Cause-Specific Excess Mortality During the COVID-19 Pandemic (2020-2021) in 12 Countries of the C-MOR Consortium.

COVID-19 Cancer Cardiovascular diseases Cause-specific mortality Public health measures Respiratory tract infections

Journal

Journal of epidemiology and global health

ISSN: 2210-6014

Titre abrégé: J Epidemiol Glob Health

Pays: Switzerland

ID NLM: 101592084

Informations de publication

Date de publication:
22 May 2024

Historique:

received: 27 10 2023

accepted: 09 05 2024

medline: 22 5 2024

pubmed: 22 5 2024

entrez: 22 5 2024

Statut: aheadofprint

Résumé

This study investigated cause-specific mortality rates in 12 countries during the COVID-19 pandemic in 2020 and 2021. We collected weekly cause-specific mortality data from respiratory disease, pneumonia, cardiovascular disease (CVD) and cancer from national vital statistic databases. We calculated excess mortality for respiratory disease (excluding COVID-19 codes), pneumonia, and CVD in 2020 and 2021 by comparing observed weekly against expected mortality based on historical data (2015-2019), accounting for seasonal trends. We used multilevel regression models to investigate the association between country-level pandemic-related variables and cause-specific mortality. Significant reductions in cumulative mortality from respiratory disease and pneumonia were observed in 2020 and/or 2021, except for Georgia, Northern Ireland, Kazakhstan, and Ukraine, which exhibited excess mortality for one or both causes. Australia, Austria, Cyprus, Georgia, and Northern Ireland experienced excess cumulative CVD mortality in 2020 and/or 2021. Australia, Austria, Brazil, Cyprus, Georgia, Northern Ireland, Scotland and Slovenia, experienced increased crude cumulative cancer mortality during 2020 and/or 2021 compared to previous years. Among pandemic-related variables, reported COVID-19 incidence was negatively associated with increased cancer mortality, excess respiratory, (2020) and pneumonia (2021) mortality, and positively associated with respiratory and CVD mortality (2021). Stringency of control measures were negatively associated with excess respiratory disease, CVD, and increased cancer mortality (2021). This study provides evidence of substantial excess mortality from CVD, and notable reductions in respiratory disease and pneumonia in both years across most countries investigated. Our study also highlights the beneficial impact of stringent control measures in mitigating excess mortality from most causes in 2021.

Sections du résumé

BACKGROUND BACKGROUND

This study investigated cause-specific mortality rates in 12 countries during the COVID-19 pandemic in 2020 and 2021.

METHODS METHODS

We collected weekly cause-specific mortality data from respiratory disease, pneumonia, cardiovascular disease (CVD) and cancer from national vital statistic databases. We calculated excess mortality for respiratory disease (excluding COVID-19 codes), pneumonia, and CVD in 2020 and 2021 by comparing observed weekly against expected mortality based on historical data (2015-2019), accounting for seasonal trends. We used multilevel regression models to investigate the association between country-level pandemic-related variables and cause-specific mortality.

RESULTS RESULTS

Significant reductions in cumulative mortality from respiratory disease and pneumonia were observed in 2020 and/or 2021, except for Georgia, Northern Ireland, Kazakhstan, and Ukraine, which exhibited excess mortality for one or both causes. Australia, Austria, Cyprus, Georgia, and Northern Ireland experienced excess cumulative CVD mortality in 2020 and/or 2021. Australia, Austria, Brazil, Cyprus, Georgia, Northern Ireland, Scotland and Slovenia, experienced increased crude cumulative cancer mortality during 2020 and/or 2021 compared to previous years. Among pandemic-related variables, reported COVID-19 incidence was negatively associated with increased cancer mortality, excess respiratory, (2020) and pneumonia (2021) mortality, and positively associated with respiratory and CVD mortality (2021). Stringency of control measures were negatively associated with excess respiratory disease, CVD, and increased cancer mortality (2021).

CONCLUSIONS CONCLUSIONS

This study provides evidence of substantial excess mortality from CVD, and notable reductions in respiratory disease and pneumonia in both years across most countries investigated. Our study also highlights the beneficial impact of stringent control measures in mitigating excess mortality from most causes in 2021.

Identifiants

DOI: 10.1007/s44197-024-00242-4 PMID: 38775902

pubmed: 38775902

doi: 10.1007/s44197-024-00242-4

pii: 10.1007/s44197-024-00242-4

doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

Informations de copyright

Références

WHO Director-General’s opening remarks at the media briefing on COVID-19. 11 March 2020. n.d. https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020. Accessed 20 July 2023.

