Excess mortality during the COVID-19 pandemic in Israel, March–November 2020: when, where, and for whom?

Abstract Background Excess all-cause mortality has been used in many countries as an estimate of mortality effects from COVID-19. What was the excess mortality in Israel in 2020 and when, where and for whom was this excess? Methods Mortality rates between March to November 2020 for various demographic groups, cities, month and week were compared with the average rate during 2017–2019 for the same groups or periods. Results Total mortality rates for March–November were significantly higher by 6% in 2020, than the average of 2017–2019, 14% higher among the Arab population and 5% among Jews and Others. Significantly higher monthly mortality rates were found in August, September and October by 11%, 13% and 19%, respectively, among Jews and Others, and by 19%, 64% and 40% in the Arab population. Excess mortality was significant only at older ages, 7% higher rates at ages 65–74 and 75–84 and 8% at ages 85 and above, and greater for males than females in all ages and population groups. Interestingly, mortality rates decreased significantly among the younger population aged under 25. The cities with most significant excess mortality were Ramla (25% higher), Bene Beraq (24%), Bat Yam (15%) and Jerusalem (8%). Conclusion Israel has seen significant excess mortality in August–October 2020, particularly in the Arab sector. The excess mortality in March–November was statistically significant only at older ages, over 65. It is very important to protect this susceptible population from exposure and prioritize them for inoculations. Lockdowns were successful in lowering the excess mortality. The excess mortality is similar to official data on COVID-19 deaths.

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A first analysis of excess mortality in Switzerland in 2020

PLoS ONE ◽

10.1371/journal.pone.0253505 ◽

2021 ◽

Vol 16 (6) ◽

pp. e0253505

Author(s):

Isabella Locatelli ◽

Valentin Rousson

Keyword(s):

Life Expectancy ◽

Excess Mortality ◽

The Elderly ◽

Mortality Rates ◽

Loss Of Life ◽

Key Indicator ◽

All Cause Mortality ◽

Specific Mortality ◽

Standardized Mortality Rate ◽

Official Data

Objective To quantify excess all-cause mortality in Switzerland in 2020, a key indicator for assessing direct and indirect consequences of the COVID-19 pandemic. Methods Using official data on deaths in Switzerland, all-cause mortality in 2020 was compared with that of previous years using directly standardized mortality rates, age- and sex-specific mortality rates, and life expectancy. Results The standardized mortality rate was 8.8% higher in 2020 than in 2019, returning to the level observed 5–6 years before, around the year 2015. This increase was greater for men (10.6%) than for women (7.2%) and was statistically significant only for men over 70 years of age, and for women over 75 years of age. The decrease in life expectancy in 2020 compared to 2019 was 0.7%, with a loss of 9.7 months for men and 5.3 months for women. Conclusions There was an excess mortality in Switzerland in 2020, linked to the COVID-19 pandemic. However, as this excess only concerned the elderly, the resulting loss of life expectancy was restricted to a few months, bringing the mortality level back to 2015.

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All-cause excess mortality in the State of Gujarat, India, during the COVID-19 pandemic (March 2020-April 2021)

10.1101/2021.08.22.21262432 ◽

2021 ◽

Cited By ~ 1

Author(s):

Rolando J. Acosta ◽

Biraj Patnaik ◽

Caroline Buckee ◽

Satchit Balsari ◽

Ayesha Mahmud

Keyword(s):

