Mortality in Norway and Sweden during the COVID-19 pandemic
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Abstract
Background: Norway and Sweden are similar countries in terms of socioeconomics and health care. Norway implemented extensive COVID-19 measures, such as school closures and lockdowns, whereas Sweden did not. Aims: To compare mortality in Norway and Sweden, two similar countries with very different mitigation measures against COVID-19. Methods: Using real-world data from national registries, we compared all-cause and COVID-19-related mortality rates with 95% confidence intervals (CI) per 100,000 person-weeks and mortality rate ratios (MRR) comparing the five preceding years (2015–2019) with the pandemic year (2020) in Norway and Sweden. Results: In Norway, all-cause mortality was stable from 2015 to 2019 (mortality rate 14.6–15.1 per 100,000 person-weeks; mean mortality rate 14.9) and was lower in 2020 than from 2015 to 2019 (mortality rate 14.4; MRR 0.97; 95% CI 0.96–0.98). In Sweden, all-cause mortality was stable from 2015 to 2018 (mortality rate 17.0–17.8; mean mortality rate 17.1) and similar to that in 2020 (mortality rate 17.6), but lower in 2019 (mortality rate 16.2). Compared with the years 2015–2019, all-cause mortality in the pandemic year was 3% higher due to the lower rate in 2019 (MRR 1.03; 95% CI 1.02–1.04). Excess mortality was confined to people aged ⩾70 years in Sweden compared with previous years. The COVID-19-associated mortality rates per 100,000 person-weeks during the first wave of the pandemic were 0.3 in Norway and 2.9 in Sweden. Conclusions: All-cause mortality in 2020 decreased in Norway and increased in Sweden compared with previous years. The observed excess deaths in Sweden during the pandemic may, in part, be explained by mortality displacement due to the low all-cause mortality in the previous year.
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SciScore for 10.1101/2020.11.11.20229708: (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 not detected. Table 2: Resources
Software and Algorithms Sentences Resources Stata 16.1 (StataCorp, College Station, TX, USA) was used for all analyses. StataCorpsuggested: (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:A limitation of this study is that we only examined all-cause and Covid-19 associated …
SciScore for 10.1101/2020.11.11.20229708: (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 not detected. Table 2: Resources
Software and Algorithms Sentences Resources Stata 16.1 (StataCorp, College Station, TX, USA) was used for all analyses. StataCorpsuggested: (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:A limitation of this study is that we only examined all-cause and Covid-19 associated mortality, and no other specific causes of death, as this information is not yet available for the study period. A Swedish study reviewing the medical records of 122 people (a total of 51% of all deaths in the study-region) found that 70% of the deaths were Covid-19 associated, however only 15% of the cases were indeed Covid-19 specific (45). In addition, the observational study design does not provide an opportunity to draw conclusions about the causal relationship between the social measures in Norway and Sweden and the two countries’ differences in mortality rates. Our study shows that all-cause mortality was largely unchanged during the epidemic as compared to the previous four years in Norway and Sweden, two countries which employed very different strategies against the epidemic. Excess mortality from Covid-19 may be less pronounced than previously perceived in Sweden, and mortality displacement might explain part of the observed findings. We hope that these findings can pave the way for a less polarized and more open-minded discussion about pros and cons with less compared with more drastic measures against the Covid-19 epidemic.
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.
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SciScore for 10.1101/2020.11.11.20229708: (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 not detected. Table 2: Resources
Software and Algorithms Sentences Resources Stata 16.1 (StataCorp, College Station, TX, USA) was used for all analyses. StataCorpsuggested: (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 …
SciScore for 10.1101/2020.11.11.20229708: (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 not detected. Table 2: Resources
Software and Algorithms Sentences Resources Stata 16.1 (StataCorp, College Station, TX, USA) was used for all analyses. StataCorpsuggested: (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:
A limitation of this study is that we only examined all-cause and Covid-19 associated mortality, and no other specific causes of death, as this information is not yet available for the study period. A Swedish study reviewing the medical records of 122 people (a total of 51% of all deaths in the study-region) found that 70% of the deaths were Covid-19 associated, however only 15% of the cases were indeed Covid-19 specific (45). In addition, the observational study design does not provide an opportunity to draw conclusions about the causal relationship between the social measures in Norway and Sweden and the two countries' differences in mortality rates. Our study shows that all-cause mortality was largely unchanged during the epidemic as compared to the previous four years in Norway and Sweden, two countries which employed very different strategies against the epidemic. Excess mortality from Covid-19 may be less pronounced than previously perceived in Sweden, and mortality displacement might explain part of the observed findings. We hope that these findings can pave the way for a less polarized and more open-minded discussion about pros and cons with less compared with more drastic measures against the Covid-19 epidemic. Footnotes Author contributions: FEJ, HCJ, IB, ML, MB, MK and LE designed the study, with contribution from all authors. FEJ, HCJ and IB analysed the data. FEJ, HCJ and IB wrote the first draft of the manuscript, and all authors revised the manuscript and appro...
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.
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.
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