Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Max Planck Institute for Demographic Research, Rostock, Germany.
Eur J Public Health. 2021 Feb 1;31(1):17-22. doi: 10.1093/eurpub/ckaa218.
Sweden has one of the highest numbers of COVID-19 deaths per inhabitant globally. However, absolute death counts can be misleading. Estimating age- and sex-specific mortality rates is necessary in order to account for the underlying population structure. Furthermore, given the difficulty of assigning causes of death, excess all-cause mortality should be estimated to assess the overall burden of the pandemic.
By estimating weekly age- and sex-specific death rates during 2020 and during the preceding 5 years, our aim is to get more accurate estimates of the excess mortality attributed to COVID-19 in Sweden, and in the most affected region Stockholm.
Eight weeks after Sweden's first confirmed case, the death rates at all ages above 60 were higher than for previous years. Persons above age 80 were disproportionally more affected, and men suffered greater excess mortality than women in ages up to 75 years. At older ages, the excess mortality was similar for men and women, with up to 1.5 times higher death rates for Sweden and up to 3 times higher for Stockholm. Life expectancy at age 50 declined by <1 year for Sweden and 1.5 years for Stockholm compared to 2019.
The excess mortality has been high in older ages during the pandemic, but it remains to be answered if this is because of age itself being a prognostic factor or a proxy for comorbidity. Only monitoring deaths at a national level may hide the effect of the pandemic on the regional level.
瑞典每百万居民 COVID-19 死亡人数在全球范围内位居前列。然而，绝对死亡人数可能会产生误导。为了考虑到潜在的人口结构，有必要估计年龄和性别特异性死亡率。此外，由于确定死因的难度，应估计超额全因死亡率，以评估大流行的总体负担。
通过估计 2020 年和之前 5 年期间每周的年龄和性别特异性死亡率，我们旨在更准确地估计瑞典 COVID-19 超额死亡率以及受影响最严重的斯德哥尔摩地区。
在瑞典首例确诊病例发生后的 8 周内，所有年龄在 60 岁以上的死亡率均高于往年。80 岁以上的人受到的影响不成比例，而在 75 岁以下，男性的超额死亡率高于女性。在年龄较大时，男性和女性的超额死亡率相似，瑞典的死亡率高达 1.5 倍，斯德哥尔摩的死亡率高达 3 倍。与 2019 年相比，瑞典和斯德哥尔摩的 50 岁人群预期寿命分别下降了不到 1 年和 1.5 年。
在大流行期间，老年人群的超额死亡率一直很高，但仍有待回答，这是因为年龄本身是一个预后因素还是合并症的指标。仅监测全国范围内的死亡人数可能会掩盖大流行对地区层面的影响。
