A few Results on Causes of Deaths – A report from Government of India

A Special Survey of Deaths (SSD), undertaken in 2001-2003, has been carried out under the domain of Sample Registration System (SRS), which covered over 6,645 small areas (sample units) in all the States and Union Territories. The causes of death have been determined using an advanced form of Verbal Autopsy called the “RHIME” or Representative, Re-sampled, Routine Household Interview of Mortality with Medical Evaluation method. The SRS field staff that have been trained extensively for collection of the symptoms, signs and key circumstances leading to death using a two-page structured form with a brief narrative in local language, have undertaken the survey. A random sample of about 5-10% of the units has been reported on Causes of Death:2001-03, Office of Registrar General, India Page 2 surveyed by an independent team to ensure the quality of fieldwork, completeness and accuracy. The assignment of causes of death has been done through a medical evaluation by two independent trained physicians who have examined the field reports using a web-based system developed specifically for the study. The cases resulting into continuing disagreements were referred to a third physician to adjudicate the final ICD-10 code. 

The following are a few results from this survey:

1. Overall non-communicable diseases are the leading causes of death in the country, constituting 42% of all deaths. Communicable, maternal, perinatal and nutritional conditions constitute another 38% of deaths. Injuries and ill-defined causes constitute 10% of deaths each. However, majority of ill-defined causes are at older ages (70 or higher years) and most of ill-defined deaths are likely to be from non-communicable diseases.
2. There is a marked regional variation in the contribution of various causes to the leading deaths. Cardiovascular disease is the leading cause of death in the all regions of India, with the highest proportion in the Southern region (25%) and the lowest in the Central region (12%). The other prominent causes of death across different regions are respiratory diseases, diarrheal diseases, peri-natal conditions, tuberculosis and cancer. Respiratory diseases account for substantial proportion of deaths in all the regions with the maximum reported in the Central region and the minimum in the North-Eastern region. The highest incidence of deaths due to diarrheal diseases is observed in Eastern region (10.4%) followed closely by Central (9.8%) and North-Eastern regions (9.2%).

3. Diarrheal diseases account for more than 5% of the total deaths in North, West and Southern regions respectively. Peri-natal conditions are responsible for the maximum proportion of deaths in Central region (7.9%) followed by West (7.3%), East (7%), North-East (6.1%), South (4.1%) and North (3.9%). The proportion of deaths attributable to tuberculosis ranges from 5.1% in Southern region to 7.2% in Central region. Cancer deaths are more pronounced in South, North, North-East and Western regions.

4. In Eastern and North-Eastern regions, deaths due to malaria are notably higher at 6% and 5% respectively, of deaths due to all causes. In the Southern region, suicide constitutes nearly 5% of all deaths at all ages. Senility and ill-defined symptoms and signs constitute 8% to 12% of deaths across different regions with the highest (12%) in Southern region. The results are influenced by the age at death, with the States having higher proportion of older populations showing more deaths due to ill-defined causes.

  The report conclude that large number of deaths in the country have been occurring in early ages as well as in middle ages, which is suggestive that proper medical attention and health care facilities can certainly help alleviate this situation. The findings of the Report highlight specifically the need for augmenting interventionist strategies and programs for reducing the mortality resulting from health problems in childhood. Similarly, there is a need to ensure that tuberculosis, HIV/AIDS and malaria programs as well as those addressing maternal mortality are implemented in areas afflicted by the problem to reduce the proportion of deaths taking place due to these diseases in the country. The spread of non-communicable diseases, particularly, the vascular, respiratory disease and cancers, which are causing maximum deaths in rural and urban areas across EAG states & Assam and the Other States, is another important finding of the Report. There is, however, a need for a word of caution. The mortality results presented in the Report should be interpreted carefully as the chance of misclassification of causes is not completely ruled out. However, despite this limitation, the study brings out findings which should definitely help enrich understanding of the mortality situation and challenges thereof in the country.