India's death toll in 2021 during the Covid-19 pandemic
Insights from delayed official civil registration data
Bibliographic Data
| ID | 19552690 |
|---|---|
| Authors | Maxwell Salvatore (0000-0002-3659-1514, University of Pennsylvania), Brian Wahl (0000-0002-0037-7364, Yale University), Bhramar Mukherjee (0000-0003-0118-4561, Yale University) |
| Year | 2025 |
| Volume | 15 |
| Pages | 03045-03045 |
| Publication date | 2025-11-14 |
| Peer Reviewed | Yes |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | Journal of Global Health (JOURNAL) |
| Journal identifiers | ISSN: 2047-2978 • E-ISSN: 2047-2986 |
| Publisher | International Society of Global Health (PUBLISHER • GB) |
| DOI | 10.7189/jogh.15.03045 |
| PMID | 41232123 |
| OpenAlex | W4416235912 |
| Language | EN |
| References cited | 27 |
India released its 2021 official death registration data in May 2025, showing a dramatic undercount of reported COVID-19 mortality in 2021 - a year that included the lethal second wave from the Delta variant in April to June 2021. The civil registration system (CRS) documented 10.2 million deaths in 2021 - a 26% increase from 2020 - compared to only 335 004 reported COVID-19 deaths. We calculated excess deaths as the difference between observed deaths and expected deaths had pre-pandemic mortality trends continued. Our analysis reveals India experienced approximately 2.4 million excess deaths in 2021, representing a 7.2× undercount compared to reported COVID-19 deaths. This aligns with the estimates derived from several epidemiological models during and after the pandemic, indicating excess-to-reported COVID-19 death ratios ranging from 4.4× to 11.9×. State-level analyses revealed considerable variation in reporting fidelity, with excess-to-COVID-19 death ratios ranging from under 2× in Kerala and Goa to over 40 in Gujarat. Limited disaggregated data showed excess death rates were substantially higher in men than women (2.2 vs. 1.3 per 1000 population), and in urban than rural areas (2.3 vs. 1.4 per 1000 population). Since the CRS data are incomplete in terms of age-stratified deaths, the proportional allocation of deaths by age according to external sources suggests excess death rates were higher in the 65 and older age group than in the population under 65 (14.1 vs. 0.9 per 1000 population). The four-year data delay and systematic underreporting underscore urgent needs for modernising India's surveillance system during acute phases of the pandemic and restructuring the official vital registration systems through protocol standardisation, real-time linkages, and infrastructure investments. Robust mortality tracking strengthens crisis preparedness and broader public health response
Cause of death · Death toll · Excess mortality · Mortality rate · Pandemic · Population · COVID-19 and healthcare impacts · COVID-19 epidemiological studies · COVID-19 Impact on Reproduction · Epidemiology
The WHO estimates of excess mortality associated with the Covid-19 pandemic
The civil registration system is a potentially viable data source for reliable subnational mortality measurement in India
Meta-analysis of nationwide Sars-CoV-2 infection fatality rates in India
Have inequalities in completeness of death registration between states in India narrowed during two decades of civil registration system strengthening
FRED (A Framework for Reconstructing Epidemic Dynamics)
Using household rosters from survey data to estimate all-cause excess death rates during the Covid pandemic in India
Estimating Covid-19‒ Related Mortality in India
Sensitivity Analysis of Excess Mortality due to the Covid-19 Pandemic
| Citation velocity | historical |
|---|---|
| Highly cited | No |