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Haidong Wang, Katherine R Paulson, Spencer A Pease, Stefanie Watson, Haley Comfort, Peng Zheng, Aleksandr Y Aravkin, Catherine Bisignano, Ryan M Barber, Tahiya Alam and 86 more
BACKGROUND: Mortality statistics are fundamental to public health decision making. Mortality varies by time and location, and its measurement is affected by well known biases that have been exacerbated during the COVID-19 pandemic. This paper aims to estimate excess mortality from the COVID-19 pandemic in 191 countries and territories, and 252 subnational units for selected countries, from Jan 1, 2020, to Dec 31, 2021. METHODS: All-cause mortality reports were collected for 74 countries and territories and 266 subnational locations (including 31 locations in low-income and middle-income countries) that had reported either weekly or monthly deaths from all causes during the pandemic in 2020 and 2021, and for up to 11 year previously. In addition, we obtained excess mortality data for 12 states in India. Excess mortality over time was calculated as observed mortality, after excluding data from periods affected by late registration and anomalies such as heat waves, minus expected mortality. Six models were used to estimate expected mortality; final estimates of expected mortality were based on an ensemble of these models. Ensemble weights were based on root mean squared errors derived from an out-of-sample predictive validity test. As mortality records are incomplete worldwide, we built a statistical model that predicted the excess mortality rate for locations and periods where all-cause mortality data were not available. We used least absolute shrinkage and selection operator (LASSO) regression as a variable selection mechanism and selected 15 covariates, including both covariates pertaining to the COVID-19 pandemic, such as seroprevalence, and to background population health metrics, such as the Healthcare Access and Quality Index, with direction of effects on excess mortality concordant with a meta-analysis by the US Centers for Disease Control and Prevention. With the selected best model, we ran a prediction process using 100 draws for each covariate and 100 draws of estimated coefficients and residuals, estimated from the regressions run at the draw level using draw-level input data on both excess mortality and covariates. Mean values and 95% uncertainty intervals were then generated at national, regional, and global levels. Out-of-sample predictive validity testing was done on the basis of our final model specification. FINDINGS: Although reported COVID-19 deaths between Jan 1, 2020, and Dec 31, 2021, totalled 5·94 million worldwide, we estimate that 18·2 million (95% uncertainty interval 17·1-19·6) people died worldwide because of the COVID-19 pandemic (as measured by excess mortality) over that period. The global all-age rate of excess mortality due to the COVID-19 pandemic was 120·3 deaths (113·1-129·3) per 100 000 of the population, and excess mortality rate exceeded 300 deaths per 100 000 of the population in 21 countries. The number of excess deaths due to COVID-19 was largest in the regions of south Asia, north Africa and the Middle East, and eastern Europe. At the country level, the highest numbers of cumulative excess deaths due to COVID-19 were estimated in India (4·07 million [3·71-4·36]), the USA (1·13 million [1·08-1·18]), Russia (1·07 million [1·06-1·08]), Mexico (798 000 [741 000-867 000]), Brazil (792 000 [730 000-847 000]), Indonesia (736 000 [594 000-955 000]), and Pakistan (664 000 [498 000-847 000]). Among these countries, the excess mortality rate was highest in Russia (374·6 deaths [369·7-378·4] per 100 000) and Mexico (325·1 [301·6-353·3] per 100 000), and was similar in Brazil (186·9 [172·2-199·8] per 100 000) and the USA (179·3 [170·7-187·5] per 100 000). INTERPRETATION: The full impact of the pandemic has been much greater than what is indicated by reported deaths due to COVID-19 alone. Strengthening death registration systems around the world, long understood to be crucial to global public health strategy, is necessary for improved monitoring of this pandemic and future pandemics. In addition, further research is warranted to help distinguish the proportion of excess mortality that was directly caused by SARS-CoV-2 infection and the changes in causes of death as an indirect consequence of the pandemic. FUNDING: Bill & Melinda Gates Foundation, J Stanton, T Gillespie, and J and E Nordstrom.
