Abstract
ABSTRACTOBJECTIVE To estimate the 2020 all-cause and COVID-19 excess mortality according to sex, age, race/color, and state, and to compare mortality rates by selected causes with that of the five previous years in Brazil.METHODS Data from the Mortality Information System were used. Expected deaths for 2020 were estimated from 2015 to 2019 data using a negative binomial log-linear model.RESULTS Excess deaths in Brazil in 2020 amounted to 13.7%, and the ratio of excess deaths to COVID-19 deaths was 0.90. Reductions in deaths from cardiovascular diseases (CVD), respiratory diseases, and external causes, and an increase in ill-defined causes were all noted. Excess deaths were also found to be heterogeneous, being higher in the Northern, Center-Western, and Northeastern states. In some states, the number of COVID-19 deaths was lower than that of excess deaths, whereas the opposite occurred in others. Moreover, excess deaths were higher in men aged 20 to 59, and in black, yellow, or indigenous individuals. Meanwhile, excess mortality was lower in women, in individuals aged 80 years or older, and in whites. Additionally, deaths among those aged 0 to 19 were 7.2% lower than expected, with reduction in mortality from respiratory diseases and external causes. There was also a drop in mortality due to external causes in men and in those aged 20 to 39 years. Moreover, reductions in deaths from CVD and neoplasms were noted in some states and groups.CONCLUSION There is evidence of underreporting of COVID-19 deaths and of the possible impact of restrictive measures in the reduction of deaths from external causes and respiratory diseases. The impacts of COVID-19 on mortality were heterogeneous among the states and groups, revealing that regional, demographic, socioeconomic, and racial differences expose individuals in distinct ways to the risk of death from both COVID-19 and other causes.
Highlights
Given the low RT-PCR (Reverse Transcription Polymerase Chain Reaction) for COVID-19 testing rate in Brazil, it is possible that some of the recorded COVID-19 deaths might have been due to other causes
The impacts of COVID-19 on mortality were heterogeneous among the states and groups, revealing that regional, demographic, socioeconomic, and racial differences expose individuals in distinct ways to the risk of death from both COVID-19 and other causes
Excess mortality began in March and April, peaked in May, decreased until September, and increased again from October onwards
Summary
Given the low RT-PCR (Reverse Transcription Polymerase Chain Reaction) for COVID-19 testing rate in Brazil, it is possible that some of the recorded COVID-19 deaths might have been due to other causes. Excess deaths from all causes have been one of the most useful measures to assess the direct impact of COVID-19 on mortality It assesses the indirect impact caused by reduced health services access in patients with other co-morbidities and the impact of restrictive measures adopted to fight the pandemic[1,2]. Most COVID-19 deaths occurred among the elderly, who commonly present with multiple co-morbidities, increasing the difficulty in identifying the basic cause of mortality[1]. Another factor that may have contributed to the underreporting was the collapse of the healthcare network, as reported in some states[7]. It was likely that people who died outside health services would have a more flawed notification of the cause of death[8]
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