Magnitude and determinants of excess total, age-specific and sex-specific all-cause mortality in 24 countries worldwide during 2020 and 2021: results on the impact of the COVID-19 pandemic from the C-MOR project
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Published:2024-04
Issue:4
Volume:9
Page:e013018
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ISSN:2059-7908
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Container-title:BMJ Global Health
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language:en
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Short-container-title:BMJ Glob Health
Author:
Pallari Chryso Th.ORCID, Achilleos SouzanaORCID, Quattrocchi Annalisa, Gabel John, Critselis Elena, Athanasiadou Maria, Rahmanian Haghighi Mohammad Reza, Papatheodorou Stefania, Liu Tianyu, Artemiou Andreas, Rodriguez-Llanes Jose M, Bennett Catherine M, Zimmermann Claudia, Schernhammer Eva, Bustos Sierra Natalia, Ekelson Reindert, Lobato Jackeline, Macedo Laylla, Mortensen Laust Hvas, Critchley Julia, Goldsmith LucyORCID, Denissov Gleb, Le Meur Nolwenn, Kandelaki Levan, Athanasakis Kostas, Binyaminy Binyamin, Maor Tamar, Stracci Fabrizio, Ambrosio Giuseppe, Davletov Kairat, Glushkova Nataliya, Martial Cyndy, Chan Sun Marie, Hagen Terje P, Chong Mario, Barron Manuel, Łyszczarz BłażejORCID, Erzen Ivan, Arcos Gonzalez Pedro, Burström Bo, Pidmurniak Nataliia, Verstiuk Olesia, Huang Qian, Polemitis Antonis, Charalambous Andreas, Demetriou Christiana A.
Abstract
IntroductionTo examine the impact of the COVID-19 pandemic on mortality, we estimated excess all-cause mortality in 24 countries for 2020 and 2021, overall and stratified by sex and age.MethodsTotal, age-specific and sex-specific weekly all-cause mortality was collected for 2015–2021 and excess mortality for 2020 and 2021 was calculated by comparing weekly 2020 and 2021 age-standardised mortality rates against expected mortality, estimated based on historical data (2015–2019), accounting for seasonality, and long-term and short-term trends. Age-specific weekly excess mortality was similarly calculated using crude mortality rates. The association of country and pandemic-related variables with excess mortality was investigated using simple and multilevel regression models.ResultsExcess cumulative mortality for both 2020 and 2021 was found in Austria, Brazil, Belgium, Cyprus, England and Wales, Estonia, France, Georgia, Greece, Israel, Italy, Kazakhstan, Mauritius, Northern Ireland, Norway, Peru, Poland, Slovenia, Spain, Sweden, Ukraine, and the USA. Australia and Denmark experienced excess mortality only in 2021. Mauritius demonstrated a statistically significant decrease in all-cause mortality during both years. Weekly incidence of COVID-19 was significantly positively associated with excess mortality for both years, but the positive association was attenuated in 2021 as percentage of the population fully vaccinated increased. Stringency index of control measures was positively and negatively associated with excess mortality in 2020 and 2021, respectively.ConclusionThis study provides evidence of substantial excess mortality in most countries investigated during the first 2 years of the pandemic and suggests that COVID-19 incidence, stringency of control measures and vaccination rates interacted in determining the magnitude of excess mortality.
Funder
The University of Nicosia Medical School
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