Modificaciones en la mortalidad por causas diferentes a COVID-19 durante el primer año de pandemia en Argentina, 2020 / Changes in non-COVID mortality during the first year of the pandemic in Argentina, 2020

RESUMEN INTRODUCCIÓN En 2020, primer año de pandemia (AP) de COVID-19, Argentina focalizó las acciones en la nueva enfermedad y dejó relegado el monitoreo de las otras (noCOV). El objetivo de este trabajo fue comparar la mortalidad por causas noCOV durante el AP con respecto a los 5 años del período previo a la pandemia (PPP) MÉTODOS Se realizó un estudio transversal con fuentes de datos secundarias y base poblacional nacional. Se utilizó la causa básica de muerte, desagregada a nivel de capítulo y grupos según la Clasificación Internacional de Enfermedades, 10a revisión. Se estimaron las tasas brutas (TBM) y ajustadas (TAM) de mortalidad, comparando con test t y considerando como significativo un valor p<0,05. Se calculó el exceso de mortalidad (EM) realizando la diferencia entre el número de defunciones noCOV del AP y el intervalo de confianza del 95% superior o inferior de la media de casos del PPP RESULTADOS La TBM disminuyó 9,1%, y el EM fue de -4,5%. Salvo en el caso de la diabetes mellitus y las enfermedades respiratorias sin especificar, la TAM disminuyó significativamente durante el AP. La mayor variación de TBM fue por infecciones respiratorias agudas bajas en menores de 19 años y por accidentes de transporte en adultos de 20 a 59 años y de 60 años o más (reducción de 46,3% y 48,8%, respectivamente) DISCUSIÓN Durante el AP hubo una disminución de la mortalidad por noCOV especialmente en el caso de las infecciones respiratorias agudas y los accidentes de tránsito.

ABSTRACT INTRODUCTION During 2020, the first year of the pandemic (YP), Argentina focused the actions on the new disease, leaving aside the monitoring of diseases other than COVID-19 (non-COV). The objective of this work was to compare mortality from non-COV causes during the YP with respect to the 5 years of the pre-pandemic period (PPP) METHODS A cross-sectional study was conducted using secondary data sources and national population-based data. The basic cause of death was disaggregated at the chapter and group level according to the International Classification of Diseases, 10th revision. Crude (CMR) and adjusted mortality rates (AMR) were estimated, comparing with t-test and considering significant a p-value<0.05. Excess mortality (EM) was calculated as the difference between the number of non-COV deaths in the YP and the upper or lower 95% confidence interval (CI95%) of the mean number of PPP cases RESULTS The CMR decreased by 9.1% and EM was -4.5%. Except for diabetes mellitus and unspecified respiratory diseases, the AMR showed a significant reduction during the YP. The greatest variation of CMR was due to acute lower respiratory infections in people under 19 years of age and due to transport accidents in adults aged 20 to 59 years and adults aged 60 or older (reduction of 46.3% and 48.8%, respectively) DISCUSSION During the YP there was a decrease in mortality due to non-COV causes, especially those related to acute respiratory infections and transport accidents.

Effects of environmental factors on the death of cardiovascular and cerebrovascular diseases during the high temperature process in Wuhan in 2014-2019 / 公共卫生与预防医学

Objective To explore the impact of temperature and environmental factors on the risk of deaths from cardiovascular and cerebrovascular diseases (CVD) in Wuhan during the course of high temperature. Methods The daily CVD death data and meteorological and atmospheric pollutant concentration data during the high temperature process in Wuhan from 2014 to 2019 were collected. The generalized additive models (GAM) were used to obtain the characteristics of meteorological factors, atmospheric pollutant concentrations, high impact factors and thresholds affecting the relative risk of CVD death. Results The analysis results showed that: (1) When the maximum temperature reached 36.7°C and the lowest temperature reached 25.3°C, the relative risk of CVD death increased significantly; (2) The risk of CVD death during the first high temperature process was the largest, and the average CVD excess mortality rate during the first high temperature process from 2014 to 2019 reached 21.7%; and (3) The average temperature, maximum temperature and PM10 during the course of high temperature were important environmental factors that increased the risk of CVD deaths, and the relative risks were 1.14 (95% confidence interval (95% CI): 1.11-1.17), 1.11 (95% confidence interval (95% CI): 1.08-1.15, and 1.06 (95% confidence interval (95% CI): 1.02-1.09), respectively. Conclusion Temperature and PM10 are important environmental factors that increase the risk of death from CVD during the high temperature process in Wuhan from 2014 to 2019, with the first annual high temperature process having the greatest impact on the risk of CVD death.

Excess of deaths during COVID-19 pandemic in Mato Grosso, Brazil / Excesso de mortes durante a pandemia de COVID-19 em Mato Grosso, Brasil

Abstract This article aims to estimate the excess of deaths in the years 2020 and 2021 in Mato Grosso state, in the state capital and in the countryside, according to gender and age group. Data was extracted from DATASUS/Ministry of Health website for the period from 2015 to 2020 and from the website of the State Department of Health - Data Warehouse System (DW) for 2021. Non-fetal deaths by natural causes of residents in Mato Grosso were analyzed and the analyses were broken down into countryside and state capital (Cuiabá). The variables selected were age group, gender, month of occurrence, and underlying cause of death. Excess mortality was calculated using generalized additive quasi-Poisson model adjustments with correction for overdispersion. A 30% excess of deaths was identified in 2020, with the state capital recording the highest estimate, in older age groups, and between the months of July and September. In 2021, the expected number of deaths was 57% higher, with the double in the younger age groups in the countryside. The study showed different demographic profiles of excess deaths in the years 2020 and 2021 during COVID-19 pandemic and distinct patterns between countryside and state capital, suggesting inequalities that may have caused impact on different risks.

