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

Abstract

Objective: To estimate excess mortality by cause of death in Brazil and states in 2020. Methods: We estimated the expected number of deaths considering a linear trend analysis with the number of deaths between 2015 and 2019 for each group of causes and each federative unit. We calculated standardized mortality ratios (SMR) and 95% confidence intervals for each SMR assuming a Poisson distribution. We performed the analyses in the R program, version 4.1.3. Results: We observed a 19% excess in deaths in 2020 (SMR=1.19; 95%CI=1.18–1.20). The Infectious and Parasitic Diseases group stood out among the defined causes (SMR=4.80; 95%CI 4.78–4.82). The ill-defined causes showed great magnitude in this period (SMR=6.08; 95%CI 6.06–6.10). Some groups had lower-than-expected deaths: respiratory diseases (10% lower than expected) and external causes (4% lower than expected). In addition to the global analysis of the country, we identified significant heterogeneity among the federative units. States with the highest SMR are concentrated in the northern region, and those with the lowest SMR are concentrated in the southern and southeastern regions. Conclusion: Excess mortality occurs during the COVID-19 pandemic. This excess results not only from COVID-19 itself, but also from the social response and the management of the health system in responding to a myriad of causes that already had a trend pattern before it.

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

“…This is consistent with the idea that disruptions in the healthcare system caused by the COVID-19 pandemic (Bigoni et al, 2022;Dey & Davidson, 2021;Griffin, 2021;Lai et al, 2020) increased the mortality from causes amenable to primary care (Nolte & McKee, 2004). On the other hand, our results also corroborate earlier studies that reveal that the COVID-19 pandemic may also decrease the mortality of other causes of death, such as heart and stroke (Brant et al, 2020;Jardim et al, 2022;Santos et al, 2021), influenza, pneumonia, chronic and other lower respiratory diseases (Arias et al, 2021(Arias et al, , 2022Guimarães et al, 2022;Kontopantelis et al, 2021;Santos et al, 2021), malignant neoplasms (Arias et al, 2021(Arias et al, , 2022Jardim et al, 2022), as well the digestive system, kidney, and urinary system. This is consistent with competing risks (Chiang, 1991;Yashin et al, 1986) and corroborates earlier studies that associated specific morbidities or conditions with increased risk of dying from COVID-19 (Castro, Gurzenda, Macário, et al, 2021;Dorjee et al, 2020;Fond et al, 2021;Thakur et al, 2021;Venkatesulu et al, 2021;Yang et al, 2021;Zambrano et al, 2020).…”

“…On the one hand, some of our findings support previous studies which show that the COVID-19 pandemic may increase the mortality of other causes of death (Arias et al, 2021, 2022; Brant et al, 2020; Guimarães et al, 2022; Jardim et al, 2022; Kontopantelis et al, 2021; Santos et al, 2021; Stokes et al, 2021). This is consistent with the idea that disruptions in the healthcare system caused by the COVID-19 pandemic (Bigoni et al, 2022; Dey & Davidson, 2021; Griffin, 2021; Lai et al, 2020) increased the mortality from causes amenable to primary care (Nolte & McKee, 2004).…”

“…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).…”

Assessing COVID-19 pandemic excess deaths in Brazil: Years 2020 and 2021

“…Our results on deficit deaths from causes other than COVID-19 agree with those from other studies. Cause-specific expected mortality indicated deficits for Respiratory, Other Infectious Diseases, Neoplasms and Cardiovascular Diseases, in the year 2020, as also pointed out in other studies [ 20 , 27 , 51 ], although some of them [ 27 , 51 ] used different death-cause grouping. With the social distancing recommendations, we expect lower exposure to risk factors associated with the first two, while deficits for Neoplasms and Cardiovascular diseases might be explained by the evidence that people suffering from these illnesses were at high risk for serious COVID-19 conditions and died from COVID-19 in the first wave [ 23 , 27 , 52 – 54 ].…”

“…While we included only the pandemic weeks of 2020, other authors presented accumulated statistics for the entire year. Reported P-Score values are 13.7% (using GLM [ 20 ]), 14% (using an auto-regressive model [ 27 ]), 19% (using averaged previous five-year mortality rate [ 51 ]) and 25% (using averaged previous five-year death counts [ 26 ]). As foreseen, using averaged statistics results in underestimated expected deaths and thus, in overestimated excess.…”