Excess Mortality from Diabetes Mellitus in the First Year of the Pandemic in Colombia

Objectives: To describe the mortality from diabetes mellitus before and after the first year of the COVID 19 pandemic in Colombia. Method(s): We conducted an ecological study to describe mortality from DM in Colombia by sex and age groups, before and in the first year of the pandemic in Colombia. We obtained DM mortality data from the national agency for population statistics (known as DANE for its initials in Spanish) which collects vital statistics in Colombia. We analyzed anonymized mortality records coded as DM (code 601 from causes of mortality grouped according to the list 6/67 of the PAHO for ICD, 10th revision) for 2019-2020 considering only the underlying cause of death. The variables considered were year of registration of death, number of deaths per year, sex, age, and underlying cause of death. Result(s): In 2019 and 2020 there were 244,355 and 300,853 deaths by all causes respectively. Out of 56,498 (23.1%) excess deaths, 46,019 were due to COVID-19 (code U071). Deaths from DM for were 7,967 (3.26% out of total;2.71% men - 3.94% women) in 2019 and 10,198 (3.39% out of total;2.82% men - 4.15% women) in 2020. The increase for deaths from DM was 28% (n=2,231) 32.7% for men(n=1,193) and 24% for women (n=1,038). Conclusion(s): The COVID-19 pandemic increased deaths from DM in Colombia with a greater impact on men. Priority should be given to rebuild health care services for chronic diseases.Copyright © 2023

The forensic pathologist's public health role

While historically some have viewed the work of medical examiners/coroners (ME/C) and death investigators as predominantly serving the criminal justice system, in fact, the act of certifying a death is—in and of itself—a public health endeavor. The purpose of the death certificate is to track how and why individuals die as a means of helping others survive. Death certificates do save lives. In addition to generating these vital statistics, which guide public health policy, ME/C also perform a public health service in a variety of other ways. For instance, autopsy pathologists report unsafe consumer products, warn of recreational hazards (e.g., the dangers of snowmobile or all-terrain vehicle use), publicize and report occupational hazards (e.g., falls and electrocution risks), identify toxic exposures (e.g., carbon monoxide from defective heating units), and evaluate the safety of medical therapies. At autopsy, ME/C perform infectious disease surveillance, diagnosing and reporting communicable diseases such as bacterial meningitis, tuberculosis, and Legionella, thereby helping to mitigate disease spread in the community. They identify and characterize emerging infectious threats, such as COVID-19. They track violent deaths, including homicides, suicides, accidents, child and domestic abuse deaths, maternal mortality, and overdose deaths—to name a few—and participate as members of death review teams that attempt to identify systemic issues and prevent further such deaths. © 2023 Elsevier Inc. All rights reserved.

Bodies in Transit: Speculation and the Biopolitical Imaginary

This essay explores the Bodies in Transit archive, an artifact of mid-nineteenth-century public health administration in New York City. The ledgers, which tracked the transit of every corpse that moved through the island of Manhattan between 1859 and 1894 and categorized entrants by their cause of death, nationality, and occupation, present a unique lens through which I explore the intersections of speculation, biopolitics, and urban space. I first establish a conceptual framework of "speculation" by dissecting its etymological genealogy, the roots of which share a preoccupation with vision and sight. I note that in practice, the ing and rationalizing tendencies of speculation operate by envisioning, calculating, and coercing specific outcomes into realization. I apply this framework to Bodies in Transit to historicize the ways in which biopolitics, the means through which the state forms, represents, and manages populations, are indexed to speculative economic practices. I read Bodies in Transit through the framework of speculation to articulate a field of meaning that illuminates the complex material and epistemic conditions surrounding its implementation and utility. As I argue, the ledgers were a response to the acceleration of real estate speculation in Manhattan, a trend that incentivized property owners to disinter burial grounds to relocate corpses to rural areas, and thereby connected the speculative logics of real estate to those of public health, spatial order, and surveillance. By thinking across and through the layered meanings of "speculation," this essay illuminates how the state's economy of knowledge is intimately related to biopolitical practices of surveillance and representations of financial value in the modern city.