Resumo O objetivo deste artigo é estimar o excesso de óbitos nos anos de 2020 e 2021 no estado de Mato Grosso, na capital do estado e no interior, segundo sexo e faixa etária. Os dados foram extraídos do site do DATASUS/Ministério da Saúde para o período de 2015 a 2020 e do site da Secretaria de Estado da Saúde - Sistema Data Warehouse (DW) para 2021. Óbitos não fetais por causas naturais de residentes no Mato Grosso foram analisados ​​e as análises foram divididas em interior e capital do estado (Cuiabá). As variáveis ​​selecionadas foram: faixa etária, sexo, mês de ocorrência e causa básica do óbito. O excesso de mortalidade foi calculado usando ajustes generalizados do modelo aditivo quase-Poisson com correção para superdispersão. Identificou-se um excesso de 30% de óbitos em 2020, com a capital do estado registrando a maior estimativa, nas faixas etárias mais avançadas, e entre os meses de julho e setembro. Em 2021, o número esperado de óbitos foi de 57% superior, sendo o dobro nas faixas etárias mais jovens do interior do estado. O estudo mostrou diferentes perfis demográficos de excesso de óbitos nos anos de 2020 e 2021 durante a pandemia de COVID-19 e padrões distintos entre interior e capital do estado, sugerindo desigualdades que podem ter impactado em diferentes riscos.

Excess mortality in elderly hip fracture patients: An Indian experience / 中华创伤杂志(英文版)

PURPOSE@#Hip fractures in elderly have a high mortality. However, there is limited literature on the excess mortality seen in hip fractures compared to the normal population. The purpose of this study was to compare the mortality of hip fractures with that of age and gender matched Indian population.@*METHODS@#There are 283 patients with hip fractures aged above 50 years admitted at single centre prospectively enrolled in this study. Patients were followed up for 1 year and the follow-up record was available for 279 patients. Mortality was assessed during the follow-up from chart review and/or by telephonic interview. One-year mortality of Indian population was obtained from public databases. Standardized mortality ratio (SMR) (observed mortality divided by expected mortality) was calculated. Kaplan-Meir analysis was used.@*RESULTS@#The overall 1-year mortality was 19.0% (53/279). Mortality increased with age (p < 0.001) and the highest mortality was seen in those above 80 years (aged 50 - 59 years: 5.0%, aged 60 - 69 years: 19.7%, aged 70 - 79 years: 15.8%, and aged over 80 years: 33.3%). Expected mortality of Indian population of similar age and gender profile was 3.7%, giving a SMR of 5.5. SMR for different age quintiles were: 3.9 (aged 50 - 59 years), 6.6 (aged 60 - 69 years), 2.2 (aged 70 - 79 years); and 2.0 (aged over 80 years). SMR in males and females were 5.7 and 5.3, respectively.@*CONCLUSIONS@#Indian patients sustaining hip fractures were about 5 times more likely to die than the general population. Although mortality rates increased with age, the highest excess mortality was seen in relatively younger patients. Hip fracture mortality was even higher than that of myocardial infarction, breast cancer, and cervical cancer.

Excesso de óbitos em adultos de Santa Catarina: estudo ecológico durante a pandemia de covid-19, 2020-2021 / Exceso de muertes en adultos en el estado de Santa Catarina: un estúdio ecológico en el período de la pandemia de COVID-19, Brasil, 2020-2021 / Excess deaths among adults in the state of Santa Catarina: an ecological study during the COVID-19 pandemic, Brazil, 2020-2021

Objective: to estimate excess deaths during the COVID-19 pandemic in the state of Santa Catarina and its macro-regions, Brazil, 2020-2021. Methods: this was an ecological study, using data from the Mortality Information System; excess deaths in adults were calculated by the difference between the observed number of deaths and expected number of deaths, taking into account the average of deaths that occurred between 2015 and 2019; the variables "macro-region of residence", "quarter", "month", "sex" and "age group" were analyzed; data were analyzed in a descriptive manner. Results: a total of 6,315 excess deaths in 2020 and 17,391 in 2021, mostly in males (57.4%) and those aged 60 years and older (74.0%); macro-regions and periods with the greatest excess deaths were those in which there were most deaths due to COVID-19; the greatest excess deaths occurred in March 2021 (n = 4,207), with a progressive decrease until the end of the year. Conclusion: there were excess deaths in the state of Santa Catarina and in all its macro-regions during the COVID-19 pandemic.

