REPORT ON MEDICAL CERTIFICATION OF CAUSE OF …

1 REPORT ON MEDICAL CERTIFICATION OF CAUSE OF death 2014 OFFICE OF THE REGISTRAR GENERAL, INDIA GOVERNMENT OF INDIA, MINISTRY OF HOME AFFAIRS, VITAL STATISTICS DIVISION, R. K. PURAM, NEW DELHI REPORT on MEDICAL CERTIFICATION of CAUSE of 2014 iii Preface This REPORT for the year 2014 is the forty first in the series of the publication presenting statistics on causes of death obtained through the Civil Registration System under the Registration of Births and Deaths Act, 1969. Section 10(2) of the Act empowers the State Government to enforce the provision relating to MEDICAL CERTIFICATION of CAUSE of death in specified areas taking into consideration the availability of MEDICAL facilities. Section 10(3) of the Act provides for issuing a certificate of the CAUSE of death by the MEDICAL practitioner who has attended to the deceased at the time of death .

2 At present, the scheme has been made applicable to limited areas and selected hospitals. 2. In the REPORT , data on medically certified deaths received from 33 States/UTs has been tabulated in conformity with the International Classification of Diseases (ICD) - Tenth Revision (1993). The statistics on causes of death have been presented, cross tabulating them by age and sex. The time series data on medically certified deaths by major CAUSE groups for the previous years have also been added. The REPORT intends to maintain the continuity in the time series of data on causes of death under MEDICAL CERTIFICATION of CAUSE of death (MCCD) which is of immense use to health planners and epidemiologists. 3. I take this opportunity to express my sincere gratitude to the State Governments and Union Territory Administrations and, specially, the Chief Registrars of Births & Deaths for furnishing the data, on the basis of which the REPORT has become possible.

3 I am thankful to each one of them for their cooperation. I am hopeful for the similar response from other states and, overall, more vigorous implementation of the provisions on MEDICAL CERTIFICATION of CAUSE of death in future, shall help reduce the time gap and establish this as a reliable source of information on the causes of deaths for the country. 4. The REPORT has been prepared by the officers and staff of the MCCD Unit of the Vital Statistics Division of this office. I must record my appreciation for the efforts put in by Shri. Kameshwar Ojha, Additional Registrar General, Shri Manoj Kumar,Deputy Registrar General, Shri R. B Singh, Senior Research Officer, Shri Pradeep Kumar Negi Assistant Director and Shri Surendra Singh Manral DEO GR-B who have been involved in the preparation of this REPORT . New Delhi SAILESH September, 2016 Addl.

4 Secretary and Registrar General & Census Commissioner, India TTAABBLLEE OOFF CCOONNTTEENNTTSS--22001144 DESCRIPTION PAGE NO. Preface iii Executive Summary vii - ix CHAPTERS Chapter I Introduction 3-5 Chapter II Scheme of MCCD Status of Implementation 9-16 Chapter III Distribution of Deaths by CAUSE 19-50 Chapter IV Specific CAUSE of Mortality in different age groups 53-63 APPENDICES Appendix-I Statistical Tables 68-201 Appendix-II MEDICAL Certificate of CAUSE of death for Hospital Events (Form No. 4). 202 Appendix-III MEDICAL Certificate of CAUSE of death - for Non-Hospital Events (Form No. 4 A) 203 Appendix-IV Major Groups and the description of ICD -10 204-205 Appendix-V National List based on ICD-10 206-214 Appendix-VI List of States/Union Territories supplied MCCD data during 2005 to 2014 215 vii EExxeeccuuttiivvee SSuummmmaarryy Reliable CAUSE -specific mortality statistics is required on a regular basis by Administrators, Policy Planners, Researchers and other Professionals for evidence-based decision-making with regard to resource allocation, monitoring of indicators, identifying the priorities for programs and other related activities in the area of Public Health.

5 Keeping this in view, the scheme of MEDICAL CERTIFICATION of CAUSE of death (MCCD) was introduced in the country under the provisions of Registration of Births and Deaths (RBD) Act, 1969. Since then, it has been operational in the country, but with varying levels of efficiency across the States/Union Territories. Under the scheme, the Office of the Registrar General, India (ORGI) obtains data on medically certified deaths as collected, compiled and tabulated by the Offices of the Chief Registrars of Births and Deaths of the States/UTs. Methodology: The necessary data is collected in the prescribed forms (Form 4 for Hospital deaths and Form 4A for Non-institutional deaths). Both these forms have been designed by World Health Organization (WHO). The forms are filled-up by the MEDICAL professionals attending to the deceased at the time of terminal illness.

