As per data from the MCCD reports, like in the case of All India figures, 19 out of the 34 States/UTs recorded their highest ever year-on-year (y-o-y) growth rate in 2021 in the number of registered deaths for the period between 2006 and 2021. In 32 out of 33 States/UTs, the share of COVID-19 deaths in 2021 was more than in 2020.
In the previous story, we analysed all India trends in the registered and medically certified deaths, with a specific focus on their trends during the COVID-19 affected year of 2021.
In this story, we look at these trends among states, together with trends in the groups of diseases which are attributed to medically certified deaths.
Data for this story is sourced from Dataful’s collection of datasets on registered and medically certified deaths, curated from Medical Certification of Cause of Death (MCCD) annual reports.
19 States/UTs Recorded Highest Ever Year-on-Year (y-o-y) Growth in Registered Deaths in 2021 Since 2006
The MCCD data on total registered and medically certified deaths for each State/UT is available from 2006 to 2021, while figures for the state of Telangana are available from the year 2013. According to this data, except for the UTs of Daman and Diu and Dadra and Nagar Haveli, 19 out of the 34 States/UTs recorded their highest ever year-on-year (y-o-y) growth rate in 2021 across the entire period from 2006 to 2021. Additionally, 6 States/UTs experienced their second-highest ever growth rate, and 2 States recorded their third-highest rate. In total, 27 out of 34 States/UTs had recorded their highest, second-highest, or third-highest y-o-y growth rates in registered deaths in 2021 for the period between 2006 and 2021.
Among the 19 States/UTs that witnessed their highest-ever growth rates in 2021, we analysed whether any particular region exhibited a concentration of these spikes. The 19 States/UTs which had the highest ever y-o-y in 2021, together with their regions, are as follows:
| REGION | STATES |
| Central | Chhattisgarh, Madhya Pradesh |
| Eastern | Jharkhand, Odisha |
| Northern | Delhi, Haryana, Himachal Pradesh, Punjab |
| North-Eastern | Manipur, Mizoram, Sikkim |
| Southern | Karnataka, Kerala, Lakshadweep, Puducherry, Tamil Nadu |
| Western | Goa, Gujarat, Maharashtra |
As can be seen, the central and eastern regions had two states/UTs each, the eastern and western regions had three each, the northern region had four, and the southern region had five States/UTs, which ranked highest. Thus, there is no evident trend to suggest a dominant contribution from any one region.
In other words, the relatively uniform distribution of States/UTs with the highest y-o-y growth in deaths during 2021 indicates that excess deaths were widespread across the country, reinforcing the conclusion that the year 2021 experienced a significant impact from COVID-19-related excess mortality.
In Medically Certified Deaths, 10 States/UTs Recorded Highest Ever Year-on-Year (y-o-y) Growth Rate in 2021
As observed in our previous story, the rate of medical certification of deaths by the government has historically remained poor. In 1991, only 14.7% of total registered deaths in India were medically certified, and by 2021, this figure had risen only marginally to 23.45%.
This persistent gap is further reflected in the State/UT-wise comparison of medically certified deaths. Firstly, unlike registered deaths, not all States/UTs have consistently reported data on medically certified deaths from 2006 to 2021. For instance, Jammu and Kashmir provided such data only in the year 2021 during the entire period, while Uttar Pradesh began reporting from 2016 onwards. Similarly, around 7 other States/UTs have provided this data inconsistently. Therefore, in this section, the rankings attributed to States/UTs are based only on the years for which they reported data.
Furthermore, while 19 out of 34 States/UTs recorded their highest ever year-on-year (y-o-y) growth in registered deaths in 2021, only 10 out of 33 States/UTs (excluding Jammu & Kashmir and Dadra & Nagar Haveli and Daman & Diu) recorded their highest ever y-o-y growth in medically certified deaths. This disparity underscores the continuing disconnect between total registered deaths and those that are medically certified.
