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The Effect of COVID-19 Pandemic on Overall and Cause-Specific Mortality

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Public Health Statistics and Risk Assessment".

Deadline for manuscript submissions: closed (31 December 2023) | Viewed by 12144

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Dr. Francesco Grippo

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Integrated System for Health, Social Assistance and Welfare, Italian National Institute of Statistics, 00198 Rome, Italy
Interests: mortality by cause; analysis of multiple causes of death; multi-morbidity and frailty at death; causes of hospitalization

Dr. Enrico Grande

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Special Issue Information

Dear Colleagues,

We are currently accepting submissions for our Special Issue for The International Journal of Environmental Research and Public Health entitled “The effect of COVID-19 pandemic on overall and cause-specific mortality” .

The COVID-19 pandemic has had a huge impact on mortality worldwide. Both direct and indirect effects of the spread of SARS-CoV-2 have contributed to the excess in mortality to different extents across countries. Analysis of mortality data provides key findings to assess the impact of the pandemic on the health status of the population, and to monitor healthcare system responses and the effectiveness of the public health measures adopted. However, about two years after the start of the pandemic, some aspects regarding mortality still remain only partially investigated or need to be better clarified. Among these are the changes in causes of death, COVID-19 related mortality, the impact of the pandemic on the inequalities in mortality, assessment of the excess mortality, geographical variations across countries and within the countries, and environmental factors. With this Special Issue, we want to identify and collect original contributions to the analysis of the aforementioned themes that would improve the knowledge of the changes in mortality in times of pandemic.

Dr. Francesco Grippo
Dr. Enrico Grande
Guest Editors

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Keywords

mortality
COVID-19
excess mortality
causes of death
COVID-19 related mortality

Published Papers (7 papers)

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Research

11 pages, 674 KiB

Open AccessArticle

Mortality in Germany during the COVID-19 Pandemic

by Alois Pichler and Dana Uhlig

Int. J. Environ. Res. Public Health 2023, 20(20), 6942; https://doi.org/10.3390/ijerph20206942 - 19 Oct 2023

Cited by 1 | Viewed by 1538

Abstract

Is there sufficient scientific evidence for excess mortality caused by COVID-19? The German population, similar to the population of many other countries, is subject to fluctuations caused by multiple factors, including migration and aging. COVID-19 is one additional factor, superposing natural or seasonal mortality fluctuations. To give scientific evidence for excess mortality caused by COVID-19, it is essential to employ appropriate statistical tools. This study develops a score indicating excess mortality and studies its evolution over time. Applied to data provided by governmental authorities, the indicator discloses, without relating to causes of death explicitly, excess mortality at the end of 2020, in 2021, and in 2022. In addition, the indicator confirms that COVID-19 particularly impacted the elderly segment of the population. Full article

(This article belongs to the Special Issue The Effect of COVID-19 Pandemic on Overall and Cause-Specific Mortality)

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13 pages, 1821 KiB

Open AccessArticle

Estimating Overall and Cause-Specific Excess Mortality during the COVID-19 Pandemic: Methodological Approaches Compared

by Claudio Barbiellini Amidei, Ugo Fedeli, Nicola Gennaro, Laura Cestari, Elena Schievano, Manuel Zorzi, Paolo Girardi and Veronica Casotto

Int. J. Environ. Res. Public Health 2023, 20(11), 5941; https://doi.org/10.3390/ijerph20115941 - 24 May 2023

Cited by 1 | Viewed by 1680

Abstract

During the COVID-19 pandemic, excess mortality has been reported worldwide, but its magnitude has varied depending on methodological differences that hinder between-study comparability. Our aim was to estimate variability attributable to different methods, focusing on specific causes of death with different pre-pandemic trends. Monthly mortality figures observed in 2020 in the Veneto Region (Italy) were compared with those forecasted using: (1) 2018–2019 monthly average number of deaths; (2) 2015–2019 monthly average age-standardized mortality rates; (3) Seasonal Autoregressive Integrated Moving Average (SARIMA) models; (4) Generalized Estimating Equations (GEE) models. We analyzed deaths due to all-causes, circulatory diseases, cancer, and neurologic/mental disorders. Excess all-cause mortality estimates in 2020 across the four approaches were: +17.2% (2018–2019 average number of deaths), +9.5% (five-year average age-standardized rates), +15.2% (SARIMA), and +15.7% (GEE). For circulatory diseases (strong pre-pandemic decreasing trend), estimates were +7.1%, −4.4%, +8.4%, and +7.2%, respectively. Cancer mortality showed no relevant variations (ranging from −1.6% to −0.1%), except for the simple comparison of age-standardized mortality rates (−5.5%). The neurologic/mental disorders (with a pre-pandemic growing trend) estimated excess corresponded to +4.0%/+5.1% based on the first two approaches, while no major change could be detected based on the SARIMA and GEE models (−1.3%/+0.3%). The magnitude of excess mortality varied largely based on the methods applied to forecast mortality figures. The comparison with average age-standardized mortality rates in the previous five years diverged from the other approaches due to the lack of control over pre-existing trends. Differences across other methods were more limited, with GEE models probably representing the most versatile option. Full article