Nicola M, Alsafi Z, Sohrabi C, Kerwan A, Al-Jabir A, Iosifidis C, et al. The socio-economic implications of the coronavirus pandemic (COVID-19): a review. Int J Surg. 2020;78:185–93. https://doi.org/10.1016/j.ijsu.2020.04.018 .

doi: 10.1016/j.ijsu.2020.04.018 pubmed: 32305533 pmcid: 7162753

Banerjee A, Chen S, Pasea L, Lai AG, Katsoulis M, Denaxas S, et al. Excess deaths in people with cardiovascular diseases during the COVID-19 pandemic. Eur J Prev Cardiol. 2021;28:1599–609. https://doi.org/10.1093/eurjpc/zwaa155 .

doi: 10.1093/eurjpc/zwaa155 pubmed: 33611594 pmcid: 7928969

Figueroa JD, Brennan PM, Theodoratou E, Poon MTC, Purshouse K, Din FVN, et al. Distinguishing between direct and indirect consequences of Covid-19. BMJ. 2020;369: m2377. https://doi.org/10.1136/bmj.m2377 .

doi: 10.1136/bmj.m2377 pubmed: 32540857

Woolf SH, Chapman DA, Sabo RT, Weinberger DM, Hill L. Excess deaths from COVID-19 and other causes, March–April 2020. JAMA. 2020;324:510–3. https://doi.org/10.1001/jama.2020.11787 .

doi: 10.1001/jama.2020.11787 pubmed: 32609307 pmcid: 7330820

Weinberger DM, Chen J, Cohen T, Crawford FW, Mostashari F, Olson D, et al. Estimation of excess deaths associated with the COVID-19 pandemic in the United States, March to May 2020. JAMA Intern Med. 2020;180:1336–44. https://doi.org/10.1001/jamainternmed.2020.3391 .

doi: 10.1001/jamainternmed.2020.3391 pubmed: 32609310

Yang BY, Barnard LM, Emert JM, Drucker C, Schwarcz L, Counts CR, et al. Clinical characteristics of patients with coronavirus disease 2019 (COVID-19) receiving emergency medical services in King County, Washington. JAMA Netw Open. 2020;3: e2014549. https://doi.org/10.1001/jamanetworkopen.2020.14549 .

doi: 10.1001/jamanetworkopen.2020.14549 pubmed: 32639570 pmcid: 7344378

Morgan D, Ino J, Paolantonio GD, Murtin F. Excess mortality: measuring the direct and indirect impact of COVID-19. OECD Health Working Papers 2020.

Demetriou CA, Achilleos S, Quattrocchi A, Gabel J, Critselis E, Constantinou C, et al. Impact of the COVID-19 pandemic on total, sex- and age-specific all-cause mortality in 20 countries worldwide during 2020: results from the C-MOR project. Int J Epidemiol. 2023;52:664–76. https://doi.org/10.1093/ije/dyac170 .

doi: 10.1093/ije/dyac170 pubmed: 36029524

Achilleos S, Quattrocchi A, Gabel J, Heraclides A, Kolokotroni O, Constantinou C, et al. Excess all-cause mortality and COVID-19-related mortality: a temporal analysis in 22 countries, from January until August 2020. Int J Epidemiol. 2022;51:35–53. https://doi.org/10.1093/ije/dyab123 .

doi: 10.1093/ije/dyab123 pubmed: 34282450

World Bank Open Data. World Bank Open Data. n.d. https://data.worldbank.org . Accessed 20 July 2023.

National life tables: UK-Office for National Statistics. n.d. https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/lifeexpectancies/datasets/nationallifetablesunitedkingdomreferencetables . Accessed 20 July 2023.

Database-Eurostat. n.d. https://ec.europa.eu/eurostat/web/main/data/database . Accessed 20 July 2023.

Joinpoint Regression Program. n.d. https://surveillance.cancer.gov/joinpoint/ . Accessed 20 July 2023.

Raknes G, Strøm MS, Sulo G, Øverland S, Roelants M, Juliusson PB. Lockdown and non-COVID-19 deaths: cause-specific mortality during the first wave of the 2020 pandemic in Norway: a population-based register study. BMJ Open. 2021;11: e050525. https://doi.org/10.1136/bmjopen-2021-050525 .

doi: 10.1136/bmjopen-2021-050525 pubmed: 34907049

Huh K, Kim Y-E, Ji W, Kim DW, Lee E-J, Kim J-H, et al. Decrease in hospital admissions for respiratory diseases during the COVID-19 pandemic: a nationwide claims study. Thorax. 2021;76:939–41. https://doi.org/10.1136/thoraxjnl-2020-216526 .

doi: 10.1136/thoraxjnl-2020-216526 pubmed: 33782081

Sullivan SG, Carlson S, Cheng AC, Chilver MB, Dwyer DE, Irwin M, et al. Where has all the influenza gone? The impact of COVID-19 on the circulation of influenza and other respiratory viruses, Australia, March to September 2020. Euro Surveill. 2020;25:2001847. https://doi.org/10.2807/1560-7917.ES.2020.25.47.2001847 .

doi: 10.2807/1560-7917.ES.2020.25.47.2001847 pubmed: 33243355 pmcid: 7693168

Mohammadi A, Chumachenko T, Makhota L, Chumachenko D. Compartment model of COVID-19 epidemic process in Ukraine. n.d.

e Silva LV, Harb MDPDAA, dos Santos AMTB, Teixeira CADM, Gomes VHM, Cardoso EHS, et al. COVID-19 mortality underreporting in Brazil: analysis of data from government internet portals. J Med Internet Res. 2020;22: e21413. https://doi.org/10.2196/21413 .

