Medical Certification of Cause of Death Report-2020

In India, medically certified deaths made make up 22.5% but after accounting for whatever medical care the deceased got during their final illness, that percentage rises to 54.6%.

Highlights:

In 2020, there were 81.2 lakh deaths in India regardless of the reason. Circulatory system diseases were the leading cause of death, accounting for about 32.1% of all deaths
India's official Covid-19 death toll is 5.2 lakhs as of May 2022

‘Actual number of deaths according to the medical certification of cause of death due to COVID 19 in 2020 was 1,60,618 while government only reported 1.49 Lakhs leading to a discrepancy of 11,618 deaths.’
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MCCD Report

The Medical Certification of Cause of Death (MCCD) programme, which is a component of the Vital Statistics System under the system of Registration of Births and Deaths, aims to provide a trustworthy and chronological database for producing cause-specific mortality statistics. In accordance with the Registration of Births and Deaths Act of 1969, the Chief Registrar of Births and Deaths of the several States and Union Territories provides information on reasons of deaths to the Office of the Registrar General of India (ORGI).

Under the terms of the Registration of Births and Deaths (RBD) Act1969, the Medical Certification of Cause of Death (MCCD) programme was established in the nation. Since then, it has been in use throughout the nation, but with variable degrees of effectiveness in various States and Union Territories. According to the plan, the Office of the Registrar General of India (ORGI) gets information on medically verified causes of deaths from the offices of the respective Chief Registrars of Births and Deaths of the States/UTs(, , ).

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How is this Data Tabulated?

Form 4 for hospital fatalities and Form 4A for non-institutional deaths are used to collect the required data. The World Health Organization (WHO) devised both of these types. The medical personnel caring for the deceased throughout their terminal illness fill out the documents. The following step is to send these forms to the relevant Registrars of Births and Deaths for transmission to the Chief Registrar Office for tabulation in accordance with the National List of Causes of Death based on the Tenth Revision of the International Classification of Disease (ICD-10). In order to be consolidated at the national level, the States/UTs provide it to the Office of RGI in the form of Statistical Table-11().

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Highlights of the MCCD Report

There were 81.2 lakh fatalities in 2020. According to the research, India will have an excess of 47.4 lakh deaths between 2020 and 2021.
According to Civil Registration System (CRS) data, there were 4.75 lakh more fatalities overall in 2020 than there were in 2019.
At the national level, medically certified deaths made up 22.5% of all deaths that are documented, but after accounting for any type of medical care the deceased got during their terminal illness, that number was raised to 54.6%.
Infants account for about 5.7% of all medically verified mortalities.

Leading Cause of Deaths in India

Nine primary cause of deaths accounting for about 88.7% of all deaths with a certified medical cause are as follows:

Circulatory system diseases (32.1%)
Respiratory system illnesses (10%)
Covid-19: Codes for Special Purposes (8.9%)
A few Parasitic and Infectious Diseases (mainly septicemia and tuberculosis) (7.1%)
Metabolic, Nutritional and Endocrine disorders (5.8%)
Injury, poisoning, and a few more effects due to outside factors (5.6%)
Tumours (4.7%).
Specific Conditions Occurring During Pregnancy (4.1%)
"Not Elsewhere Classified" Clinical Findings, Symptoms, and Signs (10.6%)(4^✔ ✔Trusted Source
In 2020, medical reason was given in only 22.5% deaths in 17 dates: RGI

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COVID-19 Death Toll in India

The respiratory condition Covid-19 virus has also been included individually in the report as ‘Deaths reported under Codes for Special Purposes (Covid-19 Deaths).’

Covid-19 fatalities accounted for 8.9% of all medically certified deaths nationwide, making it the third most common cause -group.

However only 1.49 lakh Covid-19 deaths were reported by the Union Health Ministry in 2020 as all death were not necessarily documented or captured under the COVID category. There was international criticism as it was felt that India was under-reporting the deaths. In fact some investigators looked at the deaths reported by crematorium’s in India and compared them to the previous years and were able to compute the death rate. A World Health Organization (WHO) report, claimed that Covid-19 deaths in India were nearly 10 times the figures reported by the Indian government or 4.7 million deaths (). India's official Covid-19 death toll is 5.2 lakh as of May 2022. (, , ).

Deaths Due To Respiratory Diseases

About 1,81,160 respiratory disease-related deaths were reported in 2020, which is an increase from 1,52,311 in 2019. These deaths included pneumonia, asthma and bronchitis. Respiratory disorders caused the highest number of all registered medically certified deaths (29.4%) in people over 70.

Following this, ages 55-64 reported 23.9% of deaths, and ages 65-69 reported 4.5% of deaths.
The age group of 45 and over accounted for 82.7% of all deaths making it the majority of that category (, , ).

Need For MCCD Report

Administrators, policy planners, researchers, and other professionals regularly need reliable cause-specific mortality statistics for evidence-based decision-making with regard to resource allocation, monitoring of indicators, determining the priorities for programmes, and other related activities in the field of public health.

References:

Annual Report on MCCD-2020 - (https://censusindia.gov.in/nada/index.php/catalog/42681)
Report On Medical Certification Of Cause Of Death 2020 - (https://censusindia.gov.in/nada/index.php/catalog/42681/download/46350/Annual_Report_on_MCCD_2020.pdf)
Medical Certification of Cause of Death - (https://apps.who.int/iris/bitstream/handle/10665/40557/9241560622.pdf)
In 2020, medical reason was given in only 22.5% deaths in 17 dates: RGI - (https://economictimes.indiatimes.com/news/india/in-2020-medical-reason-was-given-in-only-22-5-deaths-in-17-dates-rgi/articleshow/91842659.cms?from=mdr)
Why India's real Covid toll may never be known - (https://www.bbc.com/news/world-asia-india-60981318)
Medical certification of cause of death during COVID-19 pandemic – a challenging scenario - (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7928126/)
In first year of lockdown, more died of other respiratory diseases than COVID-19 - (https://www.thehindu.com/sci-tech/health/heart-problems-pneumonia-asthma-claim-42-of-total-deaths-in-india-in-2020-covid-9/article65463397.ece)
Medical certification of cause of death for COVID-19 - (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7265943/)