Orellana Jesem Douglas Yamall, Cunha Geraldo Marcelo da, Marrero Lihsieh, Moreira Ronaldo Ismerio, Leite Iuri da Costa, Horta Bernardo Lessa
Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Manaus, Brasil.
Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.
Cad Saude Publica. 2021 Feb 5;37(1):e00259120. doi: 10.1590/0102-311X00259120. eCollection 2021.
Brazil is one of the most heavily impacted countries by the COVID-19 pandemic, and the real number of deaths from the disease makes the scenario even more challenging. This study aimed to estimate the excess deaths and their differences in adults 20 years and older in Manaus (Amazonas State), Fortaleza (Ceará State), Rio de Janeiro, and São Paulo, according to place of death, demographic characteristics, and trajectory over time. The data were obtained from the Mortality Information System and the Central Information Office of the National Civil Registry. The estimates of expected deaths were obtained from quasi-Poisson generalized additive models, adjusting for overdispersion. From February 23 to June 13, 2020, 74,410 natural deaths were recorded in the four cities, with 46% excess deaths (95%CI: 44-47). The largest amount of excess deaths was in Manaus, with 112% (95%CI: 103-121), followed by Fortaleza with 72% (95%CI: 67-78), Rio de Janeiro with 42% (95%CI: 40-45), and São Paulo with 34% (95%CI: 32-36). Excess deaths were greater in males and non-significant in Epidemiologic Weeks (EW) 9-12, except in São Paulo, 10% (95%CI: 6-14). The peak in excess deaths generally occurred in EW 17-20. The number of excess deaths not explained directly by COVID-19 and deaths at home or on public byways is high, especially in Manaus. The high percentages of excess deaths, deaths not explained directly by COVID-19, and deaths outside the hospital suggest high underreporting of deaths from COVID-19 and reinforce the extensive spread of SARS-CoV-2, as well as the need for epidemiological surveillance services to review all causes of deaths associated with respiratory symptoms.
巴西是受新冠疫情影响最严重的国家之一，该疾病的实际死亡人数使情况更具挑战性。本研究旨在根据死亡地点、人口特征和随时间变化的轨迹，估算玛瑙斯（亚马孙州）、福塔莱萨（塞阿拉州）、里约热内卢和圣保罗20岁及以上成年人的超额死亡及其差异。数据来自死亡信息系统和国家民事登记中央信息办公室。预期死亡人数的估计值通过拟泊松广义相加模型获得，并对过度离散进行了调整。2020年2月23日至6月13日，这四个城市记录了74410例自然死亡，超额死亡比例为46%（95%置信区间：44-47）。超额死亡人数最多的是玛瑙斯，为112%（95%置信区间：103-121），其次是福塔莱萨，为72%（95%置信区间：67-78），里约热内卢为42%（95%置信区间：40-45），圣保罗为34%（95%置信区间：32-36）。男性的超额死亡人数更多，在第9-12个流行病学周（EW）中无显著差异，但圣保罗除外，为10%（95%置信区间：6-14）。超额死亡高峰通常出现在第17-20个EW。未直接由新冠病毒导致的超额死亡人数以及在家中或公共道路上的死亡人数很高，尤其是在玛瑙斯。超额死亡、未直接由新冠病毒导致的死亡以及医院外死亡的高比例表明新冠病毒死亡人数存在大量漏报，并强化了严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的广泛传播，以及流行病学监测服务机构审查所有与呼吸道症状相关死亡原因的必要性。
