Preliminary Analysis of Excess Mortality in India During the COVID-19 Pandemic

  1. Christopher T. Leffler
  2. Joseph D. Lykins V
  3. Saurav Das
  4. Edward Yang
  5. Sneha Konda

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Abstract

We studied all-cause mortality during the COVID-19 pandemic in 19 Indian states (population 1.27 billion). Excess mortality was calculated by comparison with years 2015 to 2019. The known COVID-19 deaths reported for a state were assumed to be accurate, unless excess mortality data suggested a higher toll. Data from one state were excluded due to anomalies. In several regions, fewer deaths were reported in 2020 than expected. Areas in Andhra Pradesh, Delhi, Haryana, Karnataka, Madhya Pradesh, Tamil Nadu, and West Bengal saw spikes in mortality in Spring 2021. The pandemic-related mortality through August 31, 2021, in 18 Indian states was estimated to be 198.7 per 100,000 population (range 146.1–263.8 per 100,000). If these rates apply nationally, then 2.69 million people (range 1.98 to 3.57 million) may have perished in India as a result of the pandemic by August 31, 2021.

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  1. Version published to 10.4269/ajtmh.21-0864
  2. Version published to 10.1101/2021.08.04.21261604v2 on medRxiv
  3. ScreenIT

    SciScore for 10.1101/2021.08.04.21261604: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsField Sample Permit: The study was approved by the Office of Research Subjects Protection of Virginia Commonwealth University.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: Thank you for sharing your data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    One limitation of this survey is that it included deaths outside the immediate household (Deshmukh 2021). Seroprevalence data can also help to assess the extent of infection in a population. Based on application of international age-specific infection fatality rates to Indian demography and seroprevalence, Anand estimated the Covid-19 related mortality in India to be 4.0 million (Anand 2021). One limitation of this approach is that the infection fatality rates may differ from country to country, depending on the medical system and host factors. Guilmoto analyzed Covid-19 mortality in several well-defined Indian populations: deaths in Kerala, elected representatives, Indian Railways personnel, and teachers in Karnataka (Guilmoto 2021). Application of the age-specific mortality rates to the Indian population yielded a mortality estimate of 2.2 million persons by late May 2021 (Guilmoto 2021). Our analysis has a number of limitations. The data analyzed are still incomplete for many regions and times. There may be delays in registering deaths. In addition, available data obtained from regional government websites, central government compilations, and by reporters through RTI requests are not in complete agreement. Some of the data upon which the model is based may simply be wrong, because early reports may contain errors. All-cause mortality may be higher not only due to infection with the Sars Cov-2 virus, but also because of health system overload, delays in patients entering t...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

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  4. Version published to 10.1101/2021.08.04.21261604v1 on medRxiv