Discrepancies between preliminary and final COVID-19 mortality data-the case of Serbia.

PURPOSE: Since the start of the COVID-19 pandemic, countries have scrambled to set up data collection and dissemination pipelines for various online datasets. This study aims to evaluate the reliability of the preliminary COVID-19 mortality data from Serbia, which has been included in major COVID-19 databases and utilized for research purposes worldwide. METHODS: Discrepancies between the preliminary mortality data and the final mortality data in Serbia were analyzed. The preliminary data were reported through an emergency-necessitated system, while the final data were generated by the regular vital statistics pipeline. We identified databases that include these data and conducted a literature review of articles that utilized them. RESULTS: The number of deaths due to COVID-19 in Serbia, as reported preliminarily, does not align with the final death toll, which is more than three times higher. Our literature review identified at least 86 studies that were impacted by these problematic data. CONCLUSIONS: We strongly advise researchers to disregard the preliminary COVID-19 mortality data from Serbia due to the significant discrepancies with the final data. We recommend validating any preliminary data using excess mortality if all-cause mortality data are available.

Mortality related to pulmonary embolism in the United States before and during the COVID-19 pandemic: An analysis of the CDC Multiple Cause of Death database

Background: The COVID-19 pandemic caused a large number of excess deaths. COVID-19 emerged as a prothrombotic disease often complicated by pulmonary embolism (PE). In light of this, we hypothesized that PErelated mortality rates (stable before the pandemic) would be characterized by an increasing trend following the COVID-19 outbreak. Purpose(s): To investigate the mortality rates associated with PE among deaths with or without COVID-19 during the 2020 pandemic in the United States (US). Method(s): For this retrospective epidemiological study, we analyzed public medically certified vital registration data (death certificates encompassing underlying and multiple causes of death) from the Mortality Multiple Cause-of-Death database provided by the Division of Vital Statistics of the US Centers for Disease Control and Prevention (CDC;US, 2018-20). We investigated the time trends in monthly PE-related crude mortality rates for 2018-2019 and for 2020 (the latter associated vs. not associated with COVID-19), utilizing annual national population totals from the US Census Bureau. Second, we calculated the PE-related proportionate mortality among COVID-19 deaths (overall and limited to autopsy-based diagnosis). We performed subgroup analyses based on age groups, sex and race. Result(s): During 2020, 49,423 deaths in association with PE were reported, vs. 39,450 in 2019 and 38,215 in 2018. The crude PE-related mortality rate without COVID-19 was 13.3 per 100,000 population in 2020 compared to 11.7 in 2018 and 12.0 in 2019 (Figure 1A). The PE-related mortality rate with COVID-19 was 1.6 per 100,000 population in 2020. Among non- COVID-19-related deaths, the crude PE-related mortality rate was higher in women;among COVID-19-related deaths, it was higher in men. PE-related mortality rates were approximately two-fold higher among black (vs. white) general population irrespective of COVID-19 status (Figures 1B and 1C). Among COVID-19 deaths, PE-related deaths corresponded to 1.4% of total;the value rose to 6.0% when an autopsy was performed. This figure was higher in men and its time evolution is depicted in Figure 2A. The proportionate mortality of PE in COVID-19 deaths was higher for younger age groups (15-44 years) compared to non-COVID-19-related deaths (Figure 2B). Conclusion(s): In 2020, an overall 20%-increase in PE-related mortality was reported, not being limited to patients with COVID-19. Our findings could be interpreted in the context of undiagnosed COVID-19 cases, uncounted late sequelae, and possibly sedentary lifestyle and avoidance of healthcare facilities during the pandemic that may have prevented timely diagnosis and treatment of other diseases. Whether vaccination programs had an impact on PE-associated mortality in the year 2021, remains to be determined.

Chronic Diseases Associated With Mortality in British Columbia, Canada During the 2021 Western North America Extreme Heat Event.

