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
. 2022 Dec 16:9:999225.
doi: 10.3389/fmed.2022.999225. eCollection 2022.

Coronavirus disease 2019 (COVID-19) excess mortality outcomes associated with pandemic effects study (COPES): A systematic review and meta-analysis

David Lu  1 , Sumeet Dhanoa  1 , Harleen Cheema  1 , Kimberley Lewis  2   3 , Patrick Geeraert  1 , Benjamin Merrick  1 , Aaron Vander Leek  1 , Meghan Sebastianski  4 , Brittany Kula  5 , Dipayan Chaudhuri  3 , John Basmaji  6 , Arnav Agrawal  2   7 , Dan Niven  8 , Kirsten Fiest  8 , Henry T Stelfox  8 , Danny J Zuege  8 , Oleksa G Rewa  9   10 , Sean M Bagshaw  9   10 , Vincent I Lau  9
Affiliations

Coronavirus disease 2019 (COVID-19) excess mortality outcomes associated with pandemic effects study (COPES): A systematic review and meta-analysis

David Lu et al. Front Med (Lausanne). .

Abstract

Background and aim: With the Coronavirus Disease 2019 (COVID-19) pandemic continuing to impact healthcare systems around the world, healthcare providers are attempting to balance resources devoted to COVID-19 patients while minimizing excess mortality overall (both COVID-19 and non-COVID-19 patients). To this end, we conducted a systematic review (SR) to describe the effect of the COVID-19 pandemic on all-cause excess mortality (COVID-19 and non-COVID-19) during the pandemic timeframe compared to non-pandemic times.

Methods: We searched EMBASE, Cochrane Database of SRs, MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Cochrane Controlled Trials Register (CENTRAL), from inception (1948) to December 31, 2020. We used a two-stage review process to screen/extract data. We assessed risk of bias using Newcastle-Ottawa Scale (NOS). We used Critical Appraisal and Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology.

Results: Of 11,581 citations, 194 studies met eligibility. Of these studies, 31 had mortality comparisons (n = 433,196,345 participants). Compared to pre-pandemic times, during the COVID-19 pandemic, our meta-analysis demonstrated that COVID-19 mortality had an increased risk difference (RD) of 0.06% (95% CI: 0.06-0.06% p < 0.00001). All-cause mortality also increased [relative risk (RR): 1.53, 95% confidence interval (CI): 1.38-1.70, p < 0.00001] alongside non-COVID-19 mortality (RR: 1.18, 1.07-1.30, p < 0.00001). There was "very low" certainty of evidence through GRADE assessment for all outcomes studied, demonstrating the evidence as uncertain.

Interpretation: The COVID-19 pandemic may have caused significant increases in all-cause excess mortality, greater than those accounted for by increases due to COVID-19 mortality alone, although the evidence is uncertain.

Systematic review registration: [https://www.crd.york.ac.uk/prospero/#recordDetails], identifier [CRD42020201256].

Keywords: COVID-19; excess mortality; non-COVID-19 mortality; outcomes; pandemic (COVID-19).

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
COPES PRISMA flow diagram.
FIGURE 2
FIGURE 2
Forest plot for COVID-19 mortality. CI, confidence intervals; COVID-19, coronavirus disease 2019; IV, inverse variance.
FIGURE 3
FIGURE 3
Forest plot for all–cause excess mortality. CI, confidence intervals; COVID-19, coronavirus disease 2019; IV, inverse variance.
FIGURE 4
FIGURE 4
Forest plot for non-COVID-19 mortality. CI, confidence intervals; COVID-19, coronavirus disease 2019; IV, inverse variance.
See this image and copyright information in PMC

References

    1. World Health Organization. Coronavirus Disease 2019 (COVID-19) Situation Report. Geneva: World Health Organization; (2021).
    1. McElfish PA, Purvis R, James LP, Willis DE, Andersen JA. Perceived barriers to COVID-19 testing. Int J Environ Res Public Health. (2021) 18:2278. 10.3390/ijerph18052278 - DOI - PMC - PubMed
    1. Wang YY, Jin YH, Ren XQ, Li YR, Zhang XC, Zeng XT, et al. Updating the diagnostic criteria of COVID-19 “suspected case” and “confirmed case” is necessary. Mil Med Res. (2020) 7:17. 10.1186/s40779-020-00245-9 - DOI - PMC - PubMed
    1. Kahn M, Schuierer L, Bartenschlager C, Zellmer S, Frey R, Freitag M, et al. Performance of antigen testing for diagnosis of COVID-19: a direct comparison of a lateral flow device to nucleic acid amplification based tests. BMC Infect Dis. (2021) 21:798. 10.1186/s12879-021-06524-7 - DOI - PMC - PubMed
    1. Zhan Z, Li J, Cheng ZJ. Rapid antigen test combine with nucleic acid detection: a better strategy for COVID-19 screening at points of entry. J Epidemiol Glob Health. (2022) 12:13–5. 10.1007/s44197-021-00030-4 - DOI - PMC - PubMed

Publication types