Objetivo: estimar el exceso de muertes en Santa Catarina y macrorregiones durante la pandemia de COVID-19, en los años 2020 y 2021. Métodos: estudio ecológico utilizando Sistema de Información de Mortalidad. El exceso de defunciones en adultos se calculó por la diferencia entre defunciones observadas y esperadas, considerando el promedio de defunciones entre 2015 y 2019. Las variables analizadas fueron: macrorregión de residencia, trimestre, mes, sexo y grupo de edad. Los datos se analizaron descriptivamente. Resultados: el exceso fue de 6.315 defunciones en 2020 y 17.391 en 2021, mayor en varones (57,4%) y mayores de 60 años (74,0%). Las macrorregiones y periodos con mayor superávit fueron los que registraron más muertes por COVID-19. El mayor exceso de muertes ocurrió en marzo de 2021 (n=4.207), con una disminución progresiva hasta el final del año. Conclusión: hubo exceso de muertes en Santa Catarina y en todas macrorregiones durante la pandemia de COVID-19.

Objetivo: estimar o excesso de óbitos durante a pandemia de covid-19 em Santa Catarina e suas macrorregiões, Brasil, 2020-2021. Métodos: estudo ecológico, com dados do Sistema de Informações sobre Mortalidade; o excesso de óbitos em adultos foi calculado pela diferença entre óbitos observados e óbitos esperados, considerando-se a média das mortes ocorridas entre 2015 e 2019; foram analisadas as variáveis "macrorregião de residência", "trimestre", "mês", "sexo" e "faixa etária"; os dados foram analisados descritivamente. Resultados: excesso de 6.315 óbitos em 2020 e de 17.391 em 2021, majoritariamente no sexo masculino (57,4%) e nas idades acima de 60 anos (74,0%); as macrorregiões e períodos com maior excedente foram aqueles com mais mortes por covid-19; o maior excesso ocorreu em março de 2021 (n = 4.207), com queda progressiva até o final do ano. Conclusão:houve excesso de óbitos em Santa Catarina e todas as suas macrorregiões durante a pandemia de covid-19.

Exceso de mortalidad por todas las causas en el marco de la pandemia por COVID-19 en el Valle del Cauca, 2020 / Excess Mortality from all Causes in the Framework of the COVID-19 Pandemic in Valle del Cauca, 2020

RESUMEN Introducción: La pandemia por COVID-19 ha causado un impacto negativo en la salud mundial. Colombia y específicamente el departamento del Valle del Cauca, no fue la excepción, por lo cual fue necesario implementar en todo el país diversos sistemas para la identificación, seguimiento y análisis del virus, que continúan a la fecha; en el marco de dicha necesidad se realizó esta investigación con el objeto de estimar el exceso de mortalidad por todas las causas en el departamento y compararlo con la carga de mortalidad del virus. Metodología: Se realizó un estudio observacional trasversal del exceso de mortalidad por todas las causas para el Valle del Cauca en 2020, empleando las defunciones no fetales oficiales del Departamento Administrativo Nacional de Estadística (DANE), calculando el exceso de mortalidad observada frente a la esperada, estimada utilizando proyecciones a partir de regresiones lineales. Resultados: Se encontró un exceso de mortalidad por todas las causas del 18,3 % para 2020, siendo mayor el incremento en hombres y en población de 45 años o más. Conclusiones: El exceso de mortalidad por todas las causas observadas en 2020 no se explica por el trasegar de la pandemia, dado que el volumen de defunciones observadas supera en más de 700 casos de la mortalidad que se esperaba según comportamiento histórico 2015-2019, y se evidenció un volumen importante de subregistros de mortalidad por COVID-19 o explicado por causas indirectas al virus.

ABSTRACT Introduction: The COVID-19 pandemic has had a negative impact on global health, and Colombia and, specifically, the Valle del Cauca Department are no exception, making it necessary to implement, throughout the country, various monitoring and analysis systems of the virus, which continue to this date. Within the framework of this need, the present investigation is proposed, with the aim of estimating the excess mortality from all causes in the department, and compare it with the mortality burden of the virus. Methodology: A cross-sectional observational study of excess mortality from all causes was carried out for Valle del Cauca in 2020, using official non-fetal deaths from DANE (National Administrative Department of Statistics), calculating the excess mortality observed compared to the expected one, using projections from the linear regression. Results: an excess of mortality from all causes of 18.3% was found for 2020, the increase being greater in men and the population aged 45 and over. Conclusions: The excess mortality from all causes observed in 2020 is not explained by the spread of the pandemic, given that the volume of deaths observed exceeds by more than 700 cases the mortality expected according to historical behavior 2015-2019, showing a significant volume of under-records of mortality due to COVID-19 or explained by indirect causes of the virus.

Exploratory analysis of the suitability of data from the civil registration system for estimating excess mortality due to COVID-19 in Faridabad district of India