Excess Mortality ◽

Age Groups ◽

Total Mortality ◽

The State ◽

Demographic Groups ◽

Mortality Estimate ◽

Baseline Mortality ◽

Diagnostic Capacity ◽

The Impact ◽

Civil Death

AbstractOfficial COVID-19 mortality statistics are strongly influenced by the local diagnostic capacity, strength of the healthcare system, and the recording and reporting capacities on causes of death. This can result in significant undercounting of COVID-19 attributable deaths, making it challenging to understand the total mortality burden of the pandemic. Excess mortality, which is defined as the increase in observed death counts compared to a baseline expectation, provides an alternate measure of the mortality shock of the COVID-19 pandemic. Here, we use data from civil death registers for 54 municipalities across the state of Gujarat, India, to estimate the impact of the COVID-19 pandemic on all-cause mortality. Using a model fit to monthly data from January 2019 to February 2020, we estimate excess mortality over the course of the pandemic from March 2020 to April 2021. We estimated 16,000 [95% CI: 14,000, 18,000] excess deaths across these municipalities since March 2020. The sharpest increase in deaths was observed in April 2021, with an estimated 480% [95% CI: 390%, 580%] increase in mortality from expected counts for the same period. Females and the 40 to 60 age groups experienced a greater increase from baseline mortality compared to other demographic groups. Our excess mortality estimate for these 54 municipalities, representing approximately 5% of the state population, exceeds the official COVID-19 death count for the entire state of Gujarat.

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Excess mortality due to Covid-19? A comparison of total mortality in 2020 with total mortality in 2016 to 2019 in Germany, Sweden and Spain

PLoS ONE ◽

10.1371/journal.pone.0255540 ◽

2021 ◽

Vol 16 (8) ◽

pp. e0255540

Author(s):

Bernd Kowall ◽

Fabian Standl ◽

Florian Oesterling ◽

Bastian Brune ◽

Marcus Brinkmann ◽

...

Keyword(s):

Life Expectancy ◽

Confidence Intervals ◽

Excess Mortality ◽

Total Mortality ◽

Mortality Rates ◽

Health Consequences ◽

Demographic Development ◽

Standardized Mortality Ratios ◽

Expected Mortality ◽

Overall Mortality

Introduction Excess mortality is a suitable indicator of health consequences of COVID-19 because death from any cause is clearly defined contrary to death from Covid-19. We compared the overall mortality in 2020 with the overall mortality in 2016 to 2019 in Germany, Sweden and Spain. Contrary to other studies, we also took the demographic development between 2016 and 2020 and increasing life expectancy into account. Methods Using death and population figures from the EUROSTAT database, we estimated weekly and cumulative Standardized Mortality Ratios (SMR) with 95% confidence intervals (CI) for the year 2020. We applied two approaches to calculate weekly numbers of death expected in 2020: first, we used mean weekly mortality rates from 2016 to 2019 as expected mortality rates for 2020, and, second, to consider increasing life expectancy, we calculated expected mortality rates for 2020 by extrapolation from mortality rates from 2016 to 2019. Results In the first approach, the cumulative SMRs show that in Germany and Sweden there was no or little excess mortality in 2020 (SMR = 0.976 (95% CI: 0.974–0.978), and 1.030 (1.023–1.036), respectively), while in Spain the excess mortality was 14.8% (1.148 (1.144–1.151)). In the second approach, the corresponding SMRs for Germany and Sweden increased to 1.009 (1.007–1.011) and 1.083 (1.076–1.090), respectively, whereas results for Spain were virtually unchanged. Conclusion In 2020, there was barely any excess mortality in Germany for both approaches. In Sweden, excess mortality was 3% without, and 8% with consideration of increasing life expectancy.

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Death after Widow(er)hood: An Analysis of Mortality Rates up to 13 Years after Bereavement

OMEGA - Journal of Death and Dying ◽

10.2190/uv2x-byf5-uydj-fa2r ◽

1995 ◽

Vol 31 (1) ◽

pp. 35-49 ◽

Cited By ~ 22

Author(s):

Ann Bowling ◽

Joy Windsor

Keyword(s):

Survival Time ◽

Excess Mortality ◽

Mortality Rates ◽

Proportional Hazard ◽

Significant Excess ◽

Risk Of Mortality ◽

Best Fitting ◽

Males And Females ◽

Male Sex ◽

Fitting Model

The mortality rates of a national random sample of 503 elderly people who were widowed in 1979 were analyzed. Over the thirteen and a quarter year period analyzed, 62 percent of the sample had died. Although earlier analyses had indicated excess mortality in the first six months of bereavement for men aged 75+, there were no further significant excess mortality rates over the thirteen and a quarter year period analyzed. The data were analyzed by fitting Cox's proportional hazard regression model to the widowed's survival time for factors predicting survival time. The best fitting model for males and females indicated that risk of mortality at each period was associated with older age, male sex, and poorer functional ability (measured in 1979). Frequency of telephone contacts as a risk factor for survival period was only significant for the younger widowed.

