Health

What is killing people in India: A complete picture

Disease of the Respiratory System has been the major cause of death since 2000

 
By Niharika Awasthi, Neel Mani Singh
Published: Thursday 27 May 2021
Circulatory system diseases was the major cause of death since 2000. Photo: Flickr

Death leaves behind a lot of information and questions, one of which is: What led to it?

The Registration of Births and Deaths (RBD) Act, 1969 of the Indian Constitution provides the state governments with the provision to ensure Medical Certification of Cause of Death (MCCD) of all medically certified deaths.

Under the MCCD scheme, from 1980 to 1998, the national list for the tabulation of mortality and morbidity was based on the ninth Revision of International Classification of Disease (ICD-9). In 1990, the World Health Organisation (WHO), during the 43rd World Health Assembly, endorsed the 10th Revision of ICD.

In 1999, the country finalised a national list for the tabulation of mortality and morbidity under the MCCD scheme based on ICD-10 with consultation from states.

There are 69 categories of causes of death under the broad group of I to XX of the National List of Mortality and Morbidity including external causes for MCCD. 

Disease of the Respiratory System was the major cause of death since 2000, accounting for 24.3 per cent of total medically reported deaths in 2000. This figure rose to 30.6 per cent in 2009 and 32.9 per cent in 2018. 

More than 13 per cent deaths in India were grouped under Symptoms, Sign and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified — the second major cause of death in India over the years — and Others (13.5 per cent). The cases under Other cannot be categorised among the eight groups of diseases listed under ICD-10.

But the reporting, however, showed a fluctuating trend under this between 2000 and 2018.

The percentage of deaths under this category was 14.2 per cent in 2000; it dropped by 4.4 per cent in 2001 and did not increase for the next three years. From 2003 to 2008, the percentage increased to 13.1 per cent from 10.5 per cent.

A fluctuating trend was witnessed in this group from 2008 to 2018, but the percentage of deaths reported under this cause in 2018 is the same as reported under 2008 i.e., 13.1 per cent.

Deaths under the Disease of the Respiratory System increased gradually from 2000 (7 per cent) to 2018 (9.4 per cent) with insignificant fluctuations of less than 1 per cent over these years.

The percentage of deaths under Certain Infectious and Parasitic Diseases decreased by 6.3 per cent from 2000 (15.7 per cent) to 2018 (9.4 per cent). No significant fluctuation in its percentage can be seen through all these years.

Deaths reported under the cause of Certain Conditions Originating in Perinatal Period accounted for 7.8 per cent of total deaths in 2000. The percentage fluctuated from 2000 to 2013, when it accounted for 8.1 per cent deaths.

 After 2013, deaths reported under this cause decreased every year. In 2018, 5.9 per cent deaths were recorded under this.

Deaths under Neoplasms increased from 2000 (3.6 per cent) to 2018 (5.7 per cent). The highest percentage of deaths under Neoplasms was reported in the year 2017 (6.4 per cent).

Endocrine Nutritional and Metabolic Diseases related deaths increased from 2000 (3.3 per cent) to 2018 (5.6 per cent). A slightly fluctuating trend was witnessed in the number of deaths due to this cause through all these years, but ultimately an increment of 2.3 per cent was visible since 2000.

Deaths under Injury, Poisoning, and Certain Other Consequences of External Causes registered a decline of 6.8 per cent from 2000 (11.3 per cent) to 2018 (4.5 per cent).

The MCCD data since 2000 reported that deaths under the following three causes reduced in exception with the rest five causes under which the reporting increased. These causes are

  • Certain Infectious and Parasitic Diseases
  • Certain Conditions Originating in Perinatal Period
  • Injury, Poisoning, and Certain Other Consequences of External Causes

The three causes together accounted for 34.8 per cent deaths out of the total medically reported deaths in 2000. The figure dropped to 19.8 per cent by 2018.

Contrary to this, deaths under Diseases of Circulatory and Respiratory System registered the maximum increase.  In 2000, both these causes contributed to 31.3 per cent deaths of medically reported deaths; it increased to 42.3 per cent by 2018. 

In 2018, 6,950,607 deaths were reported in India, of which 1,456,023 deaths (21 per cent) were medically certified.  

In seven states out of 35 states / Union territories — Andhra Pradesh, Goa, Gujarat, Haryana, Himachal Pradesh, Manipur and Tamil Nadu — the top three causes of deaths coincide with that for the whole country Disease of Circulatory System, Symptoms, Sign and Abnormal Clinical & Laboratory Findings N.E.C., Disease of Respiratory System.

Out of the 35 states / UTs of India, around 80 per cent had Disease of the Circulatory System as the major cause of death among the medically reported deaths.

Around 37 per cent states / UTs reported Disease of the Respiratory System as their major cause of deaths; 17 per cent reported Symptoms, Sign and Abnormal Clinical & Laboratory Findings N.E.C. as their major cause of death.

