North Korea, Somalia and Afghanistan are the worst countries to openly follow the teachings of the Bible, according to the study by Open Doors.
North Korea has been branded the most dangerous country in the world for Christians since 2002.
The Christian charity found the global level of Christian persecution has risen for the fourth year in a row, with Asian countries showing a particularly rapid rise.
The study found Islamic extremism was responsible for increased hostility in 14 of the top 20 counties on its list.
And the research discovered followers of Jesus living in India were faced with a “very high” level of persecution as “Hindu nationalists batter the churches”.
The charity concludes “millions of Christians around the world now live their lives against varying levels of discrimination, discovery, violence and arrest”.
The study highlighted the top 50 countries where it is most difficult to practice the Christian faith, and rated levels of persecution as “extreme”, “very high” or “high”.
North Korea topped the list because of dictator Kim Jong-un’s brutal crackdown against the nation’s estimated 300,000 Christians.
The tyrant’s family are worshipped like gods and any suggestion there is a higher authority than the supreme leader is “immediately crushed”.
Open Doors says: “Tens of thousands of Christians are incarcerated in horrific labour camps, and thousands more keep their faith in Christ a complete secret – often their own family members do not know of their faith.”
In lawless Somalia, which ranks second for persecution, the charity says people even suspected of being a Christian can be murdered on the spot.
The militant Islamist group al-Shabaab, which is highly active in the East African nation, has made making Somalia “free of all Christians” one of its missions.
And the Open Doors study cites a horrific case from 2016 when at least 12 Christians were killed after their faith was discovered.
The charity’s research says in Afghanistan, which ranks third in the study, it is illegal for Afghans to practice any faith other than Islam.
But despite the ban, Open Doors estimates there are thousands of Christians living in the central Asian country.
The charity says: “Discovered believers will sometimes be sent to a mental hospital, as families believe no sane person would leave Islam.”
The study ranked India 15th on its list because it says there are efforts to impose national anti-conversion laws to prevent anyone from practicing anything other than Hinduism. Full Report