Timonin Sergey, Klimkin Ilya, Shkolnikov Vladimir M, Andreev Evgeny, McKee Martin, Leon David A
International Laboratory for Population and Health, National Research University Higher School of Economics, Myasnitskaya 20, 101000, Moscow, Russian Federation.
Laboratory of Demographic Data, Max Planck Institute for Demographic Research, Konrad-Zuse-Str. 1, 18057, Rostock, Germany.
SSM Popul Health. 2021 Dec 17;17:101006. doi: 10.1016/j.ssmph.2021.101006. eCollection 2022 Mar.
Russia has been portrayed in media as having one of the highest death tolls due to the COVID-19 pandemic in the world. However, the precise scale of excess mortality is still unclear. We provide the first estimates of excess mortality in Russia as a whole and its regions in 2020, placing this in an international context.
We used monthly death rates for Russia and 83 regions plus the equivalent for 36 comparator countries. Expected mortality was derived in two ways using averages in the same months in preceding years and the same averages adjusted for secular trends. Excess death rates were estimated for the whole year and the last 3 quarters. We also estimated the relationships between excess mortality and reported COVID-19 cases and deaths across countries and Russian regions.
Estimating excess deaths rates based on the trend-adjusted average, Russia had the highest excess mortality of any of the 37 countries considered. Using the simple average, Russia had the third highest. Most of the excess deaths were recorded in the 4th quarter of 2020 and the level and trajectory of excess mortality in Russia and most of Eastern European countries differed from that in Western countries. While both the cumulative number of COVID-19 cases and deaths showed positive correlations with excess mortality across countries (r=0.65 and r=0.75, p<0.001), the association across the Russian regions was, surprisingly, negative for cases (r=-0.34, p<0.01) and deaths (r=-0.09, p=0.42). When we replaced reported deaths with final data from death certificates the correlation was positive (r=0.38, p<0.001).
Russia has one of the largest absolute burden of excess mortality in 2020 but there is a counter-intuitive negative association between excess mortality and cumulative incidence at the regional level. Under-recording of COVID-19 cases seems to be a problem in some regions.
在媒体报道中，俄罗斯被描述为全球因新冠疫情导致死亡人数最多的国家之一。然而，超额死亡率的确切规模仍不明确。我们首次对2020年俄罗斯全国及其各地区的超额死亡率进行了估算，并将其置于国际背景下进行考量。
我们使用了俄罗斯83个地区的月度死亡率数据，以及36个对照国家的相应数据。预期死亡率通过两种方式得出，一种是使用前几年同月的平均值，另一种是对上述平均值进行长期趋势调整。我们估算了全年以及最后三个季度的超额死亡率。我们还估算了各国及俄罗斯各地区超额死亡率与报告的新冠病例及死亡人数之间的关系。
基于趋势调整后的平均值估算超额死亡率，俄罗斯在37个被考虑的国家中超额死亡率最高。使用简单平均值时，俄罗斯位列第三。大部分超额死亡记录在2020年第四季度，俄罗斯及大多数东欧国家的超额死亡率水平和轨迹与西方国家不同。虽然各国新冠病例和死亡的累计数与超额死亡率均呈正相关（r = 0.65和r = 0.75，p < 0.001），但令人惊讶的是，俄罗斯各地区病例（r = -0.34，p < 0.01）和死亡（r = -0.09，p = 0.42）与超额死亡率之间的关联为负。当我们用死亡证明的最终数据取代报告的死亡人数时，相关性为正（r = 0.38，p < 0.001）。
2020年俄罗斯的超额死亡率绝对负担在全球名列前茅，但在地区层面，超额死亡率与累计发病率之间存在违反直觉的负相关。在一些地区，新冠病例记录不足似乎是一个问题。