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Wang, H., Paulson, K. R., Pease, S. A., Watson, S., Comfort, H., Zheng, P., Aravkin, A. Y., Bisignano, C., Barber, R. M., Alam, T., Fuller, J. E., May, E. A., Jones, D. P., Frisch, M. E., Abbafati, C., Adolph, C., Allorant, A., Amlag, J. O., Bang-Jensen, B., … Murray, C. J. L. (2022). Estimating excess mortality due to the COVID-19 pandemic: a systematic analysis of COVID-19-related mortality, 2020–21. The Lancet, 399(10334), 1513–1536. https://doi.org/10.1016/s0140-6736(21)02796-3
Wang, Haidong, et al. "Estimating excess mortality due to the COVID-19 pandemic: a systematic analysis of COVID-19-related mortality, 2020–21." The Lancet, vol. 399, no. 10334, 2022, pp. 1513–1536, https://doi.org/10.1016/s0140-6736(21)02796-3.
Wang, Haidong, Katherine R Paulson, Spencer A Pease, Stefanie Watson, Haley Comfort, Peng Zheng, Aleksandr Y Aravkin, et al. "Estimating excess mortality due to the COVID-19 pandemic: a systematic analysis of COVID-19-related mortality, 2020–21." The Lancet 399, no. 10334 (2022): 1513–1536. https://doi.org/10.1016/s0140-6736(21)02796-3.
Wang H., Paulson K. R., Pease S. A. [и др.] Estimating excess mortality due to the COVID-19 pandemic: a systematic analysis of COVID-19-related mortality, 2020–21 // The Lancet. — 2022. — Vol. 399, № 10334. — P. 1513–1536. — URL: https://doi.org/10.1016/s0140-6736(21)02796-3
@article{wang2022estimating,
title = {{Estimating excess mortality due to the COVID-19 pandemic: a systematic analysis of COVID-19-related mortality, 2020–21}},
author = {Haidong Wang and Katherine R Paulson and Spencer A Pease and Stefanie Watson and Haley Comfort and Peng Zheng and Aleksandr Y Aravkin and Catherine Bisignano and Ryan M Barber and Tahiya Alam and John E Fuller and Erin A May and Darwin Phan Jones and Meghan E Frisch and Cristiana Abbafati and Christopher Adolph and Adrien Allorant and Joanne O Amlag and Bree Bang-Jensen and Gregory J Bertolacci and Sabina S Bloom and Austin Carter and Emma Castro and Suman Chakrabarti and Jhilik Chattopadhyay and Rebecca M Cogen and James K Collins and Kimberly Cooperrider and Xiaochen Dai and William James Dangel and Farah Daoud and Carolyn Dapper and Amanda Deen and Bruce B Duncan and Megan Erickson and Samuel B Ewald and Tatiana Fedosseeva and Alize J Ferrari and Joseph Jon Frostad and Nancy Fullman and John Gallagher and Amiran Gamkrelidze and Gaorui Guo and Jiawei He and Monika Helak and Nathaniel J Henry and Erin N. Hulland and Bethany M Huntley and Maia Kereselidze and Alice Lazzar-Atwood and Kate E LeGrand and Akiaja Lindstrom and Emily Linebarger and Paulo A Lotufo and Rafael Lozano and Beatrice Magistro and Deborah Carvalho Malta and Johan Månsson and Ana Maria Mantilla Herrera and Fatima Marinho and Alemnesh H Mirkuzie and Awoke Temesgen Misganaw and Lorenzo Monasta and Paulami Naik and Shuhei Nomura and Edward G O'Brien and James Kevin O'Halloran and Latera Tesfaye Olana and Samuel M Ostroff and Louise Penberthy and Robert C. Reiner and Grace Reinke and Antônio Luiz Pinho Ribeiro and Damian Francesco Santomauro and Maria Inês Schmidt and David H Shaw and Brittney S Sheena and Aleksei Sholokhov and Natia Skhvitaridze and Reed J D Sorensen and Emma Elizabeth Spurlock and Ruri Syailendrawati and Roman Topór‐Mądry and Christopher E Troeger and Rebecca Walcott and Ally Walker and Charles Shey Wiysonge and Nahom Alemseged Worku and Bethany Zigler and David M Pigott and Mohsen Naghavi and Ali H Mokdad and Stephen S Lim and Simon Iain Hay and Emmanuela Gakidou and Christopher J L Murray},
