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. 2024 Mar 8:12:1250343.
doi: 10.3389/fpubh.2024.1250343. eCollection 2024.

A proposed analytical approach to estimate excess daily mortality rates in Ecuador

Raul Patricio Fernandez-Naranjo  1 , Jorge Vasconez-Gonzalez  1 , Juan S Izquierdo-Condoy  1 , Samanta Landazuri  1 , Diana Castillo  1 , Esteban Ortiz-Prado  1
Affiliations

A proposed analytical approach to estimate excess daily mortality rates in Ecuador

Raul Patricio Fernandez-Naranjo et al. Front Public Health. .

Abstract

Background: The COVID-19 pandemic has proved deadly all over the globe; however, one of the most lethal outbreaks occurred in Ecuador.

Aims: This study aims to highlight the pandemic's impact on the most affected countries worldwide in terms of excess deaths per capita and per day.

Methods: An ecological study of all-cause mortality recorded in Ecuador was performed. To calculate the excess deaths relative to the historical average for the same dates in 2017, 2018, and 2019, we developed a bootstrap method based on the central tendency measure of mean. A Poisson fitting analysis was used to identify trends on officially recorded all-cause deaths and COVID-19 deaths. A bootstrapping technique was used to emulate the sampling distribution of our expected deaths estimator μ⌢deaths by simulating the data generation and model fitting processes daily since the first confirmed case.

Results: In Ecuador, during 2020, 115,070 deaths were reported and 42,453 were cataloged as excess mortality when compared to 2017-2019 period. Ecuador is the country with the highest recorded excess mortality in the world within the shortest timespan. In one single day, Ecuador recorded 1,120 deaths (6/100,000), which represents an additional 408% of the expected fatalities.

Conclusion: Adjusting for population size and time, the hardest-hit country due to the COVID-19 pandemic was Ecuador. The mortality excess rate shows that the SARS-CoV-2 virus spread rapidly in Ecuador, especially in the coastal region. Our results and the proposed new methodology could help to address the real situation of the number of deaths during the initial phase of pandemics.

Keywords: COVID-19; Ecuador; death toll; excess deaths; statistical bootstrapping.

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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
Maximum number of deaths per date in Ecuador. Green bars are the average deaths per day from 2017 to 2019 and the red-colored bars are the excessive mortality daily curve.
Figure 2
Figure 2
Daily excess deaths per Ecuadorian provinces during 2020 (Black lines are the normal behavior of deaths in previous years; Colored lines are the observed deaths in 2020).
Figure 3
Figure 3
Daily excess deaths in Ecuadorian Regions. Green bars are the average deaths per day from 2017 to 2019 and the red-colored bars are the excessive mortality daily curve.
Figure 4
Figure 4
Excess mortality rate per province in Ecuador.
Figure 5
Figure 5
Excess deaths rate in Ecuador by canton in Ecuador.
See this image and copyright information in PMC

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