Excess deaths reveal the true spatial, temporal and demographic impact of COVID-19 on mortality in Ecuador

Abstract

Background: In early 2020, Ecuador reported one of the highest surges of per capita deaths across the globe.

Methods: We collected a comprehensive dataset containing individual death records between 2015 and 2020, from the Ecuadorian National Institute of Statistics and Census and the Ecuadorian Ministry of Government. We computed the number of excess deaths across time, geographical locations and demographic groups using Poisson regression methods.

Results: Between 1 January and 23 September 2020, the number of excess deaths in Ecuador was 36 402 [95% confidence interval (CI): 35 762-36 827] or 208 per 100 000 people, which is 171% of the expected deaths in that period in a typical year. Only 20% of the excess deaths are attributable to confirmed COVID-19 deaths. Strikingly, in provinces that were most affected by COVID-19 such as Guayas and Santa Elena, the all-cause deaths are more than double the expected number of deaths that would have occurred in a normal year. The extent of excess deaths in men is higher than in women, and the number of excess deaths increases with age. Indigenous populations had the highest level of excess deaths among all ethnic groups.

Conclusions: Overall, the exceptionally high level of excess deaths in Ecuador highlights the enormous burden and heterogeneous impact of COVID-19 on mortality, especially in older age groups and Indigenous populations in Ecuador, which was not fully revealed by COVID-19 death counts. Together with the limited testing in Ecuador, our results suggest that the majority of the excess deaths were likely to be undocumented COVID-19 deaths.

Keywords: COVID-19; Ecuador; Excess deaths.

Figure 1

Time series for excess deaths (yellow; lighter colour) and documented COVID-19 deaths (red; darker colour) per 100 000 people in Ecuador. The period of strict national lockdown by the Ecuador government (shaded area) is taken from the Oxford COVID-19 Government Response Tracker

Figure 2

Excess deaths per 100 000 people by sex (A), by age group (B) and by sex and age group (C) in Ecuador. The numbers of excess deaths are normalized by the population size in each group

Figure 3

The excess death factor, i.e. the number of all-cause deaths over the number of expected deaths, by ethnicity (A) and by sex and age for the Indigenous group (B). Estimates for ethnic groups other than Mestizo and Indigenous are not shown because of the uncertain and changing definition of these groups between 2015 and 2020

Figure 4

The spatial and temporal patterns of excess deaths in 2020 in Ecuador. (A–C) Time series for excess deaths (yellow; lighter colour) and documented COVID-19 deaths (red; darker colour) per 100 000 people in Guayas, Santa Elena and Pichincha. (D and E) Provincial maps of Ecuador showing the number of excess deaths per 100 000 people (colour) during the weeks of 1–7 April (panel D) and 22–28 July 2020 (panel E )