Apart from these, Disease of Respiratory System was the most leading cause of death in around 45 per cent states / UTs.

Certain Condition Originating in Perinatal Period was the major cause of death in only Rajasthan (23.7 per cent). It was among the top three causes of death in Andhra Pradesh (8.2 per cent), Chattisgarh (13.0 per cent), Dadra and Nagar Haveli (14.9 per cent), Madhya Pradesh (18.7 per cent) and Odisha (17.7 per cent).

In eight states / UTs, Neoplasm was among the secondary and tertiary leading causes of death. These states / UTs are Andaman and Nicobar Islands (9.7 per cent); Arunachal Pradesh (6.5 per cent); Assam (17.5 per cent); Karnataka (9.0 per cent); Kerala (16.4 per cent); Lakshadweep (8.4 per cent); Meghalaya (11.6 per cent) and Tripura (9.1 per cent).

Similarly, Endocrine, Nutritional and Metabolic Diseases was the secondary and tertiary leading cause of deaths in Arunanchal Pradesh (7.7 per cent), Assam (18.9 per cent), Karnataka (13.1 per cent) and Telangana (10.5 per cent).

Injury, Poisoning, and Certain Other Consequences of Internal Causes was the second major cause of death in Karnataka (9.8 per cent) and Telangana (13.5 per cent).

Disease of Circulatory System, Disease of Respiratory System and Certain Infectious and Parasitic Diseases are the top three causes of deaths in 10 out of 35 states / UTs.

As many as 13 states / UTs out of the 35 included in MCCD Report 2018 reported Disease of the Respiratory System as the major cause of death among all the medically reported deaths. These are Chandigarh (10.3 per cent); Daman and Diu (11.2 per cent); Goa (11.5 per cent); Himachal Pradesh (13.5 per cent); Jharkhand (16.3 per cent); Lakshadweep (12.4 per cent); Nagaland (13.9 per cent); Punjab (11.7 per cent); Sikkim (12.0 per cent); Tripura (10.2 per cent); Uttarakhand (12.9 per cent); Uttar Pradesh (15.4 per cent) and West Bengal (14.7 per cent).

All of the above mentioned 13 states / UTs, six others also have percentage deaths under the Cause of Respiratory System higher than the national percentage of 9.4 per cent, although it was not the major cause of deaths in these states.

These states are Kerala (10.0 per cent), Maharashtra (9.5 per cent); Manipur (9.7 per cent); Meghalaya (10 per cent); Mizoram (13.2 per cent) and Rajasthan (14.2 per cent).

This cause has evolved as the major cause of death also because of the increasing air pollution and consumption of tobacco. 

Certain Infectious and Parasitic Diseases was the major cause of death in Assam (27.4 per cent) and Jharkhand (20.6 per cent).The percentage of deaths reported under this cause in Assam was more than three times the national figure (9.4 per cent) for India, whereas in Jharkhand it was more than twice the national figure.

At least three states reported Certain Infectious and Parasitic Diseases as the second major cause of death among all the medically reported deaths: Arunanchal Pradesh (25.4 per cent), Bihar (19.5 per cent) and Mizoram (15.3 per cent).

In 11 states / UTs of India, Certain Infectious and Parasitic Diseases was the third major cause of death. These are Chandigarh (7.9 per cent); Delhi (14.9 per cent); Daman and Diu (6.5 per cent); Meghalaya (11.2 per cent); Nagaland (10.1 per cent); Puducherry (12.4 per cent); Punjab (10.7 per cent); Sikkim (9.8 per cent); Uttarakhand (12.4 per cent), Uttar Pradesh (14.1 per cent) and West Bengal (10.6 per cent).

India is facing a dual burden: Some regions are still under the influence of infectious diseases while others have shifted towards non-communicable diseases (NCDs). The population comprising older people is shifting towards NCDs even as they are already prone to communicable diseases.

Since longitudinal vital registration is not very effective in India, a thorough study of epidemiological transition within the country lacks satisfactory quality data. The morbidity pattern represented by this report includes only 22.1 per cent population of the country based on which a little insight on the topic can be developed, but major generalisations cannot be made.

Around 45 per cent of states in India have infectious and parasitic diseases among their top three major cause of death. This means that 45 per cent of states / UTs of the country are still underdeveloped or developing at a slower rate.

The rest of the states / UTs have shifted towards NCDs indicating their developed status, except for Rajasthan which has higher complications and deaths at perinatal age.

Diseases in the journey of epidemiological transition appear and re-appear at times. For example, the novel coronavirus disease (COVID-19) pandemic adversely affected the whole world. This is in contrast with the general belief that communicable diseases are the characteristic of underdeveloped regions only.

The MCCD data in this regard could be misleading because of the complexity of health issues faced during the pandemic.

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