Published Jun 29, 2026 | 7:00 AM ⚊ Updated Jun 29, 2026 | 7:00 AM
Death. Representative image. (iStock)
Synopsis: Kerala continues to record the highest share of deaths receiving hospital-based medical attention in India, according to the SRS 2024 report. Yet it has also witnessed one of the country’s sharpest declines since 2019. An analysis of the data reveals widening contrasts across southern states and a broader nationwide downward trend.
Kerala recorded the highest share of hospital-attended deaths anywhere in India in 2024, while recording one of the largest declines among the country’s highest-performing states over the past five years. Both findings come from the same dataset, and together they describe a state that still leads the country while losing ground faster than nearly all its peers at the top of the table.
The Sample Registration System (SRS) 2024 report tracks where Indians received medical attention before death: At a government hospital, a private hospital, from a qualified professional outside a hospital, or without qualified medical attention.
Although the report does not explain why these figures move the way they do, it documents them, year by year, state by state, and leaves the comparisons to speak for themselves.
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In 2024, 58 percent of all deaths in Kerala happened with hospital-based medical attention, government and private combined. No other major state reaches that figure. Jammu & Kashmir comes closest, at 57.7 percent. The national average sits at 40.2 percent, meaning Kerala’s lead over the rest of the country remains substantial.
Five years earlier, that lead was far larger. In 2019, Kerala posted 80.7 percent, a full 32 percentage points above the national figure. By 2024, the gap had narrowed to under 18 points. Kerala’s hospital-attendance rate fell by 22.7 percentage points across the five years, the steepest decline recorded among the states that continue to top the table.
Most of that fall happened inside a single year. Between 2020 and 2021, Kerala’s figure dropped from 80.7 percent to 56.1 percent. Rural Kerala fell from 87.8 percent to 56.6 percent over the same period. Urban Kerala also declined, from 74.9 percent to 55.6 percent, though the fall there was somewhat smaller.
The decline was concentrated within a single year rather than spread across the five years. After the sharp fall between 2020 and 2021, Kerala’s figures changed only marginally through 2024, indicating that most of the overall decline had already occurred by 2021.
Among major fertility and mortality indicators presented in the report, hospital-attended deaths follow a different trajectory from measures such as infant mortality and institutional births, which continued to improve or held steady across the same period.
Place Kerala alongside its neighbours and the regional picture turns out to be far from uniform. Each of the five southern states tracked in the report followed its own trajectory between 2019 and 2024, even though all five recorded declines.
Karnataka posted the smallest fall in the region, slipping from 51.5 percent to 44.7 percent, a decline of 6.8 points. Tamil Nadu recorded 37.2 percent in 2024, a figure that sits close to the national average of 40.2 percent.
Andhra Pradesh recorded an identical 37.2 percent in 2024, following a decline from 47.9 percent in 2019, a fall of 10.7 points. Telangana posted the lowest figure among the five southern states at 35.4 percent, below the national average, after declining from 45.6 percent in 2019.
Although all five southern states recorded declines, the scale of those declines varied considerably, from 6.8 percentage points in Karnataka to 22.7 percentage points in Kerala.
Kerala’s 2024 figure of 58 percent still exceeds Telangana’s highest recorded figure across the entire five-year window, which topped out at 45.6 percent in 2019. In other words, Kerala’s worst year on this measure comfortably beats Telangana’s best year.
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Zoom out of the southern states, and India’s national figure traces a version of the same pattern Kerala shows, only starting from a lower base and falling by a smaller margin. The all-India hospital-attendance rate held near 48–49 percent through 2019 and 2020, dropped to 39.3 percent in 2021, and recovered only as far as 40.2 percent by 2024, eight points below where it stood five years earlier.
A sharp decline between 2020 and 2021, followed by only a partial recovery, appears across almost every state and union territory included in the trend table.
Of the 22 states and union territories the SRS report tracks at this level of detail, only one, Haryana, ended the five years higher than it started, rising from 38.6 percent in 2019 to 49.7 percent in 2024. Every other state in the table recorded a net decline over the period, even after the partial recovery years following 2021.
At the opposite end of the table from Kerala sits Bihar, where the story is not one of decline from a high point but of a consistently low floor. In 2024, 67.8 percent of all deaths in Bihar occurred without qualified medical attention of any kind, the highest such share recorded among the 22 states and union territories in the table, against Kerala’s 26.8 percent, the lowest.
Bihar’s own hospital-attendance figure also fell over the period, from 33.4 percent in 2019 to 26.7 percent in 2024, a decline smaller in absolute terms than Kerala’s but one that started from a base already among the lowest nationally.
Placed side by side, Kerala and Bihar mark the two extremes the SRS data captures: A state losing a substantial lead while remaining first, and a state with little ground to lose. Haryana, the sole state moving in the opposite direction of the national trend, adds a third data point that the report records without further comment.
The SRS 2024 report documents a nationwide decline in the share of deaths receiving hospital-based medical attention before death, although the scale of that decline differs across states. Kerala’s fall was the steepest among states still leading the table, Haryana’s was the only rise nationally, and Bihar’s figures were the lowest throughout, regardless of direction.
Kerala remains the national leader on this indicator in 2024. But the size of its lead has narrowed substantially since 2019, from a 32-point advantage over the national average to 18 points. The SRS report documents the trend across states and over time. It does not attempt to explain the differences it records.
(Edited by Muhammed Fazil.)
