Large Variation between states in the share of ‘Medically Certified Deaths’ due to various causes

Recently, the Annual Report on the Medical Certification of Cause of Death (MCCD), 2020 was released by the Office of the Registrar General & Census Commissioner, India (ORGI). According to the report, there were around 18.12 lakh medically certified deaths in 2020, which is about 22% of the estimated 81.16 lakhs deaths in 2020. Large Variation between states in the share of ‘Medically Certified Deaths’ due to various causes. Recently, the Annual Report on the Medical Certification of Cause of Death (MCCD), 2020 was released by the Office of the Registrar General & Census Commissioner, India (ORGI). The report contains vital statistics on causes of death obtained through the Civil Registration System under the Registration of Births and Deaths Act, 1969. Data on medically certified causes of deaths received from each state/UT is compiled in the report. In the 2020 report, new codes to capture deaths due to COVID-19 have been introduced following ICMR’s recommendation. State-wise data on medically certified deaths by age, sex, and cause of death in the calendar year are some of the important statistics in the report. Such data is important to monitor the health trends in the population. Further, periodic cause-specific mortality statistics are useful for administrators, policy planners, researchers, etc. for evidence-based decision-making in the domain of public health such as resource allocation, monitoring of indicators, and identifying the priorities for programs and other related activities while undertaking appropriate curative and preventive measures for various health problems. Moreover, the data helps in the furtherance of medical research and identify areas for improving the methods of diagnosis and analysis. Cause of death of only 22.5% out of 81.16 lakhs has been medically certified According to the report, there were around 18.12 lakh deaths in 2020, including 11.6 lakh males and 6.52 lakh females, that were medically certified. The annual report on Vital Statistics of India based on the Civil Registration System (2020) reported that the total number of registered deaths at the national level was estimated at 81.16 lakhs in 2020. Excluding the figures of registered deaths from Jammu & Kashmir and Ladakh, the total deaths registered was nearly 80.63 lakhs. However, out of these 80+ lakh deaths registered, only about 18.12 lakh deaths have been medically certified. In other words, the cause of death is medically certified in only 22.5% of deaths in 2020. This percentage varies from 3.4% in Bihar to 100% in Goa and Manipur. However, the percentage of medically certified deaths as compared to the total number of registered deaths is the highest in 2020 in the last three decades. Over the years, there has only been a marginal improvement in the share of medically certified deaths- from 20% in 2011 to 22.5% in 2020. 9 leading causes of death, including COVID-19, accounted for nearly 90% of the medically certified deaths In 2020, the nine leading cause groups of death together accounted for about 88.9% of all the medically certified deaths. These are- Diseases of the Circulatory System; Diseases of the Respiratory System; Codes for Special Purposes (COVID-19 deaths); Certain Infectious and Parasitic Diseases; Endocrine, Nutritional and Metabolic Diseases; Injury, Poisoning and Certain Other Consequences of External Causes; Neoplasms; Certain Conditions Originating in the Perinatal Period; and Symptoms, Sign and Abnormal Clinical & Laboratory Findings Not Elsewhere Classified. The trend in the share of deaths due to leading causes seen above indicates that diseases of the circulatory system such as diseases of the pulmonary circulation and other forms of Heart Diseases, Hypertensive diseases, etc. are the cause of death in the majority of the certified deaths since 2000. It accounted for more than 30% of the medically certified deaths in each of the years since 2014. Respiratory diseases such as pneumonia, bronchitis, asthma, etc. were the second leading cause in 2020. The share of deaths due to lung diseases has been on a rise since 2014. This is for the first time since 2000 that the share of deaths due to lung diseases has touched 10%. Prior to 2020, the share of deaths due to certain infectious and parasitic diseases was the second leading cause. However, in 2020, its share was the lowest in the last two decades with 7.1%, 2.7 percentage points lower than in 2019. Though it has been on a decline for decades, such a steep decline was not reported earlier. Deaths due to COVID-19 accounted for 8.9% of the medically certified deaths in 2020. In 2020, the deaths due to circulatory diseases, respiratory diseases, and COVID-19 together accounted for 51%.