BMJ Global Health (Apr 2024)
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
- Laust Hvas Mortensen,
- Andreas Charalambous,
- Julia Critchley,
- Bo Burström,
- Kairat Davletov,
- Annalisa Quattrocchi,
- Tianyu Liu,
- Marie Chan Sun,
- Giuseppe Ambrosio,
- Eva Schernhammer,
- Qian Huang,
- Nolwenn Le Meur,
- Elena Critselis,
- Andreas Artemiou,
- Terje P Hagen,
- Fabrizio Stracci,
- Kostas Athanasakis,
- Catherine M Bennett,
- Manuel Barrón,
- Stefania Papatheodorou,
- Lucy Goldsmith,
- Jose M Rodriguez-Llanes,
- Souzana Achilleos,
- Chryso Th. Pallari,
- John Gabel,
- Maria Athanasiadou,
- Mohammad Reza Rahmanian Haghighi,
- Claudia Zimmermann,
- Natalia Bustos Sierra,
- Reindert Ekelson,
- Jackeline Lobato,
- Laylla Macedo,
- Gleb Denissov,
- Levan Kandelaki,
- Binyamin Binyaminy,
- Tamar Maor,
- Nataliya Glushkova,
- Cyndy Martial,
- Mario Chong,
- Błażej Łyszczarz,
- Ivan Erzen,
- Pedro Arcos Gonzalez,
- Nataliia Pidmurniak,
- Olesia Verstiuk,
- Antonis Polemitis,
- Christiana A. Demetriou
Affiliations
- Laust Hvas Mortensen
- Methods and Analysis Department, Statistics Denmark, Copenhagen Oe, Denmark
- Andreas Charalambous
- University of Nicosia Medical School, Nicosia, Cyprus
- Julia Critchley
- Population Health Research Institute, St George`s University of London, London, UK
- Bo Burström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Kairat Davletov
- Rector Administration, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
- Annalisa Quattrocchi
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
- Tianyu Liu
- 24 Fourth Department, Digestive Disease Center, Suining Central Hospital, Suining, Sichuan, China
- Marie Chan Sun
- Department of Medicine, University of Mauritius Faculty of Science, Reduit, Mauritius
- Giuseppe Ambrosio
- Department of Cardiology, University of Perugia School of Medicine, Perugia, Italy
- Eva Schernhammer
- Department of Epidemiology, Medical University of Vienna Center for Public Health, Vienna, Austria
- Qian Huang
- Center for Rural Health Research, College of Public Health, East Tennessee State University, Johnson City, TN, USA
- Nolwenn Le Meur
- UMR CNRS 6051 - INSERM U1309, Ecole des Hautes Etudes en Santé Publique, Rennes, France
- Elena Critselis
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
- Andreas Artemiou
- School of Information Technologies, University of Limassol, Limassol, Cyprus
- Terje P Hagen
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
- Fabrizio Stracci
- Department of Medicine, Public Health Section, University of Perugia, School of Medicine, Perugia, Italy
- Kostas Athanasakis
- Laboratory for Health Technology Assessment, University of West Attica, Athens, Greece
- Catherine M Bennett
- Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia
- Manuel Barrón
- Departamento de Economia, Universidad del Pacifico, Lima, Peru
- Stefania Papatheodorou
- Department of Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
- Lucy Goldsmith
- Division of Health Services Research and Management, School of Health and Psychological Sciences, University of London, City, London, UK
- Jose M Rodriguez-Llanes
- European Commission Joint Research Centre, Ispra, Italy
- Souzana Achilleos
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
- Chryso Th. Pallari
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
- John Gabel
- Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
- Maria Athanasiadou
- Health Monitoring Unit, Government of the Republic of Cyprus Ministry of Health, Nicosia, Cyprus
- Mohammad Reza Rahmanian Haghighi
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
- Claudia Zimmermann
- Department of Epidemiology, Medical University of Vienna Center for Public Health, Vienna, Austria
- Natalia Bustos Sierra
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Reindert Ekelson
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Jackeline Lobato
- Department of Epidemiology and Biostatistics, Institute of Collective Health (ISC), Federal Fluminense University, Niteroi, Brazil
- Laylla Macedo
- Institute of Studies in Collective Health (IESC), Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Gleb Denissov
- Department of Registries, National Institute for Health Development, Tallinn, Estonia
- Levan Kandelaki
- Department of Medical Statistics, National Center for Disease Control and Public Health, Tbilisi, Georgia
- Binyamin Binyaminy
- Israeli Center of Disease Control, State of Israel Ministry of Health, Ramat Gan, Israel
- Tamar Maor
- Israeli Center of Disease Control, State of Israel Ministry of Health, Ramat Gan, Israel
- Nataliya Glushkova
- Department of Epidemiology, Evidence-Based Medicine and Biostatistics, Al-Farabi Kazakh National University, Almaty, Kazakhstan
- Cyndy Martial
- Department of Medicine, University of Mauritius Faculty of Science, Reduit, Mauritius
- Mario Chong
- Departamento de Ingeniería, Universidad del Pacifico, Lima, Peru
- Błażej Łyszczarz
- Department of Health Economics, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
- Ivan Erzen
- Public Health School, National Institute of Public Health of the Republic of Slovenia, Ljubljana, Slovenia
- Pedro Arcos Gonzalez
- Unit for Research in Emergency and Disaster, Department of Medicine, University of Oviedo, Oviedo, Spain
- Nataliia Pidmurniak
- Department of Internal Medicine, Bogomolets National Medical University, Kyiv, Ukraine
- Olesia Verstiuk
- Department of Medical Sciences, University of Nicosia Medical School, Nicosia, Cyprus
- Antonis Polemitis
- University of Nicosia, Nicosia, Cyprus
- Christiana A. Demetriou
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
- DOI
- https://doi.org/10.1136/bmjgh-2023-013018
- Journal volume & issue
-
Vol. 9,
no. 4
Abstract
Introduction To 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.Methods Total, 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.Results Excess 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.Conclusion This 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.
