BACKGROUND: As @entity1 mortality decreases rapidly worldwide, premature adult mortality is becoming an increasingly important contributor to global mortality. Any possible worldwide reduction of premature adult mortality before the age of 70 years will depend on progress in India. Indian districts increasingly have responsibility for implementing public health programmes. We aimed to assess age-specific and sex-specific adult mortality risks in India at the district level. METHODS: We analysed data from five national surveys of 0  27 million adult @entity204 at an age of 15-69 years together with 2014 demographic data to estimate age-specific and sex-specific adult mortality risks for 597 districts. Cause of death data were drawn from the verbal autopsies in the Registrar General of India's ongoing Million Death Study. FINDINGS: In 2014, about two-fifths of India's @entity1 aged 15-69 years lived in the 253 districts where the conditional probability of a @entity1 dying at these ages exceeded 50%, and more than a third of India's @entity1 aged 15-69 years lived in the 222 districts where the conditional probability of a @entity1 dying exceeded 40%. The probabilities of a @entity1 or @entity1 dying by the age of 70 years in high-mortality districts was 62% and 54%, respectively, whereas the probability of a @entity1 or @entity1 dying by the age of 70 years in low-mortality districts was 40% and 30%, respectively. The roughly 10-year survival gap between high-mortality and low-mortality districts was nearly as extreme as the survival gap between the entire Indian population and @entity1 living in high-income countries. Adult mortality risks at ages 15-69 years was highest in east India and lowest in @entity739 , by contrast with the north-south divide for @entity1 mortality. @entity455 , @entity378 , @entity311 and other @entity281 , and @entity1576 accounted for about 60% of the absolute gap in adult mortality risk at ages 15-69 years between high-mortality and low-mortality districts. Most of the variation in adult mortality could not be explained by known determinants or risk factors for premature mortality. INTERPRETATION: India's large variation in adult mortality by district, notably the higher death rates in eastern India, requires further aetiological research, particularly to explore whether high levels of adult mortality risks from @entity281 and non-communicable diseases are a result of historical childhood @entity3147 and @entity281 . Such research can be complemented by an expanded coverage of known effective interventions to reduce adult mortality, especially in high-mortality districts. FUNDING: National Institutes of Health, Canadian Institutes of Health Research, University of Toronto.

Age-specific and sex-specific adult mortality risk in India in 2014: analysis of 0  27 million nationally surveyed XXXX and demographic estimates from 597 districts.

@entity1 :: ('9606', 'Species') :: ['women', 'woman', 'people', 'man', 'child', 'men'] @entity455 :: ('MESH:D014652', 'Disease') :: ['Vascular disease'] @entity739 :: ('MESH:D013036', 'Disease') :: ['west India'] @entity281 :: ('MESH:D007239', 'Disease') :: ['infection', 'infections'] @entity1576 :: ('MESH:D012131', 'Disease') :: ['respiratory diseases'] @entity3147 :: ('MESH:D044342', 'Disease') :: ['malnutrition'] @entity311 :: ('MESH:D008288', 'Disease') :: ['malaria'] @entity378 :: ('MESH:D014376', 'Disease') :: ['tuberculosis'] @entity204 :: ('MESH:D003643', 'Disease') :: ['deaths']
@entity204 :: (MESH:D003643,Disease) :: ['deaths']
