Beyond deaths per capita: comparative COVID-19 mortality indicators
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Abstract
Following well-established practices in demography, this article discusses several measures based on the number of COVID-19 deaths to facilitate comparisons over time and across populations.
Settings
National populations in 186 United Nations countries and territories and populations in first-level subnational administrative entities in Brazil, China, Italy, Mexico, Peru, Spain and the USA.
Participants
None (death statistics only).
Primary and secondary outcome measures
An unstandardised occurrence/exposure rate comparable to the Crude Death Rate; an indirectly age-and-sex standardised rate that can be derived even when the breakdown of COVID-19 deaths by age and sex required for direct standardisation is unavailable; the reduction in life expectancy at birth corresponding to the 2020 number of COVID-19 deaths.
Results
To date, the highest unstandardised rate has been in New York, at its peak exceeding the state 2017 crude death rate. Populations compare differently after standardisation: while parts of Italy, Spain and the USA have the highest unstandardised rates, parts of Mexico and Peru have the highest standardised rates. For several populations with the necessary data by age and sex for direct standardisation, we show that direct and indirect standardisation yield similar results. US life expectancy is estimated to have declined this year by more than a year (−1.26 years), far more than during the worst year of the HIV epidemic, or the worst 3 years of the opioid crisis, and to reach its lowest level since 2008. Substantially larger reductions, exceeding 2 years, are estimated for Panama, Peru, and parts of Italy, Spain, the USA and especially, Mexico.
Conclusions
With lesser demand on data than direct standardisation, indirect standardisation is a valid alternative to adjust international comparisons for differences in population distribution by sex and age-groups. A number of populations have experienced reductions in 2020 life expectancies that are substantial by recent historical standards.
Article activity feed
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SciScore for 10.1101/2020.04.29.20085506: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable A standard demographic technique allows to estimate the impact that eliminating a cause of death would have on life expectancy at birth.11,12 When a prior period life table (i.e., not factoring CoViD-19 mortality) is available, applying this technique backward allows to translate a cumulative CoViD-19-deaths forecast for the same period into a CoViD-19-induced reduction in male and female life expectancies at birth. Table 2: Resources
No key resources detected.
Results from OddPub: Thank you for sharing your code and data.
Results from LimitationRecogn…SciScore for 10.1101/2020.04.29.20085506: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable A standard demographic technique allows to estimate the impact that eliminating a cause of death would have on life expectancy at birth.11,12 When a prior period life table (i.e., not factoring CoViD-19 mortality) is available, applying this technique backward allows to translate a cumulative CoViD-19-deaths forecast for the same period into a CoViD-19-induced reduction in male and female life expectancies at birth. Table 2: Resources
No key resources detected.
Results from OddPub: Thank you for sharing your code and data.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Indirect standardization thus appears to provide a valid alternative to rank CoViD-19 mortality across populations when data limitations prevent direct standardization. Variations in the slope of the age-specific rates of CoViD-19 mortality would also affect the estimated reductions in life expectancy at birth. If these rates increase less rapidly with age at the oldest ages in a population than they do in the USA, the age pattern of CoViD-19 deaths obtained here by multiplying the US age-specific rates and the population sizes of the different age groups would then be “older” than the actual age pattern. In turn, this would imply that the average number of years of life lost per CoViD-19 death and the total impact of CoViD-19 on life expectancy at birth is actually larger than estimated here. A simulation using the reported sex- and age-distribution of CoViD-19 for Brazil yielded a 1.67-year estimated reduction in life expectancy, however, only a 3% difference with the reduction estimated here (1.72 years, see Supplementary Information). Another source of uncertainty originates in the role of preexisting conditions in CoViD- 19 mortality. While this role is well documented, data on CoViD-19 fatalities by preexisting conditions are even less commonly available than data CoViD-19 fatalities by age.20 One study suggests that the average number of years of life lost per CoViD-19 death might be overestimated by about 10% when preexisting conditions are not accounted for.21 This p...
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.
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- No protocol registration statement was detected.
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