The diabetes mortality burden in Kerala forms part of a broader pattern of endocrine, nutritional and metabolic diseases, which accounted for 20.5 percent of all medically certified deaths in the State.
Published Dec 28, 2025 | 7:00 AM ⚊ Updated Dec 28, 2025 | 7:00 AM
Diabetes. Representative Image. (iStock)
Synopsis: Kerala recorded the highest share of diabetes-related deaths in India at 19.1 percent in 2023, while Andhra Pradesh reported the highest proportion of deaths from circulatory system diseases at 53.2 percent, both far above the national averages. The data, from the Medical Certification of Cause of Death Report 2023, point to deep inter-State differences in diagnostic detail and certification coverage.
Kerala recorded 19.1 percent of all medically certified deaths from diabetes mellitus in 2023, the highest proportion in India and more than six times the national average of 3.1 percent. Meanwhile, Andhra Pradesh reported 53.2 percent of deaths from circulatory system diseases, the highest among all States and significantly above the national figure of 36.4 percent.
The data is from the Report on Medical Certification of Cause of Death 2023 released by the Office of the Registrar General of India. The report recorded 1,900,956 medically certified deaths across the country, representing 22 percent of all registered deaths.
Of Kerala’s 34,613 medically certified deaths in 2023, 6,624 were attributed to diabetes mellitus. This 19.1 percent share places the State in a category of its own, far exceeding Tamil Nadu’s 8.1 percent, Karnataka’s 3.2 percent and the national average of 3.1 percent.
The diabetes mortality burden in Kerala forms part of a broader pattern of endocrine, nutritional and metabolic diseases, which accounted for 20.5 percent of all medically certified deaths in the State. This is the highest proportion in the country for this disease category.
However, Kerala’s medical certification rate remains paradoxically low at 11.4 percent, meaning only 34,613 of the State’s 303,704 registered deaths were medically certified. This reflects a continued dependence on non-institutional death reporting despite the State’s strong health infrastructure.
Andhra Pradesh recorded 41,810 deaths from circulatory system diseases out of 78,522 medically certified deaths, translating to a 53.2 percent share. This is substantially higher than Karnataka’s 30.8 percent, Kerala’s 26.5 percent and Tamil Nadu’s 49.3 percent.
Within circulatory diseases, the State showed a striking concentration in non-specific categories. Of the 41,810 circulatory deaths, 35,216 deaths, or 44.8 percent of all medically certified deaths, were classified under “pulmonary circulation and other forms of heart disease” rather than specific diagnoses. This represented 84.2 percent of all circulatory deaths in the State.
In contrast, only 985 deaths, or 1.3 percent of medically certified deaths, were attributed to ischaemic heart disease, the category covering heart attacks and blocked arteries. This is dramatically lower than Tamil Nadu’s 16.5 percent, Karnataka’s 12.6 percent and Kerala’s 9.9 percent.
Cerebrovascular diseases, or stroke, accounted for 4,005 deaths in Andhra Pradesh, representing 5.1 percent of medically certified deaths or 9.6 percent of circulatory deaths. Hypertensive diseases caused 624 deaths, or 0.8 percent, while rheumatic heart diseases accounted for 115 deaths, or 0.1 percent.
Andhra Pradesh’s overall medical certification rate stood at 17.8 percent, with 78,522 medically certified deaths out of 441,236 registered deaths. This places the State below both the southern regional average and the national average.
Telangana displayed a nearly identical pattern to Andhra Pradesh. Of 92,068 medically certified deaths, 38,387, or 41.7 percent, were attributed to circulatory system diseases. Within this, 33,210 deaths, or 36.1 percent of all medically certified deaths, fell under the “pulmonary circulation and other forms of heart disease” category, representing 86.5 percent of all circulatory deaths.
Ischaemic heart disease accounted for only 1,474 deaths, or 1.6 percent of medically certified deaths, while stroke caused 2,774 deaths, or 3 percent. Hypertensive diseases were recorded in just 113 deaths, or 0.1 percent.
Telangana also reported the highest proportion of unclassified deaths in the southern region, with 19.4 percent falling under “symptoms, signs and abnormal clinical findings not elsewhere classified.” This category typically indicates deaths where a specific diagnosis was not established.
The State achieved a medical certification rate of 38.4 percent, with 92,068 certified deaths out of 239,652 registered deaths, placing it among the better-performing large States nationally.
Tamil Nadu recorded the highest absolute number of medically certified deaths in the country at 271,047, achieving a certification rate of 39.1 percent. This translates to 271,047 medically certified deaths out of 693,378 registered deaths.
Circulatory system diseases accounted for 133,558 deaths, or 49.3 percent of medically certified deaths. Unlike Andhra Pradesh and Telangana, Tamil Nadu showed more balanced reporting across circulatory subcategories. Ischaemic heart disease accounted for 44,621 deaths, or 16.5 percent of all medically certified deaths, while pulmonary circulation and other forms of heart disease caused 73,113 deaths, or 27 percent.
