Emergency Care in India: A Retrospective Cross-sectional Analysis of Health Management and Information System and Global Burden of Disease

Abstract

Background: To understand the utilization and burden of emergency medical conditions (EMCs), we assessed EM Department (EMD) data from the Health Management and Information System (HMIS) of India and EMC from the Global Burden of Diseases (GBD). Methods: This was a retrospective cross-sectional analysis of HMIS and GBD data for 2019. We extracted EMD registrations, admissions, and deaths from HMIS and incidence, deaths, and DALYs from GBD for 31 EMCs at the national and state levels. We analyzed HMIS and GBD data for proportions and rates of registrations, deaths, and incident cases relative to population counts and hospital admission numbers. Results: In 2019, 119,103,358 patients (8,935.66 per 100,000 people) were registered at EMDs. The national EMD registration rate was 6,744.21 per 100,000 hospital admissions and the EMD death rate was 43,939.49 per 100,000 inpatient deaths. Only 12.14% of all HMIS registrations had cause-specific data. GBD estimated 2,047,175,737 EMC incident cases nationally, accounting for 27.22% of all-cause incidence, 51.71% of all-cause mortality, and 42.30% of all-cause DALYs. Trauma-related registrations were 9.27% in HMIS while injuries in GBD accounted for 7% of EMCs. Overall, HMIS EMD registrations were lower than GBD EMC incidence numbers, with regional variations. Conclusions: The study reveals gaps in the EMD utilization as per HMIS data compared to the EMC burden estimates from GBD. Improved data integration and reporting can address regional disparities.

Competing Interest Statement

Siddhesh Zadey is the co-founding director of the Association for Socially Applicable Research (ASAR). He represents ASAR at the Permanent Council of The G4 Alliance. Siddhesh Zadey is the Chair of the SOTA Care in South Asia Working Group, The G4 Alliance, and the Drafting Committee Member for Maharashtra State Mental Health Policy. Other authors declare no conflicts of interest.

Funding Statement

This study did not receive any funding

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The study used (or will use) ONLY openly available human data that were originally located at: 1. https://hmis.mohfw.gov.in/downloadfile?filepath=publications/Other/HMIS%20Annual%202019-20%20Report.pdf 2. https://ghdx.healthdata.org/gbd-2019

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Data Availability

All data produced in the present study are available upon reasonable request to the authors.

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