Emergency Care in India: A Retrospective Cross-sectional Analysis of Health Management and Information System and Global Burden of Disease

ABSTRACT Background To understand the utilization and burden of emergency medical conditions (EMCs), we assessed Emergency Medicine Department (EMD) data from the Health Management and Information System (HMIS) of India and EMC from the Global Burden of Diseases (GBD). Methods This was a retrospective cross-sectional analysis of HMIS and GBD data for 2019. We extracted EMD registrations, admissions, and deaths from HMIS and incidence and deaths from GBD for 31 EMCs at the national and state levels. We analyzed HMIS and GBD data for proportions and rates of registrations, deaths, and incident cases relative to population counts and hospital admission numbers. Results In 2019, 119,103,358 patients (8935.66 per 100,000 people) were registered at EMDs. The national EMD registration rate was 6744.21 per 100,000 hospital admissions, and the EMD death rate was 36002.6 per 100,000 hospital deaths. Only 12.14% of all HMIS registrations had cause-specific data. GBD estimated 2,047,175,737 EMC incident cases nationally, accounting for 27.22% of all-cause incidence, 51.71% of all-cause mortality, and Trauma-related registrations were 9.27% in HMIS, while injuries in GBD accounted for 7% of EMCs. Overall, HMIS EMD registrations were lower than GBD EMC incidence numbers, with regional variations. Conclusions The study reveals gaps in the EMD utilization as per HMIS data compared to the EMC burden estimates from GBD. Improved data integration and reporting can address regional disparities. KEY MESSAGES What is already known on this topic Emergency medical conditions (EMCs) are among the top 15 causes of global morbidity and mortality. Previous literature has focused on training programs for emergency medicine as a specialty. Assessments of EMC burden that can improve health system preparedness have been limited. What this study adds We retrospectively analyzed the Indian government’s HMIS database documenting hospital-level Emergency Medicine Department (EMD) registrations and deaths, as well as the Global Burden of Disease Study’s estimates for EMC incidence and deaths for 2019. We identified potential similarities and gaps across sources in reporting cause-specific differences in burdens at the state and national levels. We found that only 12.14% of HMIS EMD registrations had cause-specific data. These causes represented 8.1% of the EMC incidence per GBD. Additionally, HMIS data lags the GBD estimates at the state and national levels, which can be attributed to the underutilization of EM facilities nationwide or the underreporting of EMCs. How this study might affect research, practice, or policy Our study provides a systematic subnational assessment highlighting the absence of a standardized data reporting system capturing the complete EMC burden in India. Our findings depict under-utilization of EM facilities across states, pointing to the need for better policies on monitoring and evaluating health system resources in the country.