Reported COVID-19 Deaths Research Articles

Fighting the Disease or Manipulating the Data? Democracy, State Capacity, and the COVID-19 Pandemic

abstract: In this article, the authors discuss and analyze how regime type and state capacity shape the abilities and incentives of political leaders to respond to covid-19. They suggest that a complementary relationship exists between democracy and state capacity, both in terms of mitigating the adverse consequences of the pandemic, such as deaths, and the honest reporting of these consequences. Using a recent global data set on officially reported covid-19 deaths and estimated deaths based on excess mortality, the authors present evidence that supports different implications from their argument. Empirically, democracies have much higher officially reported death tolls than do autocracies, a result driven by underreporting in autocracies. In high-capacity states, democracies have fewer covid-19 deaths than do autocracies. State capacity generally seems to mitigate both deaths and underreporting, but these relationships are stronger in democracies. Countries that combine democracy with high state capacity experience fewer covid-19 deaths and provide more accurate tolls of the pandemic’s consequences.

Stock Market Performance in the Face of External Shocks. Does ESG Compliance Immunize Against the Pandemic?

Purpose: This study explores the link between corporate social responsibility and enhanced stock market resilience during crises. It examines whether adherence to Environmental, Social, and Governance (ESG) principles improves stock performance under economic stress. Methodology/approach: We use a standard event study with market model estimation to evaluate the impact of the first reported COVID-19 deaths on stock performance for companies in the STOXX Europe 600 and the S&P 500. Findings: The results show that capital market participants reward ESG performance during crises. Environmental and social factors enhance resilience, while corporate governance does not seem relevant in this context. Research limitations: The research focuses on the early COVID-19 pandemic stages, potentially missing long-term ESG dynamics. The sample comprises US and European companies, possibly limiting global generalizability. Practical implications: Understanding the relationship between ESG compliance and stock market resilience is crucial for investors, corporations, and policymakers to make informed decisions in a changing economic environment. Originality/value: This study demonstrates that during a pandemic, stock market resilience is driven by strong environmental and social performance rather than corporate governance, using a broad sample of US and European companies to highlight regional differences in ESG impact during crises.

Conventional and frugal methods of estimating COVID-19-related excess deaths and undercount factors

Across the world, the officially reported number of COVID-19 deaths is likely an undercount. Establishing true mortality is key to improving data transparency and strengthening public health systems to tackle future disease outbreaks. In this study, we estimated excess deaths during the COVID-19 pandemic in the Pune region of India. Excess deaths are defined as the number of additional deaths relative to those expected from pre-COVID-19-pandemic trends. We integrated data from: (a) epidemiological modeling using pre-pandemic all-cause mortality data, (b) discrepancies between media-reported death compensation claims and official reported mortality, and (c) the “wisdom of crowds” public surveying. Our results point to an estimated 14,770 excess deaths [95% CI 9820–22,790] in Pune from March 2020 to December 2021, of which 9093 were officially counted as COVID-19 deaths. We further calculated the undercount factor—the ratio of excess deaths to officially reported COVID-19 deaths. Our results point to an estimated undercount factor of 1.6 [95% CI 1.1–2.5]. Besides providing similar conclusions about excess deaths estimates across different methods, our study demonstrates the utility of frugal methods such as the analysis of death compensation claims and the wisdom of crowds in estimating excess mortality.

What COVID-19 Vaccine Distribution Disparity Reveals About Solidarity

What COVID-19 Vaccine Distribution Disparity Reveals About Solidarity

Excess natural-cause mortality in US counties and its association with reported COVID-19 deaths

