美国 COVID-19 大流行期间不明原因死亡率：死亡证明数据的回顾性分析和对超额死亡计算的批判性评估。

Unexplained mortality during the US COVID-19 pandemic: retrospective analysis of death certificate data and critical assessment of excess death calculations.

机构信息

Department of Pharmacy Practice, Midwestern University College of Pharmacy, Glendale, Arizona, USA

Kathleen Fairman LTD, Phoenix, Arizona, USA.

出版信息

BMJ Open. 2021 Nov 16;11(11):e050361. doi: 10.1136/bmjopen-2021-050361.

DOI:10.1136/bmjopen-2021-050361

PMID:34785551

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8595295/

Abstract

OBJECTIVES

Cause-of-death discrepancies are common in respiratory illness-related mortality. A standard epidemiological metric, excess all-cause death, is unaffected by these discrepancies but provides no actionable policy information when increased all-cause mortality is unexplained by reported specific causes. To assess the contribution of unexplained mortality to the excess death metric, we parsed excess deaths in the COVID-19 pandemic into changes in explained versus unexplained (unreported or unspecified) causes.

DESIGN

Retrospective repeated cross-sectional analysis, US death certificate data for six influenza seasons beginning October 2014, comparing population-adjusted historical benchmarks from the previous two, three and five seasons with 2019-2020.

SETTING

48 of 50 states with complete data.

PARTICIPANTS

16.3 million deaths in 312 weeks, reported in categories-all causes, top eight natural causes and respiratory causes including COVID-19.

OUTCOME MEASURES

Change in population-adjusted counts of deaths from seasonal benchmarks to 2019-2020, from all causes (ie, total excess deaths) and from explained versus unexplained causes, reported for the season overall and for time periods defined a priori: pandemic awareness (19 January through 28 March); initial pandemic peak (29 March through 30 May) and pandemic post-peak (31 May through 26 September).

RESULTS

Depending on seasonal benchmark, 287 957-306 267 excess deaths occurred through September 2020: 179 903 (58.7%-62.5%) attributed to COVID-19; 44 022-49 311 (15.2%-16.1%) to other reported causes; 64 032-77 054 (22.2%-25.2%) unexplained (unspecified or unreported cause). Unexplained deaths constituted 65.2%-72.5% of excess deaths from 19 January to 28 March and 14.1%-16.1% from 29 March through 30 May.

CONCLUSIONS

Unexplained mortality contributed substantially to US pandemic period excess deaths. Onset of unexplained mortality in February 2020 coincided with previously reported increases in psychotropic use, suggesting possible psychiatric or injurious causes. Because underlying causes of unexplained deaths may vary by group or region, results suggest excess death calculations provide limited actionable information, supporting previous calls for improved cause-of-death data to support evidence-based policy.

摘要

目的

与呼吸道疾病相关的死亡原因差异在死因统计中很常见。一个标准的流行病学指标，全因超额死亡，不受这些差异的影响，但当报告的具体原因无法解释全因死亡率增加时，它不会提供任何可行的政策信息。为了评估未解释的死亡率对超额死亡指标的贡献，我们将 COVID-19 大流行期间的超额死亡分为已解释和未解释（未报告或未指定）原因的变化。

设计

回顾性重复横断面分析，使用美国六个流感季节（2014 年 10 月开始）的死亡证明数据，将人群调整后的历史基准与前两个、三个和五个季节进行比较，时间跨度为 2019-2020 年。

地点

48 个州的数据完整。

参与者

312 周内报告的 1630 万例死亡，包括所有原因、前 8 大自然原因和包括 COVID-19 在内的呼吸道原因。

主要结果测量

从季节性基准到 2019-2020 年的人口调整死亡人数变化，包括所有原因（即总超额死亡）以及已解释和未解释原因的变化，按预先定义的时间段报告：大流行意识（1 月 19 日至 3 月 28 日）；初始大流行高峰（3 月 29 日至 5 月 30 日）和大流行后期（5 月 31 日至 9 月 26 日）。

结果

截至 2020 年 9 月，根据季节性基准，发生了 287957-306267 例超额死亡：179903 例（58.7%-62.5%）归因于 COVID-19；44022-49311 例（15.2%-16.1%）归因于其他报告的原因；64032-77054 例（22.2%-25.2%）归因于未解释的（未指定或未报告的原因）。未解释的死亡占 1 月 19 日至 28 日期间超额死亡的 65.2%-72.5%，占 3 月 29 日至 5 月 30 日期间超额死亡的 14.1%-16.1%。