Death registration coverage 2019-2021, India.

Objective: To investigate coverage and factors associated with death registration in India. Methods: We used data from the Indian National Family Health Survey 2019-2021. Based on responses of eligible household members, we estimated death registration in 84 390 deaths in all age groups across the country. We used multilevel logistic regression analysis to determine sociodemographic variables associated with death registration at state, district and individual levels. Findings: Nationally, 70.8% (59 748/84 390) of deaths were registered. Of 707 districts in our study period, 122 and 53 districts had death registration levels less than 40% in females and males, respectively. The likelihood of death registration was significantly lower for females than males (adjusted odds ratios, aOR: 0.61; 95% confidence interval, CI: 0.59-0.64). Death registration increased significantly with age of the deceased person, with the highest odds in 35-49-year-olds (aOR: 5.05; 95% CI: 4.58-5.57) compared with 0-4-year-olds. Death registration was less likely among rural households, disadvantaged castes, the poorest wealth quintile, Muslims and households without a below poverty level card. Higher education was associated with higher death registration with the greatest likelihood of registration in households with a member with post-secondary school education (aOR: 1.54; 95% CI: 1.42-1.66). District-level factors were not significantly associated with death registration. Conclusion: Sociodemographic characteristics of the deceased person were significantly associated with death registration. Strategies to raise awareness of death registration procedures among disadvantaged population groups and the introduction of a mobile telephone application for death registration are recommended to improve death registration in India.