In the United States, estimates of excess deaths attributable to the COVID-19 pandemic have consistently surpassed reported COVID-19 death counts. Excess deaths reported to non-COVID-19 natural causes may represent unrecognized COVID-19 deaths, deaths caused by pandemic health care interruptions, and/or deaths from the pandemic's socioeconomic impacts. The geographic and temporal distribution of these deaths may help to evaluate which explanation is most plausible. We developed a Bayesian hierarchical model to produce monthly estimates of excess natural-cause mortality for US counties over the first 30 mo of the pandemic. From March 2020 through August 2022, 1,194,610 excess natural-cause deaths occurred nationally [90% PI (Posterior Interval): 1,046,000 to 1,340,204]. A total of 162,886 of these excess natural-cause deaths (90% PI: 14,276 to 308,480) were not reported to COVID-19. Overall, 15.8 excess deaths were reported to non-COVID-19 natural causes for every 100 reported COVID-19 deaths. This number was greater in nonmetropolitan counties (36.0 deaths), the West (Rocky Mountain states: 31.6 deaths; Pacific states: 25.5 deaths), and the South (East South Central states: 26.0 deaths; South Atlantic states: 25.0 deaths; West South Central states: 24.2 deaths). In contrast, reported COVID-19 death counts surpassed estimates of excess natural-cause deaths in metropolitan counties in the New England and Middle Atlantic states. Increases in reported COVID-19 deaths correlated temporally with increases in excess deaths reported to non-COVID-19 natural causes in the same and/or prior month. This suggests that many excess deaths reported to non-COVID-19 natural causes during the first 30 mo of the pandemic in the United States were unrecognized COVID-19 deaths.

Comparative impact assessment of COVID-19 policy interventions in five South Asian countries using reported and estimated unreported death counts during 2020-2021.

There has been raging discussion and debate around the quality of COVID death data in South Asia. According to WHO, of the 5.5 million reported COVID-19 deaths from 2020-2021, 0.57 million (10%) were contributed by five low and middle income countries (LMIC) countries in the Global South: India, Pakistan, Bangladesh, Sri Lanka and Nepal. However, a number of excess death estimates show that the actual death toll from COVID-19 is significantly higher than the reported number of deaths. For example, the IHME and WHO both project around 14.9 million total deaths, of which 4.5-5.5 million were attributed to these five countries in 2020-2021. We focus our gaze on the COVID-19 performance of these five countries where 23.5% of the world population lives in 2020 and 2021, via a counterfactual lens and ask, to what extent the mortality of one LMIC would have been affected if it adopted the pandemic policies of another, similar country? We use a Bayesian semi-mechanistic model developed by Mishra et al. (2021) to compare both the reported and estimated total death tolls by permuting the time-varying reproduction number (Rt) across these countries over a similar time period. Our analysis shows that, in the first half of 2021, mortality in India in terms of reported deaths could have been reduced to 96 and 102 deaths per million compared to actual 170 reported deaths per million had it adopted the policies of Nepal and Pakistan respectively. In terms of total deaths, India could have averted 481 and 466 deaths per million had it adopted the policies of Bangladesh and Pakistan. On the other hand, India had a lower number of reported COVID-19 deaths per million (48 deaths per million) and a lower estimated total deaths per million (80 deaths per million) in the second half of 2021, and LMICs other than Pakistan would have lower reported mortality had they followed India's strategy. The gap between the reported and estimated total deaths highlights the varying level and extent of under-reporting of deaths across the subcontinent, and that model estimates are contingent on accuracy of the death data. Our analysis shows the importance of timely public health intervention and vaccines for lowering mortality and the need for better coverage infrastructure for the death registration system in LMICs.

