Magnitude, demographics and dynamics of the effect of the first wave of the COVID-19 pandemic on all-cause mortality in 21 industrialized countries
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Abstract
The Coronavirus Disease 2019 (COVID-19) pandemic has changed many social, economic, environmental and healthcare determinants of health. We applied an ensemble of 16 Bayesian models to vital statistics data to estimate the all-cause mortality effect of the pandemic for 21 industrialized countries. From mid-February through May 2020, 206,000 (95% credible interval, 178,100-231,000) more people died in these countries than would have had the pandemic not occurred. The number of excess deaths, excess deaths per 100,000 people and relative increase in deaths were similar between men and women in most countries. England and Wales and Spain experienced the largest effect: ~100 excess deaths per 100,000 people, equivalent to a 37% (30-44%) relative increase in England and Wales and 38% (31-45%) in Spain. Bulgaria, New Zealand, Slovakia, Australia, Czechia, Hungary, Poland, Norway, Denmark and Finland experienced mortality changes that ranged from possible small declines to increases of 5% or less in either sex. The heterogeneous mortality effects of the COVID-19 pandemic reflect differences in how well countries have managed the pandemic and the resilience and preparedness of the health and social care system.
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Each of the data series observed in prior analyses has potential biases: reported cases capture only a portion of infections; reported deaths capture only a subset of total COVID-19 deaths; the IFR can vary widely over time and across locations; the proportion of patients with an infection who are admitted to hospital can vary over time and location; and seroprevalence surveys can be influenced by
“The fundamental problem in all of these analyses is that each of the data series observed has potential biases”
From Estimating global, regional, and national daily and cumulative infections with SARS-CoV-2 through Nov 14, 2021: a statistical analysis (2022) · cites this paper as [18]
Other countries, such as Australia and New Zealand, have shown how early and effective lockdowns, combined with geographical isolation and travel restrictions, have kept transmission low throughout the study period.
“Other countries, such as Australia and New Zealand, have shown how early and effective lockdowns, combined with geographical isolation and travel restrictions, have kept transmission low throughout the study period.18, 55, 56”
From Estimating global, regional, and national daily and cumulative infections with SARS-CoV-2 through Nov 14, 2021: a statistical analysis (2022) · cites this paper as [18]
Pandemic excess mortality patterns have been heterogeneous globally.
“Pandemic excess mortality patterns have been heterogeneous globally (Islam et al., 2021; Karlinsky & Kobak, 2021; Kontis et al., 2020; Nørgaard et al., 2021).”
From Direct and indirect mortality impacts of the COVID-19 pandemic in the United States, March 1, 2020 to January 1, 2022 (2023) · cites this paper as Kontis et al., 2020
There was greater disconnect between estimates in hard-hit countries such as the UK, Spain, Italy, and Belgium.
“However, there was greater disconnect between estimates in hard-hit countries such as the UK, Spain, Italy, and Belgium (Kontis et al., 2020; Kontopantelis et al., 2021; Odone et al., 2021).”
From Direct and indirect mortality impacts of the COVID-19 pandemic in the United States, March 1, 2020 to January 1, 2022 (2023) · cites this paper as Kontis et al., 2020
In a comprehensive analysis of mortality in 21 countries in Europe, New Zealand and Australia, official COVID-19 deaths accounted for an average of 77% (62%−93%) of all-cause excess deaths during the first wave of the pandemic March-May 2020.
“In a comprehensive analysis of mortality in 21 countries in Europe, New Zealand and Australia, official COVID-19 deaths accounted for an average of 77% (62%−93%) of all-cause excess deaths during the first wave of the pandemic March-May 2020 (Kontis et al., 2020).”
From Direct and indirect mortality impacts of the COVID-19 pandemic in the United States, March 1, 2020 to January 1, 2022 (2023) · cites this paper as Kontis et al., 2020
In New Zealand, where control of COVID-19 has been remarkable, mortality was slightly but not significantly below baseline.
“Interestingly, in New Zealand, where control of COVID-19 has been remarkable, mortality was slightly but not significantly below baseline (Kontis et al., 2020).”
From Direct and indirect mortality impacts of the COVID-19 pandemic in the United States, March 1, 2020 to January 1, 2022 (2023) · cites this paper as Kontis et al., 2020
Estimates of expected deaths should ideally account for recent temporal trends in mortality that are likely to have occurred in the absence of the pandemic.
“However, estimates of expected deaths should ideally account for recent temporal trends in mortality that are likely to have occurred in the absence of the pandemic.”
From Excess deaths associated with covid-19 pandemic in 2020: age and sex disaggregated time series analysis in 29 high income countries (2021) · cites this paper as [21]
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- Authors
- Kontis, V., Bennett, J. E., Rashid, T., Parks, R. M., Pearson-Stuttard, J., Guillot, M., Asaria, P., Zhou, B., Battaglini, M., Corsetti, G., McKee, M., Di Cesare, M., Mathers, C. D., & Ezzati, M.
- Affiliations
- MRC Centre for Environment and Health (GB)
- Columbia University (US)
- Institut national d'études démographiques (FR)
- Istituto Nazionale di Statistica (IT)
- London School of Hygiene & Tropical Medicine (GB)
- University of Ghana (GH)
- Corresponding author
- Ezzati, Majid
- ORCID
- Venue
- Nature Medicine
- Published
- 2020-10-14
- Volume
- 26
- Issue
- 12
- Pages
- 1919-1928
- ISSN
- 1078-8956 (ISSN-L)
- 1546-170X
- PMC
- PMC7615092
- OpenAlex
- W3093011094
- Cited by
- 410
- References
- 45
- Citations by year
- 2026: 19 · 2025: 33 · 2024: 40 · 2023: 54 · 2022: 90 · 2021: 164 · 2020: 10
- FWCI
- 12.64
- Type
- journal article
- Language
- en
- Update notices
- correction (2021-02-02)
- Open access
- bronze
- doi.org
- Locations
- Nature Medicine (publishedVersion)
- medRxiv (acceptedVersion, cc-by)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Archined (submittedVersion)
- Middlesex University Research Repository (Middlesex University Of London) (submittedVersion)
- Spiral (Imperial College London) (submittedVersion)
- Funders
- Wellcome Trust (209376/Z/17/Z)
- Abdul Latif Jameel Institute for Disease and Emergency Analytics at Imperial College London
- Topics
- Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
- Health Sciences › Medicine › Oncology › COVID-19 and healthcare impacts
- Social Sciences › Demography › Insurance, Mortality, Demography, Risk Management
- Keywords
- COVID-19 pandemic, excess mortality, all-cause mortality, sex differences in mortality, developed countries, pandemic response, health system resilience, health system preparedness, vital statistics
- MeSH terms
- Industrial Development, COVID-19, SARS-CoV-2, Cause of Death, Demography, Female, Geography, Humans, Male, Mortality, Population Density, Population Dynamics, Public Policy, Time Factors, Developed Countries, Pandemics
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