It is a well established fact that a very few percentage of death in India is registered [8]. Out of this few percentage of mortality registered the MCCD is also only a few percent of mortality registered. Hence for COVID-19 deaths it is evident from this study that only a few percentages were certified as mortality due to Covid-19. This research study revealed that during the year 2020, MCCD to total RD (registered deaths) has increased by 1.8 percent as compared to 2019 (last year).
This increase was chiefly due to two reasons; first and most important was COVID-19 and secondly improvement in MCCD by some states leading to gross improvement at national level – see table 1,2,3,4,5 and figures 1,2,3,4,5 for better understanding of the scenario and issues. The total registered death during 2018 was 6911197 for 2019 it was 7596849 and in 2020 8062070. The figure increased continuously during successive years but there is a question mark on this data. The total RD increased by 685652 numbers in 2019 compared to 2018 whereas despite the COVID-19 PANDEMIC impact the increase in figures during 2020 was 240148 only which are highly questionable? The researcher found that this controversy is also raised by several global highly accredited international organizations like WHO etc [8].
The total MCCD during 2018 was 1456023 for 2019 it was 1571540 and in 2020 1811688, see table-1 and figure-1. The figure increased continuously during successive years and The total MCCD increased by 115517 numbers in 2019 compared to 2018 whereas despite the COVID-19 PANDEMIC impact the increase in figures during 2020 was 240148 only which are highly questionable? The researcher found that this controversy is also raised by several global highly accredited international organizations like WHO etc [8].
This research study revealed that MCCD declined in 11 States/UTs in 2020 compared to the previous year 2019. These states were Arunachal Pradesh, Bihar, Chandigarh, Delhi, Haryana, Kerala, Madhya Pradesh, Meghalaya, Mizoram, Nagaland and Telangana. This research study revealed that Bihar which is second most populous state in India ranked lowest in medical certification of cause of death, 2020 which is amazing see- Table – 5 and Figure-5.
Table-5- Ranking of States/UTs of India in medical certification of cause of death, 2020
State/Union Territory
|
Total Registered Deaths
|
Total Medically Certified Deaths
|
Percentage of Medically Certified Deaths to Total Registered Deaths
|
Rank of State/ Union Territory
|
Goa
|
14601
|
14601
|
100
|
1
|
Manipur
|
2230
|
2266
|
100
|
2
|
Lakshadweep
|
342
|
341
|
99.7
|
3
|
Puducherry
|
12923
|
10231
|
79.2
|
4
|
Dadra & Nagar Haveli and Daman & Diu
|
3414
|
2269
|
66.5
|
5
|
Chandigarh
|
18370
|
12200
|
66.4
|
6
|
A & N Islands
|
2951
|
1871
|
63.4
|
7
|
Delhi
|
142789
|
80866
|
56.6
|
8
|
Mizoram
|
6703
|
3329
|
49.7
|
9
|
Sikkim
|
3543
|
1648
|
46.5
|
10
|
Tamil Nadu
|
687212
|
295539
|
43
|
11
|
Maharashtra
|
808783
|
345760
|
42.8
|
12
|
Tripura
|
31645
|
11160
|
35.3
|
13
|
Arunachal Pradesh
|
3475
|
1160
|
33.4
|
14
|
Telangana
|
203127
|
62796
|
30.9
|
15
|
Karnataka
|
551808
|
158603
|
28.7
|
16
|
Meghalaya
|
19191
|
4566
|
23.8
|
17
|
Andhra Pradesh
|
455000
|
101353
|
22.3
|
18
|
Chhattisgarh
|
191938
|
41358
|
21.5
|
19
|
Gujarat
|
523892
|
107983
|
20.6
|
20
|
Assam
|
187085
|
36785
|
19.7
|
21
|
Punjab
|
229846
|
39621
|
17.2
|
22
|
West Bengal
|
606714
|
99931
|
16.5
|
23
|
Odisha
|
362982
|
59296
|
16.3
|
24
|
Rajasthan
|
477151
|
77626
|
16.3
|
25
|
Himachal Pradesh
|
44449
|
6445
|
14.5
|
26
|
Haryana
|
212238
|
29699
|
14
|
27
|
Uttar Pradesh
|
873419
|
109688
|
12.6
|
28
|
Uttarakhand
|
62219
|
7305
|
11.7
|
29
|
Kerala
|
250983
|
28192
|
11.2
|
30
|
Nagaland
|
2509
|
191
|
7.6
|
31
|
Madhya Pradesh
|
524454
|
35105
|
6.7
|
32
|
Jharkhand
|
119037
|
7313
|
6.1
|
33
|
Bihar
|
425047
|
14591
|
3.4
|
34
|
Total
|
8062070
|
1811688
|
22.5
|
|
The MCCD data of UTs of J&K and Laddakh were not available. During the years 2018-2020, Daman & Diu, A & N Islands, Chandigarh, Dadra & Nagar Haveli and Manipur and Puducherry had issued MCCD for more than 50 percent of registered deaths. The percentage of MCCD increased in Rajasthan, Sikkim, Tripura, Uttar Pradesh, A & N Islands, Assam, Chhattisgarh, Lakshadweep, Maharashtra, Manipur, Odisha, and West Bengal during 2018-2020 periods. Manipur and Goa has 100 percent MCCD during 2020 –SEE TABLE-5-FIGURE-2. Bihar ranked lowest with only 3.4 percent medically certified deaths during 2020 the COVID-19 pandemic era. Hence a large number of mortality during COVID-19 era remains uncertified till date in states like Bihar.
