Impact of the COVID-19 pandemic on total, sex- and age-specific all-cause mortality in 20 countries worldwide during 2020: results from the C-MOR project
Christiana A. Demetriou, Souzana Achilleos, Annalisa Quattrocchi, John Gabel, Elena Critselis, Constantina Constantinou, Nicoletta Nicolaou, Giuseppe Ambrosio, Catherine Bennett, Nolwenn Le Meur, Julia Critchley, Laust Hvas Mortensen, José Manuel Rodriguez-Llanes, Mario Chong, Gleb Denissov, Petra Klepac, Lucy Goldsmith, Antônio José Leal Costa, Terje P. Hagen, Marie Chan Sun, Qian Huang, Nataliia Pidmurniak, Inbar Zucker, Joseph Cuthbertson, Bo Burström, Manuel Barrón, Ivan Eržen, Fabrizio Stracci, Wilson Calmon, Cyndy Martial, Olesia Verstiuk, Zalman Kaufman, Wenjing Tao, Maia Kereselidze, Nino Chikhladze, Claudia Zimmermann, Eva Schernhammer, Antonis Polemitis, Andreas Charalambous
Abstract
BACKGROUND: To understand the impact of the COVID-19 pandemic on mortality, this study investigates overall, sex- and age-specific excess all-cause mortality in 20 countries, during 2020. METHODS: Total, sex- and age-specific weekly all-cause mortality for 2015-2020 was collected from national vital statistics databases. Excess mortality for 2020 was calculated by comparing weekly 2020 observed mortality against expected mortality, estimated from historical data (2015-2019) accounting for seasonality, long- and short-term trends. Crude and age-standardized rates were analysed for total and sex-specific mortality. RESULTS: Austria, Brazil, Cyprus, England and Wales, France, Georgia, Israel, Italy, Northern Ireland, Peru, Scotland, Slovenia, Sweden, and the USA displayed substantial excess age-standardized mortality of varying duration during 2020, while Australia, Denmark, Estonia, Mauritius, Norway, and Ukraine did not. In sex-specific analyses, excess mortality was higher in males than females, except for Slovenia (higher in females) and Cyprus (similar in both sexes). Lastly, for most countries substantial excess mortality was only detectable (Austria, Cyprus, Israel, and Slovenia) or was higher (Brazil, England and Wales, France, Georgia, Italy, Northern Ireland, Sweden, Peru and the USA) in the oldest age group investigated. Peru demonstrated substantial excess mortality even in the <45 age group. CONCLUSIONS: This study highlights that excess all-cause mortality during 2020 is context dependent, with specific countries, sex- and age-groups being most affected. As the pandemic continues, tracking excess mortality is important to accurately estimate the true toll of COVID-19, while at the same time investigating the effects of changing contexts, different variants, testing, quarantine, and vaccination strategies.