Abstract
The COVID-19 pandemic prompted extraordinary response measures in Central Asia (Kazakhstan, Kyrgyzstan, and Mongolia), but mortality outcomes varied. This retrospective population-based ecological study assessed age-standardized COVID-19 mortality rates (ASMRs per 100,000) from January 2020 to December 2021. Monthly COVID-19 deaths and population data by age and sex were obtained from official statistical and health sources. ASMRs were calculated using direct age standardization; monthly trends were examined by country, sex, and age group using joinpoint regression and interpreted in relation to governmental mitigation measures and circulating SARS-CoV-2 variants. Rates were higher in men than in women: in Kazakhstan, 24.8 vs. 12.8 in 2020 and 87.3 vs. 67.6 in 2021, in Kyrgyzstan, 46.6 vs. 25.2 and 40.8 vs. 29.7, respectively; and in Mongolia, 91.5 vs. 73.1 in 2021, with no deaths reported in 2020. In 2021, the gap between men and women narrowed as female ASMR increased fivefold. COVID-19 mortality was observed among infants in Kazakhstan and children ages 0-4 in Mongolia (2021). Rates rose sharply from age 60, especially among men and showed distinct country-specific timing: an early peak in Kyrgyzstan, delayed acceleration in Kazakhstan, and a late rise in Mongolia. These results underscore the need for timely, coordinated, age- and sex-sensitive response measures and targeted protection of vulnerable groups.