Background & objectives: Due to shortcomings in death registration and medical certification, the excess death approach is recommended for COVID-19 mortality burden estimation. In this study the data from the civil registration system (CRS) from one district in India was explored for its suitability in the estimation of excess deaths, both directly and indirectly attributable to COVID-19. Methods: All deaths registered on the CRS portal at the selected registrar’s office of Faridabad district in Haryana between January 2016 and September 2021 were included. The deaths registered in 2020 and 2021 were compared to previous years (2016-2019), and excess mortality in both years was estimated by gender and age groups as the difference between the registered deaths and historical average month wise during 2016-2019 using three approaches – mean and 95 per cent confidence interval, FORECAST.ETS function in Microsoft Excel and linear regression. To assess the completeness of registration in the district, 150 deaths were sampled from crematoria and graveyards during 2020 and checked for registration in the CRS portal. Agreement in the cause of death (CoD) in CRS with the International Classification of Diseases-10 codes assigned for a subset of 585 deaths after verbal autopsy was calculated. Results: A total of 7017 deaths were registered in 2020, whereas 6792 deaths were registered till 30 September 2021 which represent a 9 and 44 per cent increase, respectively, from the historical average for that period. The highest increase was seen in the age group >60 yr (19% in 2020 and 56% in 2021). All deaths identified in crematoria and graveyards in 2020 had been registered. Observed peaks of all-cause excess deaths corresponded temporally and in magnitude to infection surges in the district. All three approaches gave overlapping estimates of the ratio of excess mortality to reported COVID-19 deaths of 1.8-4 in 2020 and 10.9-13.9 in 2021. There was poor agreement (?<0.4) between CoD in CRS and that assigned after physician review for most causes, except tuberculosis and injuries. Interpretation & conclusions: CRS data, despite the limitations, appeared to be appropriate for all-cause excess mortality estimation by age and sex but not by cause. There was an increase in death registration in 2020 and 2021 in the district.

Influenza-associated excess mortality in Zhejiang Province from 2016 to 2019 / 预防医学

Objective@#To estimate the influenza-associated excess mortality (IEM) in Zhejiang Province from 2016 to 2019, so as to provide insights into estimates of mortality burden due to influenza. @* Methods@#The data pertaining to all-cause death and influenza surveillance in Zhejiang Province from 2016 to 2019 were retrieved from Zhejiang Provincial Cause of Death Registration System and Influenza Surveillance System to create distributed lag non-linear models (DLNMs). The year-, influenza subtype- and age-specific IEM rates were estimated.@*Results@#The overall IEM was 18.67/105 (95%CI: 15.32/105-21.97/105) in Zhejiang Province from 2016 to 2019, with the lowest in 2016 (14.19/105, 95%CI: 12.00/105-16.37/105) and the highest in 2018 (22.92/105, 95%CI: 19.23/105-26.56/105). The IEM rates of influenza A (H1N1), influenza A (H3N2) and influenza B were 9.32/105 (95%CI: 7.65/105-10.98/105), 5.68/105 (95%CI: 4.24/105-7.11/105), and 3.66/105 (95%CI: 2.13/105-5.18/105). The greatest IEM was seen among residents at ages of 65 years and older (142.91/105, 95%CI: (115.99/105-169.55/105, followed by among individuals at ages of 15 to 64 years (2.74/105, 95%CI: 1.87/105-3.61/105), and the lowest was seen among individuals under 15 years of age (0.41/105, 95%CI: -0.33/105-1.14/105). @*Conclusions@#From 2016 to 2019, the highest IEM was seen in Zhejiang Province in 2018, and the elderly residents at ages of 65 years and above presented the greatest IEM, with influenza A (H1N1) as the predominant influenza subtype. Influenza surveillance and vaccination is recommended to be reinforced.

Estimating national excess mortality from subnational data: application to Argentina / Cálculo de la tasa nacional de exceso de mortalidad con datos subnacionales: el caso de Argentina / Estimativa do excesso de mortalidade nacional a partir de dados subnacionais: o caso da Argentina

ABSTRACT This paper presents a method to estimate excess mortality where national data are missing for some or all of the coronavirus disease 2019 (COVID-19) pandemic period, but subnational data exist, such as in Argentina. By making use of the stability of the regional distribution of deaths, data on deaths in Córdoba province were used to project excess deaths in Argentina from March 2020 up to the end of 2021. The number of excess deaths was estimated at 134 504, which is 14.8% higher than the reported number of COVID-19 deaths in Argentina for the same time period.

RESUMEN En este estudio se presenta un método para calcular el exceso de mortalidad cuando no se dispone de datos nacionales de una parte o la totalidad del período de la pandemia de la enfermedad por el coronavirus del 2019 (COVID-19), pero sí se cuenta con datos subnacionales, como es el caso en Argentina. Aprovechando la estabilidad de la distribución regional de las muertes, se emplearon los datos sobre las muertes en la provincia de Córdoba para hacer una proyección del exceso de mortalidad en Argentina desde marzo del 2020 hasta finales del 2021. Se estimó en 134 504 el número de muertes en exceso, que es 14,8% mayor que la cifra notificada de muertes por COVID-19 en Argentina en el mismo período.

RESUMO Este artigo apresenta um método para estimar o excesso de mortalidade durante a pandemia da doença causada pelo coronavírus 2019 (COVID-19) na Argentina quando faltam dados nacionais relativos a um dado período - ou ao período inteiro -, mas existem dados subnacionais disponíveis. Diante da estabilidade da distribuição regional das mortes, foram usados os dados de mortalidade da Província de Córdoba para fazer uma projeção do excesso de mortes ocorridas no país entre março de 2020 e o final de 2021. Estimou-se um excesso de 134 504 mortes, o que corresponde a 14,8% a mais do número notificado de mortes por COVID-19 na Argentina no mesmo período.

