Singh Aditya, Kundu Ananya, Ram Sumit, Chandra Rakesh, Tanti Arabindo, Singh Shivani, Kumar Vineet
Department of Geography, Banaras Hindu University, Varanasi, India.
Department of Geography, University of Calcutta, Kolkata, India.
BMC Public Health. 2025 May 10;25(1):1733. doi: 10.1186/s12889-025-22707-2.
The persistent issue of incomplete death registration in India, with a significant number of deaths going unrecorded, underscores the critical need for a granular understanding of spatial variations. Given the nation's vast geographic and demographic diversity, this granular understanding, particularly at the district level, is crucial for effective interventions. This analysis, therefore, aims to examine spatial disparities in death registration at both the state and district levels across India.
Using data from the fifth round of the National Family Health Survey (NFHS-5) conducted in 2019-21, this study analyzed information on 79,449 deaths occurring in the three years preceding the survey, across 707 districts in India. The study explored spatial patterns and identified clusters of death registration using Moran's I and univariate Local Indicators of Spatial Association (LISA) maps. Additionally, spatial regression models were employed to examine the factors influencing death registration at the district level.
In 2019-21, only 71% of deaths in India were registered, with significant variations across states and districts. The univariate Moran's I value of 0.69 (p < 0.001) indicated strong spatial clustering in death registration at the district level. Two notable 'cold spots'-districts with low death registration rates surrounded by other low-registration districts-were identified across 152 districts, primarily in the eastern states of Uttar Pradesh, Jharkhand, Bihar, and the northeastern regions of Arunachal Pradesh, Nagaland, and parts of Manipur. Results from regression models revealed that factors such as the proportion of poor households, rural households, Muslim and Scheduled Tribe (ST) households, and households with at least one uneducated member were negatively associated with death registration at the district level.
The findings suggest the necessity for region-specific focused interventions to improve death registration in India, taking the social determinants of death registration into consideration and raising societal awareness about it.
印度死亡登记不完整这一长期问题依然存在，大量死亡未被记录，这凸显了深入了解空间差异的迫切需求。鉴于该国广阔的地理和人口多样性，这种细致入微的了解，尤其是在地区层面，对于有效干预措施至关重要。因此，本分析旨在研究印度各邦和地区层面死亡登记的空间差异。
利用2019 - 2021年进行的第五轮全国家庭健康调查（NFHS - 5）的数据，本研究分析了印度707个地区在调查前三年发生的79449例死亡信息。该研究探索了空间模式，并使用莫兰指数（Moran's I）和单变量局部空间自相关（LISA）地图确定了死亡登记的聚类情况。此外，还采用空间回归模型来研究影响地区层面死亡登记的因素。
在2019 - 2021年期间，印度仅有71%的死亡进行了登记，各邦和地区之间存在显著差异。地区层面死亡登记的单变量莫兰指数值为0.69（p < 0.001），表明存在强烈的空间聚类。在152个地区发现了两个显著的“冷点”——死亡登记率低的地区被其他低登记率地区包围，主要分布在北方邦、贾坎德邦、比哈尔邦等东部邦以及阿鲁纳恰尔邦、那加兰邦和曼尼普尔邦部分地区等东北地区。回归模型结果显示，贫困家庭、农村家庭、穆斯林和在册部落（ST）家庭以及至少有一名未受过教育成员的家庭比例等因素与地区层面的死亡登记呈负相关。
研究结果表明，有必要针对不同地区采取有针对性的干预措施，以改善印度的死亡登记情况，同时考虑到死亡登记的社会决定因素并提高社会对此的认识。
