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Subnational mortality estimates for India in 2019: a baseline for evaluating excess deaths due to the COVID-19 pandemic
  1. Chalapati Rao1,
  2. Amrit Jose John2,
  3. Ajit Kumar Yadav3,
  4. Mansha Siraj4
  1. 1Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
  2. 2International Institute for Population Sciences, Mumbai, India
  3. 3Indo German Programme on Universal Health Coverage, GIZ, Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, Delhi, India
  4. 4Goldman School of Public Policy, University of California Berkeley, Berkeley, California, USA
  1. Correspondence to Dr Chalapati Rao; chalapati.rao{at}anu.edu.au

Abstract

Background Estimates of excess mortality are required to assess and compare the impact of the COVID-19 pandemic across populations. For India, reliable baseline prepandemic mortality patterns at national and subnational level are necessary for such assessments. However, available data from the Civil Registration System (CRS) is affected by incompleteness of death recording that varies by sex, age and location.

Methods Under-reporting of CRS 2019 deaths was assessed for three age groups (< 5 years, 15–59 years and ≥60 years) at subnational level, through comparison with age-specific death rates from alternate sources. Age-specific corrections for under-reporting were applied to derive adjusted death counts by sex for each location. These were used to compute life expectancy (LE) at birth by sex in 2019, which were compared with subnational LEs from the Global Burden of Disease (GBD) 2019 Study.

Results A total of 9.92 million deaths (95% UI 9.70 to 10.02) were estimated across India in 2019, about 2.28 million more than CRS reports. Adjustments to under-five and elderly mortality accounted for 30% and 56% of additional deaths, respectively. Adjustments in Bihar, Jharkhand, Madhya Pradesh, Maharashtra, Rajasthan and Uttar Pradesh accounted for 75% of all additional deaths. Adjusted LEs were below corresponding GBD estimates by ≥2 years for males at national level and in 20 states, and by ≥1 year for females in 12 states.

Conclusions These results represent the first-ever subnational mortality estimates for India derived from CRS reported deaths, and serve as a baseline for assessing excess mortality from the COVID-19 pandemic. Adjusted life expectancies indicate higher mortality patterns in India than previously perceived. Under-reporting of infant deaths and those among women and the elderly is evident in many locations. Further CRS strengthening is required to improve the empirical basis for local mortality measurement across the country.

  • public health
  • epidemiology
  • health policy

Data availability statement

All data relevant to the study are available from the various references provided in the bibliography or uploaded as supplementary information.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

http://dx.doi.org/10.1136/bmjgh-2021-007399

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    Data availability statement

    All data relevant to the study are available from the various references provided in the bibliography or uploaded as supplementary information.

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    Footnotes

    • Handling editor Seye Abimbola

    • Twitter @ChalapatiRao13, @AmritJJohn1

    • Contributors CR conceptualised and led this analysis and also drafted the initial version of the manuscript. AJJ, AKY and MS all participated in the analysis, contributed to developing the figures, tables and supplementary files and critically reviewed draft versions of the manuscript. All authors contributed to the development of the final version of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.