In addition, 6 States/UTs each recorded their second-highest and third-highest ever y-o-y growth rates in medically certified deaths in 2021. Altogether, 22 out of 33 States/UTs recorded either their highest, second-highest, or third-highest growth rates that year.
Thus, even this proportion of States/UTs points to a significant level of excess deaths likely attributable to the impact of COVID-19 during 2021.
In 32 out of 33 States/UTs, share of COVID-19 deaths in 2021 more than in 2020
To further examine excess deaths across States/UTs, we also analysed trends in medically certified deaths categorised by groups of diseases that are attributed as the cause of death. The MCCD reports included COVID-19-specific data for the years 2020 and 2021. A comparison of these two years across States/UTs reveals that 32 out of 33 States/UTs showed an increase in the number of medically certified deaths, from 2020 to 2021.
The highest increase was observed in Uttarakhand. In 2020, 12.8% of the total registered deaths in the state were attributed to COVID-19. This figure rose sharply to 47% in 2021, marking a 34.2 percentage point increase. Kerala and Bihar followed, with increases of 27.9 and 27.8 percentage points, respectively. Only the state of Tripura reported a slight decrease in the share of COVID-19 deaths, from 2.4% in 2020 to 2.1% in 2021.
In addition to deaths directly attributed to COVID-19, increases were also observed in other disease groups commonly associated with COVID-19-related complications. For instance, 12 States/UTs recorded an increase in deaths under Diseases of the Circulatory System, and 15 States/UTs showed an increase under Diseases of the Respiratory System from 2020 to 2021. Both of the groups of diseases are highly attributed to COVID-19.
These patterns further underline the broader health impact of the pandemic, extending beyond officially recorded COVID-19 deaths.
The number of States/UTs that showed a rising trend in their share of deaths between 2020 and 2021 in the Other disease categories were: 4 States/UTs each in Certain Conditions Originating in the Perinatal Period and Certain Infectious and Parasitic Diseases, 7 States/UTs in Neoplasms, and 12 States/UTs in Symptoms, Signs, and Abnormal Clinical and Laboratory Findings Not Elsewhere Classified (N.E.C.).
Strong Possibility of Excess COVID-19 deaths than officially reported in Maharashtra
Notable among the States/UTs that showed an increase in the share of COVID-19 deaths from 2020 to 2021 is the state of Maharashtra. Interestingly, it ranked lowest among all states in terms of the increase in medically certified deaths attributed to COVID-19.
According to official data, the total registered deaths in Maharashtra stood at 6.9 lakhs in 2019, 8 lakhs in 2020, and 10 lakhs in 2021. This corresponds to a year-on-year growth rate of 16% in 2020 and 25% in 2021. In comparison, the number of medically certified deaths in the same years was 2.6 lakhs (2019), 3.4 lakhs (2020), and 3.9 lakhs (2021). The proportion of registered deaths that were medically certified was 39.1% in 2019, increased to 42.8% in 2020, but then declined back to 39.2% in 2021. In other words, despite a significant 25% increase in registered deaths in 2021, the proportion of deaths that were medically certified actually dropped compared to the previous year.
Further, multiple reports (here, here & here) have consistently identified Maharashtra as the hardest-hit state in terms of COVID-19 cases and deaths, especially during the devastating second wave in 2021. Yet, the official data shows that the share of COVID-19 deaths among medically certified deaths in Maharashtra increased by only 0.5%, from 17.7% in 2020 to 18.2% in 2021. This increase is far below even the national averages of 6% in 2020 and 12% in 2021 for COVID-19 deaths among medically certified deaths across States/UTs.
As noted in our earlier analysis, the national average share of medically certified deaths attributed to COVID-19 rose from 8.9% in 2020 to 17.3% in 2021. Against this backdrop, Maharashtra, one of the worst-affected states, recording only a 0.5 percentage point increase in 2021 and ranking at the bottom among States/UTs in this metric, suggests a strong possibility of underreporting of COVID-19 deaths or medically certifying such deaths. A similar analysis across other states could further support the case for excess deaths attributable to COVID-19, beyond what is reflected in the official figures.