Excess mortality according to group of causes in the first year of the COVID-19 pandemic in Brazil / Excesso de mortalidade segundo grupo de causas no primeiro ano de pandemia de COVID-19 no Brasil

ABSTRACT Objective: To estimate excess mortality by cause of death in Brazil and states in 2020. Methods: We estimated the expected number of deaths considering a linear trend analysis with the number of deaths between 2015 and 2019 for each group of causes and each federative unit. We calculated standardized mortality ratios (SMR) and 95% confidence intervals for each SMR assuming a Poisson distribution. We performed the analyses in the R program, version 4.1.3. Results: We observed a 19% excess in deaths in 2020 (SMR=1.19; 95%CI=1.18-1.20). The Infectious and Parasitic Diseases group stood out among the defined causes (SMR=4.80; 95%CI 4.78-4.82). The ill-defined causes showed great magnitude in this period (SMR=6.08; 95%CI 6.06-6.10). Some groups had lower-than-expected deaths: respiratory diseases (10% lower than expected) and external causes (4% lower than expected). In addition to the global analysis of the country, we identified significant heterogeneity among the federative units. States with the highest SMR are concentrated in the northern region, and those with the lowest SMR are concentrated in the southern and southeastern regions. Conclusion: Excess mortality occurs during the COVID-19 pandemic. This excess results not only from COVID-19 itself, but also from the social response and the management of the health system in responding to a myriad of causes that already had a trend pattern before it.

RESUMO Objetivo: Estimar o excesso de mortalidade segundo causa de óbito no Brasil e estados em 2020. Métodos: O número de óbitos esperado foi estimado considerando análise de tendência linear com o número de mortes entre os anos de 2015 e 2019, para cada grupo de causas e cada unidade da federação. Calculamos as razões de mortalidade padronizadas, e os intervalos com 95% de confiança para cada SMR foram calculados assumindo uma distribuição Poisson. As análises foram realizadas no programa R, versão 4.1.3. Resultados: Observamos um excesso de 19% nos óbitos em 2020 (SMR=1,19; IC=1,18-1,20). O grupo de Doenças Infecciosas e Parasitárias obteve maior destaque entre as causas definidas (SMR=4,80; IC95% 4,78-4,82). As causas mal definidas apresentaram grande magnitude neste período (SMR=6,08; IC95% 6,06-6,10). Há, ainda, grupos que apresentaram número de óbitos abaixo do esperado: doenças do aparelho respiratório (10% abaixo do esperado) e causas externas (4% abaixo do esperado). Além da análise global para o país, identificamos grande heterogeneidade entre as unidades da federação. Os estados com maiores SMR estão concentrados na região norte, e os que possuem menores SMR estão concentrados nas regiões sul e sudeste. Conclusões: Há um excesso de mortalidade ocorrendo durante a pandemia de COVID-19. Este excesso é resultado não apenas da COVID-19 em si, mas da resposta social e da gestão do sistema de saúde em responder a uma miríade de causas que já possuíam um ritmo de tendência anterior a ela.

Excess Mortality due to natural causes among whites and blacks during the COVID-19 pandemic in Brazil

Abstract INTRODUCTION: Excess Mortality by all causes considers deaths directly related to COVID-19 and those attributed to conditions caused by the pandemic. When stratified by social dimensions, such as race/color, it allows for the evaluation of more vulnerable populations. The study estimated the excess mortality by natural causes, separating the white and black populations in 2020. METHODS Public civil registration data on deaths observed in 2020, corrected for under registration, were used. The expected number of deaths was estimated based on the mortality rates observed in 2019, applied to the estimated population in 2020. The difference between the values expected and observed and the proportion of excess was considered the excess mortality. RESULTS: The present study found an excess of 270,321 deaths (22.2% above the expected) in 2020. Every state of Brazil reported deaths above the corresponding expected figure. The excess was higher for men (25.2%) than for women (19.0%). Blacks showed an excess of 27.8%, as compared to whites at 17.6%. In both sexes and all age groups, excess was higher in the black population, especially in the South, Southeast, and Midwest regions. São Paulo, the largest in population number, had twice as much excess death in the black population (25.1%) than in the white population (11.5%). CONCLUSIONS: The present study showed racial disparities in excess mortality during the COVID-19 pandemic in Brazil. The higher excess found for the black suggests an intrinsic relationship with the socioeconomic situation, further exposing the Brazilian reality, in which social and structural inequality is evident.

All-cause excess mortality during the COVID-19 pandemic in Argentina, 2020 / Exceso de mortalidad por todas las causas en el contexto de la pandemia de covid-19 en argentina, 2020

RESUMEN INTRODUCCIÓN: La vigilancia del exceso de mortalidad (EM) por todas las causas puede ser utilizada para evaluar la magnitud del impacto de la pandemia de la enfermedad por el coronavirus 2019 (COVID-19, por sus siglas en inglés). El objetivo de este estudio fue calcular el EM en Argentina durante 2020 y compararlo con las muertes por COVID-19 notificadas en el Sistema Nacional de Vigilancia de la Salud (SNVS). MÉTODOS: Se realizó un estudio descriptivo, en el que se analizaron las series de defunciones por todas las causas de los períodos 2015-2019 y 2020, y las muertes por COVID-19 notificadas al SNVS durante 2020. El EM se estableció como la diferencia entre el número de defunciones por todas las causas del año 2020 y el umbral de alerta (percentil 75 de los datos históricos). Se calculó la proporción de muertes en exceso no explicadas por los casos confirmados de COVID-19 fallecidos. RESULTADOS: En 2020 el EM en Argentina fue de 10,6% (36 306 muertes sobre el umbral). En el primer semestre no hubo exceso, las muertes observadas se encontraron por debajo del límite inferior esperado; en el segundo semestre fue de 25,6% por encima del umbral. Se notificaron 45 568 fallecidos por COVID-19 mediante el SNVS. DISCUSIÓN: Los valores de mortalidad concuerdan con la evolución de la pandemia en el país. El sistema de notificación de fallecidos por COVID-19 es robusto debido al aporte de una amplia red y al cotejo con otras fuentes oficiales para completar la información en el SNVS.