Regional and temporal patterns of Italian COVID-19 mortality

Abstract Background Italy responded to COVID-19 with stringent lockdowns and a mass vaccination campaign. We describe the temporal and regional impact of these measures on mortality, along with social-behavioral correlates. Methods The analysis uses National Ministry of Health data on COVID-19 mortality (CM), excess mortality (EM), and vaccine uptake, along with survey data. We calculate avoidable mortality (AM) as observed mortality minus the lowest regional EM rate in each period. Results In 2020-21 EM was 180,169, of which 76% were counted as COVID-19. This fraction varied from 13% in the South in Jun-Oct 2020 to 140% in the Northeast in Mar-Jul 2021. Impact varied across Italy, with EM and AM highest in the North during the first and second waves (Feb-Jun 2020 & Nov 2020-Feb 2021) and in the South afterwards (Mar-Dec 2021). After the first wave, there were 33,587 avoidable deaths, 41% of which were in the South. Higher rates in the North in Nov 2020-Feb 2021 were possibly due to less social distancing (e.g. avoiding social events and staying home from work/school), perhaps because residents of the North are more likely to be employed in private industry, which were more likely than public agencies to remain open. Higher rates in the South after Mar 2021 were possibly due to lower trust in hospitals and reduced vaccine uptake, particularly among those aged 80+. Conclusions Official CM was differentially under-reported, so EM estimates provide a more robust picture of regional and temporal patterns of COVID-19 deaths. Mortality was high in the North in the second as well as first wave. It was high in the South afterwards (Mar-Dec 2021), accounting for 41% of avoidable mortality. Key messages • Excess mortality estimates provide a more robust understanding of regional and temporal patterns of COVID-19 deaths than reported COVID-19 deaths. • Heterogeneous impact of COVID-19 was associated with differences in preventive habits, trust levels, and vaccine uptake.

Exploring the relationship between government stringency and preventative social behaviours during the COVID-19 pandemic in the United Kingdom.

We constructed a preventive social behaviours (PSB) Index using survey questions that were aligned with WHO recommendations, and used linear regression to assess the impact of reported COVID-19 deaths (RCD), people's confidence of government handling of the pandemic (CGH) and government stringency (GS) in the United Kingdom (UK) over time on the PSB index. We used repeated, nationally representative, cross-sectional surveys in the UK over the course of 41weeks from 1st April 2020 to January 28th, 2021, including a total of 38,092 participants. The PSB index was positively correlated with the logarithm of RCD (R: 0.881, p < .001), CGH (R: 0.592, p < .001) and GS (R: 0.785, p < .001), but was not correlated with time (R: -0.118, p = .485). A multivariate linear regression analysis suggests that the log of RCD (coefficient: 0.125, p < .001), GS (coefficient: 0.010, p = .019), and CGH (coefficient: 0.0.009, p < .001) had a positive and significant impact on the PSB Index, while time did not affect it significantly. These findings suggest that people's behaviours could have been affected by multiple factors during the pandemic, with the number of COVID-19 deaths being the largest contributor towards an increase in protective behaviours in our model.

All-cause Excess Mortality Cross-sectional Correlation Analysis at Global Scale during COVID-19, 2020-22

The excess mortality during COVID-19 is significantly higher than the reported death due to COVID-19 infections. This study conducts a cross-sectional correlation analysis between excess mortality and reported COVID-19 death, aging rate, GHS (Global Health Security) index, and government response stringency index in the timeframe from January 2020 to September 2022. This study aims to explore the main contributors to excess mortality, hence to provide guidance on future diagnosis and control of the pandemic. A cross-sectional log-linear model is fitted with 79 observations to estimate the explanatory power of reported COVID-19 death, aging rate, GHS index and stringency index on excess mortality at a global scale. The correlation between excess mortality and reported COVID-19 death is also examined on a nation level by calculating the Spearman correlation coefficient on the time series of the two. The cross-sectional log-linear model has adjusted . The estimate for log of reported COVID death is ; aging rate is ; GHS index is ; stringency index is not significant. On a nation level, Brazil and United States have high correlations between reported and excess death (), the reported death takes up 85% and 86% respectively, of excess death. India and Japan, similarly, have high correlation coefficient (), but with COVID-19 death accounting 9% and 47% of excess death. Germany and China have relatively small correlations between reported and excess death (), but Germany has reported death taking up 89% of excess death, whereas in China the ratio is 4%. At a global scale, the reported COVID-19 death has the most explanatory power in excess mortality, which means that most of excess mortality is attributed to death from COVID-19 infections. Aging rate has a negative correlation between excess mortality, this is partly because of the preference of aged population to live in countries with better health care capacities. There is no significant explanatory power of stringency index on excess mortality, suggesting that the impact of government responses on COVID-19 vary by each nation. On a country level, the correlation between COVID-19 death and excess mortality can also vary, mostly due to the different levels of health care disruptions, efficiency and impact of government measures and other COVID-19 unrelated events such as wars and heat waves.

