A retrospective cluster analysis of regional disparities and healthcare factors influencing causes of death certification and mortality statistics in India

Reliable cause-specific mortality statistics are crucial for defining health priorities, public health programs, allocating resources, designing and implementing policies to improve healthcare quality and accessibility. India accounts for almost 18 percent of the world's population. The 2020 report from the Office of the Registrar General of India indicates that the Medical Certification of Cause of Death (MCCD) rate is only 22.5%, with a minimal improvement of just 2.5% over the past decade. This study is the first to provide a comprehensive evaluation of MCCD-patterns across India over the past 15 years, addressing a critical-gap in the literature by identifying regional patterns, disparities, and healthcare variables that have previously been underexplored. Based on MCCD-trends over this period, the states and Union-Territories of India can be categorized into three clusters. Cluster1 includes 23 states with the lowest-average MCCD-rate of 18%, attributed to a low 0.14 doctors per 1000 people, with only 27.4% of hospitals actively reporting-MCCD. In contrast, Clusters2 and 3 have higher-average MCCD-rates of 63% and 60%, respectively, supported by higher 0.27 and 0.33 doctors per 1000 people, with over 80% of hospitals actively reporting-MCCD. Although, the findings indicate that active MCCD-reporting is a major factor associated with MCCD rates, other factors including healthcare infrastructure, state-specific healthcare policies, socioeconomic factors, and administrative management also influence MCCD-rates.