New Delhi: The Centre has commissioned the first nationwide study to assess the pattern of ‘sudden deaths’ in India amid concerns that such deaths are rising among those under 45 years of age, especially since COVID-19, ThePrint has learnt.
The Union health ministry’s health research department (DHR) is collaborating with INCLEN International, a New Delhi-based health research organisation, to conduct a national, community-level study, and sources say its details are in the works.
The World Health Organisation defines sudden death as mortality due to natural causes within 24 hours from the onset of symptoms. The leading cause of these deaths is likely cardiovascular system disorders.
Following the publication of this report, the health ministry insisted that no such nationwide study has been commissioned by ICMR in partnership with INCLEN, as reported by The Print.
Last week, Karnataka Chief Minister Siddaramaiah sparked a row by expressing doubts over the safety of COVID-19 jabs, suggesting a potential link between the vaccines and fatal heart attacks reported among young people in Hassan district, Karnataka, in just a few months.
The Union government quickly refuted the claim, saying extensive studies by the Indian Council of Medical Research (ICMR) and AIIMS, Delhi, on sudden deaths among adults, post-pandemic, have “conclusively established no linkage between COVID-19 vaccines and such fatalities”.
According to sources, AIIMS, Delhi, is carrying out a study to document the presence of coronary artery disease in roughly 300 patients, especially the young, purportedly in good health, before they suddenly died, after which AIIMS received their bodies for postmortem.
The new nationwide assessment will aim to document sudden deaths at the community level across states. This larger study will analyse the trend of such deaths in an attempt to determine the risk factors for such mortalities, said INCLEN International Executive Director and proposed lead analyst N.K. Arora.
The AIIMS study, Establishing the Cause in Sudden Unexplained Deaths in Young, is underway in collaboration with the ICMR. It is an analysis of the postmortem data the hospital has collected since 2003. Preliminary findings have suggested the incidence of coronary artery disease, a leading cause of heart attacks, had remained similar in the deceased young patients before and after COVID-19 vaccination.
The ICMR is also designing another analysis covering more ground. “The idea is to scientifically probe the incidence and prevalence of sudden deaths in India for the first time, as not many people who die suddenly always reach hospitals,” Arora, who is the chairman of the Covid Working Group of the top vaccination advisory body in India, the National Technical Advisory Group on Immunisation (NTAGI), told ThePrint.
Unlike many developed countries, experts point out, India does not have a registry of sudden deaths. Such deaths have, over the last few years, been linked increasingly to either COVID-19 or COVID-19 vaccines.
A study published in 2023 by the ICMR-National Institute of Epidemiology(NIE) earlier revealed that COVID-19 vaccination did not increase the risk of unexplained sudden deaths among young adults. Instead, a history of hospitalisation with COVID-19, binge drinking, recreational use of drugs, family history of heart attacks, and rigorous physical activities, including exercise up to 48 hours before the death, were identified as the major risk factors behind such deaths.
This study, titled Factors associated with unexplained sudden deaths among adults aged 18-45 years in India–A multi-centric matched case-control study, was conducted from May to August 2023 across 47 tertiary care hospitals in 19 states and Union Territories in India.
In Karnataka, the state government Monday decided to treat sudden death as a notifiable disease, meaning all public and private hospitals must alert the government of every such death and conduct a postmortem in all cases.
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Understanding sudden deaths
Experts say mortalities are categorised as sudden deaths when people considered supposedly normal or not expected to have a serious condition die without an explanation within up to 24 hours of symptom onset.
According to Dr Ambuj Roy, a senior cardiologist with AIIMS, Delhi, nearly 75 percent of sudden deaths are due to cardiac reasons, heart attacks, or sudden cardiac arrests.
Nearly 50 percent of all sudden deaths are due to heart attacks, when blood flow to the heart is blocked. Coronary artery disease, in which arteries supplying blood to the heart muscle become narrowed or blocked due to plaque buildup, is one of the main risk factors for a heart attack.
Some other malfunctions of the heart that can lead to sudden deaths or trigger cardiac arrests when the heart malfunctions or stops beating include the Long QT syndrome—a heart rhythm disorder that affects the electrical system in the heart, cardiomyopathies, or weakened heart muscles, and hypertrophic cardiomyopathies—very thick heart muscles—or other undetected genetic abnormalities.
In nearly 25 percent of sudden deaths, Roy said, the reasons are found to be acute respiratory distress or neurological issues such as fatal strokes.
Experts, however, point out that since there is no nationwide data available on the incidence of sudden deaths, any new studies will be able to generate statistics on incidence and risk factors from now onwards.
“It is true that we have been seeing images and videos of people collapsing suddenly over the last few years but to make claims that such incidents have increased now is totally unscientific,” said a cardiologist at Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, who did not wish to be named. The proliferation of mobile phones, CCTV cameras, and social media may have made it easier for people to capture such images, he added.
“In my view, it is mostly undetected cardiovascular conditions that may be behind such deaths, and since such diseases are growing in India due to lifestyle reasons, we feel that sudden deaths are also rising,” the cardiologist said.
He further underlined that various international studies have also shown South Asians, including Indians, are more prone to metabolic disorders, one of the main risk factors for cardiovascular diseases.
Editor’s Note: This report has been updated to reflect the response of the health ministry
(Edited by Madhurita Goswami)