Chen Yea-Hung, Stokes Andrew C, Aschmann Hélène E, Chen Ruijia, DeVost Shelley, Kiang Mathew V, Koliwad Suneil, Riley Alicia R, Glymour M Maria, Bibbins-Domingo Kirsten
Department of Epidemiology and Biostatistics, University of California, 550 16th St, San Francisco, CA 94158, USA.
Department of Global Health, Boston University School of Public Health, Boston, MA 02118, USA.
PNAS Nexus. 2022 Jun 8;1(3):pgac079. doi: 10.1093/pnasnexus/pgac079. eCollection 2022 Jul.
Excess mortality has exceeded reported deaths from Covid-19 during the pandemic. This gap may be attributable to deaths that occurred among individuals with undiagnosed Covid-19 infections or indirect consequences of the pandemic response such as interruptions in medical care; distinguishing these possibilities has implications for public health responses. In the present study, we examined patterns of excess mortality over time and by setting (in-hospital or out-of-hospital) and cause of death using death certificate data from California. The estimated number of excess natural-cause deaths from 2020 March 1 to 2021 February 28 (69,182) exceeded the number of Covid-19 diagnosed deaths (53,667) by 29%. Nearly half, 47.4% (32,775), of excess natural-cause deaths occurred out of the hospital, where only 28.6% (9,366) of excess mortality was attributed to Covid-19. Over time, increases or decreases in excess natural non-Covid-19 mortality closely mirrored increases or decreases in Covid-19 mortality. The time series were positively correlated in out-of-hospital settings, particularly at time lags when excess natural-cause deaths preceded reported Covid-19 deaths; for example, when comparing Covid-19 deaths to excess natural-cause deaths in the week prior, the correlation was 0.73. The strong temporal association of reported Covid-19 deaths with excess out-of-hospital deaths from other reported natural-cause causes suggests Covid-19 deaths were undercounted during the first year of the pandemic.
在疫情期间，超额死亡率已超过报告的新冠病毒肺炎死亡人数。这一差距可能归因于未被诊断出感染新冠病毒肺炎的个体死亡，或疫情应对措施的间接后果，如医疗服务中断；区分这些可能性对公共卫生应对措施具有重要意义。在本研究中，我们利用加利福尼亚州的死亡证明数据，研究了随时间推移以及按地点（住院或院外）和死因划分的超额死亡率模式。2020年3月1日至2021年2月28日期间，估计的自然原因超额死亡人数（69,182人）比确诊的新冠病毒肺炎死亡人数（53,667人）高出29%。近一半（47.4%，即32,775人）的自然原因超额死亡发生在院外，而院外超额死亡率中只有28.6%（9,366人）归因于新冠病毒肺炎。随着时间的推移，自然原因非新冠病毒肺炎超额死亡率的增加或减少与新冠病毒肺炎死亡率的增加或减少密切相关。在院外环境中，时间序列呈正相关，特别是在自然原因超额死亡先于报告的新冠病毒肺炎死亡的时间滞后情况下；例如，将前一周的新冠病毒肺炎死亡人数与自然原因超额死亡人数进行比较时，相关性为0.73。报告的新冠病毒肺炎死亡人数与其他报告的自然原因导致的院外超额死亡之间的强烈时间关联表明，在疫情的第一年，新冠病毒肺炎死亡人数被低估了。