Attitudes and behaviors of university students during the COVID-19 pandemic in a predominantly Indigenous population in Mexico: a survey study

BackgroundThe COVID-19 pandemic has become one of the most devastating worldwide crises. The pandemic has heavily affected the most vulnerable groups, including Indigenous communities. Our study aimed to evaluate the attitudes and behaviors relating to care and prevention of COVID-19 in a predominantly Indigenous university population in Mexico.MethodsA cross-sectional descriptive study was conducted in early February 2022 focused on university students in a predominantly Indigenous community in central Mexico. The survey addressed prevention, vaccination, anthropometric data, and food intake.ResultsWe obtained a high response rate of 71.6%, with 981 students (41.2%) identifying as belonging to an Indigenous group. In the sample, 3.1% (95% CI 2.07, 4.33) of the Indigenous group reported COVID-19 deaths among family members older than 18 years; this rate was 3% (95% CI 2.17, 4.03) in the non-Indigenous group. Whereas most of the students [98% (95% CI 97.62, 98.72)] reported having received COVID-19 vaccines, 36.6% (95% CI 33.57, 39.70) and 39.9% (95% CI (37.32, 42.52) of the Indigenous and non-Indigenous respondents, respectively, reported that their parents were fully vaccinated against COVID-19. Finally, we found important differences in weight and Body Mass Index (BMI) between pre-pandemic baseline and two years after confinement in the general population as well as between Indigenous and non-Indigenous: general BMI increased from 22.9 ± 4.1 kg/m2 to 23.6 ± 4.1 kg/m2 (Wilcoxon test; P < 0.001). The BMI for the Indigenous went up from 22.4 ± 3.8 kg/m2 to 23.1 ± 3.8 kg/m2 (Wilcoxon test; P < 0.001), and BMI for non-Indigenous rose from 23.2 ± 4.2 kg/m2 to 24.0 4.2 kg/m2 (Wilcoxon test; P < 0.001).ConclusionOur study highlights significant vaccination disparities between our university population and their parents, although no substantial differences regarding attitudes and prevention of COVID-19 between the Indigenous and non-Indigenous populations were found. Findings suggest that efforts to expand prevention to students’ families and surrounding communities could lead to significant public health gains and should be further investigated. Furthermore, the university setting may improve access to prevention tools against COVID-19.

Evaluation of the Global Health Security Index as a predictor of COVID-19 excess mortality standardised for under-reporting and age structure

BackgroundPrevious studies have observed that countries with the strongest levels of pandemic preparedness capacities experience the greatest levels of COVID-19 burden. However, these analyses have been limited by cross-country differentials...

Research Note: COVID-19 Is Not an Independent Cause of Death

The COVID-19 pandemic has had overwhelming global impacts with deleterious social, economic, and health consequences. To assess the COVID-19 death toll, researchers have estimated declines in 2020 life expectancy at birth (e0). When data are available only for COVID-19 deaths, but not for deaths from other causes, the risks of dying from COVID-19 are typically assumed to be independent of those from other causes. In this research note, we explore the soundness of this assumption using data from the United States and Brazil, the countries with the largest number of reported COVID-19 deaths. We use three methods: one estimates the difference between 2019 and 2020 life tables and therefore does not require the assumption of independence, and the other two assume independence to simulate scenarios in which COVID-19 mortality is added to 2019 death rates or is eliminated from 2020 rates. Our results reveal that COVID-19 is not independent of other causes of death. The assumption of independence can lead to either an overestimate (Brazil) or an underestimate (United States) of the decline in e0, depending on how the number of other reported causes of death changed in 2020.

