On July 19, 2024, Science Advances, an academic journal of the American Association for the Advancement of Science published findings of a study by 10 India-origin researchers affiliated with universities in Europe and the US, who used survey data of 7,65,180 individuals, representative of one-fourth of India’s total population.
The research found that compared to 2019, life expectancy at birth was 2.6 years lower and mortality was 17 percent higher in 2020, implying 1.19 million excess deaths in 2020.
This extrapolated estimate is about eight times higher than the official number of Covid-19 deaths in India and 1.5 times higher than the World Health Organisation’s (WHO) estimates.
However, on Saturday, 20 July, the Union Health Ministry issued a strong rebuttal, stating that the estimates were “untenable and unacceptable”.
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Life expectancy of Muslims, Dalits
The government response, however, was silent about the study finding that the life expectancy of Muslims declined four times more than that of high-caste Hindu groups.
The research noted that the life expectancy of Scheduled Tribes declined three times more, from 2019 to 2020, after the Covid-19 pandemic.
High-caste Hindu groups experienced a life expectancy decline of 1.3 years during this period. In contrast, the loss for Muslims was 5.4 years, 4.1 years for Scheduled Tribes, and 2.7 years for Scheduled Castes.
These marginalised caste and religious groups already faced significant disadvantages in life expectancy — disparities that were only exacerbated by the pandemic, according to the study.
“In 2020, Muslim life expectancy was the lowest across the five social groups — high caste Hindus, Scheduled Tribes, Scheduled Castes, and Other Backward Classes — due to the greatest declines in life expectancy at birth observed among Muslims between 2019 and 2020. This decline is consistent with the further marginalisation of Muslims in 2020 and a greater increase in neonatal mortality among Muslims,” the study stated.
The study
The international study, with 10 authors including Dr Aashish Gupta and Professor Ridhi Kashyap from the Department of Sociology and the Leverhulme Centre for Demographic Science at the University of Oxford, Payal Hathi of the Department of Demography and Sociology of the University of California in Berkeley in the US, Murad Banaji of the Mathematical Institute at the University of Oxford, Prankur Gupta of the Department of Economics of the University of Texas at Austin in the US, Vipul Paikra of the Research Institute for Compassionate Economics in the US, Kanika Sharma of the Department of Sociology of the Emory University in Atlanta in the US, Anmol Somanchi of the Paris School of Economics in France, Nikkil Sudarsanan of the Heidelberg Institute of Global Health in Germany and Sangita Vyas of the Department of Economics at Hunter College of the City University of New York in the US reveals that life expectancy in India suffered large and unequal declines during the Covid-19 pandemic.
Ridhi Kashyap, Professor of Demography and Computational Social Science at the University of Oxford, said in a statement, “Our findings challenge the view that 2020 was not significant in terms of the mortality impacts and severity of the Covid-19 pandemic in India.
“While a mortality surge caused by the Delta variant in 2021 received more attention, our study reveals significant and unequal mortality increases even earlier during the pandemic,” the professor said.
The study also found larger losses among females compared to males across almost all Indian social groups and classes.
Women in India experienced life expectancy declines of 3.1 years —one year more than men, who experienced life expectancy losses of 2.1 years.
This pattern could be explained by gender inequalities in healthcare and the allocation of resources within households.
It also contrasts with the pattern found in high-income countries, where excess mortality was higher among men than women during the Covid-19 pandemic.
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The study design
Using high-quality NHFS-5 survey data from 765,180 individuals, the study estimated changes in life expectancy at birth by sex and social group between 2019 and 2020 in India — where a third of global pandemic excess deaths are thought to have occurred.
The study found significant mortality impacts from the Covid-19 pandemic in 2020 on younger age groups, women, and marginalised social groups. Marginalised social groups within India experienced greater life expectancy declines than the most privileged social groups.
Dr. Aashish Gupta, Marie Sklodowska-Curie Fellow at the University of Oxford, stated, “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.”
While life expectancy declines in high-income countries were primarily driven by mortality increases in those over 60, mortality increased in almost all age groups in India, most prominently in the youngest and older age groups. Excess mortality in the youngest age groups could be explained by children in certain areas being more susceptible to Covid-19 and by indirect effects of the pandemic and subsequent lockdowns, including deteriorating economic conditions and disruptions to public health services.
Professor Ridhi Kashyap said, “Using unique demographic and health survey data, our study highlights the importance of focusing on inequality when measuring mortality and shows that pandemics can worsen, rather than equalise, existing disparities. This was particularly noticeable in the role that Covid-19 had in further exacerbating the health impacts of pre-pandemic gender disparities.”
Selection and reporting biases possible: GOI
In its statement, the Union health ministry explained that the methodology was wrong, as researchers had taken a subset of households in the National Family Health Survey (NHFS) and extrapolated the results for the whole country.
“The NFHS sample is representative of the country only when it is considered as a whole,” the statement said, adding that selection and reporting biases were possible, given the data was collected during the height of the Covid pandemic.
The government refuted the claim that the vital registration system was weak, asserting that the Civil Registration System in India is robust, capturing 99 percent of all deaths.
The excess deaths were also because of the increasing trend of death registration, which was 92 percent in 2019.
Besides, excess mortality during the pandemic “means an increase in deaths due to all causes, and cannot be equated with deaths that were directly caused by Covid-19”.
Union Health Ministry rebuts research findings
Union Health Ministry said that the research used data from only 14 states and hence it cannot be representative of the whole country.
“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 considered as a whole,” the ministry stated in a release issued to the press.
“The 23 percent of households included in this analysis from part of 14 states cannot be considered representative of the country. 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 added.
It further added that the paper erroneously argues for the need for such analyses, claiming that the vital registration system 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 percent of deaths. This reporting has constantly increased from 75 percent in 2015 to over 99 percent in 2020. Data from this system shows death registration increased by 4.74 lakh in 2020 compared to 2019. There was a similar increase of 4.86 lakh and 6.90 lakh in death registration in 2018 and 2019 over the respective previous years. Notably, all excess deaths in a year in the CRS are not attributable to the pandemic. The excess number is also due to an increasing trend of death registration in the CRS (it was 92 percent in 2019) and a larger population base in the succeeding year,” the ministry explained.
The ministry pointed out that excess mortality during the pandemic means an increase in deaths due to all causes and cannot be equated with deaths directly caused by Covid-19.
Contradicted SRS data
The ministry also noted that the estimates published by the researchers are further contradicted by data from India’s Sample Registration System (SRS).
SRS covers around 84 lakh people in 24 lakh households in 8,842 sample units spread across 36 States/UTs in the country.
“While the authors take great pains to show that results from NFHS analyses and Sample Registration Survey analyses for 2018 and 2019 are comparable, they completely fail to report that SRS data in 2020 shows very little, if any, excess mortality compared with 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.
“Data on about 5.3 lakh recorded deaths due to Covid-19, as well as research data from cohorts and registries, consistently show higher mortality due to Covid-19 in males than females (2:1) and in older age groups (Multiple folds higher in those over 60 years old than in 0-15 year-old children). These inconsistent and unexplainable results in the published paper further reduce any confidence in its claims,” the ministry said.
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