume":"184","author":"de Bont","year":"2024","journal-title":"Environ Int"},{"key":"R9-20260921","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1007\/s40572-025-00496-5","article-title":"A systematic review of heat health warning systems: Enhancing the framework towards effective health outcomes","volume":"12","author":"Chandra","year":"2025","journal-title":"Curr Environ Health Rep"},{"key":"R10-20260921","doi-asserted-by":"crossref","first-page":"e91831","DOI":"10.1371\/journal.pone.0091831","article-title":"Heat-related mortality in India: Excess all-cause mortality associated with the 2010 Ahmedabad heat wave","volume":"9","author":"Azhar","year":"2014","journal-title":"PLoS One"},{"key":"R11-20260921","doi-asserted-by":"crossref","first-page":"22238","DOI":"10.1038\/s41598-023-49491-6","article-title":"The trends of disease burden due to high temperature in Mainland China from 1990 to 2019 and its prediction to 2030","volume":"13","author":"Zheng","year":"2023","journal-title":"Sci Rep"},{"key":"R12-20260921","doi-asserted-by":"crossref","first-page":"2475","DOI":"10.1186\/s12889-024-19947-z","article-title":"Burden of non-communicable diseases attributable to high temperature in a changing climate from 1990 to 2019: A global analysis","volume":"24","author":"Zhang","year":"2024","journal-title":"BMC Public Health"},{"key":"R13-20260921","first-page":"1","article-title":"Epidemiological features of cardiovascular disease in Asia","volume":"1","author":"Zhao","year":"2021","journal-title":"JACC: Asia"},{"key":"R14-20260921","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1007\/s11596-025-00148-7","article-title":"Burden of non-communicable diseases attributable to high and low ambient temperatures, 1990-2031: A forecasting analysis for GBD 2021","volume":"46","author":"Pu","year":"2026","journal-title":"Curr Med Sci"},{"key":"R15-20260921","doi-asserted-by":"crossref","first-page":"2162","DOI":"10.1016\/S0140-6736(24)00933-4","article-title":"Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990\u20132021: A systematic analysis for the Global Burden of Disease Study 2021","volume":"403","author":"Brauer","year":"2024","journal-title":"Lancet"},{"key":"R16-20260921","doi-asserted-by":"crossref","first-page":"2133","DOI":"10.1016\/S0140-6736(24)00757-8","article-title":"Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990\u20132021: A systematic analysis for the global burden of disease study 2021","volume":"403","author":"Ferrari","year":"2024","journal-title":"Lancet"},{"key":"R17-20260921","doi-asserted-by":"crossref","first-page":"2133","DOI":"10.1016\/S0140-6736(24)00757-8","article-title":"Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990\u20132021: A systema","volume":"403","author":"Ferrari","year":"2024","journal-title":"Lancet"},{"key":"R18-20260921","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1478-7954-10-1","article-title":"Modeling causes of death: An integrated approach using CODEm","volume":"10","author":"Foreman","year":"2012","journal-title":"Popul Health Metr"},{"key":"R19-20260921","doi-asserted-by":"crossref","first-page":"2063","DOI":"10.1093\/aje\/kwac115","article-title":"A framework for descriptive epidemiology","volume":"191","author":"Lesko","year":"2022","journal-title":"Am J Epidemiol"},{"key":"R21-20260921","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1186\/s41182-025-00823-4","article-title":"Disease burden attributable to high temperature between 1990 and 2021 in South Asia and Southeast Asia, with projections to 2045","volume":"53","author":"Cai","year":"2025","journal-title":"Trop Med Health"},{"key":"R22-20260921","doi-asserted-by":"crossref","first-page":"23248","DOI":"10.3402\/gha.v7.23248","article-title":"Understanding epidemiological transition in India","volume":"7","author":"Yadav","year":"2014","journal-title":"Glob Health Action"},{"key":"R23-20260921","doi-asserted-by":"crossref","first-page":"171120","DOI":"10.1016\/j.scitotenv.2024.171120","article-title":"Gender disparities in summer outdoor heat risk across China: Findings from a national county-level assessment during 1991-2020","volume":"921","author":"Zeng","year":"2024","journal-title":"Sci Total Environ"},{"key":"R24-20260921","doi-asserted-by":"crossref","first-page":"5034","DOI":"10.3402\/gha.v3i0.5034","article-title":"The association between overall health, psychological distress, and occupational heat stress among a large national cohort of 40,913 Thai workers","volume":"3","author":"Tawatsupa","year":"2010","journal-title":"Glob Health Action"},{"key":"R25-20260921","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/S0140-6736(20)32290-X","article-title":"The 2020 report of The Lancet Countdown on health and climate change: Responding to converging crises","volume":"397","author":"Watts","year":"2021","journal-title":"Lancet"},{"key":"R26-20260921","doi-asserted-by":"crossref","first-page":"1472","DOI":"10.2215\/CJN.13841215","article-title":"Climate change and the emergent epidemic of CKD from heat stress in rural communities: The case for heat stress nephropathy","volume":"11","author":"Glaser","year":"2016","journal-title":"Clin J Am Soc Nephrol"},{"key":"R27-20260921","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1007\/s11897-014-0191-y","article-title":"Cardiovascular responses to heat stress in chronic heart failure","volume":"11","author":"Cui","year":"2014","journal-title":"Curr Heart Fail Rep"},{"key":"R28-20260921","doi-asserted-by":"crossref","first-page":"1204","DOI":"10.1016\/S0140-6736(20)30925-9","article-title":"Global burden of 369 diseases and injuries in 204 countries and territories, 1990\u20132019: A systematic analysis for the global burden of disease study 2019","volume":"396","author":"Vos","year":"2020","journal-title":"Lancet"},{"key":"R29-20260921","doi-asserted-by":"crossref","first-page":"2437","DOI":"10.1016\/S0140-6736(17)32804-0","article-title":"Nations within a nation: Variations in epidemiological transition across the states of India, 1990-2016 in the Global Burden of Disease Study","volume":"390","year":"2017","journal-title":"Lancet"},{"key":"R30-20260921","doi-asserted-by":"crossref","first-page":"1260","DOI":"10.1016\/S0140-6736(17)32130-X","article-title":"Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990\u20132016: A systematic analysis for the global burden of disease study 2016","volume":"390","author":"Hay","year":"2017","journal-title":"Lancet"}],"container-title":["Indian Journal of Community Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/ijcm.ijcm_706_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T13:02:18Z","timestamp":1789995738000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/ijcm.ijcm_706_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":29,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/ijcm.ijcm_706_25","relation":{},"ISSN":["0970-0218","1998-3581"],"issn-type":[{"value":"0970-0218","type":"print"},{"value":"1998-3581","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9]]},"assertion":[{"value":"2025-09-13","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-10","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}