Even as data from an international study emerged, estimating that 11.19 lakh excess deaths occurred in 2020 during the Covid-19 pandemic in India, and that life expectancy among Indian men and women fell, the Union Health Ministry on Saturday, July 20, 2024, issued a statement contesting these findings and, stating that they were based on “untenable and unacceptable” estimates.
While the paper’s authors claim to have followed a standard methodology of analysing National Family Health Survey-5 (NFHS-5) data, the Ministry said there were “critical flaws” in the methodology.
According to the paper, ‘Large and unequal life expectancy declines during the COVID-19 pandemic in India in 2020’, published in the journal Science Advances, 11.9 lakh excess deaths occurred in 2020 in the country during the pandemic, 17 per cent higher compared to the deaths in 2019. Their estimate is about eight times higher than the official COVID-19 deaths in India, and 1.5 times the World Health Organisation's estimates, researchers, including those from the University of Oxford, UK, said.
Using data of over 7.65 lakh individuals, the study also estimated changes in life expectancy at birth, by gender and social group between 2019 and 2020 in India. The data was taken from the National Family Health Survey-5 (NFHS-5).
According to the study, the life expectancy in women fell by 3.1 years, while it fell by 2.1 years in men, the authors said. Gender inequalities in healthcare and resource distribution within households could be possible reasons, they said. These patterns contrast with those seen in high-income countries, where excess deaths were higher among men than women during the pandemic, the authors pointed out.
Ministry says there are ‘critical flaws’ in methodology
However, the Health Ministry, in its statement said: “The most important flaw is that the authors have taken a subset of households included in the NFHS survey between January and April 2021, compared mortality in these households in 2020 with 2019, and extrapolated the results to the entire country.” The NFHS sample is representative of the country only when it is considered as a whole. The 23 per cent of households included in this analysis from part of 14 states cannot be considered representative of the country, the statement said.
“The other critical flaw is related to possible selection and reporting biases in the included sample due to the time in which these data were collected, at the peak of the COVID-19 pandemic,” it said.
Life expectancy among different social groups
In another finding, the researchers, while looking at social groups, found that high caste Hindu groups experienced a life expectancy decline of 1.3 years, whereas Muslims and Scheduled Tribes experienced a 5.4-year and 4.1-year drop in their life expectancies. The pandemic therefore, exacerbated the disparities already faced by these marginalised caste and religious groups in terms of life expectancy, the authors said.
"Marginalised groups already had lower life expectancy, and the pandemic further increased the gap between the most privileged Indian social groups, and the most marginalised social groups in India," said first author Aashish Gupta, a research fellow at the University of Oxford.
Further, the researchers found that deaths in India increased across age groups, most prominently among the youngest and the oldest, whereas drops in life expectancy in high-income countries were largely driven by increased deaths in those aged 60 years and above.
Excess deaths among the youngest could be explained by children in certain areas being more vulnerable to the COVID-19 infection, they said. The indirect effects of the pandemic and lockdowns, including deteriorating economic conditions and disruptions to public health services, also contributed to excess mortality in the youngest age groups, according to the authors.
CRS is a robust system: Health Ministry
Contesting all of the findings, the Union Health Ministry said the paper erroneously argues for the need for such analyses claiming that vital registration systems in low and middle income countries, including India, is weak. “This is far from being correct. The Civil Registration System (CRS) in India is highly robust and captures over 99 per cent of deaths. This reporting has constantly increased from 75 per cent in 2015 to over 99 per cent in 2020,” the statement said.
Data from this system shows death registration has increased by 4.74 lakh in 2020 compared to 2019, it said. There was a similar increase of 4.86 lakh and 6.90 lakh in death registrations in 2018 and 2019 over the respective previous years, the statement said.
“Notably, all excess deaths in a year in the CRS are not attributable to the pandemic. Excess number is also due to an increasing trend of death registration in CRS (it was 92 per cent in 2019) and a larger population base in the succeeding year,” it said.
“It is strongly asserted that an excess mortality of about 11.9 lakh deaths reported in the Science Advances paper in 2020 over the previous year is a gross and misleading overestimate,” the statement said.
It is noteworthy that excess mortality during the pandemic means increase in deaths due to all causes, and cannot be equated with deaths that were directly caused by Covid, it said.
Estimates are erroneous: Health Ministry
The erroneous nature of the estimates published by the researchers is further corroborated by data from India’s Sample Registration System (SRS), the statement said.
The SRS covers a population of 84 lakh in 24 lakh households in 8,842 sample units spread across 36 states and UTs, it said. While the authors take great pains to show that results from the NFHS analyses and SRS analyses for 2018 and 2019 are comparable, they completely fail to report that the SRS data in 2020 shows very little, if any, excess mortality compared to the 2019 data (crude death rate 6.0/1000 in 2020, crude death rate 6.0/1000 in 2019) and no reduction in life expectancy, the statement said.
The paper reports results on age and sex, which are contrary to research and programme data on COVID-19 in India. The paper claims that excess mortality was greater in females and in younger age groups (particularly 0-19 year old children), it said. Data on about 5.3 lakh recorded deaths due to Covid-19, as well as research data from cohorts and registries consistently shows higher mortality due to Covid-19 in males than females (2:1) and in older age groups.
These inconsistent and unexplainable results in the published paper further reduce any confidence in its claims, the statement said.
In conclusion, the all-cause excess mortality in 2020 compared with the previous year in India is markedly less than the 11.9 lakh deaths reported in the Science Advances paper.
“The paper published today is methodologically flawed and shows results that are untenable and unacceptable,” the statement added.
Published - July 20, 2024 03:50 pm IST