Assessing the impacts of COVID-19 vaccination programme’s timing and speed on health benefits, cost-effectiveness, and relative affordability in 27 African countries

BackgroundThe COVID-19 vaccine supply shortage in 2021 constrained roll-out efforts in Africa while populations experienced waves of epidemics. As supply improves, a key question is whether vaccination remains an impactful and cost-effective strategy given changes in the timing of implementation.MethodsWe assessed the impact of vaccination programme timing using an epidemiological and economic model. We fitted an age-specific dynamic transmission model to reported COVID-19 deaths in 27 African countries to approximate existing immunity resulting from infection before substantial vaccine roll-out. We then projected health outcomes (from symptomatic cases to overall disability-adjusted life years (DALYs) averted) for different programme start dates (01 January to 01 December 2021, n = 12) and roll-out rates (slow, medium, fast; 275, 826, and 2066 doses/million population-day, respectively) for viral vector and mRNA vaccines by the end of 2022. Roll-out rates used were derived from observed uptake trajectories in this region. Vaccination programmes were assumed to prioritise those above 60 years before other adults.We collected data on vaccine delivery costs, calculated incremental cost-effectiveness ratios (ICERs) compared to no vaccine use, and compared these ICERs to GDP per capita. We additionally calculated a relative affordability measure of vaccination programmes to assess potential nonmarginal budget impacts.ResultsVaccination programmes with early start dates yielded the most health benefits and lowest ICERs compared to those with late starts. While producing the most health benefits, fast vaccine roll-out did not always result in the lowest ICERs. The highest marginal effectiveness within vaccination programmes was found among older adults. High country income groups, high proportions of populations over 60 years or non-susceptible at the start of vaccination programmes are associated with low ICERs relative to GDP per capita. Most vaccination programmes with small ICERs relative to GDP per capita were also relatively affordable.ConclusionAlthough ICERs increased significantly as vaccination programmes were delayed, programmes starting late in 2021 may still generate low ICERs and manageable affordability measures. Looking forward, lower vaccine purchasing costs and vaccines with improved efficacies can help increase the economic value of COVID-19 vaccination programmes.

The impact of COVID-19 vaccination campaign in Hong Kong SAR China and Singapore.

Vaccination has been the most important measure to mitigate the COVID-19 pandemic. The vaccination coverage was relatively low in Hong Kong Special Administrative Region China, compared to Singapore, in early 2022. Hypothetically, if the two regions, Hong Kong (HK) and Singapore (SG), swap their vaccination coverage rate, what outcome would occur? We adopt the Susceptible - Vaccinated - Exposed - Infectious - Hospitalized - Death - Recovered model with a time-varying transmission rate and fit the model to weekly reported COVID-19 deaths (the data up to 2022 Nov 4) in HK and SG using R package POMP. After we obtain a reasonable fitting, we rerun our model with the estimated parameter values and swap the vaccination rates between HK and SG to explore what would happen. Our model fits the data well. The reconstructed transmission rate was higher in HK than in SG in 2022. With a higher vaccination rate as in SG, the death total reported in HK would decrease by 37.5% and the timing of the peak would delay by 3 weeks. With a lower vaccination rate as in HK, the death total reported in SG would increase to 5.5-fold high with a peak 6 weeks earlier than the actual during the Delta variant period. Vaccination rate changes in HK and SG may lead to very different outcomes. This is likely due that the estimated transmission rates were very different in HK and SG which reflect the different control policies and dominant variants. Because of strong control measures, HK avoided large-scale community transmission of the Delta variant. Given the high breakthrough infection rate and transmission rate of the Omicron variant, increasing the vaccination rate in HK will likely yield a mild (but significant) contribution in terms of lives saved. While in SG, lower vaccination coverage to the level of HK will be disastrous.

