Diseases of the circulatory system were the leading cause of medically certified deaths in India in 2023, accounting for 36.4% of such deaths. This is slightly down from over 40% in 2022, according to the "Annual Report on Medical Certification of Cause of Death, 2023" released by the Office of the Registrar General of India (RGI). The report showed that only 22% of all deaths registered in the Civil Registration System were medically certified in 2023, a small drop from 2022. Heart and pulmonary circulation diseases caused more than half of the circulatory system deaths. The highest death rates were among those aged above 70 years, with over one-third of deaths in this age group due to these diseases. People aged 55–64 years were the second most affected. Interestingly, circulatory system diseases were the leading cause of death for all age groups starting from 15 years old. For example, 21% of certified deaths in the 15-24 age group were from these diseases, rising to 27.8% in 25-34 years and 33.1% in 35-44 years. More than 80% of circulatory deaths occurred in those over 45 years. The report highlights academic findings of a rise in heart attacks among younger Indians. It cited data pointing out that half of all heart attacks in Indian men occur under 50 years. Gender-wise, women over 70 years had a higher death rate from circulatory diseases by over 10 percentage points compared to men, but in other age groups, rates were similar or lower for women. Beyond circulatory diseases, respiratory system diseases caused 11.5% of certified deaths, while infectious and parasitic diseases caused over 8%. Other causes like digestive diseases, neoplasms, and injuries each accounted for about 4%. The report also noted that several States and Union Territories fall short on medical death certification. Only Andaman and Nicobar Islands, Chandigarh, Dadra and Nagar Haveli and Daman and Diu, Delhi, Goa, Lakshadweep, and Puducherry medically certified over half of registered deaths. Goa stands out as the only State with 100% medical certification of registered deaths.