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Are we really all in this together? The social patterning of mortality during the first wave of the COVID-19 pandemic in Belgium

International Journal for Equity in Health ◽

10.1186/s12939-021-01594-0 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Sylvie Gadeyne ◽

Lucia Rodriguez-Loureiro ◽

Johan Surkyn ◽

Wanda Van Hemelrijck ◽

Wilma Nusselder ◽

...

Keyword(s):

Linked Data ◽

Excess Mortality ◽

Living Arrangement ◽

Care Home ◽

Total Mortality ◽

Main Question ◽

Demographic Groups ◽

Socioeconomic Groups ◽

The Social ◽

All Cause Mortality

Abstract Background Belgium was one of the countries that was struck hard by COVID-19. Initially, the belief was that we were ‘all in it together’. Emerging evidence showed however that deprived socioeconomic groups suffered disproportionally. Yet, few studies are available for Belgium. The main question addressed in this paper is whether excess mortality during the first COVID-19 wave followed a social gradient and whether the classic mortality gradient was reproduced. Methods We used nationwide individually linked data from the Belgian National Register and the Census 2011. Age-standardized all-cause mortality rates were calculated during the first COVID-19 wave in weeks 11-20 in 2020 and compared with the rates during weeks 11-20 in 2015-2019 to calculate absolute and relative excess mortality by socioeconomic and -demographic characteristics. For both periods, relative inequalities in total mortality between socioeconomic and -demographic groups were calculated using Poisson regression. Analyses were stratified by age, gender and care home residence. Results Excess mortality during the first COVID-19 wave was high in collective households, with care homes hit extremely hard by the pandemic. The social patterning of excess mortality was rather inconsistent and deviated from the usual gradient, mainly through higher mortality excesses among higher socioeconomic groups classes in specific age-sex groups. Overall, the first COVID-19 wave did not change the social patterning of mortality, however. Differences in relative inequalities between both periods were generally small and insignificant, except by household living arrangement. Conclusion The social patterning during the first COVID-19 wave was exceptional as excess mortality did not follow the classic lines of higher mortality in lower classes and patterns were not always consistent. Relative mortality inequalities did not change substantially during the first COVID-19 wave compared to the reference period.

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A First Analysis of Excess Mortality in Switzerland in 2020

10.1101/2021.03.14.21253551 ◽

2021 ◽

Author(s):

Isabella Locatelli ◽

Valentin Rousson

Keyword(s):

Life Expectancy ◽

Excess Mortality ◽

The Elderly ◽

Mortality Rates ◽

Loss Of Life ◽

Key Indicator ◽

All Cause Mortality ◽

Specific Mortality ◽

Standardized Mortality Rate ◽

Official Data

AbstractObjectiveTo quantify the excess all-cause mortality in Switzerland in 2020, a key indicator for assessing direct and indirect consequences of the COVID-19 pandemic.MethodsUsing official data on deaths in Switzerland, all-cause mortality in 2020 was compared with that of previous years using directly standardized mortality rates, age- and sex-specific mortality rates, and life expectancy.ResultsThe standardized mortality rate was 8.6% higher in 2020 than in 2019, returning to the level observed 5-6 years ago. This increase was greater for men (10.4%) than for women (7.0%), and was statistically significant only for men over 70 years of age, and for women over 75 years of age. The decrease in life expectancy in 2020 compared to 2019 was about 1%, with a loss of 9.4 months for men and 5.1 months for women.ConclusionsThere was an excess mortality in Switzerland in 2020, linked to the COVID-19 pandemic. However, as this excess only concerned the elderly, the resulting loss of life expectancy was restricted to a few months.

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Trends in mortality from external causes in the Republic of Seychelles between 1989 and 2018

Scientific Reports ◽

10.1038/s41598-020-79228-8 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Anne Abio ◽

Pascal Bovet ◽

Joachim Didon ◽

Till Bärnighausen ◽

Masood Ali Shaikh ◽

...