In 2020 there were 18, 11,688, in 2018 it was 1456023 and in 2019 1571540 total medically certified deaths. The actual the number of registered mortality at National level is 81, 15,882 and figure 80, 62,070 comes after excluding the figures of registered deaths from Jammu & Kashmir and Laddakh as per Vital Statistics of India based on CRS (Civil Registration System), 2020. MCCD in the year 2020 accounted for 22.5 per cent of total registered deaths while for the year 2018-21.1% and 20.7% for 2019 at National level (including figures of 34 States/UTs).
The ranking of States/UTs on the basis of percentage of MCCD to total registered deaths for the year 2020 shows that Manipur & Goa are top rankers with cent per cent registered deaths medically certified, followed by Lakshadweep with 99.7 per cent MCCD, 79.2 per cent in Puducherry, 66.5 per cent in D & N Haveli and Daman & Diu, 66.4 per cent in Chandigarh, 63.4 per cent in A & N Islands, 56.6 per cent in Delhi. Amongst bigger States, Tamil Nadu MCCD were 43.0 per cent followed by Maharashtra 42.8 per cent, Telangana 30.9 per cent, Karnataka 28.7 per cent, Andhra Pradesh 22.3 per cent and Gujarat 20.6 per cent see table-5 and figure-5. Bihar ranked lowest with only 3.4% MCCD followed by Jharkhand – 6.1%, Madhya Pradesh-6.7% and Nagaland-7.6%.
Deaths reported under Covid 19
COVID-19 associated mortality were leading cause group accounting for 8.9 per cent of total medically certified deaths at national level. Gender analysis revealed that 9.8 per cent of male and 7.1 per cent of female were medically certified as COVID-19 mortality at national level. The age distribution and statistical analysis of medically certified deaths due to Covid 19 for the cases of virus identified and not identified i.e. U07.1 & U07.2 were presented in Table 2, 3, 4 and figure 3, 4 and 5. More description and analysis will be discussed in next version with more data. In MCCD, as discussed earlier an urgent situation ICD-10 code of ‘U07.1 COVID 19, virus identified’ is imparted to diagnosis of COVID-19 which was definite by laboratory testing whereas ICD-10 code of ‘U07.2 COVID-19, virus not identified’ is imparted to a clinical or epidemiological diagnosis of COVID-19 in the circumstances where laboratory verification is unconvincing or not available. Both these codes U07.1 and U07.2 were used by the States/UTs for COVID-19 mortality coding as the cause of mortality. Table-2 shows that out of total 1,60, 618 COVID-19 associated mortality the virus was acknowledged in 1, 38,713 deceased whereas it was not confirmed in 21,905 cases.
Table-3 and Figure-5 shows that, the maximum percentage of death of 29.4 % was in the age group of 70 years or above followed by 55-64 years age group accounting for 23.9 % while the age group of 65-69, with class interval of only 5 years accounted for significant 14.5 per cent of COVID-19 mortality. This observational research study revealed that the majority of COVID-19 mortality was found in the age group of 45 years and above accounting for 82.7 per cent of total deaths in the group. The percentage of female mortality aged 34 years and below as well as for 55-64 years age group and 65-69 years age group, to total female deaths are greater in comparison to corresponding age groups mortality for male while in other groups male mortality were more than females. Out of the total 1, 60,618 MCCD as COVID-19 deaths; 1, 14,217 male and 46,401 female died due to COVID-19, which indicates that COVID-19 is more detrimental for males. The age and sex wise allocation of COVID-19 mortality is shown in table-2, 3, 4 and figures 3, 4, 5.