背景:为了研究COVID-19大流行对死亡率的影响,我们估计了24个国家2020年和2021年的超额全因死亡率,总体上按性别和年龄分层.
方法:总计,收集了2015-2021年的特定年龄和特定性别的每周全因死亡率,并通过比较2020年和2021年的每周年龄标准化死亡率与预期死亡率来计算2020年和2021年的超额死亡率,根据历史数据(2015-2019年)估计,考虑季节性,以及长期和短期的趋势。使用粗死亡率类似地计算特定年龄的每周超额死亡率。使用简单和多水平回归模型研究了国家和大流行相关变量与超额死亡率的关系。
结果:在奥地利发现了2020年和2021年的超额累计死亡率,巴西,比利时,塞浦路斯,英格兰和威尔士,爱沙尼亚,法国,格鲁吉亚,希腊,以色列,意大利,哈萨克斯坦,毛里求斯,北爱尔兰,挪威,秘鲁,波兰,斯洛文尼亚,西班牙,瑞典,乌克兰,和美国。澳大利亚和丹麦仅在2021年经历了超额死亡率。在这两年中,毛里求斯的全因死亡率在统计上显着下降。COVID-19的每周发病率与两年的超额死亡率显著正相关,但随着完全接种疫苗的人口百分比的增加,正相关在2021年减弱。控制措施的严谨性指数分别与2020年和2021年的超额死亡率呈正相关和负相关。
结论:这项研究提供了证据,表明在大流行的头2年中,大多数国家的死亡率都在大幅增加,控制措施的严格性和疫苗接种率在确定超额死亡率的幅度方面相互作用。
BACKGROUND: To examine the impact of the COVID-19 pandemic on mortality, we estimated excess all-cause mortality in 24 countries for 2020 and 2021, overall and stratified by sex and age.
METHODS: Total, age-specific and sex-specific weekly all-cause mortality was collected for 2015-2021 and excess mortality for 2020 and 2021 was calculated by comparing weekly 2020 and 2021 age-standardised mortality rates against expected mortality, estimated based on historical data (2015-2019), accounting for seasonality, and long-term and short-term trends. Age-specific weekly excess mortality was similarly calculated using crude mortality rates. The association of country and pandemic-related variables with excess mortality was investigated using simple and multilevel regression models.
RESULTS: Excess cumulative mortality for both 2020 and 2021 was found in Austria, Brazil, Belgium, Cyprus, England and Wales, Estonia, France, Georgia, Greece, Israel, Italy, Kazakhstan, Mauritius, Northern Ireland, Norway, Peru, Poland, Slovenia, Spain, Sweden, Ukraine, and the USA. Australia and Denmark experienced excess mortality only in 2021. Mauritius demonstrated a statistically significant decrease in all-cause mortality during both years. Weekly incidence of COVID-19 was significantly positively associated with excess mortality for both years, but the positive association was attenuated in 2021 as percentage of the population fully vaccinated increased. Stringency index of control measures was positively and negatively associated with excess mortality in 2020 and 2021, respectively.
CONCLUSIONS: This study provides evidence of substantial excess mortality in most countries investigated during the first 2 years of the pandemic and suggests that COVID-19 incidence, stringency of control measures and vaccination rates interacted in determining the magnitude of excess mortality.