ABSTRACT INTRODUCTION: All-cause excess mortality (EM) surveillance can be used to assess the impact of the COVID-19 pandemic. The aim of this study was to estimate the EM in Argentina in 2020 and compare it with the deaths from COVID-19 reported in the National Health Surveillance System (SNVS). METHODS: A descriptive study was conducted based on the analysis of all-cause mortality series for the period 2015-2019,2020 and confirmed COVID-19 deaths during 2020 in Argentina. The EM was calculated as the difference between the number of deaths in 2020 and the alert threshold (75th percentile of historical data). The proportion of excess deaths not explained by deaths reported by COVID-19 in the surveillance system was calculated. RESULTS: EM in Argentina in 2020 was 10.6% (36306 deaths above the threshold). In the first half of the year there was no excess, deaths were below the expected lower limit; in the second half of the year it was 25.6% above the threshold. A total of45568 COVID-19 deaths were reported to the SNVS. DISCUSSION: Mortality values are in accordance with the evolution of the pandemic in the country. The COVID-19 death reporting system is robust due to the contribution of a wide notification network and the cross-checking with other official sources to complete the information in the SNVS.

Mortalidade infantil e gênero no Brasil: uma investigação usando dados em painel / Infant mortality and gender in Brazil: an investigation using updated statistics

Resumo Diversos estudos indicam que a mortalidade para crianças do sexo masculino é maior do que a do feminino no Brasil. Estudos recentes também têm mostrado uma redução na sobremortalidade infantil masculina nos últimos anos. Entretanto, pouco se sabe sobre quais fatores estão associados a esse fenômeno. Como os bebês do sexo masculino são, em geral, mais frágeis, uma hipótese é de que melhorias no nível de renda e cuidados com a saúde pré e pós-natal tenham um impacto maior na redução da mortalidade infantil masculina. Dessa forma, o objetivo deste artigo foi analisar como esses fatores afetam a mortalidade no Brasil. Para a estimação do modelo, utilizaram-se dados estaduais do Brasil do período de 1996 a 2014. Os resultados indicam que a renda média, o baixo peso ao nascer, o número de consultas de pré-natal e a taxa de fecundidade são importantes fatores associados à mortalidade infantil no país. De modo geral, o impacto dessas variáveis é maior na mortalidade de crianças do sexo masculino, evidenciando que a maior fragilidade dessas crianças exige maior cuidado de pais e autoridades de saúde. Além disso, outros estudos podem analisar a importância do aleitamento materno sobre a mortalidade infantil e gênero no Brasil, de forma a verificar o impacto da amamentação na redução dos óbitos infantis.

Abstract Various studies reveal that male mortality is higher than female mortality among children in Brazil. Recent studies have also revealed a reduction in excess male infant mortality in the last few years. However, little is known about which factors are associated with this phenomenon. Since male infants are generally more susceptible, a potential hypothesis is that an improvement in income levels and pre- and post-natal healthcare have a greater impact on reducing male infant mortality. Thus, the scope of this article was to analyze how these factors affect infant mortality in Brazil. For the creation of the model, data for the period from 1996 to 2014 from Brazilian states were utilized. The results indicate that average income, low birth weight, the number of prenatal visits and the fertility rate, are important factors associated with infant mortality in the country. In general, the impact of these variables is greater in the mortality of male children, which would indicate that the higher susceptibility of male children requires greater care from the parents and the health authorities. Furthermore, future studies could analyze the importance of breastfeeding on infant mortality and gender in Brazil, in order to verify the impact of breastfeeding on the reduction of infant deaths.

Evaluation of excess mortality risk related to heat wave in Ningbofrom 2013 to 2018 / 预防医学

Objective @#To evaluate the excess mortality risk related to heat wave in Ningbo, Zhejiang from 2013 to 2018, so as to provide a basis for formulating coping strategies for heat wave.@*Methods @#The data of daily mortality, meteorological and air quality from May to October in Ningbo from 2013 to 2018 were obtained from Ningbo Center for Disease Control and Prevention, Ningbo Meteorological Bureau and Environmental Monitoring Center of Ningbo, respectively. The generalized linear model ( GLM ) and distributed lag non-linear model ( DLNM ) were used to estimate the associations between heat wave and cause-specific mortality. @*Results @#Among 1 104 days of the study period, 18 heat waves occured and lasted for 132 days, accounting for 11.96%. A total of 102 954 deaths were reported in the same period. The risks of mortality in circulatory system diseases ( RR=1.09, 95%CI: 1.03-1.16 ), respiratory system diseases ( RR=1.14, 95%CI: 1.04-1.25 ), digestive system diseases ( RR=1.38, 95%CI: 1.15-1.65 ), nervous system diseases ( RR=1.32, 95%CI: 1.08-1.61 ), mental disorders ( RR=1.51, 95%CI: 1.12-2.03 ) and accidental injury ( RR=1.18, 95%CI: 1.06-1.32 ) and all causes ( RR=1.10, 95%CI: 1.06-1.14 ) increased at lag 0-1 day of heat wave. The total excess death related to heat wave was 1 218 ( 95%CI: 731-1 705 ) . The excess deaths of circulatory system diseases, respiratory system diseases, accidental injury, digestive system diseases, nervous system diseases, mental disorders, urinary system diseases and endocrine system diseases were 313 ( 95%CI: 104-556 ), 206 ( 95%CI: 59-368 ), 164 ( 95%CI: 55-292 ), 122 ( 95%CI: 48-208 ), 69 ( 95%CI: 17-131 ), 56 ( 95%CI: 13-113 ), 18 ( 95%CI: -15-64 ) and 3 ( 95%CI: -51-72 ). The excess deaths of urinary system and endocrine system diseases was not statistically significant ( P>0.05 ). @*Conclusion @#Heat wave can increase the mortality risk on the day and after a day in Ningbo from 2013 to 2018. Circulatory system diseases, respiratory system diseases and accidental injury rank top three in excess deaths.