6 Thereafter, these forms are to be sent to the concerned Registrars of Births and Deaths for onward transmission to the Chief Registrar Office for tabulation as per the National List of causes of death based on Tenth Revision of International Classification of Disease (ICD-10). The States/UTs subsequently send it to the Office of RGI in the form of Statistical Table-9 for consolidation at the national level. Scope of the REPORT : The REPORT on MCCD-2014, is based upon 10,66,221 total medically certified deaths (Male: 6,66,686 and Female: 3,99,535) accounting for per cent of total registered deaths in respect of 33 States/UTs who supplied data for the REPORT . As mentioned above, owing to different levels of efficiency of MEDICAL CERTIFICATION across the States/UTs, the number of deaths reported therein may lack the representative character in the strict sense, however, it may be sufficient to throw some valuable insights into deaths by various CAUSE groups and their gravity.

7 Findings: Overall: Following are eight leading CAUSE -groups of deaths constituting around per cent of total medically certified CAUSE of deaths: Diseases of Circulatory System ( per cent) Symptoms Signs & Abnormal Clinical Findings Not Elsewhere Classified ( per cent) Certain Infectious and Parasitic Diseases ( per cent) Diseases of Respiratory System ( per cent) Certain Conditions Originating in the Perinatal Period per cent) Injury, Poisoning and Certain other Consequences of External causes ( per cent). Neoplasm ( per cent) Diseases of Digestive System( per cent) viii Among the Diseases of Circulatory System deaths, the Diseases of Pulmonary Circulation and Other Forms of Heart diseases and Ischemic Heart Diseases (IHD) account for and per cent deaths respectively. per cent of the total medically certified deaths were classified under the Symptoms, signs & abnormal clinical and laboratory findings not elsewhere classified which is the second leading CAUSE of death .

8 The major Group Certain Infectious and Parasitic Diseases which is the third leading CAUSE of death is mainly constituted by Tuberculosis and Septicemia. Under this major group, the shares of these two diseases are and per cent respectively. Septicemia alone accounts for per cent of the total medically certified deaths. Under the fourth leading group Diseases of Respiratory System , Pneumonia, caused per cent deaths, followed by Asthma causing per cent deaths. Pneumonia alone accounts for per cent of the total medically certified deaths. The group of diseases relating to Certain Conditions originating in the Perinatal Period is the fifth leading CAUSE of death , accounting for per cent of the total medically certified deaths. Hypoxia, birth asphyxia and other Respiratory Conditions accounts for per cent of the deaths under the group and per cent of total medically certified deaths.

9 The sixth leading CAUSE group Injury, Poisoning and Certain Other Consequences of External causes , has a major constituent Burns and Corrosions contributing per cent of the total deaths under this CAUSE group and per cent of the total medically certified deaths. The major group Neoplasm (Cancer) is the seventh leading CAUSE accounting for per cent of the total medically certified deaths, of which Malignant neoplasm of digestive organs accounts for per cent of deaths. The eighth leading CAUSE , Diseases of Digestive System is responsible for per cent of the total medically certified deaths, of which Diseases of Liver alone accounts for per cent of the deaths. The share of Liver diseases in the total medically certified deaths is per cent. Age-wise: Every tenth reported medically certified death has been of the infants (age less than 1 year) About per cent of infant deaths have been reported to be caused by Certain Conditions originating in the Perinatal Period.

10 Among the children aged 1-4 years, Heart Diseases have taken the highest toll of per cent. Among the children aged 0-4 years, Complication originating in the Perinatal Period caused of deaths. In the age-group 5-14 years, the CAUSE group Certain Infectious and Parasitic Diseases claimed the top most position with the share of per cent. ix In the age-group of 15-24 and 25-34 years, major group Injury, Poisoning & Certain Other Consequences of External causes is the first among the leading causes contributing per cent and per cent deaths respectively. It implies that these age-groups of youth and adolescent are more vulnerable to injuries and poisoning related deaths. In the age-group 35-44 years, the first two leading causes , Diseases of Circulatory System and Certain Infectious and Parasitic Diseases are having the shares of per cent and per cent respectively.