Western North America experienced an unprecedented extreme heat event (EHE) in 2021, characterized by high temperatures and reduced air quality. There were approximately 740 excess deaths during the EHE in the province of British Columbia, making it one of the deadliest weather events in Canadian history. It is important to understand who is at risk of death during EHEs so that appropriate public health interventions can be developed. This study compares 1,614 deaths from 25 June to 02 July 2021 with 6,524 deaths on the same dates from 2012 to 2020 to examine differences in the prevalence of 26 chronic diseases between the two groups. Conditional logistic regression was used to estimate the odds ratio (OR) for each chronic disease, adjusted for age, sex, and all other diseases, and conditioned on geographic area. The OR [95% confidence interval] for schizophrenia among all EHE deaths was 3.07 [2.39, 3.94], and was larger than the ORs for other conditions. Chronic kidney disease and ischemic heart disease were also significantly increased among all EHE deaths, with ORs of 1.36 [1.18, 1.56] and 1.18 [1.00, 1.38], respectively. Chronic diseases associated with EHE mortality were somewhat different for deaths attributed to extreme heat, deaths with an unknown/pending cause, and non-heat-related deaths. Schizophrenia was the only condition associated with significantly increased odds of EHE mortality in all three subgroups. These results confirm the role of mental illness in EHE risk and provide further impetus for interventions that target specific groups of high-risk individuals based on underlying chronic conditions.

The Need to Address Fragmentation and Silos in Mortality Information Systems: The Case of Ghana and Peru.

Objectives: We aimed to understand the information architecture and degree of integration of mortality surveillance systems in Ghana and Peru. Methods: We conducted a cross-sectional study using a combination of document review and unstructured interviews to describe and analyse the sub-systems collecting mortality data. Results: We identified 18 and 16 information subsystems with independent databases capturing death events in Peru and Ghana respectively. The mortality information architecture was highly fragmented with a multiplicity of unconnected data silos and with formal and informal data collection systems. Conclusion: Reliable and timely information about who dies where and from what underlying cause is essential to reporting progress on Sustainable Development Goals, ensuring policies are responding to population health dynamics, and understanding the impact of threats and events like the COVID-19 pandemic. Integrating systems hosted in different parts of government remains a challenge for countries and limits the ability of statistics systems to produce accurate and timely information. Our study exposes multiple opportunities to improve the design of mortality surveillance systems by integrating existing subsystems currently operating in silos.

Digitalisation of birth registration system in Malaysia: Boon or bane for the hard-to-reach and marginalised?

Access to birth registration among the refugees, migrants, and undocumented or stateless individuals in Sabah and Peninsular Malaysia remains hindered largely due to their lack of legal status. This study identifies the barriers to birth registration faced by these communities, including during the COVID-19 pandemic, and explores the extent to which digital technologies may overcome or amplify these barriers. Findings are reported from a review of literature, websites, and media articles and semi-structured interviews with community-based organisations and community leaders representing the communities. The themes for the questions were structured based on Plan International's (2015) Step-by-step Guide for Identifying and Addressing the Risks to Children in Digitised birth registration systems. We identified that the digitalisation of birth registration poses more risks of exclusion than benefits to the marginalised communities without a secure and inclusive operating environment. Subject to an inequality assessment to evaluate and address the existing inequalities, a hybrid system that factors in the role of citizen facilitation hubs would be ideal for ensuring no one gets "left behind".

Vital Events and Estimation of Mortality during COVID-19 Pandemic

Vital statistics-where vital means the different events that occur in one’s life and statistics is the branch of mathematics that help in the study of collection, analysis, interpretation, and presentation. Therefore, vital statistics means the branch that agrees with the collection,analysis, interpretation, and presentation of vital events. Here, in this paper, we will learn about the basic vital statistics in detail which include its types, history, methodology, and uses. Moreover, it also explains the different vital rates that are useful to us in several ways and, lastly, life tables. Finally, the mortality estimation has been used from the recent pandemic COVID-19 for a better understanding.

