背景:目前,报告的COVID-19死亡不足以评估大流行对全球超额死亡率的影响。全因超额死亡率是世卫组织推荐的评估COVID-19死亡负担的指标。然而,该指数评估的全球超额死亡率尚不清楚.我们的目的是评估COVID-19大流行期间的全球超额死亡率。
方法:我们搜索了PubMed,EMBASE,和WebofScience在2020年1月1日至2022年5月21日以英文发表的研究。纳入了报告大流行期间超额死亡率数据的横断面和队列研究。两名研究人员独立搜索了已发表的研究,提取的数据,并评估质量。采用Mantel-Haenszel随机效应方法估计合并风险差异(RD)及其95%置信区间(CI)。
结果:共纳入来自20项研究的79个国家。在COVID-19大流行期间,在2,228,109,318个人中,报告了17,974,051例全因死亡,预计死亡人数为15,498,145人。汇总的全球超额死亡率为104.84(95%CI85.56-124.13)/100,000。南美的总超额死亡率最高[134.02(95%CI:68.24-199.80)/100,000],而大洋洲的最低[-32.15(95%CI:-60.53--3.77)/100,000]。发展中国家的超额死亡率[135.80(95%CI:107.83-163.76)/100,000]高于发达国家[68.08(95%CI:42.61-93.55)/100,000]。中低收入国家[133.45(95%CI:75.10-191.81)/100,000]和中高收入国家[149.88(110.35-189.38)/100,000]的超额死亡率高于高收入国家[75.54(95%CI:53.44-97.64)/100,000]。男性的超额死亡率[130.10(95%CI:94.15-166.05)/100,000]高于女性[102.16(95%CI:85.76-118.56)/100,000]。≥60岁人群的超额死亡率最高[781.74(95%CI:626.24-937.24)/100,000]。
结论:在全球COVID-19大流行期间,汇总的全球超额死亡率为每100,000例死亡104.84例,报告的全因死亡人数高于预期死亡人数。在南美洲,发展中国家和中等收入国家,男性人口,年龄≥60岁的个体有较重的超额死亡负担.
BACKGROUND: Currently, reported COVID-19 deaths are inadequate to assess the impact of the pandemic on global excess mortality. All-cause excess mortality is a WHO-recommended index for assessing the death burden of COVID-19. However, the global excess mortality assessed by this index remains unclear. We aimed to assess the global excess mortality during the COVID-19 pandemic.
METHODS: We searched PubMed, EMBASE, and Web of Science for studies published in English between 1 January 2020, and 21 May 2022. Cross-sectional and cohort studies that reported data about excess mortality during the pandemic were included. Two researchers independently searched the published studies, extracted data, and assessed quality. The Mantel-Haenszel random-effects method was adopted to estimate pooled risk difference (RD) and their 95% confidence intervals (CIs).
RESULTS: A total of 79 countries from twenty studies were included. During the COVID-19 pandemic, of 2,228,109,318 individuals, 17,974,051 all-cause deaths were reported, and 15,498,145 deaths were expected. The pooled global excess mortality was 104.84 (95% CI 85.56-124.13) per 100,000. South America had the highest pooled excess mortality [134.02 (95% CI: 68.24-199.80) per 100,000], while Oceania had the lowest [-32.15 (95% CI: -60.53--3.77) per 100,000]. Developing countries had higher excess mortality [135.80 (95% CI: 107.83-163.76) per 100,000] than developed countries [68.08 (95% CI: 42.61-93.55) per 100,000]. Lower middle-income countries [133.45 (95% CI: 75.10-191.81) per 100,000] and upper-middle-income countries [149.88 (110.35-189.38) per 100,000] had higher excess mortality than high-income countries [75.54 (95% CI: 53.44-97.64) per 100,000]. Males had higher excess mortality [130.10 (95% CI: 94.15-166.05) per 100,000] than females [102.16 (95% CI: 85.76-118.56) per 100,000]. The population aged ≥ 60 years had the highest excess mortality [781.74 (95% CI: 626.24-937.24) per 100,000].
CONCLUSIONS: The pooled global excess mortality was 104.84 deaths per 100,000, and the number of reported all-cause deaths was higher than expected deaths during the global COVID-19 pandemic. In South America, developing and middle-income countries, male populations, and individuals aged ≥ 60 years had a heavier excess mortality burden.