Using an online calculator to describe excess mortality in the Philippines during the COVID-19 pandemic

Excess mortality is an indicator of the impact of the coronavirus disease (COVID-19) pandemic. This study aims to describe excess mortality in the Philippines from January 2020 to December 2021 using an online all-cause mortality and excess mortality calculator. All-cause mortality data sets from 2015 to 2021 from the Philippine Statistics Authority were obtained and analysed using the World Health Organization Western Pacific Regional Office All-Cause Mortality Calculator. Expected mortality, excess mortality and P-scores were obtained using two models, 5-year averages and negative binomial regression, for total deaths and by administrative region. Reported national all-cause mortality exceeded the expected mortality in August 2020 and from January to November 2021, peaking in September 2021 at 104 per 100 000. Total excess mortality using negative binomial regression was -13 900 deaths in 2020 and 212 000 deaths in 2021, peaking in September 2021. P-scores were -2% in 2020 and 33% in 2021, again peaking in September 2021 at 114%. Reported COVID-19 deaths accounted for 20% of excess deaths in 2021. In 2020, consistently high P-scores were recorded in the National Capital Region from July to September and in the Bangsamoro Autonomous Region in Muslim Mindanao from June to July. In 2021, most regions recorded high P-scores from June to October. Tracking excess mortality using a robust, accessible and standardized online tool provided a comprehensive assessment of the direct and indirect impacts of the COVID-19 pandemic in the Philippines. Furthermore, analysis by administrative region highlighted the key regions disproportionately affected by the pandemic, information that may not have been fully captured from routine COVID-19 surveillance.

Editorial

From Editor’s Desk… It’s been around three years since we first encountered the COVID-19 crisis. We still need to be on the lookout for COVID-19, even if the illness is no longer a global public health emergency. Since fewer countries are regularly reporting COVID-19 deaths, the World Health Organization (WHO) estimates that roughly 1,000 new cases of COVID-19 occur in the Region each week. And it still has a disproportionate impact on society’s most vulnera¬ble individuals. Cancer, heart disease, diabetes, and chronic respiratory diseases, which together ac-count for 75% of deaths, were used as a cover by COVID-19. Those already suffer¬ing from such conditions were and still are more susceptible to the harmful effects of COVID-19. According to newly released statistics from WHO, children and adolescents from lower socioeconomic backgrounds, those who had protracted school closures, and those who lacked crucial support systems like family and instructors were hit most by the COVID-19 epidemic. The teens’ mental and physical health, as well as their social lives, were all negatively impacted by the pandemic. Since the onset of the COVID-19 epidemic, there has been a significant increase in the number of young people reporting several health conditions that need to be managed promptly. • Source: WHO, EUROPE Dr. Khaid Mohammed Alabdulwahhab Editor in Chief

Addressing Disparities and Inequalities in Healthcare: Disproportionate Representation of Minorities in COVID-19 Deaths as a Health and Social Injustice

Social inequalities exist around the world limiting a group's social, health, and economic advancement. These unfavorable conditions inhibit people from having access to essential resources such as healthcare, housing, education, employment, and transportation. Consequently, inequalities in accessing indispensable social goods generally affects diets and overall health and wellness of individuals negatively. Unfortunately, this systemic problem tends to inflict greater harm to lower-income groups disproportionately. These limitations usually result in poorer health and higher rates of health problems. Historically, existing inequalities in society are manifested in moments of crisis, and the COVID-19 pandemic (2019-2021) revealed overwhelming manifestation of this fact. The mortality rates for African Americans are more than triple the rates for whites after correcting for age, and the rates for Hispanic/Latinos are almost double the rates for non-Hispanic whites. According to the CDC’s racial demographic information on COVID-19 cases and deaths, almost 23% of reported COVID-19 deaths in the U.S. are African Americans, even though blacks make up approximately only 13% of the U.S. population. This glaring revelation of the health inequities that exist in our society must be addressed. This paper examines the documented cases of significant health inequities in the U.S. including the underlying social determinants and implications that make minority groups vulnerable, contributing to their higher risk of morbidity and mortalities, and argued that healthcare is a fundamental human rights issue as stated in a 2017 WHO press release. This author contends that health inequity due to social inequity is unsustainable, and a detriment to sustainable development and provide recommendations to address the health inequities.

Are COVID-19 age-mortality curves for 2020 flatter in developing countries? Evidence from a cross-sectional observational study of population-level official death counts and excess deaths estimates

ObjectivesPrevious studies have found a pattern of flatter COVID-19 age-mortality curves among low-income and middle-income countries (LMICs) using only official COVID-19 death counts. This study examines this question by comparing...