doi: 10.2196/21413

COVID-19 Excess Mortality Collaborators. Estimating excess mortality due to the COVID-19 pandemic: a systematic analysis of COVID-19-related mortality, 2020–21. Lancet. 2022;399:1513–36. https://doi.org/10.1016/S0140-6736(21)02796-3 .

doi: 10.1016/S0140-6736(21)02796-3

Brant LCC, Nascimento BR, Teixeira RA, Lopes MACQ, Malta DC, Oliveira GMM, et al. Excess of cardiovascular deaths during the COVID-19 pandemic in Brazilian capital cities. Heart. 2020;106:1898–905. https://doi.org/10.1136/heartjnl-2020-317663 .

doi: 10.1136/heartjnl-2020-317663 pubmed: 33060261

Zhu D, Ozaki A, Virani SS. Disease-specific excess mortality during the COVID-19 pandemic: an analysis of weekly US death data for 2020. Am J Public Health. 2021;111:1518–22. https://doi.org/10.2105/AJPH.2021.306315 .

doi: 10.2105/AJPH.2021.306315 pubmed: 34185569 pmcid: 8489629

Janus SE, Makhlouf M, Chahine N, Motairek I, Al-Kindi SG. Examining disparities and excess cardiovascular mortality before and during the COVID-19 pandemic. Mayo Clin Proc. 2022;97:2206–14. https://doi.org/10.1016/j.mayocp.2022.07.008 .

doi: 10.1016/j.mayocp.2022.07.008 pubmed: 36336516

Sofi F, Dinu M, Reboldi G, Stracci F, Pedretti RFE, Valente S, et al. Worldwide differences of hospitalization for ST-segment elevation myocardial infarction during COVID-19: a systematic review and meta-analysis. Int J Cardiol. 2022;347:89–96. https://doi.org/10.1016/j.ijcard.2021.10.156 .

doi: 10.1016/j.ijcard.2021.10.156 pubmed: 34740717

Onder G, Olimpieri PP, Celant S, Di Lenarda A, Ambrosio G, Reboldi G, et al. Under-prescription of direct oral anticoagulants for treatment of non-valvular atrial fibrillation and venous thromboembolism in the COVID-19 lockdown period. Eur J Prev Cardiol. 2022;29:e149–52. https://doi.org/10.1093/eurjpc/zwab096 .

doi: 10.1093/eurjpc/zwab096 pubmed: 34151366

Rosano GMC, Celant S, Olimpieri PP, Colatrella A, Onder G, Di Lenarda A, et al. Impact of the COVID-19 pandemic on prescription of sacubitril/valsartan in Italy. Eur J Heart Fail. 2022;24:855–60. https://doi.org/10.1002/ejhf.2490 .

doi: 10.1002/ejhf.2490 pubmed: 35303393

Fernandes GA, Junior APN, e Silva GA, Feriani D, e Silva ILAF, Caruso P, et al. Excess mortality by specific causes of deaths in the city of São Paulo, Brazil, during the COVID-19 pandemic. PLoS ONE. 2021;16: e0252238. https://doi.org/10.1371/journal.pone.0252238 .

doi: 10.1371/journal.pone.0252238 pubmed: 34097694 pmcid: 8184000

Malagón T, Yong JHE, Tope P, Miller WH Jr, Franco EL. McGill Task Force on the impact of COVID-19 on cancer control and care. Predicted long-term impact of COVID-19 pandemic-related care delays on cancer mortality in Canada. Int J Cancer. 2022;150:1244–54. https://doi.org/10.1002/ijc.33884 .

doi: 10.1002/ijc.33884 pubmed: 34843106

Elhadi M, Khaled A, Msherghi A. Infectious diseases as a cause of death among cancer patients: a trend analysis and population-based study of outcome in the United States based on the Surveillance, Epidemiology, and End Results database. Infect Agents Cancer. 2021;16:72. https://doi.org/10.1186/s13027-021-00413-z .

doi: 10.1186/s13027-021-00413-z

Vosko I, Zirlik A, Bugger H. Impact of COVID-19 on cardiovascular disease. Viruses. 2023;15:508. https://doi.org/10.3390/v15020508 .

doi: 10.3390/v15020508 pubmed: 36851722 pmcid: 9962056

Excess mortality and vaccination 2022. https://pandem-ic.com/excess-mortality-and-vaccination/ . Accessed 20 July 2023.

Nepomuceno MR, Klimkin I, Jdanov DA, Alustiza-Galarza A, Shkolnikov VM. Sensitivity analysis of excess mortality due to the COVID-19 pandemic. Popul Dev Rev. 2022;48:279–302. https://doi.org/10.1111/padr.12475 .

doi: 10.1111/padr.12475 pubmed: 35600716 pmcid: 9115405

Civil registration and vital statistics - civil registration and vital statistics—UN statistics Wiki. n.d. https://unstats.un.org/wiki/display/CRAVS . Accessed 31 July 2023.