Nearly 1 million extra deaths occurred in high-income countries in 2020

Across 29 high-income countries, excess deaths in 2020 — the contrast between the number of all-cause deaths compared with historic projections — approached 1 million, a recent study showed.

In most countries, the estimated number of excess deaths surpassed the number of reported COVID-19 deaths, according to Nazrul Islam, PhD, MBBS, MPH, a quantitative research associate from the MRC Epidemiology Unit at the University of Cambridge, and colleagues. In the United States and the United Kingdom, the estimated number of excess deaths were more than 30% higher than the number of COVID-19 deaths.

Writing in The BMJ, Islam and colleagues noted that the “accuracy and completeness of reported deaths from COVID-19” as well as efforts to bring the pandemic under control across countries and jurisdictions vary greatly.

“Therefore, assessment of the full impact of the pandemic on mortality should include both the direct effect of the pandemic on deaths from COVID-19 and the indirect effect of the pandemic on deaths from other causes, as might be expected from the disruption to health services or from wider economic and social changes,” they continued.

The researchers analyzed data from Human Mortality Database from 2016 to 2020 and compared the data with weekly excess deaths in 2020. The findings were stratified by sex and age.

Islam and colleagues reported that overall, an estimated 979,000 excess deaths (95% CI, 954,000-1,001,000) occurred in high-income countries in 2020. Broken down by country, the U.S. had the highest absolute number (excess deaths = 458,000; 95% CI, 454,000-461,000), followed by Italy (excess deaths = 89,100; 95% CI, 87,500-90,700), England and Wales (excess deaths = 85,400; 95% CI, 83,900-86,800), Spain (excess deaths = 84,100; 95% CI, 82,800-85,300) and Poland (excess deaths = 60,100; 95% CI, 58,800- 61,300). New Zealand, Norway and Denmark were the only countries that did not have excess deaths.

“In most countries, age-specific excess death rates were higher in men than in women,” the researchers wrote.

For each 100,000 men, the data show the highest excess death rates occurred in Lithuania (excess deaths = 285; 95% CI, 259-311), Poland (excess deaths = 191; 95% CI, 184-197), Spain (excess deaths = 179; 95% CI, 174-184), Hungary (excess deaths = 174; 95% CI, 161-188) and Italy (excess deaths = 168; 95% CI, 163-173). For each 100,000 women, the highest rates were in Lithuania (excess deaths = 210; 95% CI, 185-234), Spain (excess deaths = 180; 95% CI, 175-185), Hungary (excess deaths = 169; 95 CI, 156-182), Slovenia (excess deaths = 158; 95% CI, 132-184) and Belgium (excess deaths = 151; 95% CI,141-162).

According to Islam and colleagues, “little evidence was found of subsequent compensatory reductions following excess mortality.”

They added that their U.S. findings are “consistent” with CDC projections. In addition, the overall estimates up to May 2020 that Italy, Spain and England and Wales had the highest number of excess deaths also correspond with findings that were reported in Nature Medicine and The Guardian newspaper.

Islam and colleagues also wrote that their study underscores the importance of having data aggregated by age and sex, and “suggest that many countries had an underestimation or underreporting of COVID-19 deaths, a substantial increase in non-COVID-19 deaths, or both.”

“Our study also highlights the need for nuanced analysis taking into account the other potential sources of social inequalities including ethnicity and socioeconomic status,” they wrote.

In a related editorial, Jonathan M. Clarke, PhD, a faculty member of natural sciences in the department of mathematics at Imperial College in London, and colleagues noted that excess morbidity between and within countries must be determined “if we are to truly understand and intervene to mitigate the impact of the pandemic.”

They also called for additional research and policies into “long COVID,” since “the true burden of this condition has yet to be quantified.”

References:

BMJ. Study finds almost 1 million extra deaths in 29 high-income countries in 2020. Available at: https://www.eurekalert.org/pub_releases/2021-05/b-sfa051821.php. Accessed May 19, 2021.

Clarke JM, et al. 2021;doi:10.1136/bmj.n1239.

Islam N, et al. BMJ. 2021;doi:10.1136/bmj.n1137.