The civil registration system is a potentially viable data source for reliable subnational mortality measurement in India

Abstract

ABSTRACT Introduction The Indian national Civil Registration System (CRS) is the optimal data source for mortality measurement, but is yet under development. As an alternative, data from the Sample Registration System (SRS) which covers less than 1% of the national population is used. This article presents a comparative analysis of mortality measures from the SRS and CRS in 2017, and explores the potential of the CRS to meet these subnational data needs. Methods Data on population and deaths by age and sex for 2017 from each source were used to compute national and state level life tables. Sex specific ratios of death probabilities in five age categories (0-4, 5-14, 15-29, 30-69, 70 -84, 85+) were used to evaluate CRS data completeness, using SRS probabilities as reference values. The quality of medically certified causes of death was assessed through hospital reporting coverage and proportions of deaths registered with ill-defined causes from each state. Results The CRS operates through an extensive infrastructure with high reporting coverage, but child deaths are uniformly under reported, as well as female deaths in some states. However, at ages 30 to 69 years, CRS death probabilities are higher than the SRS values in 15 states in males and 10 states in females. SRS death probabilities are of limited precision for measuring mortality trends and differentials. Medical certification of cause of death is affected by low hospital reporting coverage. Conclusions The Indian CRS is more reliable than the SRS for measuring adult mortality in several states. Targeted initiatives to improve the recording of child and female deaths, to strengthen the quality of medical certification of cause of death, and to promote use of verbal autopsy methods are necessary to establish the CRS as a reliable source of sub national mortality statistics in the near future. KEY MESSAGES The Sample Registration System (SRS) is currently the main source of mortality statistics in India, since the Civil Registration System (CRS) is yet under development Limitations in sample size as well as problems with quality of causes of death result in considerable uncertainty in population level mortality estimates from the SRS This research evaluated the quality of the sex and age specific mortality risks from the CRS, using the SRS values in each state as reference values The CRS has high levels of reporting coverage for death registration, and also measures higher levels of mortality at ages 30 to 69 years in several states, with high precision Interventions are required to improve child death registration, strengthen medical certification of cause of death in hospitals, and introduce verbal autopsy for home deaths These interventions will establish the CRS as a routine and reliable source for national and subnational mortality measurement in India in the near future

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