Excess Deaths in Uttar Pradesh till April 2021

If our eminent intellectuals and politicians have taught us anything, it is that one can have opinions on anything.

In this article, we shall look into the excess deaths which took place in Uttar Pradesh till April 2021. As a caveat, I would be using rounded numbers for ease. 

The inspiration for writing this article came from a news item published in Article-14 website which basically says that there were almost 1.97 lacs excess deaths in UP from July 2020 to April 2021.

I was able to get the district-level monthly data for UP from GitHub.

While the soundness of the analysis can be debated, they should be applauded to taking out this data.

What is Excess Deaths  

Now, excess deaths basically means the number of excess deaths which have occurred compared to a base period. E.g. Suppose in a place there were 100 deaths which happened in 2019 while in 2020 the figure was 125. So, the excess deaths are 25. During COVID-19, this excess death parameter has been used to speculate whether the governments are not reporting COVID-19 deaths.

There is a debate whether the excess deaths are exactly equal to the deaths caused by COVID-19. On the one hand, there may be lower deaths during the COVID-19 period due to lower accidents, less spread of contagious diseases during lockdowns. On the other hand during the peak period of a wave and also during lockdowns, there would be more deaths due to lack of medical care. Since both these factors offset each other, we can assume for the time being that excess deaths will be more or less equal to the COVID-19 deaths.

Let's see what IHME has to say on this. As per them, "Overall, the evidence suggests reductions of 615,000 deaths, or potentially more, stemming from behavioral changes at the global level. The main potential increases in excess mortality due to deferred care and increases in drug overdose and depression are hard to quantify at this point or are of a much smaller magnitude. Given that there is insufficient evidence to estimate these contributions to excess mortality, for now we assume that excess COVID-19 deaths equal excess mortality."

Now, coming to the baseline which is used for computing excess deaths. While developed countries tend to have very less variation on deaths registered every year, in India due to increase in registration (as a % of total estimated deaths) and also due to increase in population the number of deaths registered shows an increasing trend. This is even more true when it comes to states like UP, Bihar etc. 

Uttar Pradesh Excess Deaths

Coming to the specific case of Uttar Pradesh, as per the data available in GitHub, the number of deaths as per raw civil registration data in 2019 is 7.7 lacs in 2019, 7.9 lacs in 2020 and 3.3 lacs for the 4 months period from January to April 2021. Now, if we see the number of deaths per month, it is 64k in 2019, 66k in 2020 and 83k up to April 2021.

       



At the outset, I should point out some discrepancies in the data available in GitHub. 

  1. The number of deaths in UP as per CRS report of 2019 is 9.4 lacs while it is 7.7 lacs as per the GitHub data. However, for the excess death computation, I shall use only data available in GitHub for a like-to-like analysis with 2020 and 2021.  
  2. As per the GitHub data, for 11 out of the 75 districts in UP deaths registrations is not available for all the 12 months for 2019 (for some districts, data is available only for 3 months). This reduces to 5 districts for 2020.
  3. For some districts like Lucknow, the deaths registered has gone up from 6k in 2019 to 29k in 2020 while for districts like Hardoi, the number of deaths registered have gone down from 33k in 2019 to 14k in 2020. These will compensate each other hence, they have been considered as it is.    
To normalize the effect of non-availability of monthly data, I took the average deaths per month per district only for the months which registrations are not 0. E.g. Suppose there were 200 deaths in a district in 2019 and death registration data is not 0 only for 8 of the 12 months, the average I considered for my analysis was 200/8=25 and not 200/12.

If we make this change, the above graph will change as shown below. The number of deaths in 2019 would be 8.2 lacs in 2019, 8.2 lacs in 2020 and 3.4 lacs for the 4 months period from January to April 2021. Now, if we see the number of deaths per month, it is 69k in 2019, 68k in 2020 and 86k up to April 2021.



The reported COVID deaths in UP in 2020 is 8.3k in 2020. Even with these COVID deaths, the total deaths in 2020 (on adjusted basis) is slightly lower than 2019. There may have been some decline in registrations in 2020 compared to 2019 due to lockdowns. This is evident in the March 2020 to May 2020 deaths registrations which fell down drastically. However, the same would have been compensated in the later months of 2020 and also the trend of registrations (as % of total estimated deaths) were going up from 2017 onwards (refer graph below). Considering the offsetting impact of both these factors, we can safely assume that registration levels would have remained more or less similar in 2020 compared to 2019. Hence, on an overall basis, the total number of excess deaths in 2020 is 0. 

In 2021, as mentioned above, number of deaths per month increased by 17k on average. This would lead to excess deaths of 68k until April 2021. 

We should note that the figure of 68k excess deaths is only for registered deaths. In UP, as per CRS 2019 report, the total number of estimated deaths is 1.5 mn in 2019 while the normalized deaths arrived at above is 8.2 lacs. This is 55% of total deaths. To estimate total excess deaths we should do 68k/55%=1.2 lac excess deaths due to COVID-19. Further, assuming that half the COVID-19 deaths were missed in 2020 in UP, the total excess deaths would be close to 1.4 lacs till April 2021.  

The total COVID-19 deaths reported in UP till April 2021 is 12.6k. This would lead to excess deaths of almost 11x of  reported figures. 

This is a much lower estimate of excess deaths compared to the Article-14 report. However, I believe even my estimate might be on the higher side considering:
  1. The death registrations in UP have been going up after 2017 refer graph below). The deaths registered (as % of total deaths) was around 51% in 2010 which went down to 38% in 2017. This shot up to 61% in 2018 and 63% in 2019. 
  2. While there is a case that the post-2017 registration trend may not be hold for 2020, it cannot be the case in 2021 when the economy was fully functional until March 2021 and it is only in April we saw lockdowns (though that is nothing compared to what we witnessed in 2020).   



    


                                                               
For the above excess deaths computation, I have assumed that the registration levels would have remained the same as the levels observed in 2019.

However, as a sensitivity, I should mention that 1% increase in registration levels would decrease the excess deaths per month by 1.25k and it is quite possible that registration levels would have gone up in 2021. E.g.: If the death registration increased by 5% in 2021 compared to 2019, the number of excess death per month would reduce from 17k to 11k per month. The total excess deaths (registered-plus unregistered and assuming 50% of COVID deaths in 2020 were missed) would reduce to around 90k and undercounting factor would go down from 11x to 7x. Considering there was an increase of 2.5% increase in death registrations in UP from 2018 to 2019, it is likely that it may have gone up by 5% in 2021 compared to 2019.    

Sources: 

https://article-14.com/post/untitled-60cf605395758

https://github.com/muradbanaji/IndiaACMdata

https://www.covid19india.org/state/UP

http://www.healthdata.org/special-analysis/estimation-excess-mortality-due-covid-19-and-scalars-reported-covid-19-deaths

  

 

  

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