Physicians' Perceptions as Predictors of the Future Use of the National Death Information System in Peru: Cross-sectional Study.

BACKGROUND: A computer application called the National Death Information System (SINADEF) was implemented in Peru so that physicians can prepare death certificates in electronic format and the information is available online. In 2018, only half of the estimated deaths in Peru were certified using SINADEF. When a death is certified in paper format, the probability being entered in the mortality database decreases. It is important to know, from the user's perspective, the factors that can influence the successful implementation of SINADEF. SINADEF can only be successfully implemented if it is known whether physicians believe that it is useful and easy to operate. OBJECTIVE: The aim of this study was to identify the perceptions of physicians and other factors as predictors of their behavioral intention to use SINADEF to certify a death. METHODS: This study had an observational, cross-sectional design. A survey was provided to physicians working in Peru, who used SINADEF to certify a death for a period of 12 months, starting in November 2019. A questionnaire was adapted based on the Technology Acceptance Model. The questions measured the dimensions of subjective norm, image, job relevance, output quality, demonstrability of results, perceived usefulness, perceived ease of use, and behavioral intention to use. Chi-square and logistic regression tests were used in the analysis, and a confidence level of 95% was chosen to support a significant association. RESULTS: In this study, 272 physicians responded to the survey; 184 (67.6%) were men and the average age was 45.3 (SD 10.1) years. The age range was 24 to 73 years. In the bivariate analysis, the intention to use SINADEF was found to be associated with (1) perceived usefulness, expressed as "using SINADEF avoids falsifying a death certificate" (P<.001), "using SINADEF reduces the risk of errors" (P<.001), and "using SINADEF allows for filling out a certificate in less time" (P<.001); and (2) perceived ease of use, expressed as "I think SINADEF is easy to use" (P<.001). In the logistic regression, perceived usefulness (odds ratio [OR] 8.5, 95% CI 2.2-32.3; P=.002), perceived ease of use (OR 10.1, 95% CI 2.4-41.8; P=.001), and training in filling out death certificates (OR 8.3, 95% CI 1.6-42.8; P=.01) were found to be predictors of the behavioral intention to use SINADEF. CONCLUSIONS: The behavioral intention to use SINADEF was related to the perception that it is an easy-to-use system, the belief that it improves the performance of physicians in carrying out the task at hand, and with training in filling out death certificates.

Coverage of deaths with medical certification in Peru, 2012 -2019

The strengthening of civil registration and vital statistics (RCEV) systems is essential to assess the impact of health interventions and the effects of health emergencies. Peru faced the COVID-19 pandemic, in the process of strengthening the RCEV system, in which the implementation of SINADEF stood out, which allowed it to improve the quality and coverage of information on mortality. A compilation of information from various public information sources was carried out to calculate the coverage of mortality in Peru for the period 2012 to 2019. The coverage of deaths with medical certification rose from 57.65% in 2016 to 71.6% in 2019 and improved in all regions of Peru at the national level, additionally, online certification of deaths rose from 29% in 2017 to 86% in 2020. The SINADEF has made it possible to implement a rapid mortality surveillance system and measure the excess mortality that is occurring in the context of the pandemic.

COVID-19 and all-cause mortality in South Africa – the hidden deaths in the first four waves

Accurate statistics are essential for policy guidance and decisions. However, the reported number of cases and COVID-19 deaths are known to be biased due to under-ascertainment of SARS-CoV-2 and incomplete reporting of deaths. Making use of death data from the National Population Register has made it possible to track in near-real time the number of excess deaths experienced in South Africa. These data reveal considerable provincial differences in the impact of COVID-19, likely associated with differences in population age structure and density, patterns of social mixing, and differences in the prevalence of known comorbidities such as diabetes, hypertension, and obesity. As the waves unfolded, levels of natural immunity together with vaccination began to reduce levels of mortality. Mortality rates during the second (Beta) wave were much higher than mortality in the third (Delta) wave, which were higher than in either the first or the fourth (Omicron) waves. However, the cumulative death toll during the second (Beta) wave was of a similar order of magnitude as that during the third (Delta) wave due to the longer duration of the Delta wave. Near-real time monitoring of all-cause deaths should be refined to provide more granular-level information to enable district-level policy support. In the meanwhile, there is an urgent need to re-engineer the civil registration and vital statistics system to enable more timely access to cause of death information for public health actions.

