Keskin Salih, Ergör Gül
Balıkesir Karesi Provincial Directorate of Health, Balıkesir, Türkiye.
Department of Public Health, Dokuz Eylül University Faculty of Medicine, İzmir, Türkiye.
Balkan Med J. 2025 Mar 3;42(2):130-137. doi: 10.4274/balkanmedj.galenos.2025.2025-1-91.
The coronavirus disease-2019 (COVID-19) pandemic significantly impacted global mortality, albeit Türkiye has been largely excluded from mortality studies owing to delayed data release and a lack of nationwide analyses.
To identify the excess mortality rates in Türkiye between 2020 and 2022, analyze the temporal trends and regional differences, and determine factors associated with excess deaths at the regional level.
A cross-sectional ecological analysis.
We analyzed all-cause mortality data from the Turkish Statistical Institute from January 2015 to December 2022. The projected deaths during 2020-2022 were derived from Quasi-Poisson Regression models applied to the 2015-2019 provincial mortality data, adjusting for seasonal trends, population offsets, and overdispersion. The results were aggregated to national and socioeconomic levels for comparative analyses. Excess deaths were calculated as the difference between observed and projected deaths. P-scores and excess mortality per 100,000 inhabitants were utilized as standardized metrics. Socioeconomic disparities were examined using the Socioeconomic Development Ranking of Provinces and Regions (SEGE-2017). We assessed the associations between excess mortality and vaccination coverage, elderly population ratio, intensive care unit beds per 100,000 population, and population per family physician.
Türkiye experienced 247,640 excess deaths [95% confidence interval (CI): 176,405-315,204] from 2020 to 2022. Excess mortality peaked in 2021 with 121,426 excess deaths (27.2% P-score, 143.5 per 100,000 population). Lower vaccination coverage [estimate: -0.51, 95% CI: (-0.81, -0.20), = 0.001] and higher population per family physician [estimate: 0.01, 95% CI: (0.00, 0.02), = 0.005] were significantly associated with higher excess mortality. A higher elderly population ratio was positively associated with excess deaths [estimate: 1.41, 95% CI: (0.50, 2.32), = 0.003]. Socioeconomically less developed regions (SEGE 5 and SEGE 6) exhibited higher P-scores (21.3% and 20.2%, respectively), indicating greater relative increases in mortality when compared with the relatively more developed regions.
Excess mortality in Türkiye during the COVID-19 pandemic was substantial, particularly in 2021, and was influenced by regional socioeconomic disparities, vaccination coverage, and healthcare access. These findings underscore the importance of addressing sociodemographic factors and strengthening primary healthcare services in pandemic responses.
2019冠状病毒病（COVID-19）大流行对全球死亡率产生了重大影响，尽管由于数据发布延迟和缺乏全国性分析，土耳其在很大程度上被排除在死亡率研究之外。
确定2020年至2022年土耳其的超额死亡率，分析时间趋势和地区差异，并确定地区层面与超额死亡相关的因素。
横断面生态分析。
我们分析了土耳其统计局2015年1月至2022年12月的全因死亡率数据。2020 - 2022年期间的预计死亡人数来自应用于2015 - 2019年省级死亡率数据的拟泊松回归模型，并对季节趋势、人口偏移和过度离散进行了调整。结果汇总到国家和社会经济层面进行比较分析。超额死亡人数计算为观察到的死亡人数与预计死亡人数之间的差值。P值和每10万居民的超额死亡率用作标准化指标。使用省份和地区社会经济发展排名（SEGE - 2017）来研究社会经济差异。我们评估了超额死亡率与疫苗接种覆盖率、老年人口比例、每10万人口的重症监护病床数以及每名家庭医生服务的人口数之间的关联。
2020年至2022年，土耳其有247,640例超额死亡[95%置信区间（CI）：176,405 - 315,204]。2021年超额死亡率达到峰值，有121,426例超额死亡（P值为27.2%，每10万人口为143.5例）。较低的疫苗接种覆盖率[估计值： - 0.51，95% CI：（ - 0.81， - 0.20），P = 0.001]和每名家庭医生服务的人口数较高[估计值：0.01，95% CI：（0.00，0.02），P = 0.005]与较高的超额死亡率显著相关。较高的老年人口比例与超额死亡呈正相关[估计值：1.41，95% CI：（0.50，2.32），P = 0.003]。社会经济欠发达地区（SEGE 5和SEGE 6）的P值较高（分别为21.3%和20.2%），这表明与相对较发达地区相比，死亡率的相对增幅更大。
COVID - 19大流行期间土耳其的超额死亡率很高，尤其是在2021年，并且受到地区社会经济差异、疫苗接种覆盖率和医疗服务可及性的影响。这些发现强调了在应对大流行时解决社会人口因素和加强初级医疗服务的重要性。
