COVID-19 is not an Independent Cause of Death

Abstract

The COVID-19 pandemic has had overwhelming global impacts with deleterious social, economic, and health consequences. To assess the COVID-19 death toll researchers have estimated declines in 2020 life expectancy at birth. Because data are often available only for COVID-19 deaths, the risks of dying from COVID-19 are assumed to be independent of those from other causes. We explore the soundness of this assumption based on data from the US and Brazil, the countries with the largest number of reported COVID-19 deaths. We use three methods. One estimates the difference between 2019 and 2020 life tables and therefore does not require the assumption of independence. The other two assume independence to simulate scenarios in which COVID-19 mortality is added to 2019 death rates or is eliminated from 2020 rates. Our results reveal that COVID-19 is not independent of other causes of death. The assumption of independence can lead to either an overestimate (Brazil) or an underestimate (US) of the decline in e0, depending on how the number of other reported causes of death changed in 2020.

Excess mortality according to group of causes in the first year of the COVID-19 pandemic in Brazil

“…However, there was a reduction of 9.7 and 8.8%, respectively, compared with the same period of the previous year. The result of this study is aligned with the idea presented by Caldas et al 27 of the assumption of independence from the risks of dying from complications related to COVID-19 in the face of other causes, and that such an assumption may lead to an overestimation of the decline in life expectancy. For this reason, it is crucial to consider the analysis of competing causes for a more robust description of mortality scenarios in Brazil.…”

Excesso de mortalidade segundo grupo de causas no primeiro ano de pandemia de COVID-19 no Brasil

“…De fato, a análise Jardim et al 26 demonstrou que o excesso de óbitos por câncer e condições cardiovasculares como comorbidade em 2020 pode indicar que a COVID-19 teve importante impacto entre pacientes portadores dessas condições, ainda que tenha havido redução de 9,7 e 8,8%, respectivamente, em relação ao mesmo período do ano anterior. O resultado deste estudo se alinha à ideia apresentada por Caldas et al 27 de suposição de independência dos riscos de morrer por complicações relacionadas à CO-VID-19 diante de outras causas, e que tal assunção pode levar a uma superestimação do declínio da expectativa de vida. Por essa razão, é importante considerar a análise de causas concorrentes para uma descrição mais robusta dos cenários de mortalidade no Brasil.…”

Mortality by cause of death in Brazil: effects of the COVID-19 pandemic and contribution to changes in life expectancy at birth

“…However, the mortality burden of the COVID-19 pandemic is not limited to the deaths directly attributed to COVID-19 but also the indirect effects on other underlying causes of death (Castro et al, 2022). Indirect effects could manifest in different and contradictory ways.…”

“…Assessments of the impact of the COVID-19 pandemic on mortality include estimates of years of life lost (YLL), excess deaths, and changes in life expectancy at birth (𝑒 0 ) and at other specific ages (e.g., 65 years). Some of these studies explore the direct (COVID-19 deaths) and indirect (non-COVID-19 deaths) mortality impacts of the COVID-19 pandemic according to different dimensions, including age, sex, race and ethnicity, socioeconomic status, regional distribution, and mortality causes (Ackley et al, 2022; Andrasfay & Goldman, 2021; Arias et al, 2021, 2022; Brant et al, 2020; Castro et al, 2022; Castro, Gurzenda, Turra, et al, 2021; Chan et al, 2021; Cronin & Evans, 2021; Guimarães et al, 2022; Iuliano et al, 2021; Jardim et al, 2022; Kelly et al, 2021; Kontopantelis et al, 2021; Lima et al, 2021; Marinho et al, 2020; Sanmarchi et al, 2021; Santos et al, 2021; Stokes et al, 2021; World Health Organization, 2022). These assessments show that along with specific mortality causes, the COVID-19 pandemic may result in decreasing indirect mortality for particular populations (e.g., economically privileged) and countries (e.g., Belgium, Canada, Costa Rica, and France).…”