Keyword(s):

Causes Of Death ◽

Road Traffic ◽

Marked Change ◽

Total Mortality ◽

Mortality Rates ◽

Vital Statistics ◽

African Region ◽

Road Traffic Injuries ◽

External Causes ◽

Over Time

AbstractData on injury-related mortality are scarce in the African region. Mortality from external causes in the Seychelles was assessed, where all deaths are medically certified and the population is regularly enumerated. The four fields for underlying causes of death recorded were reviewed in the national vital statistics register. The age-standardised mortality rates were estimated (per 100,000 person-years) from external causes in 1989–1998, 1999–2008, and 2009–2018. Mortality rates per 100,000 person-years from external causes were 4–5 times higher among males than females, and decreased among males over the three 10-year periods (127.5, 101.4, 97.1) but not among females (26.9, 23.1, 26.9). The contribution of external causes to total mortality did not change markedly over time (males 11.6%, females 4.3% in 1989–2018). Apart from external deaths from undetermined causes (males 14.6, females 2.4) and “other unintentional injuries” (males 14.1, females 8.0), the leading external causes of death in 2009–2018 were drowning (25.9), road traffic injuries (18.0) and suicide (10.4) among males; and road traffic injuries (4.6), drowning (3.4) and poisoning (2.6) among females. Mortality from broad categories of external causes did not change consistently over time but rates of road traffic injuries increased among males. External causes contributed approximately 1 in 10 deaths among males and 1 in 20 among females, with no marked change in cause-specific rates over time, except for road traffic injuries. These findings emphasise the need for programs and policies in various sectors to address this large, but mostly avoidable health burden.

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Diet, total plasma homocysteine concentrations and mortality rates in broiler chickens

Canadian Journal of Animal Science ◽

10.4141/a02-029 ◽

2003 ◽

Vol 83 (3) ◽

pp. 601-604 ◽

Cited By ~ 1

Author(s):

S. E. Samuels

Keyword(s):

Cardiovascular Disease ◽

Sudden Death ◽

Broiler Chickens ◽

Independent Risk Factor ◽

Total Mortality ◽

Mortality Rates ◽

Plasma Homocysteine ◽

Sudden Death Syndrome ◽

Total Plasma ◽

Elevated Plasma

The aim of this study was to determine if total plasma homocysteine (HCY) concentrations and mortality rates due to ascites syndrome and (AS) sudden death syndrome (SDS) in broiler chickens could be lowered by diet. Elevated plasma HCY is an independent risk factor for cardiovascular disease in humans. A total of 828 day-old male broiler chickens (Arbor Acre) were fed, for 6 wk, either a basal practical diet or one supplemented with excess vitamins B6 and B12, folic acid and betaine to stimulate the degradation of HCY. The supplemented diet decreased plasma HCY by 17% (P < 0.05; n = 16 per diet). Total mortality due to AS and SDS was 18% lower in the supplemented diet but this difference was not statistically significant. Key words: Homocysteine, folate, chickens, cardiovascular disease, ascites, sudden death syndrome

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Impact of the period of the day on mortality and major cardiovascular complications after vascular surgeries

European Heart Journal ◽

10.1093/ehjci/ehaa946.3213 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

F.A.M Cardozo ◽

T Artioli ◽

B Caramelli ◽

D Calderaro ◽

P.C Yu ◽

...

Keyword(s):

