A comprehensive analysis of all-cause and cause-specific excess deaths in 30 countries during 2020

Abstract

The impact of COVID-19 on mortality from specific causes of death remains poorly understood. This study analysed cause-of-death data provided by the World Health Organization from 2011 to 2019 to estimate excess deaths in 2020 in 30 countries. Over-dispersed Poisson regression models were used to estimate the number of deaths that would have been expected if the pandemic had not occurred, separately for men and women. The models included year and age categories to account for temporal trends and changes in size and age structure of the populations. Excess deaths were calculated by subtracting observed deaths from expected ones. Our analysis revealed significant excess deaths from ischemic heart diseases (IHD) (in 10 countries), cerebrovascular diseases (CVD) (in 10 countries), and diabetes (in 19 countries). The majority of countries experienced excess mortality greater than 10%, including Mexico (+ 38·8% for IHD, + 34·9% for diabetes), Guatemala (+ 30·0% for IHD, + 10·2% for CVD, + 39·7% for diabetes), Cuba (+ 18·8% for diabetes), Brazil (+ 12·9% for diabetes), the USA (+ 15·1% for diabetes), Slovenia (+ 33·8% for diabetes), Poland (+ 30·2% for IHD, + 19·5% for CVD, + 26 1% for diabetes), Estonia (+ 26·9% for CVD, + 34·7% for diabetes), Bulgaria (+ 22·8% for IHD, + 11·4% for diabetes), Spain (+ 19·7% for diabetes), Italy (+ 18·0% for diabetes), Lithuania (+ 17·6% for diabetes), Finland (+ 13·2% for diabetes) and Georgia (+ 10·7% for IHD, + 19·0% for diabetes). In 2020, 22 out of 30 countries had a significant increase in total mortality. Some of this excess was attributed to COVID-19, but a substantial increase was also observed in deaths attributed to cardiovascular diseases and diabetes.

Keywords: COVID-19; Cardiovascular diseases; Diabetes; Excess deaths; Mortality; SARS-CoV-2.

Fig. 1

Percent difference between observed and expected deaths (P-score) from ischemic heart diseases, cerebrovascular disease and diabetes by sex and age group (< 75 vs. ≥ 75 years), in 12 high-income countries (gross national income per capita of $13,205 or more) with population size ≥ 10 million. CZE: Czech Republic. GER: Germany. ITA: Italy. NET: Netherlands. POL: Poland. SPA: Spain. UK: United Kingdom. CHI: Chile. USA: United States of America. JAP: Japan. KOR: Republic of Korea. AUS: Australia

Fig. 2

Percent difference between observed and expected deaths (P-score) from ischemic heart diseases, cerebrovascular diseases and diabetes by sex and age group (< 75 vs. ≥ 75 years), in 5 upper-middle-income countries (gross national income per capita between $4256 and $13,205) with population size ≥ 10 million. ARG: Argentina. BRA: Brazil. CUB: Cuba. GUA: Guatemala. MEX: Mexico