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. 2025 Mar;19(3):e70086.
doi: 10.1111/irv.70086.

Excess All-Cause Mortality by Age and Gender During the COVID-19 Pandemic in the Federation of Bosnia and Herzegovina, Bosnia and Herzegovina: 2020-2022

Šeila Cilović-Lagarija  1 , Johanna Thea Mølgaard Rantzau  2 , Siniša Skočibušić  1   3 , Sanjin Musa  1 , Armin Sprečo  4   5 , Amna Isaković  1 , Mirza Palo  6 , Faris Dizdar  6 , Hidajeta Čolović  7 , Veronica Ivey Sawin  1 , Jens Nielsen  2 , Pernille Jorgensen  8
Affiliations

Excess All-Cause Mortality by Age and Gender During the COVID-19 Pandemic in the Federation of Bosnia and Herzegovina, Bosnia and Herzegovina: 2020-2022

Šeila Cilović-Lagarija et al. Influenza Other Respir Viruses. 2025 Mar.

Abstract

Objectives: COVID-19 has had a profound impact on global mortality and morbidity, yet only a fraction of deaths was confirmed and reported. We estimated all-cause excess mortality from 1 January 2020 to 31 December 2022 in the Federation of Bosnia and Herzegovina (FBiH) to assess the true magnitude of the pandemic.

Methods: Data for this analysis was sourced from the FBiH mortality register and supplemented with population statistics and official COVID-19 death counts (i.e., cases where COVID-19 was registered as the cause of death). Using a Poisson model, all-cause excess number of deaths and rates per 100,000 person-years, adjusted for registration delays and stratified by age and gender, were calculated.

Results: FBiH experienced three periods of excess all-cause mortality throughout the first 3 years of the pandemic, with a total of 12,000 excess deaths, highest among adults 45-74 years and males. No excess mortality was observed in children <15 years.

Conclusions: The true mortality impact of COVID-19 in FBiH was substantially higher than the reported deaths, including among younger adults. Strengthening civil registration and vital statistics, including establishment of all-cause mortality surveillance, is essential for improved monitoring of future pandemics and other important public health events. A detailed review of the direct and indirect effects of COVID-19 on mortality should be conducted to identify areas that require more resources, improve health provision and inform mitigation efforts in future pandemics to save lives.

Keywords: COVID‐19; excess mortality; mortality.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
All‐cause mortality per 100,000 person‐years in the Federation of Bosnia and Herzegovina, Bosnia and Herzegovina through the COVID‐19 pandemic, 2020 to 2022.
FIGURE 2
FIGURE 2
All‐cause excess mortality and 95% Uncertainty Intervals in the Federation of Bosnia and Herzegovina, Bosnia and Herzegovina through the COVID‐19 pandemic, 2020 to 2022.
FIGURE 3
FIGURE 3
All‐cause‐excess and official* COVID‐19 mortality in the Federation of Bosnia and Herzegovina, Bosnia and Herzegovina through the COVID‐19 pandemic, 2020 to 2022 (*cases where COVID‐19 was registered as the cause of death).
See this image and copyright information in PMC

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