Analysis of Excess All-Cause Mortality and COVID-19 Mortality in Peru: Observational Study.

Max Carlos Ramírez-Soto,Gutia Ortega-Cáceres

doi:10.3390/tropicalmed7030044

Max Carlos Ramírez-Soto, Gutia Ortega-Cáceres

Open Access

https://doi.org/10.3390/tropicalmed7030044

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Abstract

During the COVID-19 pandemic, an excess of all-cause mortality has been recorded in several countries, including Peru. Most excess deaths were likely attributable to COVID-19. In this study, we compared the excess all-cause mortality and COVID-19 mortality in 25 Peruvian regions to determine whether most of the excess deaths in 2020 were attributable to COVID-19. Excess deaths were calculated as the difference between the number of observed deaths from all causes during the COVID-19 pandemic (in 2020) and the number of expected deaths in 2020 based on a historical from recent years (2017–2019). Death data were retrieved from the Sistema Informatico Nacional de Defunciones (SINADEF) at the Ministry of Health of Peru from January 2017 to December 2020. Population counts were obtained from projections from Peru’s Instituto Nacional de Estadística e Informática (INEI). All-cause excess mortality and COVID-19 mortality were calculated by region per 100,000 population. Spearman’s test and linear and multiple regression models were used to estimate the correlation between excess all-cause mortality and COVID-19 mortality per 100,000 population. Excess all-cause death rates varied widely among regions (range: 115.1 to 519.8 per 100,000 population), and COVID-19 mortality ranged between 83.8 and 464.6 per 100,000 population. There was a correlation between the all-cause excess mortality and COVID-19 mortality (r = 0.90; p = 0.00001; y = 0.8729x + 90.808; R2 = 0.84). Adjusted for confounding factors (mean age in the region, gender balance, and number of intensive care unit (ICU) beds), the all-cause excess mortality rate was correlated with COVID-19 mortality rate (β = 0.921; p = 0.0001). These findings suggest that most of the excess deaths in Peru are related to COVID-19. Therefore, these findings can help decision-makers to understand the high COVID-19 mortality rates in Peru.

Highlights

During the COVID-19 pandemic, an all-cause mortality excess has been recorded in several countries, including Peru [1–4]
The highest COVID-19 mortality rates per 100,000 habitants were reported in Moquegua, Lima, Ica, and Lambayeque
In six Peruvian regions, there was a gap between the all-cause excess mortality

Summary

Introduction

During the COVID-19 pandemic, an all-cause mortality excess has been recorded in several countries, including Peru [1–4]. This all-cause mortality excess varied substantially across countries [1–3] because of measures taken to handle the COVID-19 pandemic, demographic and socio-economic characteristics, and capacity of health care systems [5–8]. Mortality below the expected levels is called “avoided mortality”, whereas the mortality above the expected levels is known as “excess deaths” [3]. Assessing the direct and indirect effects of the COVID-19 pandemic on overall mortality requires the measurement of excess deaths since most excess deaths are likely attributable to COVID-19 [3,8]

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