Characterization of Excess Death in the Mexican State of Guanajuato, during the COVID-19 Pandemic: An Ecological Study

Due to SARS-CoV-2 infection, which causes COVID-19, the total number of annual deaths increased in Mexico during 2020. To analyze the mortality in the Mexican state of Guanajuato from 2015 to 2020, we designed an ecological study. We used the registries of deaths in the vital statistics database of the Epidemiological and Statistical Subsystem of Deaths that includes age, sex, cause of death, epidemiological week of death as variables. Mortality Rates, Rates Ratios, Difference of Rates, Adjusted Mortality Rates, Adjusted Rates Ratios, and Difference of Rates were computed as part of the statistical analysis. To show the patterns regarding deaths in Guanajuato Sate from 2015 to 2020, we also calculated some dendrograms. The difference between the number of deaths in 2020 and 2019 is 13,286, while, in previous years, the differences were under 3000. The percentage of males that died (59.30%) shows an increment in 2020. Also, the mean age increased in 2020 (62.9 ± 22.56). The gender ratio of deaths (males/females) is greater than 1 in all the age groups except for those over 80. The age and geographic patterns of deaths changed in 2020. The 3rd cause of death among the top 10 leading causes is COVID-19. It has been detected an excess of mortality in 2020, although the integrity of the record is questionable since COVID-19 is an emergent disease. The highest effect is observed among males and older people. This situation has changed the age and geographic patterns of death in Guanajuato state. The long-term consequences on society remain to be observed.

Impact of COVID-19 state-level hospital capacity on overall stroke mortality in 2020 in The United States

Background: Although hospital admissions for stroke declined in 2020 during the COVID-19 pandemic, patients with comorbid COVID-19 and stroke had increased mortality. We explored stroke mortality in 2020 and its association with COVID-19 prevalence and state-level hospital capacities. Methods: We analyzed CDC National Vital Statistics System and COVID Data Tracker data from 2017-2020. The primary outcome was age-adjusted stroke (ischemic and hemorrhagic) mortality rate per 100,000. The secondary outcome was % change in state-level stroke mortality rates in 2020 (vs. 2017-19);we report its correlation with state-level 1) prevalence of confirmed COVID-19 infections by 12/31/2021, 2) total COVID mortality by 12/31/20, and the 2020 average state-level % of 3) hospital and 4) ICU beds occupied by COVID-19 patients. Results: Figure 1A shows the typical seasonal decline in stroke mortality in quarters 2/3 was attenuated in 2020. The % change in state-level stroke mortality in 2020 (Figure 1B) was not correlated with prevalence of COVID-19 infection (rho=0.05, p=0.74), mortality (rho=0.10, p=0.49), or the % of ICU beds occupied by COVID-19 patients (rho=0.24, p=0.09). There was a correlation with % of hospital beds occupied by COVID-19 patients (rho=0.35, p=0.01) (Figure 2) Conclusion: Overall stroke mortality increased in 2020, particularly in Q2/3, the early-to-mid phase of the COVID-19 pandemic. At the state level, the average % of all hospital beds occupied by COVID-19 patients in 2020 was the only COVID-19 metric associated with change in stroke mortality. Future work should determine if this association was due to decreased hospital capacity to deliver standard stroke care.

Forecasting COVID-19 Cases Based on Social Distancing in Maryland, USA: A Time-Series Approach.