(This article belongs to the Special Issue The Effect of COVID-19 Pandemic on Overall and Cause-Specific Mortality)

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10 pages, 595 KiB

Open AccessArticle

The Effect of COVID-19 Pandemic on Overall and Cause-Specific Mortality in Pavia, Northern Italy: Updated Estimates for the Year 2021

by Paola Bertuccio, Pietro Perotti, Giansanto Mosconi, Simona Dalle Carbonare, Federica Manzoni, Lorenza Boschetti, Stefano Marguati, Paolo Paraluppi, Lorenzo Blandi, Leandro Gentile, Maddalena Gaeta, Lorella Cecconami and Anna Odone

Int. J. Environ. Res. Public Health 2023, 20(8), 5529; https://doi.org/10.3390/ijerph20085529 - 17 Apr 2023

Cited by 1 | Viewed by 1410

Abstract

Excess mortality estimates are considered relevant indicators of direct and indirect pandemic effects on the population. Scant data have been published on cause-specific excess mortality. Using individual-level administrative data covering the Pavia province of Italian northern Lombardy region, we provided all-cause and cause-specific raw (RMR) and age-standardized (ASMR) mortality rates in 2021 and 2015–2019, the rate ratio, and 95% confidence intervals, overall and by sex. We obtained the excess deaths in 2021 as the difference between the number of observed and expected deaths from all causes and the two leading causes of death (all neoplasms and circulatory system diseases) by fitting over-dispersed quasi-Poisson regression models, accounting for temporal, seasonal and demographic changes. The total ASMR in 2021 was 972.4/100,000 (6836 certified deaths), with the highest ASMRs for circulatory system diseases (272.6/100,000) and all neoplasms (270.3/100,000), followed by COVID-19 (94.8/100,000 and 662 deaths). Compared to the expected, we estimated a total of 6.2% excess deaths in 2021 (7.2% in males and 5.4% in females), with no excess deaths from all neoplasms and a 6.2% reduction from circulatory system diseases. COVID-19 continued to affect total mortality in 2021, albeit to a lesser extent than in 2020, consistently with national patterns. Full article

(This article belongs to the Special Issue The Effect of COVID-19 Pandemic on Overall and Cause-Specific Mortality)

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14 pages, 1803 KiB

Open AccessArticle

Assessment of Excess Mortality in Italy in 2020–2021 as a Function of Selected Macro-Factors

by Emiliano Ceccarelli, Giada Minelli, Viviana Egidi and Giovanna Jona Lasinio

Int. J. Environ. Res. Public Health 2023, 20(4), 2812; https://doi.org/10.3390/ijerph20042812 - 5 Feb 2023

Cited by 3 | Viewed by 1396

Abstract

Background: Excess mortality (EM) can reliably capture the impact of a pandemic, this study aims at assessing the numerous factors associated with EM during the COVID-19 pandemic in Italy. Methods: Mortality records (ISTAT 2015–2021) aggregated in the 610 Italian Labour Market Areas (LMAs) were used to obtain the EM P-scores to associate EM with socioeconomic variables. A two-step analysis was implemented: (1) Functional representation of EM and clustering. (2) Distinct functional regression by cluster. Results: The LMAs are divided into four clusters: 1 low EM; 2 moderate EM; 3 high EM; and 4 high EM-first wave. Low-Income showed a negative association with EM clusters 1 and 4. Population density and percentage of over 70 did not seem to affect EM significantly. Bed availability positively associates with EM during the first wave. The employment rate positively associates with EM during the first two waves, becoming negatively associated when the vaccination campaign began. Conclusions: The clustering shows diverse behaviours by geography and time, the impact of socioeconomic characteristics, and local governments and health services’ responses. The LMAs allow to draw a clear picture of local characteristics associated with the spread of the virus. The employment rate trend confirmed that essential workers were at risk, especially during the first wave. Full article

(This article belongs to the Special Issue The Effect of COVID-19 Pandemic on Overall and Cause-Specific Mortality)

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12 pages, 1014 KiB

Open AccessArticle

COVID-19 Mortality in the Colorado Center for Personalized Medicine Biobank

by Amanda N. Brice, Lauren A. Vanderlinden, Katie M. Marker, David Mayer, Meng Lin, Nicholas Rafaels, Jonathan A. Shortt, Alex Romero, Jan T. Lowery, Christopher R. Gignoux and Randi K. Johnson

Int. J. Environ. Res. Public Health 2023, 20(3), 2368; https://doi.org/10.3390/ijerph20032368 - 29 Jan 2023

