Change of the burden of infectious diseases and antimicrobial resistance in India: a systematic analysis for the Global Burden of Disease Study 2019 and 2021

Abstract

Infectious diseases and antimicrobial resistance (AMR) remain one of the major causes of mortality and disability in India. But age- and pathogen-specific evidence on recent changes in AMR burden is limited. We analysed India-specific data from the Global Burden of Disease Antimicrobial Resistance Study to quantify changes in infectious disease and AMR-related deaths and disability-adjusted life years (DALYs) between 2019 and 2021. Deaths and DALYs, both associated with and attributable to AMR, were examined across 11 infectious syndromes, major bacterial pathogens, across age groups, and sex. Between 2019 and 2021, total infectious disease deaths declined by 5.3% and DALYs by 9.0%. AMR-associated deaths fell from 1.05 million to 0.99 million (− 6.0%), and AMR-attributable deaths from 283,556 to 266,734 (− 5.9%). Reductions were greatest among children under five years, while adults aged 60 years and older accounted for an increasing share of AMR-attributable mortality. Bloodstream and lower respiratory infections remained the dominant contributors. Despite overall declines, AMR continues to account for a substantial proportion of preventable deaths in India, highlighting the need for strengthened surveillance, age-targeted antimicrobial strategy, and pathogen-specific interventions.