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
. 2021 Aug 12;11(1):16443.
doi: 10.1038/s41598-021-95658-4.

Comparing the COVID-19 pandemic in space and over time in Europe, using numbers of deaths, crude rates and adjusted mortality trend ratios

Valentina Gallo  1   2   3 , Paolo Chiodini  4 , Dario Bruzzese  5 , Elias Kondilis  6 , Dan Howdon  7 , Jochen Mierau  8 , Raj Bhopal  9
Affiliations

Comparing the COVID-19 pandemic in space and over time in Europe, using numbers of deaths, crude rates and adjusted mortality trend ratios

Valentina Gallo et al. Sci Rep. .

Abstract

Comparison of COVID-19 trends in space and over time is essential to monitor the pandemic and to indirectly evaluate non-pharmacological policies aimed at reducing the burden of disease. Given the specific age- and sex- distribution of COVID-19 mortality, the underlying sex- and age-distribution of populations need to be accounted for. The aim of this paper is to present a method for monitoring trends of COVID-19 using adjusted mortality trend ratios (AMTRs). Age- and sex-mortality distribution of a reference European population (N = 14,086) was used to calculate age- and sex-specific mortality rates. These were applied to each country to calculate the expected deaths. Adjusted Mortality Trend Ratios (AMTRs) with 95% confidence intervals (C.I.) were calculated for selected European countries on a daily basis from 17th March 2020 to 29th April 2021 by dividing observed cumulative mortality, by expected mortality, times the crude mortality of the reference population. These estimated the sex- and age-adjusted mortality for COVID-19 per million population in each country. United Kingdom experienced the highest number of COVID-19 related death in Europe. Crude mortality rates were highest Hungary, Czech Republic, and Luxembourg. Accounting for the age-and sex-distribution of the underlying populations with AMTRs for each European country, four different patterns were identified: countries which experienced a two-wave pandemic, countries with almost undetectable first wave, but with either a fast or a slow increase of mortality during the second wave; countries with consistently low rates throughout the period. AMTRs were highest in Eastern European countries (Hungary, Czech Republic, Slovakia, and Poland). Our methods allow a fair comparison of mortality in space and over time. These might be of use to indirectly estimating the efficacy of non-pharmacological health policies. The authors urge the World Health Organisation, given the absence of age and sex-specific mortality data for direct standardisation, to adopt this method to estimate the comparative mortality from COVID-19 pandemic worldwide.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Daily mortality from COVID-19 reported in selected European counties from 17/03/2020 to 29/04/2021.
Figure 2
Figure 2
Crude Mortality Rates (CMRs) from COVID-19 per 1,000,000 inhabitants in European countries from 17/03/2020 to 29/04/2021.
Figure 3
Figure 3
Adjusted Mortality Trend Rates (AMTRs) per 1,000,000 inhabitants due to mortality from COVID-19 in European countries from 17/03/2020 to 29/04/2021.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Steffens I. A hundred days into the coronavirus disease (COVID-19) pandemic. Euro Surveill Bull. Eur. Sur Mal Transm. Eur. Commun. Dis. Bull. 2020 doi: 10.2807/1560-7917.ES.2020.25.14.2000550. - DOI - PMC - PubMed
    1. Li Q, Guan X, Wu P, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N. Engl. J. Med. 2020 doi: 10.1056/NEJMoa2001316. - DOI - PMC - PubMed
    1. Wang W, Tang J, Wei F. Updated understanding of the outbreak of 2019 novel coronavirus (2019-nCoV) in Wuhan, China. J. Med. Virol. 2020;92(4):441–447. doi: 10.1002/jmv.25689. - DOI - PMC - PubMed
    1. Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. J. Autoimmun. 2020;109:1024. doi: 10.1016/j.jaut.2020.102433. - DOI - PMC - PubMed
    1. Ren L-L, Wang Y-M, Wu Z-Q, et al. Identification of a novel coronavirus causing severe pneumonia in human: A descriptive study. Chin Med J (Engl). 2020;133(9):1015–1024. doi: 10.1097/CM9.0000000000000722. - DOI - PMC - PubMed