The COVID-19 pandemic's true death toll in Iran after two years: an interrupted time series analysis of weekly all-cause mortality data.

ABSTRACT

INTRODUCTION: This study aimed to investigate overall and age group/region/sex-specific excess all-cause mortality from the inception of the COVID-19 pandemic in Iran until February 2022. METHODS: Weekly all-cause mortality data were obtained for the period March 2015 until February 2022. We conducted interrupted time series analyses, using a generalized least-square regression model to estimate excess mortality after the COVID-19 pandemic. Using this approach, we estimated the expected post-pandemic death counts based on five years of pre-pandemic data and compared the results with observed mortality during the pandemic. RESULTS: After the COVID-19 pandemic, we observed an immediate increase (1,934 deaths per week, p = 0.01) in weekly all-cause mortality. An estimated 240,390 excess deaths were observed in two years after the pandemic. Within the same period, 136,166 deaths were officially attributed to COVID-19. The excess mortality was greatest among males compared with females (326 versus 264 per 100k), with an increasing trend by age group. There is a clear increased excess mortality in the central and northwestern provinces. CONCLUSION: We found that the full mortality burden during the outbreak has been much heavier than what is officially reported, with clear differences by sex, age group, and geographical region.