Multivariable Analysis ◽

Total Mortality ◽

Mortality Rates ◽

Cardiovascular Complications ◽

Cardiac Complications ◽

Funding Source ◽

Confounding Variables ◽

Significant Difference ◽

One Year ◽

Night Period

Abstract Introduction Patients submitted to arterial vascular surgeries are at a high risk of postoperative cardiac and non-cardiac complications, therefore developing strategies to lower perioperative complications is essential to optimize outcomes for this subgroup. Recent studies have suggested that the period of the day in which surgeries are performed may influence postoperative major cardiovascular complications but there is still no evidence of this association in vascular surgeries. Purpose Our goal is to evaluate whether the period of the day in which surgeries are performed may influence mortality and cardiovascular outcomes in patients undergoing non-cardiac vascular procedures. Methods Patients who underwent non-cardiac vascular surgeries between 2012 and 2018 were prospectively included at our cohort. For this analysis, subjects were categorized into two groups: those who underwent surgery in the morning (7am - 12am) and those who underwent surgery in the afternoon/night (12:01pm - 6:59am). The primary endpoints were to compare the incidence of major adverse cardiac events (MACE - acute myocardial infarction, acute heart failure, arrhythmias, and cardiovascular death) and total mortality between morning and afternoon/night surgeries within 30 days and one year. The secondary endpoint was the incidence of perioperative myocardial injury (PMI) in both groups. PMI was defined as an absolute elevation of high-sensitivity cardiac troponin T (hs-cTnT) concentrations ≥14ng/L. Multivariable analysis using Cox proportional regression (with Hazard Ratio – HR and Confidence Interval – 95% CI) was performed to adjust for confounding variables, including emergency and urgent surgeries. Results Of 1267 patients included, 1002 (79.1%) underwent vascular surgery in the morning and 265 (20.9%) in the afternoon/night. After adjusting for confounding variables, the incidence of MACE at 30 days was higher among those who underwent surgery in the afternoon/night period (37.4% vs 20.4% – HR 1.43, 95% CI: 1.10–1.85; p=0.008). Mortality rates were also elevated in the afternoon/night group (21.5% vs 9.9%, HR 1.59, 95% CI: 1.10–2.29; p=0.013). After one-year of follow-up the worst outcomes persisted in patients operated in the afternoon/night: higher incidence of MACE (37.7% vs 21.2%, HR 1.37, 95% CI: 1.06–1.78; p=0.017) and mortality (35.8% vs 17.6%, HR 1.72, 95% CI 1.31–2.27; p<0.001). There was no significant difference in the incidence of PMI between groups (p=0.8). Conclusions In this group of patients, being operated in the afternoon/night period was independently associated with increased mortality rates and incidence of MACE. Mortality and MACE at one year Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): FAPESP - Fundação de Amparo a Pesquisa do Estado de São Paulo

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Incidence, Characteristics, and Outcome of COVID-19 in Adults on Kidney Replacement Therapy: A Regionwide Registry Study

Journal of the American Society of Nephrology ◽

10.1681/asn.2020060875 ◽

2020 ◽

pp. ASN.2020060875

Author(s):

Johan De Meester ◽

Dirk De Bacquer ◽

Maarten Naesens ◽

Bjorn Meijers ◽

Marie M. Couttenye ◽

...

Keyword(s):

General Population ◽

Excess Mortality ◽

Mortality Rates ◽

Incidence Rates ◽

Registry Study ◽

Additional Risk ◽

Mortality Burden ◽

Kidney Replacement Therapy ◽

Expected Mortality ◽

Chronic Comorbidities

BackgroundSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection disproportionally affects frail, elderly patients and those with multiple chronic comorbidities. Whether patients on RRT have an additional risk because of their specific exposure and complex immune dysregulation is controversial.MethodsTo describe the incidence, characteristics, and outcomes of SARS-CoV-2 infection, we conducted a prospective, multicenter, region-wide registry study in adult patients on RRT versus the general population from March 2 to May 25, 2020. This study comprised all patients undergoing RRT in the Flanders region of Belgium, a country that has been severely affected by coronavirus disease 2019 (COVID-19).Results At the end of the epidemic wave, crude and age-standardized cumulative incidence rates of SARS-CoV-2 infection were 5.3% versus 2.5%, respectively, among 4297 patients on hemodialysis, and 1.4% versus 1.6%, respectively, among 3293 patients with kidney transplants (compared with 0.6% in the general population). Crude and age-standardized cumulative mortality rates were 29.6% versus 19.9%, respectively, among patients on hemodialysis, and 14.0% versus 23.0%, respectively, among patients with transplants (compared with 15.3% in the general population). We found no excess mortality in the hemodialysis population when compared with mean mortality rates during the same 12-week period in 2015–2019 because COVID-19 mortality was balanced by lower than expected mortality among uninfected patients. Only 0.18% of the kidney transplant population died of SARS-CoV-2 infection.ConclusionsMortality associated with SARS-CoV-2 infection is high in patients on RRT. Nevertheless, the epidemic’s overall effect on the RRT population remained remarkably limited in Flanders. Calculation of excess mortality and age standardization provide a more reliable picture of the mortality burden of COVID-19 among patients on RRT.

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