Abstract
Background: Coronavirus disease 2019 (COVID-19) has spread globally, and the government of each affected country is publishing the number of deaths every day. This official figure is an underestimate as it excludes anybody who did not die in a hospital, who did not test positive, who had a false result, or those who recovered on their own without a test.Objective: This study aimed to measure the community level excess mortality using health and demographic surveillance in a rural area of Bangladesh.Method: The study was conducted in Matlab, in a rural area of Bangladesh, with a Health and Demographic Surveillance System (HDSS) covering a population of 239,030 individuals living in 54,823 households in 142 villages. We examined the mortality in January-April from 2015 to 2020 and compared the mortality in 2020 with the historical trend of 2015–2019. Between 2015 and 2020, we followed 276,868 people until migration or death, whichever occurred first. We analyzed mortality using crude mortality rate ratio (MRR) and adjusted MRR (aMRR) from a Cox proportional hazard model. Mortality was analyzed according to age, sex, and period.Results: During follow-up, 3,197 people died. The mortality rate per 1,000 person-years increased from 10 in 2019 to 12 in 2020. Excess mortality was observed among the elderly population (aged 65 years and above). The elderly mortality rate per 1,000 person-years increased from 80 in 2019 to 110 in 2020, and the aMRR was 1.40 (95% CI: 1.19–1.64). Although an increasing tendency in mortality was observed between 2015 and 2019, it was statistically insignificant.Conclusions: The study reported a 28% increase in excess deaths among the elderly population during the first months of the pandemic. This all-cause mortality estimation at the community level will urge policymakers, public health professionals, and researchers to further investigate the causes of death and the underlying reasons for excess deaths in the older age-group.
Highlights
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [1], first emerged in Wuhan city of Hubei province in China on December 31, 2020, when Chinese health officials informed the WHO about a cluster of 41 patients with mysterious pneumonia, supposedly connected to Huanan Seafood Wholesale Market [2]
We presented age-specific and sex-specific mortality and population size as the denominator
From 2015 to 2019, the crude mortality rates (CMRs) per 1,000 person-years were 7.37, 7.63, 7.81, 8.98, and 9.70, respectively
Summary
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [1], first emerged in Wuhan city of Hubei province in China on December 31, 2020, when Chinese health officials informed the WHO about a cluster of 41 patients with mysterious pneumonia, supposedly connected to Huanan Seafood Wholesale Market [2]. When Bangladesh announced its own lockdown on March 22, 2020 [18], after detecting the first three cases, an increasing number of people were leaving the capital city [19]. Such movement of people opens the window for the spreading of the virus to more places in the country. Coronavirus disease 2019 (COVID-19) has spread globally, and the government of each affected country is publishing the number of deaths every day This official figure is an underestimate as it excludes anybody who did not die in a hospital, who did not test positive, who had a false result, or those who recovered on their own without a test
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