Estimación del exceso de mortalidad por todas las causas durante la pandemia del Covid-19 en México / All-cause excess mortality during the Covid-19 pandemic in Mexico

Resumen: Objetivo: Estimar el exceso de defunciones por todas las causas en México durante 2020. Material y métodos: Se construyó un canal endémico con las defunciones (2015-2019), estableciendo el umbral epidémico en el percentil 90, y se comparó con las actas de defunción para estimar el exceso de mortalidad. Resultados: A la semana 53, ocurrieron 326 612 defunciones en exceso (45.1%), con un máximo en la semana 28 (98.0%) y un mínimo en la semana 41 (35.2%); después de la semana 42, la tendencia vuelve a ser ascendente por el resto del año. Esto fue proporcionalmente mayor en los hombres (51.3%), principalmente de 45-64 años de edad, sin embargo, en los de 60 años o más ocurrió el mayor número de defunciones. Conclusión: En México, el exceso de mortalidad ha sido prolongado en comparación con otros países, con alta variabilidad interestatal. Esto podría deberse a las condiciones socioeconómicas y a la alta prevalencia de comorbilidades que aumentan el riesgo de morir en la población mexicana.

Abstract: Objective: To estimate excess mortality from all causes in Mexico in 2020. Materials and methods: We constructed an endemic channel with deaths (2015-2018) establishing the epidemic threshold at the 90th percentile, comparing with death certificates counts to estimate excess mortality. Results: At week 53, there were 326 612 excess deaths (45.1%), with a maximum in week 28 (98.0%) and a minimum at week 41 (35.2%); after week 42, the increasing trend remained for the rest of the year. It was proportionally higher in men, mainly aged 45-64 years, however, in those aged 60 and over, the highest number of deaths occurred. Conclusion: In Mexico, excess mortality has been prolonged compared to other countries, with high interstate variability. This could be explained by socioeconomic conditions and the high prevalence of comorbidities in the Mexican population.

Excesso de mortalidade no Brasil em tempos de COVID-19 / Excess mortality in Brazil in times of Covid-19

Resumo Tendo em vista o crescente número de óbitos pela pandemia de COVID-19 no país, o presente trabalho apresenta análise descritiva inicial e exploratória sobre o excesso de mortalidade observado nos meses de março a maio de 2020 nas capitais e nos demais municípios do país. A fonte de dados utilizada foi o registro de óbitos pelos Cartórios de Registro Civil. Os dados foram desagregados por capitais e demais municípios das 26 unidades federativas e do Distrito Federal segundo sexo. A razão de mortalidade ajustada para o ano de 2020 foi calculada tendo como padrão os coeficientes de mortalidade do ano de 2019. Os resultados indicaram excesso de 39.146 óbitos para o período estudado, sendo maior entre homens do que nas mulheres. Esse aumento foi maior nas capitais das regiões Norte, Nordeste e Sudeste. Nos demais municípios dessas regiões o incremento foi observado em maio, indicando possível interiorização da transmissão da COVID-19. Evidencia-se a necessidade de se aprimorar a detecção e o registro de casos para viabilizar o monitoramento eficiente da pandemia.

Abstract Given the growing number of deaths due to the COVID-19 pandemic in Brazil, this study presents an initial and exploratory descriptive analysis of the excess mortality observed from March to May 2020 in capitals and other municipalities. The data source was the death registers from the Civil Registry Offices. The data were disaggregated by gender and capitals and other municipalities of the 26 federative units and the Federal District. The standardized mortality ratio for 2020 was calculated with the 2019 mortality coefficients as standards. The results showed 39,146 excess deaths for the period studied and is higher among men. This increase was more significant among the capitals of the North, Northeast, and Southeast regions. In the other municipalities in these regions, the increase was observed in May, indicating a possible inland-bound COVID-19 transmission. The need to improve the detection and registration of cases is highlighted to enable the efficient monitoring of the pandemic.

