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Affiliation
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Department of Public Health Sciences, University of Chicago, Chicago, IL 60637, USA. |
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Abstract
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Unintentional fires pose a unique threat to women in India owing to a cluster of risks, ranging from unsafe kerosene cookstoves being used near highly flammable garments, to sacrificial suicide, and interpersonal violence. In 2009, we estimated that fires kill 106 000 women in India annually,1 six times the figure reported by official national statistics.1 Our estimates were consistent with those from the Global Burden of Disease Study (GBD) 2013,2 which estimated that more women aged 15–49 years in India died in unintentional fires than in childbirth, at a rate more than 20 times that in the rest of the world. However, subsequent GBD revisions have reduced these estimates to unrealistically low levels.
GBD 20163 lowered the GBD 2013 estimates of unintentional fire deaths in India by three-quarters (appendix), which caused global estimates to be reduced by half. Current GBD estimates are similar to GBD 2016.4 Why did these estimates change? Previously, GBD triangulated estimates of cause-specific mortality in India from a patchwork of data that were not nationally representative. Now, the standard source is the national sample registration system (SRS), which collects cause of death information for about 50 000 annual deaths using verbal autopsy.3 However, medicolegal practices in India require all fire-related deaths to be investigated as potential homicides, and verbal autopsy performs poorly when interviewees have strong incentives not to disclose information and interviewers have a responsibility to report crimes.
We assessed the validity of GBD estimates by comparing them with fire-related deaths registered by the Indian Civil Registration System (CRS; appendix).6 Although the CRS has low completeness and many deaths are classified with unspecified causes, it provides a reliable lower bound for estimates of fire-related deaths. GBD and CRS estimates are available for three states for 2016: Delhi, Karnataka, and Kerala. Medically certified fire-related deaths of women that were registered by CRS far exceeded GBD estimates in Karnataka, where they were 93% greater, and in Delhi, where they were 260% greater. Although CRS data for 2016 are unavailable for other states, comparisons with older data suggest large discrepancies there too. In 2013, fire-related deaths of women registered in Andhra Pradesh exceeded GBD 2016 estimates by 133%, and in 2014 in Tamil Nadu they exceeded GBD 2016 estimates by 101%.6 These discrepancies form strong evidence that current GBD estimates for fire deaths in India are too low ...
Language: en |