Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Aug 10;21(1):164.
doi: 10.1186/s12874-021-01349-z.

Quantifying and communicating the burden of COVID-19

Maja von Cube  1 , Jéan-Francois Timsit  2   3 , Andreas Kammerlander  4 , Martin Schumacher  5
Affiliations
Review

Quantifying and communicating the burden of COVID-19

Maja von Cube et al. BMC Med Res Methodol. .

Abstract

Background: An essential aspect of preventing further COVID-19 outbreaks and to learn for future pandemics is the evaluation of different political strategies, which aim at reducing transmission of and mortality due to COVID-19. One important aspect in this context is the comparison of attributable mortality.

Methods: We give a comprehensive overview of six epidemiological measures that are used to quantify COVID-19 attributable mortality (p-score, standardized mortality ratio, absolute number of excess deaths, per capita rate, z-score and the population attributable fraction).

Results: By defining the six measures based on observed and expected deaths, we explain their relationship. Moreover, three publicly available data examples serve to illustrate the interpretational strengths and weaknesses of the various measures. Finally, we give recommendation which measures are suitable for an evaluation of public health strategies against COVID-19. The R code to reproduce the results is available as online supplementary material.

Conclusion: The number of excess deaths should be always reported together with the population attributable fraction, the p-score or the standardized mortality ratio instead of a per capita rate. For a complete picture of COVID-19 attributable mortality, quantifying and communicating its relative burden also to a lay audience is of major importance.

Keywords: Excess deaths; P-score; Per capita rate; Population attributable fraction; Preventable deaths; SARS-CoV-2; Standardized mortality ratio; Z-score.

PubMed Disclaimer

Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
The upper panel shows the cumulative excess risk (RD) over calendar time for states with a large number of reported COVID-19 deaths. The panel in the middle shows the excess deaths per 100,000 inhabitants (RDp.c.). The lower panel shows the population attributable fraction (PAF). The data was obtained from [15]. The number of expected deaths had COVID-19 been eliminated is an adjusted average over previous years using the Serflings model [17]
Fig. 2
Fig. 2
P-score, standardized mortality ratio (SMR) and population attributable fraction (PAF) of the COVID-19 pandemic in Germany adjusted for age and stratified by age group. The expected deaths had COVID-19 been entirely eliminated correspond to the number of observed deaths within the same time period, but from the year 2016
See this image and copyright information in PMC

References

    1. Halpern SD, Truog RD, Miller FG. Cognitive bias and public health policy during the COVID-19 pandemic. JAMA. 2020;324(4):337–338. doi: 10.1001/jama.2020.11623. - DOI - PubMed
    1. Kiang MV, et al. Every body counts: measuring mortality from the COVID-19 pandemic. Ann Intern Med. 2020;173(12):1004–1007. doi: 10.7326/M20-3100. - DOI - PMC - PubMed
    1. von Cube M, Timsit J-F, Schumacher M, Motschall E, Schumacher M. On the reporting and interpretation of attributable deaths - A systematic review of attributable mortality in core clinical journals on infectious diseases. Lancet Infect Dis. 2020;20(12):E299–E306. doi: 10.1016/S1473-3099(20)30485-0. - DOI - PubMed
    1. Pulla P. What counts as a covid-19 death? BMJ. 2020;370:m2859. - PubMed
    1. Tebé C, Valls J, Satorra P, Tobías A. COVID19-world: a shiny application to perform comprehensive country-specific data visualization for SARS-CoV-2 epidemic. BMC Med Res Methodol. 2020;20(1):235. doi: 10.1186/s12874-020-01121-9. - DOI - PMC - PubMed