The MCCD-2020 report gives a tantalising glimpse of epidemiological gems that can be gleaned. But given the data gaps, would it be wise to act on these insights?
Data is the new oil, but unfortunately, the recently released report on Medical Certification of Cause of Death (MCCD)-2020 reveals that India still cannot tap fully into its health data. This is a waste of resources, akin to an oil well spewing precious oil, with future generations unable to benefit from the epidemiological insights that could have been gleaned.
MCCD-2020 shows that medically certified deaths account for a mere 22.5 per cent of total registered deaths at the national level (including figures of 34 States/UTs). This is a slight improvement (1.8 percentage point) from the previous year’s 20.7 per cent so there is obviously a lot of room for improvement. Especially with COVID-19 cases slowing rising, thanks to various variants. Add in the approaching monsoons and reports of monkey pox, and you have the makings of a perfect storm.
Of the 36 states/UTs represented in the MCCD2020 report, almost half (17) fall below the national average of 22.5 percent of medically certified deaths to total registered deaths for 2020.
Though the MCCD-2020 report is the 47th in the series, it unfortunately remains a work in progress. It cautions that there are ‘varying levels of efficiency’ of data reporting across the country, with reporting limited to selected hospitals, from mostly urban areas, so ‘the profile presented may not yield the reliable pattern of cause specific mortality prevalent in the states/country’.
It is unfortunate that these data gaps exist even though this is the 47th such report on cause of death statistics. Thus the government needs to urgently step up efforts to get more states/UTs and the medical facilities within them to report in the format required. These gaps in data could prove very expensive for public health authorities and will have tragic consequences for patients as accurate health data is essential for health planners and epidemiologists to track effective allocation of resources and monitoring the implementation of a nation’s public health policy.
But even with these gaps, some data points indicate trends which bear further investigation, where the states with positive indicators can be taken as examples to be followed.
Manipur’s performance bears special mention: it went from 51.4 per cent in 2018, 67.3 percent in 2019 to cent per cent in 2020. Goa has in fact reported cent per cent medically certified deaths from 2018. Even though these are smaller states, with significantly lower mortality numbers than the larger states, they are definitely doing something right which can be replicated and scale up in larger states.
Jharkhand is another example where medically certified deaths is slowly inching up from 4.6 percent (2018), to 5.8 (2019) to 6.1 percent in 2020.They are proof that where there is a will, ways can be found.
Goa had 14601 registered deaths, whereas Bihar had 425047 registered deaths, of which just 3.4 per cent (14591) were medically certified deaths. Reflecting the complexity of all larger states, Bihar shows the most drastic decrease in percentage of medically certified deaths to total registered deaths during 2018-2020. The state went from 13.6 per cent in 2018 to 5.1 per cent in 2019 and a worrying 3.4 per cent in 2020.
Madhya Pradesh is in the same bracket as Bihar: (10.5 per cent to 9.1 per cent to 6.7 per cent) Bihar and Madhya Pradesh are part of the cohort of 11 states/UTs which have reported a decline in absolute number of medically certified deaths in 2020 over the previous year.
Just a cursory look at the data gives a tantalising glimpse of the epidemiological gems that can be gleaned. For example, of the nine leading cause-groups of deaths which make up around 88.7 per cent of total medically certified cause of deaths, diseases of the circulatory system leads with 32.1 per cent. Within this group, the diseases of pulmonary circulation and other forms of heart diseases and Ischemic Heart Diseases (IHD) account for 47.7 and 23.3 per cent deaths respectively.
In fact, the share of these two groups is 22.8 per cent of total medically certified deaths (15.3 & 7.5 per cent). The second cause of deaths is diseases of the respiratory system (10.0 per cent), followed by COVID-19 related deaths (8.9 per cent).
An inter-state comparative analysis shows that more than 30 per cent of total medically certified deaths under the diseases of the circulatory system category are from 14 states/UTs with Jharkhand, Andhra Pradesh and Lakshadweep reporting as high as 61.3, 60.6 and 57.8 per cent of deaths (more than half of the deaths), under this category, compared to Uttar Pradesh which reported just 13.5 per cent in this category. The corresponding figure at the national level for all reporting states taken together is 32.1 per cent.
But given the data gaps, would it be wise to act on these insights? Let us not forget that these data points represent real patients, beloved to their families. Strengthening health data reporting systems is the best way to create better health policies and coverage for the loved ones they leave behind and society at large. This is a legacy worth working for.
VIVEKA ROYCHOWDHURY
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