OBJECTIVE: Our objective is to forecast the number of coronavirus disease 2019 (COVID-19) cases in the state of Maryland, United States, using transfer function time series (TS) models based on a Social Distancing Index (SDI) and determine how their parameters relate to the pandemic mechanics. METHODS: A moving window of 2 mo was used to train the transfer function TS model that was then tested on the next week data. After accounting for a secular trend and weekly cycle of the SDI, a high correlation was documented between it and the daily caseload 9 days later. Similar patterns were also observed on the daily COVID-19 cases and incorporated in our models. RESULTS: In most cases, the proposed models provide a reasonable performance that was, on average, moderately better than that delivered by TS models based only on previous observations. The model coefficients associated with the SDI were statistically significant for most of the training/test sets. CONCLUSIONS: Our proposed models that incorporate SDI can forecast the number of COVID-19 cases in a region. Their parameters have real-life interpretations and, hence, can help understand the inner workings of the epidemic. The methods detailed here can help local health governments and other agencies adjust their response to the epidemic.

The Use of Cremation Data for Timely Mortality Surveillance During the COVID-19 Pandemic in Ontario, Canada: Validation Study.

BACKGROUND: Early estimates of excess mortality are crucial for understanding the impact of COVID-19. However, there is a lag of several months in the reporting of vital statistics mortality data for many jurisdictions, including across Canada. In Ontario, a Canadian province, certification by a coroner is required before cremation can occur, creating real-time mortality data that encompasses the majority of deaths within the province. OBJECTIVE: This study aimed to validate the use of cremation data as a timely surveillance tool for all-cause mortality during a public health emergency in a jurisdiction with delays in vital statistics data. Specifically, this study aimed to validate this surveillance tool by determining the stability, timeliness, and robustness of its real-time estimation of all-cause mortality. METHODS: Cremation records from January 2020 until April 2021 were compared to the historical records from 2017 to 2019, grouped according to week, age, sex, and whether COVID-19 was the cause of death. Cremation data were compared to Ontario's provisional vital statistics mortality data released by Statistics Canada. The 2020 and 2021 records were then compared to previous years (2017-2019) to determine whether there was excess mortality within various age groups and whether deaths attributed to COVID-19 accounted for the entirety of the excess mortality. RESULTS: Between 2017 and 2019, cremations were performed for 67.4% (95% CI 67.3%-67.5%) of deaths. The proportion of cremated deaths remained stable throughout 2020, even within age and sex categories. Cremation records are 99% complete within 3 weeks of the date of death, which precedes the compilation of vital statistics data by several months. Consequently, during the first wave (from April to June 2020), cremation records detected a 16.9% increase (95% CI 14.6%-19.3%) in all-cause mortality, a finding that was confirmed several months later with cremation data. CONCLUSIONS: The percentage of Ontarians cremated and the completion of cremation data several months before vital statistics did not change meaningfully during the COVID-19 pandemic period, establishing that the pandemic did not significantly alter cremation practices. Cremation data can be used to accurately estimate all-cause mortality in near real-time, particularly when real-time mortality estimates are needed to inform policy decisions for public health measures. The accuracy of this excess mortality estimation was confirmed by comparing it with official vital statistics data. These findings demonstrate the utility of cremation data as a complementary data source for timely mortality information during public health emergencies.

Serious Illness and Limitations of Death Certificate-Based Data: Urgent Lessons From the Opioid Epidemic

CAUSE OF DEATH REPORTING Even if immediate and underlying CODs are entered accurately according to these standards, important information is lost in the process that leads to the "leading causes of death" reported by the Centers for Disease Control and Prevention (CDC). [...]when regional vital statistics offices share death certificate data with the CDC, the CDC's computerized algorithm selects one diagnosis as the underlying COD, and this is the diagnosis that is reported in CDC mortality statistics.4 Other diagnoses appear in separate COD fields in mortality databases but in no particular order, and they are not included in the vast majority of mortality statistics. [...]in this example, the death might be attributed to cancer orto something else entirely. Another recent study of opioidrelated deaths among "cancer survivors" (which the authors did not explicitly define, but they cited an article that Included In Its definition Individuals with active disease and those with a more remote history of cancer) highlights the potential for loss of data on acute events when a serious Illness and an acute event coexist at the time of death.6 The authors found that decedents with opioid-related primary CODs were less likely to have a cancer diagnosis Included as a contributing COD than would be expected.

