Abstract
BackgroundThe actual human cost of the pandemic cannot be viewed through the COVID-19 mortality rates alone, especially when the pandemic is widening the existing health disparities among different subpopulations within the same society. In Kuwait, migrant workers were already disproportionately impacted by COVID-19 and its unintended consequences. The totality of that effect on mortality is yet to be fully understood.ObjectiveTo estimate excess deaths in the pandemic year of 2020 among the Kuwaiti and non-Kuwaiti migrant populations.MethodsWe analyzed publicly available retrospective data in Kuwait on total annual mortality historically (from 2005 to 2019) and in 2020. We fitted a quasi-poisson generalized linear model adjusted for yearly trend and nationality to estimate the expected deaths in 2020 in the absence of the pandemic. We calculated excess deaths as the difference between observed and expected mortality for the year of the pandemic in both Kuwaitis and non-Kuwaitis.ResultsIn the absence of the pandemic, we expected the total mortality in Kuwait to be 6629 (95% CI: 6472 to 6789) deaths. However, the observed total mortality in 2020 was 9975 deaths; about 3346 (3186 to 3503) more deaths above the expected historical trend. Deaths among migrant workers would have been approximately 71.9% (67.8 to 76.0) lower in the absence of the pandemic. On the other hand, deaths among Kuwaitis would have been 32.4% (29.3 to 35.6) lower if the country had not been hit by the pandemic.ConclusionThe burden of mortality brought on by the COVID-19 pandemic is substantially higher than what the official tally might suggest. Systematically disadvantaged migrant workers shouldered a larger burden of deaths in the pandemic year. Public health interventions must consider structural and societal determinants that give rise to the health disparities seen among migrant workers.
Highlights
The coronavirus disease 2019 (COVID-19) pandemic triggered a mass disruption to social, economic, and environmental modes of operation
In the absence of the pandemic, we expected the total mortality in Kuwait to be 6629 deaths
The burden of mortality brought on by the COVID-19 pandemic is substantially higher than what the official tally might suggest
Summary
The coronavirus disease 2019 (COVID-19) pandemic triggered a mass disruption to social, economic, and environmental modes of operation. Excess death is the difference between the number of deaths from all causes observed during a public health crisis and the expected number of deaths in its absence or in otherwise ‘normal’ conditions This provides an efficient mortality surveillance strategy accounting for the indirect burden of disease caused by disruptions to the access and use of healthcare [4]. This estimate overcomes the variability between different countries in how they report COVID-19 deaths as well as allowing for a clearer indication of the impact of the pandemic in each country. The totality of that effect on mortality is yet to be fully understood
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