journal = {The Lancet},
year = {2022},
volume = {399},
number = {10334},
pages = {1513--1536},
doi = {10.1016/s0140-6736(21)02796-3},
url = {https://doi.org/10.1016/s0140-6736(21)02796-3}
}TY - JOUR AU - Wang, Haidong AU - Paulson, Katherine R AU - Pease, Spencer A AU - Watson, Stefanie AU - Comfort, Haley AU - Zheng, Peng AU - Aravkin, Aleksandr Y AU - Bisignano, Catherine AU - Barber, Ryan M AU - Alam, Tahiya AU - Fuller, John E AU - May, Erin A AU - Jones, Darwin Phan AU - Frisch, Meghan E AU - Abbafati, Cristiana AU - Adolph, Christopher AU - Allorant, Adrien AU - Amlag, Joanne O AU - Bang-Jensen, Bree AU - Bertolacci, Gregory J AU - Bloom, Sabina S AU - Carter, Austin AU - Castro, Emma AU - Chakrabarti, Suman AU - Chattopadhyay, Jhilik AU - Cogen, Rebecca M AU - Collins, James K AU - Cooperrider, Kimberly AU - Dai, Xiaochen AU - Dangel, William James AU - Daoud, Farah AU - Dapper, Carolyn AU - Deen, Amanda AU - Duncan, Bruce B AU - Erickson, Megan AU - Ewald, Samuel B AU - Fedosseeva, Tatiana AU - Ferrari, Alize J AU - Frostad, Joseph Jon AU - Fullman, Nancy AU - Gallagher, John AU - Gamkrelidze, Amiran AU - Guo, Gaorui AU - He, Jiawei AU - Helak, Monika AU - Henry, Nathaniel J AU - Hulland, Erin N. AU - Huntley, Bethany M AU - Kereselidze, Maia AU - Lazzar-Atwood, Alice AU - LeGrand, Kate E AU - Lindstrom, Akiaja AU - Linebarger, Emily AU - Lotufo, Paulo A AU - Lozano, Rafael AU - Magistro, Beatrice AU - Malta, Deborah Carvalho AU - Månsson, Johan AU - Herrera, Ana Maria Mantilla AU - Marinho, Fatima AU - Mirkuzie, Alemnesh H AU - Misganaw, Awoke Temesgen AU - Monasta, Lorenzo AU - Naik, Paulami AU - Nomura, Shuhei AU - O'Brien, Edward G AU - O'Halloran, James Kevin AU - Olana, Latera Tesfaye AU - Ostroff, Samuel M AU - Penberthy, Louise AU - Reiner, Robert C. AU - Reinke, Grace AU - Ribeiro, Antônio Luiz Pinho AU - Santomauro, Damian Francesco AU - Schmidt, Maria Inês AU - Shaw, David H AU - Sheena, Brittney S AU - Sholokhov, Aleksei AU - Skhvitaridze, Natia AU - Sorensen, Reed J D AU - Spurlock, Emma Elizabeth AU - Syailendrawati, Ruri AU - Topór‐Mądry, Roman AU - Troeger, Christopher E AU - Walcott, Rebecca AU - Walker, Ally AU - Wiysonge, Charles Shey AU - Worku, Nahom Alemseged AU - Zigler, Bethany AU - Pigott, David M AU - Naghavi, Mohsen AU - Mokdad, Ali H AU - Lim, Stephen S AU - Hay, Simon Iain AU - Gakidou, Emmanuela AU - Murray, Christopher J L TI - Estimating excess mortality due to the COVID-19 pandemic: a systematic analysis of COVID-19-related mortality, 2020–21 JO - The Lancet VL - 399 IS - 10334 SP - 1513 EP - 1536 PY - 2022 DA - 2022/03/10 DO - 10.1016/s0140-6736(21)02796-3 UR - https://doi.org/10.1016/s0140-6736(21)02796-3 ER -
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