Results presented in this section are based on the general demographic estimates of mortality level and population, and causes of death in the state. Epidemiological estimates of incidence, age at onset, and duration are taken from the Global Burden of Disease study 1996 (Murray and Lopez, 1996) for the India region. The disability weights are based on VAS results from the community survey of health state valuations in Kondakkal village in Andhra Pradesh (APHSV99-VAS weights).

The rural-urban distribution of disease burden in the state figure shows the overall rate of disease burden is higher at 537 DALY / 1000 population compared to 277 DALY / 1000 population according to the estimate using expert rated disability weights. The rate of estimated burden is 560 DALYs / 1000 population in rural areas and 474 DALYs / 1000 population in urban areas. This is expected, since the community ratings of disability weights has been higher than the expert rated disability weights. The share of disease burden in rural areas is slightly less at 76% with a corresponding increase in share of disease burden in urban areas at 24%. The change in rural urban distribution of disease burden is because the rural burden is largely due to premature mortality and the urban disease burden is largely due to degenerative and non communicable diseases. Since the community rated disability weights are higher than the expert rated weights, the years lived with disability due to degenerative and non communicable disease in the urban areas get emphasised. Hence share of urban disease burden increases by 3% with a corresponding decrease in share of disease burden in rural areas.

The below figureshows age-sex distribution of disease burden and the composition in terms of YLL : YLD ratios, according to the estimate using community rated disability weights. In the earlier estimate using expert rated disability weights, maximum disease burden was located in infancy and childhood (0 to 4 years). Now the locus of maximum percentage of disease burden has shifted to adults in age group 15-44 years.

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Use of community rated disability weights increased the disability component of disease burden giving rise to a reduction in highest YLL:YLD ratio from 6 to 2.5. Except for the elderly age group of 60+ years, the disability component of disease burden is more than the premature mortality component. Most of the YLL:YLD ratios at these age groups are less than one. The sex differentials in disability - premature mortality composition is maintained as in case of the earlier estimate using expert rated disability weights.

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Above table shows ten leading causes of burden in rural and urban areas of the state, according to the estimate using community rated disability weights. According to this estimate, nine leading causes are common to both the areas. These are: (a) periodontal disease, (b) protein energy malnutrition, (c) lower respiratory tract infections, (d) fires, (e) falls, (f) diarrhoeal diseases, (g) low birth weight, (h) obstructed labour, (i) tuberculosis. Five of these (shown in bold) were there in six of the top ten causes common to both rural and urban areas according to the estimate using expert rated disability weights. These are: (a) Low birth weight, (b) Lower respiratory infections, (c) Diarhoeal disease, (d) Fall, and (e) Tuberculosis. Certain diseases characterised mostly by morbidity appear in the present list. For example; periodontal disease. Fire accidents was already among the top ten causes of burden in urban areas, in the estimate using expert rating of disability weights. Here with community rated disability weights, fire accidents show up among the ten leading causes of burden both in rural and urban areas. But self-inflicted injuries recede lower down, since most of the burden under this cause is due to suicides. The disease burden due to fire accidents and suicides are manifestations of social problems.

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Inputs from the Global Burden of Disease study (World Bank, 1993; Murray and Lopez, 1996) were used to generate the minimally anchored NBD estimates for Andhra Pradesh. The final results of the first global burden of disease study were published in 1996 - GBD96. By the time of this final revision, causes of death in urban areas of Maharashtra had been gathered by the Andhra Pradesh Burden of Disease Study, to approximate the mortality experience in urban areas of India. The urban cause of death data from Maharashtra was incorporated by the GBD96 study for the Indian estimates (Murray and Lopez, 1996 p139). In the present study, urban causes of death data remain the same while rural causes of death data have been a recent addition. The GBD96 study also had access to some preliminary insights from the pilot study on rural cause of death in Andhra Pradesh (Murray and Lopez, 1996 p140). Since the GBD96 study already incorporates a lot of local information on causes of death, it will be interesting to look at the first GBD estimates published in the World Development Report, 1993 (World Bank, 1993). Call this the WDR93. The WDR93 results used here for comparative purposes are the results taken for India directly from the World Development Report . The GBD96 based estimates have been computed for Andhra Pradesh using the cause-specific mortality proportions, incidence, and duration data for India as used by the GBD96 study. The GBD96 disability weights are also used as such. These general demographic estimates are common inputs to the GBD96 based estimate and the intermediately anchored estimates for Andhra Pradesh.