How has COVID-19 impacted the civil registration and vital statistics system in Loreto, Perú? Evidence using process mapping and qualitative analysis.

OBJECTIVES: Accurate civil registration and vital statistics (CRVS) systems are the primary data source to measure the impact of the COVID-19 pandemic on mortality. This study assesses how the pandemic impacted CRVS system processes in Loreto region of Peru, one of the worst affected countries globally. DESIGN: Qualitative study. SETTING: Loreto, a remote region, which had the highest reported mortality rate in Peru during the pandemic. PARTICIPANTS: Semistructured individual interviews and documentary analysis were conducted between September 2020 and May 2021 with 28 key informants from eight institutions involved in death certification. Key informants were identified using a purposive sampling strategy commencing at the Health Directorate of Loreto, and the snowball method was used where a participant suggested another organisation or person. Information from key informants was used to compare business process maps of the CRVS system before and during the pandemic. RESULTS: During early May 2020, there were seven times more registered deaths than in earlier years, but key informants believed this underestimated mortality by 20%-30%. During the pandemic, families had to interact with more institutions during the death certification process. Several issues disrupted death certification processes, including the burden of increased deaths, the Environmental Health Directorate often removing a body without the family's express agreement, the creation of COVID-19 cemeteries where no death certificate was needed for burial, greater participation of funeral homes that often used outdated paper forms, and closure of civil registry offices. There was increased use of the online National Death System (SINADEF) but many users had problems with access. CONCLUSIONS: The pandemic substantially disrupted CRVS processes in Loreto, making death certification more difficult, placing greater burden on the family and leading to more participation from unregulated organisations such as funeral homes or cemeteries. These disruptions were impacted by limitations of the CRVS system's processes before the pandemic.

Timeliness of provisional United States mortality data releases during the COVID-19 pandemic: delays associated with electronic death registration system and weekly mortality.

All-cause mortality counts allow public health authorities to identify populations experiencing excess deaths from pandemics, natural disasters, and other emergencies. Delays in the completeness of mortality counts may contribute to misinformation because death counts take weeks to become accurate. We estimate the timeliness of all-cause mortality releases during the COVID-19 pandemic for the dates 3 April to 5 September 2020 by estimating the number of weekly data releases of the NCHS Fluview Mortality Surveillance System until mortality comes within 99% of the counts in the 19 March 19 2021 provisional mortality data release. States' mortality counts take 5 weeks at median (interquartile range 4-7 weeks) to completion. The fastest states were Maine, New Hampshire, Vermont, New York, Utah, Idaho, and Hawaii. States that had not adopted the electronic death registration system (EDRS) were 4.8 weeks slower to achieve complete mortality counts, and each weekly death per 10^8 was associated with a 0.8 week delay. Emergency planning should improve the timeliness of mortality data by improving state vital statistics digital infrastructure.

Lessons Learnt and Pathways forward for National Civil Registration and Vital Statistics Systems after the COVID-19 Pandemic.

The COVID-19 pandemic has had a substantial impact on government services in many areas, including Civil Registration and Vital Statistics (CRVS). However, the pandemic has also highlighted the importance of recording of mortality and causes of death, with some potentially positive impacts for longer term CRVS strengthening, including: (1) increasing online provision of registration services (2) reporting of mortality statistics from settings which had not previously done so (3) improved intersectoral cooperation, particularly with the health sector, improving the ability to record deaths and (4) increased awareness among governments and public of the importance of mortality statistics. Now, it is pressing for national governments, and international organizations working to strengthen CRVS systems, to evaluate the effectiveness of strategies adopted over the last year, and use lessons learnt to catalyse broader sustainable CRVS improvement strategies, providing governments with essential data on mortality and causes of death into the future.