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.2021 Jun 30:10:e69336.
doi: 10.7554/eLife.69336.

Tracking excess mortality across countries during the COVID-19 pandemic with the World Mortality Dataset

Affiliations

Tracking excess mortality across countries during the COVID-19 pandemic with the World Mortality Dataset

Ariel Karlinsky et al. Elife..

Abstract

Comparing the impact of the COVID-19 pandemic between countries or across time is difficult because the reported numbers of cases and deaths can be strongly affected by testing capacity and reporting policy. Excess mortality, defined as the increase in all-cause mortality relative to the expected mortality, is widely considered as a more objective indicator of the COVID-19 death toll. However, there has been no global, frequently updated repository of the all-cause mortality data across countries. To fill this gap, we have collected weekly, monthly, or quarterly all-cause mortality data from 103 countries and territories, openly available as the regularly updated World Mortality Dataset. We used this dataset to compute the excess mortality in each country during the COVID-19 pandemic. We found that in several worst-affected countries (Peru, Ecuador, Bolivia, Mexico) the excess mortality was above 50% of the expected annual mortality (Peru, Ecuador, Bolivia, Mexico) or above 400 excess deaths per 100,000 population (Peru, Bulgaria, North Macedonia, Serbia). At the same time, in several other countries (e.g. Australia and New Zealand) mortality during the pandemic was below the usual level, presumably due to social distancing measures decreasing the non-COVID infectious mortality. Furthermore, we found that while many countries have been reporting the COVID-19 deaths very accurately, some countries have been substantially underreporting their COVID-19 deaths (e.g. Nicaragua, Russia, Uzbekistan), by up to two orders of magnitude (Tajikistan). Our results highlight the importance of open and rapid all-cause mortality reporting for pandemic monitoring.

Keywords: COVID; data; epidemiology; global health; human; international; mortality.

Plain language summary

Countries around the world reported 4.2 million deaths from SARS-CoV-2 (the virus that causes COVID-19) from the beginning of pandemic until the end of July 2021, but the actual number of deaths is likely higher. While some countries may have imperfect systems for counting deaths, others may have intentionally underreported them. To get a better estimate of deaths from an event such as a pandemic, scientists often compare the total number of deaths in a country during the event to the expected number of deaths based on data from previous years. This tells them how many excess deaths occurred during the event. To provide a more accurate count of deaths caused by COVID-19, Karlinsky and Kobak built a database called the World Mortality Dataset. It includes information on deaths from all causes from 103 countries. Karlinsky and Kobak used the database to compare the number of reported COVID-19 deaths reported to the excess deaths from all causes during the pandemic. Some of the hardest hit countries, including Peru, Ecuador, Bolivia, and Mexico, experienced over 50% more deaths than expected during the pandemic. Meanwhile, other countries like Australia and New Zealand, reported fewer deaths than normal. This is likely because social distancing measures reduced deaths from infections like influenza. Many countries reported their COVID-19 deaths accurately, but Karlinsky and Kobak argue that other countries, including Nicaragua, Russia, and Uzbekistan, underreported COVID-19 deaths. Using their database, Karlinsky and Kobak estimate that, in those countries, there have been at least 1.4 times more deaths due to COVID-19 than reported – adding over 1 million extra deaths in total. But they note that the actual number is likely much higher because data from more than 100 countries were not available to include in the database. The World Mortality Dataset provides a more accurate picture of the number of people who died because of the COVID-19 pandemic, and it is available online and updated daily. The database may help scientists develop better mitigation strategies for this pandemic or future ones.

© 2021, Karlinsky and Kobak.

PubMed Disclaimer

Conflict of interest statement

AK, DK No competing interests declared

Figures

Figure 1.
Figure 1.. Countries in the World Mortality Dataset are shown in blue.
Small countries and territories are shown with circles.
Figure 2.
Figure 2.. Excess mortality time series.
Each subplot shows baseline mortality (black), mortality in 2015–2019 (gray), in 2020 (red) and in 2021 (blue). Excess mortality is shown in red/blue shading. The numbers in each subplot are: total excess mortality (red), excess mortality per 100,000 population (black), excess mortality as a percentage of annual baseline mortality (gray), and undercount ratio of COVID-19 deaths (blue). See text for the exact definitions. All numbers were rounded to two significant digits; numbers below 100 to one significant digit. They-axis in each subplot starts at 0 and goes until 200% where 100% corresponds to the average baseline mortality. Thex-axis covers the entire year. Asterisks mark excess mortality estimates that were downwards corrected (see Materials and methods). Countries are sorted by the excess mortality as a percentage of annual baseline mortality (gray number). Undercount estimates are not shown for countries with negative total excess deaths and for selected countries where excess deaths were likely not related to the COVID-19 pandemic (Hong Kong, Thailand, Cuba); see Materials and methods.
Figure 2—figure supplement 1.
Figure 2—figure supplement 1.. Excess mortality time series, normalized per population size.
The figure is fully analogous to Figure 2, but countries are sorted by the excess mortality per 100,000 population, and all shown curves are normalized to yield mortality per 1000 people per year (each data point shows what mortality per 1000 people per year would be if the death rate stayed at the same level throughout the year).
Figure 3.
Figure 3.. Top 10 countries in the World Mortality Dataset by various excess mortality measures.
Each subplot shows the top 10 countries for each of our four excess mortality measures: total number of excess deaths; excess deaths per 100,000 population; excess deaths as a percentage of baseline annual mortality; undercount ratio (ratio of excess deaths to reported COVID-19 deaths by the same date). Error bars denote 95% confidence intervals corresponding to the uncertainty of the excess deaths estimate. Countries with population below 500,000 are not shown. Different countries have different reporting lags, so the estimates shown here correspond to different time points, as indicated. Excess mortality estimates in Armenia and Azerbaijan were downwards corrected by 4000 to account for the war casualties (see Materials and methods).
Figure 3—figure supplement 1.
Figure 3—figure supplement 1.. Top 10 countries in the World Mortality Dataset by various excess mortality measures by the end of 2020.
Each subplot shows the top 10 countries for each of our four excess mortality measures: total number of excess deaths; excess deaths per 100,000 population; excess deaths as a percentage of baseline annual mortality; undercount ratio (ratio of excess deaths to reported COVID-19 deaths by the same date). Error bars denote 95% confidence intervals corresponding to the uncertainty of the excess deaths estimate. Countries with population below 500,000 are not shown. Excess mortality estimates in Armenia and Azerbaijan were downwards corrected by 4000 to account for the war casualties (see Materials and mthods).
Figure 4.
Figure 4.. Relation between weekly excess deaths and weekly reported COVID-19 deaths.
Sixteen selected countries are shown together with the Pearson correlation coefficient (r) between the two time series, starting from week 10 of 2020. Note the peak in excess mortality (but not in the reported COVID-19 deaths) associated with the August 2020 heat wave in Belgium, France, Germany, and Netherlands.
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