PDF(Pubmed)
Abstract：
Excess death estimates have great value in public health, but they can be sensitive to analytical choices. Here we propose a multiverse analysis approach that considers all possible different time periods for defining the reference baseline and a range of 1 to 4 years for the projected time period for which excess deaths are calculated. We used data from the Human Mortality Database on 33 countries with detailed age-stratified death information on an annual basis during the period 2009-2021. The use of different time periods for reference baseline led to large variability in the absolute magnitude of the exact excess death estimates. However, the relative ranking of different countries compared to others for specific years remained largely unaltered. The relative ranking of different years for the specific country was also largely independent of baseline. Averaging across all possible analyses, distinct time patterns were discerned across different countries. Countries had declines between 2009 and 2019, but the steepness of the decline varied markedly. There were also large differences across countries on whether the COVID-19 pandemic years 2020-2021 resulted in an increase of excess deaths and by how much. Consideration of longer projected time windows resulted in substantial shrinking of the excess deaths in many, but not all countries. Multiverse analysis of excess deaths over long periods of interest can offer an approach that better accounts for the uncertainty in estimating expected mortality patterns, comparative mortality trends across different countries, and the nature of observed mortality peaks.
摘要：
超额死亡估计在公共卫生方面有很大价值，但它们对分析选择很敏感.在这里，我们提出了一种多元分析方法，该方法考虑了定义参考基线的所有可能的不同时间段，以及计算超额死亡的预计时间段的1至4年范围。我们使用了来自33个国家的人类死亡率数据库的数据，并在2009-2021年期间每年提供详细的年龄分层死亡信息。使用不同的时间段作为参考基线导致确切的超额死亡估计值的绝对幅度存在很大差异。然而,不同国家与其他国家在特定年份的相对排名基本保持不变。特定国家不同年份的相对排名也在很大程度上独立于基线。对所有可能的分析进行平均，不同的时间模式在不同的国家被辨别出来。各国在2009年至2019年期间有所下降，但下降的幅度差异很大。各国在2020-2021年COVID-19大流行是否导致超额死亡人数增加以及增加多少方面也存在很大差异。考虑到更长的预计时间窗口，导致许多人的超额死亡人数大幅减少，但不是所有国家。对长期感兴趣的超额死亡进行多重分析可以提供一种方法，可以更好地解释估计预期死亡率模式的不确定性，不同国家的死亡率比较趋势，以及观察到的死亡率峰值的性质。
