Excess deaths during the Covid-19 pandemic: An international comparison

  1. Kieran F. Docherty
  2. Jawad H. Butt
  3. Rudolf A. de Boer
  4. Pooja Dewan
  5. Lars Køber
  6. Aldo P. Maggioni
  7. John J.V. McMurray
  8. Scott D. Solomon
  9. Pardeep S. Jhund

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Abstract

Background

With the global pandemic of coronavirus disease 2019 (Covid-19) there has been disruption to normal clinical activity in response to the increased demand on health services. There are reports of a reduction in non-Covid-19 emergency presentations. Consequentially, there are concerns that deaths from non-Covid-19 causes could increase. We examined recent reported population-based mortality rates, compared with expected rates, and compared any excess in deaths with the number of deaths attributed to Covid-19.

Methods

National agency and death registration reports were searched for numbers of deaths attributed to Covid-19 and overall mortality that had been publicly reported by 06 May 2020. Data on the number of deaths attributed to Covid-19, the total number of deaths registered in the population and the historical average over at least 3 years were collected. Data were available for 4 European countries (England & Wales, Scotland, Netherlands and Italy) and New York State, United States of America.

Results

There was an increase in observed, compared with expected, mortality in Scotland (+68%), England and Wales (+74%), the Netherlands (+58%), Italy (+39%) and New York state (+49%). Of these deaths, only 73% in Scotland, 71 % in England and Wales, 53% in the Netherlands, 54% in Italy and 79% in New York state were attributed to Covid-19 leaving a number of excess deaths not attributed to Covid-19. In the 5-week period of study, Scotland, 10% of the excess of deaths were attributed to dementia/Alzheimer’s disease and 7% to cardiovascular causes.

Conclusion

A substantial proportion of excess deaths observed during the current COVID-19 pandemic are not attributed to COVID-19 and may represent unrecognised deaths due to Covid-19, an excess of deaths due to other causes, or both. The impact of Covid-19 on mortality and morbidity from other causes needs to be quantified and addressed in public health planning.

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  1. ScreenIT

    SciScore for 10.1101/2020.04.21.20073114: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    All analyses were carried out using Stata software, version 16 (StataCorp, College Station, TX, USA).
    StataCorp
    suggested: (Stata, RRID:SCR_012763)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our analysis has several limitations. It would have been of interest to include other countries but we could only use those providing the required data. We relied on publicly available data that are collected and collated in a fast-moving pandemic and may be subject to revision. The coding and therefore definition of a Covid-19 related death may be influenced by local regulations and guidelines on certifying the cause of death in each country, as discussed in relation to Spain above. Finally, the availability of testing for Covid-19 may have influenced the ascertainment of Covid-19 related deaths in each country and therefore the excess of non-Covid-19 deaths in each of the countries may represent an under-identification of cases of SARS-Cov-2 infection. Conversely, the number of Covid-19 deaths may be inflated by deaths in people who had Covid-19 at the time of death but did not die from their viral illness i.e. died from another non-Covid-19 reason despite infection with SARS-Cov-2. The lack of age specific data in countries other than England and Wales prevented the calculation of age adjusted rates and the ability to compare using standardised mortality statistics. In summary, a substantial proportion of excess deaths observed during the current COVID-19 pandemic are not attributed to COVID-19. This may indicate an increase in non-COVID-19 deaths due to changes in routine health care delivery during this pandemic. People should be reminded that it is still appropriate to ...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2020.04.21.20073114v3 on medRxiv
  3. Version published to 10.1101/2020.04.21.20073114v2 on medRxiv
  4. Version published to 10.1101/2020.04.21.20073114v1 on medRxiv