Global Excess Mortality during COVID-19 Pandemic: A Systematic Review and Meta-Analysis.

Background: Currently, reported COVID-19 deaths are inadequate to assess the impact of the pandemic on global excess mortality. All-cause excess mortality is a WHO-recommended index for assessing the death burden of COVID-19. However, the global excess mortality assessed by this index remains unclear. We aimed to assess the global excess mortality during the COVID-19 pandemic. Methods: We searched PubMed, EMBASE, and Web of Science for studies published in English between 1 January 2020, and 21 May 2022. Cross-sectional and cohort studies that reported data about excess mortality during the pandemic were included. Two researchers independently searched the published studies, extracted data, and assessed quality. The Mantel–Haenszel random-effects method was adopted to estimate pooled risk difference (RD) and their 95% confidence intervals (CIs). Results: A total of 79 countries from twenty studies were included. During the COVID-19 pandemic, of 2,228,109,318 individuals, 17,974,051 all-cause deaths were reported, and 15,498,145 deaths were expected. The pooled global excess mortality was 104.84 (95% CI 85.56–124.13) per 100,000. South America had the highest pooled excess mortality [134.02 (95% CI: 68.24–199.80) per 100,000], while Oceania had the lowest [−32.15 (95% CI: −60.53–−3.77) per 100,000]. Developing countries had higher excess mortality [135.80 (95% CI: 107.83–163.76) per 100,000] than developed countries [68.08 (95% CI: 42.61–93.55) per 100,000]. Lower middle-income countries [133.45 (95% CI: 75.10–191.81) per 100,000] and upper-middle-income countries [149.88 (110.35–189.38) per 100,000] had higher excess mortality than high-income countries [75.54 (95% CI: 53.44–97.64) per 100,000]. Males had higher excess mortality [130.10 (95% CI: 94.15–166.05) per 100,000] than females [102.16 (95% CI: 85.76–118.56) per 100,000]. The population aged ≥ 60 years had the highest excess mortality [781.74 (95% CI: 626.24–937.24) per 100,000]. Conclusions: The pooled global excess mortality was 104.84 deaths per 100,000, and the number of reported all-cause deaths was higher than expected deaths during the global COVID-19 pandemic. In South America, developing and middle-income countries, male populations, and individuals aged ≥ 60 years had a heavier excess mortality burden.

Excess deaths during the COVID-19 pandemic in Iran

Background The actual number of deaths during the COVID-19 pandemic is expected to be higher than the reported deaths. We aimed to estimate the number of deaths in Iran during the COVID-19 pandemic from December 22, 2019 to March 20, 2022. Methods We compared the number of age- and sex-specific deaths reported by Iran’s Bureau of Vital Statistics with the predicted deaths estimated using an improved Lee-Carter model. We estimated the number of all-cause excess deaths in three scenarios, including the baseline scenario (without any undercounting of deaths) and 4% and 8% undercounting of all-cause deaths. Results We estimated 282,378 (95% confidence intervals [CI]: 225,439; 341,951) excess deaths in the baseline model. This number was 303,148 (95% CI: 246,417; 357,823) and 308,486 (95% CI: 250,607; 364,417) in the 4% and 8% scenarios, respectively. During the same period, Iran reported 139,610 deaths as being directly related to COVID-19. The ratio of reported COVID-19 deaths to total excess deaths ranged from 45.2% to 49.4% in the various scenarios. Most excess deaths occurred in the baseline scenario in males (157,552 [95% CI: 125,142; 191,265]) and those aged ≥75 years (102,369 [95% CI: 93,894; 111,188]). Conclusions The reported number of COVID-19 deaths was less than half of Iran’s estimated number of excess deaths. The results of this study will be helpful for health policymakers’ planning, and call for strengthening the timeliness and accuracy of Iran’s death registration systems, planning for more accurate monitoring of epidemics, and planning to provide support services for survivors’ families.