Viewed by 1658

Abstract

Over 6.37 million people have died from COVID-19 worldwide, but factors influencing COVID-19-related mortality remain understudied. We aimed to describe and identify risk factors for COVID-19 mortality in the Colorado Center for Personalized Medicine (CCPM) Biobank using integrated data sources, including Electronic Health Records (EHRs). We calculated cause-specific mortality and case-fatality rates for COVID-19 and common pre-existing health conditions defined by diagnostic phecodes and encounters in EHRs. We performed multivariable logistic regression analyses of the association between each pre-existing condition and COVID-19 mortality. Of the 155,859 Biobank participants enrolled as of July 2022, 20,797 had been diagnosed with COVID-19. Of 5334 Biobank participants who had died, 190 were attributed to COVID-19. The case-fatality rate was 0.91% and the COVID-19 mortality rate was 122 per 100,000 persons. The odds of dying from COVID-19 were significantly increased among older men, and those with 14 of the 61 pre-existing conditions tested, including hypertensive chronic kidney disease (OR: 10.14, 95% CI: 5.48, 19.16) and type 2 diabetes with renal manifestations (OR: 5.59, 95% CI: 3.42, 8.97). Male patients who are older and have pre-existing kidney diseases may be at higher risk for death from COVID-19 and may require special care. Full article

(This article belongs to the Special Issue The Effect of COVID-19 Pandemic on Overall and Cause-Specific Mortality)

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13 pages, 941 KiB

Open AccessArticle

Assessing COVID-19-Related Excess Mortality Using Multiple Approaches—Italy, 2020–2021

by Emiliano Ceccarelli, Maria Dorrucci, Giada Minelli, Giovanna Jona Lasinio, Sabrina Prati, Marco Battaglini, Gianni Corsetti, Antonino Bella, Stefano Boros, Daniele Petrone, Flavia Riccardo, Antonello Maruotti and Patrizio Pezzotti

Int. J. Environ. Res. Public Health 2022, 19(24), 16998; https://doi.org/10.3390/ijerph192416998 - 17 Dec 2022

Cited by 4 | Viewed by 1874

Abstract

Introduction: Excess mortality (EM) is a valid indicator of COVID-19’s impact on public health. Several studies regarding the estimation of EM have been conducted in Italy, and some of them have shown conflicting values. We focused on three estimation models and compared their results with respect to the same target population, which allowed us to highlight their strengths and limitations. Methods: We selected three estimation models: model 1 (Maruotti et al.) is a Negative-Binomial GLMM with seasonal patterns; model 2 (Dorrucci et al.) is a Negative Binomial GLM epidemiological approach; and model 3 (Scortichini et al.) is a quasi-Poisson GLM time-series approach with temperature distributions. We extended the time windows of the original models until December 2021, computing various EM estimates to allow for comparisons. Results: We compared the results with our benchmark, the ISS-ISTAT official estimates. Model 1 was the most consistent, model 2 was almost identical, and model 3 differed from the two. Model 1 was the most stable towards changes in the baseline years, while model 2 had a lower cross-validation RMSE. Discussion: Presently, an unambiguous explanation of EM in Italy is not possible. We provide a range that we consider sound, given the high variability associated with the use of different models. However, all three models accurately represented the spatiotemporal trends of the pandemic waves in Italy. Full article

(This article belongs to the Special Issue The Effect of COVID-19 Pandemic on Overall and Cause-Specific Mortality)

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13 pages, 2081 KiB

Open AccessArticle

Two-Dose Vaccination Significantly Prolongs the Duration from Symptom Onset to Death: A Retrospective Study Based on 173,894 SARS-CoV-2 Cases in Khyber Pakhtunkhwa, Pakistan

by Qianqian Song, Naseem Asghar, Ata Ullah, Baosheng Liang, Mengping Long, Taobo Hu and Xiaohua Zhou

Int. J. Environ. Res. Public Health 2022, 19(18), 11531; https://doi.org/10.3390/ijerph191811531 - 13 Sep 2022

Cited by 1 | Viewed by 1613

Abstract

This research was carried out to quantify the duration from symptom onset to recovery/death (SOR/SOD) during the first four waves and the Alpha/Delta period of the epidemic in Khyber Pakhtunkhwa, Pakistan, and identify the associated factors. A total of 173,894 COVID-19 cases were admitted between 16 March 2020 and 30 November 2021, including 458 intensive care unit (ICU) cases. The results showed that the case fatality rate (CFR) increased with age, and females had a higher CFR. The median SOR of ICU cases was longer than that of non-ICU cases (27.6 vs. 17.0 days), while the median SOD was much shorter (6.9 vs. 8.4 days). The SOR and SOD in the Delta period were slightly shortened than the Alpha period. Age, cardiovascular diseases, chronic lung disease, diabetes, fever, breathing issues, and ICU admission were risk factors that were significantly associated with SOD (p < 0.001). A control measure, in-home quarantine, was found to be significantly associated with longer SOD (odds ratio = 9.49, p < 0.001). Infected vaccinated individuals had longer SOD than unvaccinated individuals, especially for cases that had received two vaccine doses (p < 0.001). Finally, an advice on getting full-dose vaccination is given specifically to individuals aged 20–59 years. Full article

(This article belongs to the Special Issue The Effect of COVID-19 Pandemic on Overall and Cause-Specific Mortality)

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