Elsevier

The Lancet

Volume 373, Issue 9671, 11–17 April 2009, Pages 1282-1288
The Lancet

Articles
Fire-related deaths in India in 2001: a retrospective analysis of data

https://doi.org/10.1016/S0140-6736(09)60235-XGet rights and content

Summary

Background

Hospital-based studies have suggested that fire-related deaths might be a neglected public-health issue in India. However, no national estimates of these deaths exist and the only numbers reported in published literature come from the Indian police. We combined multiple health datasets to assess the extent of the problem.

Methods

We computed age–sex-specific fire-related mortality fractions nationally using a death registration system based on medically certified causes of death in urban areas and a verbal autopsy based sample survey for rural populations. We combined these data with all-cause mortality estimates based on the sample registration system and the population census. We adjusted for ill-defined injury categories that might contain misclassified fire-related deaths, and estimated the proportion of suicides due to self-immolation when deaths were reported by external causes.

Findings

We estimated over 163 000 fire-related deaths in 2001 in India, which is about 2% of all deaths. This number was six times that reported by police. About 106 000 of these deaths occurred in women, mostly between 15 and 34 years of age. This age–sex pattern was consistent across multiple local studies, and the average ratio of fire-related deaths of young women to young men was 3:1.

Interpretation

The high frequency of fire-related deaths in young women suggests that these deaths share common causes, including kitchen accidents, self-immolation, and different forms of domestic violence. Identification of populations at risk and description of structural determinants from existing data sources are urgently needed so that interventions can be rapidly implemented.

Funding

None.

Introduction

Although dramatic incidents of fire-related deaths in public spaces, such as schools, cinemas, and makeshift tents, have received substantial media coverage in India, much less awareness exists of the high frequency of these deaths within the domestic environment. An important demographic feature of injuries and deaths caused by domestic fire events is that a large proportion of victims are young women.1, 2, 3, 4, 5, 6, 7, 8 Various local studies have suggested that, among women, these injuries result from kitchen accidents,1, 2, 3, 4, 5, 6, 8, 9 self-immolation,10, 11 and different forms of domestic violence,3, 12 which could include dowry related harassment that leads to death. A dowry death is the killing of a young woman by members of her conjugal family for bringing insufficient dowry, and is commonly executed by first dousing the woman with kerosene and then setting her alight. Some studies further suggested that fire-related homicides are often disguised as accidents and suicides.5, 7

Because India does not have a national injury surveillance system, the only official source of information about the incidence of burn morbidity and mortality is from police reports.13 However, it is well known that police can be extremely lax in registering reports14 and that, in cases of suspected criminality, family members of a victim might be able to bribe police to avoid investigation. Although some highly publicised cases of such connivance of police have received public attention, the issue might be much more widespread than is often believed.

Because of the difficulty in distinguishing between accidents, suicides, and homicides, our analysis focused on all possible causes of fire-related mortality. Although several hospital-based studies have collated the demographic profile of victims on the basis of admissions,1, 2, 3, 4, 5, 6, 8, 9 it is not possible to use these to estimate the incidence nationally or regionally because the underlying catchment areas cannot be accurately defined. Thus, we computed a national estimate of fire-related deaths for 2001 using data from a national hospital registry for urban areas and a nationally representative survey of causes of death for rural populations. We describe our data sources and methods, and then present a range of national estimates based on alternative adjustments.

Section snippets

Data sources

The medical certification of cause of death (MCCD)15 is a national death registry that reports cause-specific mortality from participating urban hospitals (table 1). Causes of death are recorded by the attending health-care provider and are reported in International Classification of Disease 10th revision format (ICD-10).16 In 2001 (the most recent year available), MCCD covered 29% of all urban deaths. The Registrar General of India provided MCCD data tabulated by age and sex, with no further

Results

Applying both adjustments—the redistribution of unspecified injuries and the addition of suicides by self-immolation—we estimated 68 000 urban and 95 000 rural fire-related deaths in India in 2001. These numbers added to a national estimate of 163 000 deaths caused by fire, of which 106 000 (65%) were female deaths, 57% of which happened in women between 15 and 34 years of age. This estimate did not include homicides by fire in rural areas (because we were unable to adjust for homicides by fire

Discussion

We estimated, with appropriate adjustments, that more than 163 000 fire-related deaths occurred in India in 2001. Most deaths happened in women, mainly between 15 and 34 years of age. This estimate is six times higher than that quoted in published work, which is based on national crime statistics. In the absence of any adjustments and with SCD fire-related death rates applied to urban areas, our lowest estimate was 92 000 deaths.

India is estimated to have had 117 100 maternal deaths in 2005,

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