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Relationship between COVID-19 cases and monthly mortality from all causes, cancer, cardiovascular diseases and diabetes in 16 countries, 2020–21

Relationship between COVID-19 cases and monthly mortality from all causes, cancer, cardiovascular diseases and diabetes in 16 countries, 2020–21
Relationship between COVID-19 cases and monthly mortality from all causes, cancer, cardiovascular diseases and diabetes in 16 countries, 2020–21

Background: during the COVID-19 pandemic, mortality from some chronic diseases increased. In this study, we evaluated monthly excess mortality from all causes, cancer, cardiovascular diseases (CVD) and diabetes during the months of 2020 and 2021, examining its relationship with COVID-19 cases. 

Methods: monthly cause-specific mortality data were downloaded from public repositories of national statistics offices or directly requested from them, and population data were obtained from the United Nations archives. Excess deaths were estimated as the difference between observed and expected deaths. Monthly expected deaths for 2020 and 2021 were calculated using a quasi-Poisson regression model trained on 2010-19 data (or a shorter timespan if the full decade of data was not available). To quantify the correlation between COVID-19 cases and monthly excess mortality, we used the Spearman's correlation coefficient (r s).

Results: the study included 16 countries that provided monthly national data on causes of death (Argentina, Austria, Brazil, Switzerland, Chile, the Czech Republic, Germany, Georgia, Hungary, Italy, Lithuania, Latvia, Mexico, Serbia, Slovakia and the USA). A positive correlation was found between COVID-19 cases and monthly excess mortality from all causes in all countries (r s ranging from 0.61 to 0.91), from CVD in 11 countries (r s ranging from 0.45 to 0.85) and for diabetes in 13 countries (r s ranging from 0.42 to 0.79). Excess mortality above 5% was estimated from all causes in 14 countries for both 2020 and 2021, from CVD in seven countries for 2020 and in nine countries for 2021, and from diabetes in 11 countries for 2020 and in 12 countries for 2021. No excess above 5% was estimated for cancer mortality in any of the countries considered. 

Conclusions: excess mortality from CVD and diabetes persisted in several countries throughout 2021. These increases coincide with COVID-19 peaks, supporting a short-term impact of the COVID-19 pandemic on mortality from these causes.

COVID-19, SARS-CoV-2, cancer, cardiovascular diseases, causes of death, diabetes, excess deaths, excess mortality, pandemic
1464-3685
Pizzato, Margherita
89143166-4c2e-41b7-8140-7d046dfcb342
Santucci, Claudia
f360829b-728d-44a0-a4fc-148178d34933
Islam, Nazrul
e5345196-7479-438f-b4f6-c372d2135586
La Vecchia, Carlo
2712dd2f-1f71-4cb8-ad8f-03f5b75187a2
Alicandro, Gianfranco
035cde0b-0b40-48cd-921a-44ecd82039bb
Pizzato, Margherita
89143166-4c2e-41b7-8140-7d046dfcb342
Santucci, Claudia
f360829b-728d-44a0-a4fc-148178d34933
Islam, Nazrul
e5345196-7479-438f-b4f6-c372d2135586
La Vecchia, Carlo
2712dd2f-1f71-4cb8-ad8f-03f5b75187a2
Alicandro, Gianfranco
035cde0b-0b40-48cd-921a-44ecd82039bb

Pizzato, Margherita, Santucci, Claudia, Islam, Nazrul, La Vecchia, Carlo and Alicandro, Gianfranco (2025) Relationship between COVID-19 cases and monthly mortality from all causes, cancer, cardiovascular diseases and diabetes in 16 countries, 2020–21. International Journal of Epidemiology, 54 (1), [dyaf006]. (doi:10.1093/ije/dyaf006).

Record type: Article

Abstract

Background: during the COVID-19 pandemic, mortality from some chronic diseases increased. In this study, we evaluated monthly excess mortality from all causes, cancer, cardiovascular diseases (CVD) and diabetes during the months of 2020 and 2021, examining its relationship with COVID-19 cases. 

Methods: monthly cause-specific mortality data were downloaded from public repositories of national statistics offices or directly requested from them, and population data were obtained from the United Nations archives. Excess deaths were estimated as the difference between observed and expected deaths. Monthly expected deaths for 2020 and 2021 were calculated using a quasi-Poisson regression model trained on 2010-19 data (or a shorter timespan if the full decade of data was not available). To quantify the correlation between COVID-19 cases and monthly excess mortality, we used the Spearman's correlation coefficient (r s).

Results: the study included 16 countries that provided monthly national data on causes of death (Argentina, Austria, Brazil, Switzerland, Chile, the Czech Republic, Germany, Georgia, Hungary, Italy, Lithuania, Latvia, Mexico, Serbia, Slovakia and the USA). A positive correlation was found between COVID-19 cases and monthly excess mortality from all causes in all countries (r s ranging from 0.61 to 0.91), from CVD in 11 countries (r s ranging from 0.45 to 0.85) and for diabetes in 13 countries (r s ranging from 0.42 to 0.79). Excess mortality above 5% was estimated from all causes in 14 countries for both 2020 and 2021, from CVD in seven countries for 2020 and in nine countries for 2021, and from diabetes in 11 countries for 2020 and in 12 countries for 2021. No excess above 5% was estimated for cancer mortality in any of the countries considered. 

Conclusions: excess mortality from CVD and diabetes persisted in several countries throughout 2021. These increases coincide with COVID-19 peaks, supporting a short-term impact of the COVID-19 pandemic on mortality from these causes.

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Accepted/In Press date: 17 January 2025
Published date: 13 February 2025
Keywords: COVID-19, SARS-CoV-2, cancer, cardiovascular diseases, causes of death, diabetes, excess deaths, excess mortality, pandemic

Identifiers

Local EPrints ID: 500734
URI: http://eprints.soton.ac.uk/id/eprint/500734
ISSN: 1464-3685
PURE UUID: 21d4efb7-831c-4c4b-ac53-043ba9a2f147
ORCID for Nazrul Islam: ORCID iD orcid.org/0000-0003-3982-4325

Catalogue record

Date deposited: 12 May 2025 16:40
Last modified: 13 May 2025 02:04

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Contributors

Author: Margherita Pizzato
Author: Claudia Santucci
Author: Nazrul Islam ORCID iD
Author: Carlo La Vecchia
Author: Gianfranco Alicandro

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