Estimating excess mortality due to the COVID-19 pandemic: a systematic analysis of COVID-19-related mortality, 2020-21
The World Health Organization website defines ‘excess mortality’ as the difference between the number of deaths reported during a crisis and those recorded in normal conditions. Published on the website of The Lancet, a peer-reviewed medical journal, this report estimates the excess mortality rates during the Covid-19 pandemic between January 2020 and December 2021 in 191 countries and 252 subnational units.
The 24-page paper was written by the COVID-19 Excess Mortality Collaborators, a team of 96 researchers from across countries, and analyses ‘all cause mortality reports’ from 74 countries and territories and 266 subnational units. The paper finds that the pandemic’s impact has been more severe than the Covid-19 death tally indicates: 18.2 million people worldwide died between January 2020 and December 2021, in contrast with the reported Covid-19 deaths of 5.94 million.
Reasons for the gap between actual and reported deaths include low testing capacity in certain areas, varying systems for registering Covid-19 deaths across countries, and a lack of consensus in the global medical community regarding when the death of a person infected with Covid-19 can be attributed to the virus. The paper encourages the strengthening of health monitoring and death registration systems around the world.
The reported Covid-19 mortality rate from January 2020 to December 2021 was 39.2 per 100,000 people. The paper estimates the excess mortality rate – the difference in the number of deaths recorded during a crisis compared to those recorded in normal conditions – to be 120.3 deaths for every 100,000 people.
India and USA registered the highest number of cumulative excess deaths during the pandemic. India recorded 4.07 million estimated excess deaths, whereas USA reported 1.13 million.
The excess mortality rate in India was estimated to be 152.5 deaths per 100,000 people between January 2020 and December 2021. The reported Covid-19 mortality rate during this period was much lower: 18 deaths per 100,000 people.
The paper found considerable variation in the mortality rates of the 30 Indian states and union territories analysed. The states of Chhattisgarh, Haryana, Himachal Pradesh, Karnataka, Maharashtra, Manipur, Punjab and Uttarakhand reported more than 200 excess mortalities per 100,000 people. On the other hand, Arunachal Pradesh, Goa, Gujarat, Jharkhand, Rajasthan, Sikkim, Telangana, Uttar Pradesh and West Bengal recorded lesser than the global rate of 120.6 excess mortalities per 100,000 people.
As many as 21 of the 191 surveyed countries recorded excess mortality rates above 300 deaths per 100,000 people. Countries with the highest estimated excess mortality rates were Bolivia (734.9), Bulgaria (647.3), Eswatini (634.9), North Macedonia (583.6) and Lesotho (562.9).
Some countries reported negative excess mortality rates: Iceland (-47.8 per 100,000 people), Australia (-37.6), Singapore (-15.8), New Zealand (-9.3) and Taiwan (-5.9).
Apart from India and USA, countries that registered estimated cumulative excess deaths over 500,000 were Russia (1.07 million), Mexico (798,000), Brazil (792,000), Indonesia (736,000) and Pakistan (664,000). These seven countries contributed to more than half of the global excess deaths due to Covid-19 in 2020 and 2021.
Countries that registered estimated excess deaths of more than 250,000 were Bangladesh (413,000), Peru (349,000), South Africa (302,000), Iran (274,000), Egypt (265,000) and Italy (259,000). States with high death rates were spread across the world, depicting the global spread of the pandemic.
The report calculates the ratio of the excess mortality rate to the reported Covid-19 mortality rate to highlight the extent of undercounting. Among the 191 countries, the ones with the lowest ratios (indicating less undercounting) were New Zealand (-17.1), Iceland (-8.49), Australia (-8.03), Taiwan (-3.2) and Singapore (-2.14). Countries with the highest ratios were Tanzania (178.81), Nicaragua (149.99), Central African Republic (139.24), Burundi (126.85) and Tajikistan (115.80).
In South Asia, the ratios between the excess mortality rate and reported Covid-19 mortality rate for various countries were: India (8.33), Nepal (10.61), Bangladesh (14.72), Pakistan (22.99) and Bhutan (36.06).
Focus and factoids by Tathagat Singh.
PARI Library's health archive project is part of an initiative supported by the Azim Premji University to develop a free-access repository of health-related reports relevant to rural India.
COVID-19 Excess Mortality Collaborators
COVID-19 Excess Mortality Collaborators
10 Mar, 2022