Tracking excess deaths associated with the COVID-19 epidemic as an epidemiological surveillance strategy-preliminary results of the evaluation of six Brazilian capitals

Abstract INTRODUCTION: In March 2020, the World Health Organization declared the coronavirus disease (COVID-19) outbreak a pandemic. In Brazil, 110 thousand cases and 5,901 deaths were confirmed by the end of April 2020. The scarcity of laboratory resources, the overload on the service network, and the broad clinical spectrum of the disease make it difficult to document all the deaths due to COVID-19. The aim of this study was to assess the mortality rate in Brazilian capitals with a high incidence of COVID-19. METHODS: We assessed the weekly mortality between epidemiological week 1 and 16 in 2020 and the corresponding period in 2019. We estimated the expected mortality at 95% confidence interval by projecting the mortality in 2019 to the population in 2020, using data from the National Association of Civil Registrars (ARPEN-Brasil). RESULTS: In the five capitals with the highest incidence of COVID-19, we identified excess deaths during the pandemic. The age group above 60 years was severely affected, while 31% of the excess deaths occurred in the age group of 20-59 years. There was a strong correlation (r = 0.94) between excess deaths and the number of deaths confirmed by epidemiological monitoring. The epidemiological surveillance captured only 52% of all mortality associated with the COVID-19 pandemic in the cities examined. CONCLUSIONS: Considering the simplicity of the method and its low cost, we believe that the assessment of excess mortality associated with the COVID-19 pandemic should be used as a complementary tool for regular epidemiological surveillance.

Short term effect of PM2.5 on cardiovascular mortality in residents in Changping district, Beijing / 中华流行病学杂志

Objective@#To make a quantitative evaluation on the short term effect of particulate matter with aerodynamic diameter no more than 2.5 μm (PM2.5) on cumulative excess mortality rate (CER) and years of life lost (YLL) in residents in Changping district of Beijing.@*Methods@#The death data in local residents, daily mortality, meteorology data and air pollution data (PM2.5, SO2 and NO2 concentrations) in Changping from 2014 to 2017 were collected. Distributed lag non-linear model was used to assess the age and gender specific cumulative lag effects of PM2.5 on cardiovascular CER and daily YLL in Changping.@*Results@#The effects of PM2.5 on cardiovascular CER and YLL were obvious on lag 7 days and lag 9 days, respectively, peaking on day 14, and lasting for 21 days. On lag0-21 days, for a 10 μg/m3 increase in PM2.5, the population based CER of cardiovascular disease death was 0.021% (95%CI: 0.004%-0.038%), and the YLL was 1.47 (95%CI: 0.23-2.70) years. Greater PM2.5 effect were observed in males and the elderly.@*Conclusion@#PM2.5 increased the risk of cardiovascular disease death and YLL.

An analysis on the influenza -related excess mortality in Ningbo City / 预防医学

Objective To examine influenza -related excess mortality in Ningbo City from 2010—2014.Methods Data related to death and virology were collected from surveillance system of Ningbo Center for Disease Control and Prevention from 2010 to 2014.Rate differential model was used for data analysis to calculate excess mortality caused by five different cause of death.Results The duration of influenza prevalence was about 37 weeks from 2010 to 2014.The prevalent influenza strains from 2010—2013 were type B,H1NI and H3N2,and the prevalent influenza strains in 2014 were H1NI and H3N2 .From 2010 to 2014,for all cause of death (AC),the average influence -related excess mortality per week was 2.54 per 100 000 in Ningbo City.In five influence seasons,the average influence -related excess mortality for AC were 12.66 /100 000,15.19 /100 000,27.86 /100 000,12.66 /100 000 and 25.32 /100 000,respectively.The average influence -related excess mortality for five cause of death (PI,RC,IHD,COPD,AC)were 1.68 /100 000,12.83 /100 000,1.34 /100 000,0.84 /100 000 and 18.74 /100 000.During 5 monitoring years,annual excess mortality of≥65 group were more higher than that of total population,and annual excess mortality of 0 -4 group were lower than that of total population.Conclusion Influenza was prevalent mainly in winter and spring.The excess mortality resulted from influenza was high.Vaccinating people older than 65 and chronic cardiovascular patients could reduce the risk.

Analysis on cancer mortality level and change trends in Yingcheng of Hubei Province / 中华疾病控制杂志

Objective To analyze the level and change trends of cancer mortality in the media focused area,Yingcheng of Hubei Province,to further support the authenticity and reliability of the information from media report.Methods Use the data of the first national retrospective death survey and the third national retrospective sampling death survey to describe cancer mortality and change trends in Yingcheng of Hubei Province.Results Crude cancer mortality in Yingcheng was 148.26/100 000.In the past 30 years,cancer mortality significantly increased by 9.27 times.Among 100 000 people in the county,each year 43 cases of malignant tumor death occurred more than the national average level.A variety of malignant tumors' mortality change in the county is significantly different from those of the country,such as esophageal cancer,stomach cancer did not fall but rise;liver cancer,lung cancer,leukaemia and colorectal cancer increased 5.84 times,5.61 times,5.07 times and 17.91 times more than the national average,respectively.The excess mortality rate of stomach cancer,liver cancer,lung cancer and colorectal cancer were 15.32/100 000,16.78/100 000,8.32/100 000 and 3.98/100 000 respectively.Negative binomial distribution fitting results suggest that death of stomach cancer exists village aggregation.Conclusions The level of historical cancer mortality in Yingcheng was low,but increase quickly,presently it is on the national high-incidence level.It presents the phenomenon that a variety of malignant tumors is generally on high-incidence level and stomach cancer exists village aggregation.