Cause-Specific Excess Mortality During the COVID-19 Pandemic (2020–2021) in 12 Countries of the C-MOR Consortium

Victoria Virginia Beeks, Souzana Achilleos, Annalisa Quattrocchi, Chryso Th. Pallari, Elena Critselis, Pascale Salameh, Mohammad Reza Rahmanian Haghighi, José Manuel Rodriguez-Llanes, Giuseppe Ambrosio, Andreas Artemiou

21 more authors

John Gabel, Catherine Marie Bennett, Joseph L. Cuthbertson, Claudia Zimmermann, Eva S. Schernhammer, Antônio José Leal Costa, Luciana Freire de Carvalho, Jackeline Christiane Pinto Lobato, Maria Athanasiadou, Julia Critchley, Lucy Pollyanna Goldsmith, Levan Kandelaki, Natalya Glushkova, Kairat Davletov, Yuliya M. Semenova, Ivan Eržen, Olesia Verstiuk, Dimos Alekkou, Antonis Polemitis, Andreas Charalambous, Christiana A. Demetriou

Data confidence 85 high

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Abstract

BACKGROUND: This study investigated cause-specific mortality rates in 12 countries during the COVID-19 pandemic in 2020 and 2021. METHODS: We collected weekly cause-specific mortality data from respiratory disease, pneumonia, cardiovascular disease (CVD) and cancer from national vital statistic databases. We calculated excess mortality for respiratory disease (excluding COVID-19 codes), pneumonia, and CVD in 2020 and 2021 by comparing observed weekly against expected mortality based on historical data (2015-2019), accounting for seasonal trends. We used multilevel regression models to investigate the association between country-level pandemic-related variables and cause-specific mortality. RESULTS: Significant reductions in cumulative mortality from respiratory disease and pneumonia were observed in 2020 and/or 2021, except for Georgia, Northern Ireland, Kazakhstan, and Ukraine, which exhibited excess mortality for one or both causes. Australia, Austria, Cyprus, Georgia, and Northern Ireland experienced excess cumulative CVD mortality in 2020 and/or 2021. Australia, Austria, Brazil, Cyprus, Georgia, Northern Ireland, Scotland and Slovenia, experienced increased crude cumulative cancer mortality during 2020 and/or 2021 compared to previous years. Among pandemic-related variables, reported COVID-19 incidence was negatively associated with increased cancer mortality, excess respiratory, (2020) and pneumonia (2021) mortality, and positively associated with respiratory and CVD mortality (2021). Stringency of control measures were negatively associated with excess respiratory disease, CVD, and increased cancer mortality (2021). CONCLUSIONS: This study provides evidence of substantial excess mortality from CVD, and notable reductions in respiratory disease and pneumonia in both years across most countries investigated. Our study also highlights the beneficial impact of stringent control measures in mitigating excess mortality from most causes in 2021.