The link between air pollution-attributed cardiovascular disease (APACVD) burden and its contributing factors can aid in detecting vulnerabilities and providing forewarnings for India.

We examined the association between the status and trends of the APACVD burden obtained from the Global Burden of Diseases and Injuries study with the two development metrics in India; the human development index (HDI) and indirect indices of economic development, namely annual new motor vehicle registration and the number of functional factories for 10 years from 2009 to 2019. Lorenz curves and concentration index were used to estimate the inequalities in the state-APACVD burden and the burden per 100,000 population.

At the state level, APACVD burden was inversely related to the HDI value in India for the years 2009 (r=-0.48), 2014 (r=-0.47), and 2019 (r=-0.37), and the association was statistically significant (p<0.05). The correlation between state-level APACVD burden with the annual new motor vehicle registration and the number of functional factories in India for these years was also positive and significant (p<0.05). The APACVD was 53% unequally distributed across the states, with a concentration index of 0.53 in 2009.

We observed that at the state level, the APACVD burden was inversely related to HDI. But the APACVD burden increased with the country's economic development. Also, the excess APACVD burden appears to be attributable to the economically developed states.

At the state level, APACVD burden decreased as HDI rose over time, indicating that the burden increased with the country's economic development. It is noticeable that the economically developed states may be contributing a higher share of the APACVD burden in India.