With almost one-fifth of the world’s population living in India, the health status and the drivers of health loss are expected to vary between different parts of the country and between the states. Accordingly, effective efforts to improve population health in each state require systematic knowledge of the local health status and trends. While state-level trends for some important health indicators have been available in India, a comprehensive assessment of the diseases causing the most premature deaths and disability in each state, the risk factors responsible for this burden, and their time trends have not been available in a single standardised framework. The India State-level Disease Burden Initiative was launched in October 2015 to address this crucial knowledge gap with support from the Ministry of Health and Family Welfare of the Government of India. This is a collaborative effort between the Indian Council of Medical Research, Public Health Foundation of India, Institute for Health Metrics and Evalua ion, and experts and stakeholders from about 100 institutions across India. The work of this Initiative is overseen by an Advisory Board consisting of eminent policymakers and involves extensive engagement of 14 domain expert groups with the estimation process. Based on intense work over two years, this report describes the distribution and trends of diseases and risk factors for every state of India from 1990 to 2016.