Stroke accounted for 8,710 deaths, or 3.2 percent, hypertensive diseases for 5,639 deaths, or 2.1 percent, and rheumatic heart diseases for 708 deaths, or 0.3 percent.
Tamil Nadu also recorded 21,986 deaths from diabetes mellitus, representing 8.1 percent of medically certified deaths. While lower than Kerala in percentage terms, this represents the second-highest absolute burden of diabetes mortality in the southern region.
Infectious and parasitic diseases accounted for 9.5 percent of Tamil Nadu’s medically certified deaths, the highest in the southern region. Congenital malformations represented 5.8 percent, also the highest regionally.
Karnataka recorded 144,189 medically certified deaths, achieving a certification rate of 26.7 percent out of 539,924 registered deaths. Circulatory diseases accounted for 44,399 deaths, or 30.8 percent, the lowest proportion among the major southern States.
The State showed more specific diagnostic reporting for heart conditions. Ischaemic heart disease accounted for 18,168 deaths, or 12.6 percent of medically certified deaths, representing 40.9 percent of all circulatory deaths. This contrasts sharply with Andhra Pradesh’s 2.4 percent and Telangana’s 3.8 percent.
“Pulmonary circulation and other forms of heart disease” caused 16,471 deaths, or 11.4 percent of medically certified deaths, while stroke accounted for 6,843 deaths, or 4.7 percent. Hypertensive diseases caused 2,375 deaths, or 1.6 percent.
Karnataka recorded the highest regional burden of genitourinary system diseases at 10.4 percent, or 15,015 deaths, primarily driven by renal failure. Cancer deaths accounted for 7 percent, or 10,093 deaths, while diabetes mellitus represented 3.2 percent, or 4,617 deaths.
The State also recorded 8,645 perinatal deaths, accounting for 6 percent of medically certified deaths, the highest proportion in the southern region.
Nationally, circulatory system diseases accounted for 691,086 deaths, or 36.4 percent of the 1,900,956 medically certified deaths. Within this category, “pulmonary circulation and other forms of heart disease” represented 51.5 percent of circulatory deaths, while ischaemic heart diseases accounted for 23.9 percent.
Respiratory diseases caused 218,610 deaths, or 11.5 percent, with pneumonia representing 16.4 percent of respiratory deaths. Infectious and parasitic diseases accounted for 165,383 deaths, or 8.7 percent, with septicaemia responsible for 63.1 percent of this category.
Genitourinary system diseases caused 93,147 deaths, or 4.9 percent nationally, with renal failure accounting for 78.5 percent of deaths in this group. Cancer deaths totalled 91,246, or 4.8 percent, with malignant neoplasms of digestive organs representing 25.5 percent of cancer deaths.
Injury, poisoning and external causes accounted for 81,741 deaths, or 4.3 percent, while digestive system diseases caused 79,840 deaths, or 4.2 percent. Perinatal conditions accounted for 78,039 deaths, or 4.1 percent, representing the primary cause of infant mortality at 66.3 percent of all infant deaths.
The category “symptoms, signs and abnormal clinical findings” accounted for 226,233 deaths, or 11.9 percent nationally, indicating cases where specific diagnoses were not established. Within this category, shock represented 31 percent and senility 14.6 percent.
Men accounted for 62.8 percent of medically certified deaths nationally, or 1,193,800 deaths, while women represented 37.2 percent, or 707,156 deaths. This suggests that males may access medical facilities more frequently during terminal illness.
Age patterns showed distinct disease profiles. Perinatal conditions caused 66.3 percent of infant deaths among those aged under one year, while respiratory diseases dominated childhood deaths at 17.3 percent for ages one to four years. Injury and poisoning represented 15.7 percent of deaths among youth aged 15 to 24 years.
Circulatory diseases became the leading cause for every age group from 15 years onwards. Among adults aged 45 years and above, 82.1 percent of all circulatory deaths occurred in this age bracket. The 70 years and above age group reported the highest absolute number of deaths, accounting for 26.7 percent of the total.
Deep inter-State disparities persist in medical certification coverage. Goa maintained 100 percent certification, followed by Lakshadweep at 99.2 percent and Puducherry at 91.4 percent. Among the southern Union Territories, Puducherry’s 91.4 percent certification rate represents near-complete institutional reporting.
Maharashtra led the major States nationally at 42.4 percent certification. In contrast, Bihar recorded only 5.5 percent, Assam 5.6 percent, Uttar Pradesh 5.8 percent, Madhya Pradesh 9.5 percent and Jharkhand 11.8 percent.
Urban areas continue to dominate medical certification. When deaths involving any form of medical attention before death are considered, the national certification rate rises to 48.5 percent, underscoring the gap between institutional and non-institutional deaths.
