Million Death Study

The Million Death Study (MDS) is an ongoing human premature mortality study conducted in India. It began in 1998 and the will continue to 2014. Among a sample size of 14 million Indians, approximately 1 million deaths are assigned medical causes through the Verbal Autopsy method to determine disease patterns and direct public health policy. The principal investigator of the study is Dr. Prabhat Jha, director of the Centre for Global Health Research and professor of epidemiology at the Dalla Lana School of Public Health, University of Toronto, Canada.

In India, like many low and middle income countries, the vast majority of deaths occur at home without medical attention (over 75%), rather than with the standard of hospital care and supervision common in high income countries prior to death. As a result, estimates suggest a majority of the approximately 60 million global annual deaths, and specifically over half of Indian at-home deaths, are undocumented and do not have a medically certified cause of death. Deaths occurring in hospitals may be documented with official death certificates issued by medical professionals. The MDS was conceived to study previously undocumented at-home deaths to gain a more statistically representative understanding of disease patterns in India.

Between the study period of 1998-2014, the MDS investigators collaborated with the Registrar General of India to monitor approximately 14 million people in 2.4 million nationally representative Indian households, to produce underlying medical causes of deaths for about 1 million deaths. This made the MDS one of the largest studies of premature mortality in the world.

The MDS used India’s existing Sample Registration System (SRS), a government program operated by the Registrar General of India since 1971, as a sampling framework for data harvest by trained surveyors. The collaborators of the MDS successfully arranged to expand the overall size of the SRS at the inception of the study in 1998.

Surveyors visited households in the sample units of the SRS every 6 months to inquire about deaths in the family. When a death was noted, an in-person interview of an extant, close family member was administered using the Verbal Autopsy method to determine the deceased’s health status prior to death and record a narrative of the events leading to death. This written information was then used by trained physicians to assign a probable cause of death using the International Classification of Diseases (ICD-10). The information for each death was provided to two physicians to ensure greater accuracy, with a senior physician adjudicating the assignment of a cause of death in the event of an initial disagreement.

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