Li Yu, Li Hang, Adair Tim
Melbourne School of Population and Global Health, Nossal Institute for Global Health, The University of Melbourne, Level 2, 32 Lincoln Square North, Melbourne, VIC, 3010, Australia.
Eur J Epidemiol. 2025 Apr;40(4):463-474. doi: 10.1007/s10654-025-01214-z. Epub 2025 Mar 19.
Multiple cause of death data allow for a more granular analysis of the pandemic's impact on mortality from non-COVID-19 causes of death compared with analysis of a single underlying cause of each death because they are often a co-morbidity of COVID-19. This study estimates excess mortality in the US of non-COVID-19 causes measured as a multiple cause (reported anywhere on the death certificate). Death registration data were used to conduct Poisson regressions of 24 non-COVID-19 causes to estimate expected age-standardized death rates and excess mortality in 2020-21, including by place of death. The ratio of COVID-19 mortality (as underlying or contributing cause) to excess mortality of each non-COVID-19 cause was calculated. During 2020-21, 21 of 24 non-COVID-19 causes exhibited excess mortality, highest for pneumonia (males 126.5%; 95% confidence interval 116.6-136.9%), other respiratory diseases (males 45.2%; 42.2-48.2%), other kidney diseases (males 45.0%, 37.8-52.0%), diabetes (females 38.3%, 32.8-43.4%) and hypertensive heart disease (females 28.9%, 22.8-33.9%). Suicide and influenza mortality was lower than expected. The ratio of COVID-19 (underlying cause) to excess mortality was 74.2% (69.2-79.7%) for men and 68.7% (63.5-75.0%) for women, was significantly higher for hospital (over 90%) than home (less than 16%) deaths and varied greatly between causes. The pandemic led to excess mortality for almost all non-COVID-19 causes in the US when measured as a multiple cause, being particularly high in several non-communicable diseases that increase the risk of dying from COVID-19. COVID-19 appears underreported for home deaths due to its low ratio to excess mortality in this setting.
与仅分析每例死亡的单一根本原因相比，多死因数据能够更细致地分析大流行对非新冠病毒导致的死亡的影响，因为这些死因往往是新冠病毒感染的合并症。本研究估算了美国非新冠病毒导致的多死因（在死亡证明上任何位置报告）的超额死亡率。死亡登记数据用于对24种非新冠病毒导致的死因进行泊松回归分析，以估算2020 - 2021年按年龄标准化的预期死亡率和超额死亡率，包括按死亡地点进行估算。计算了新冠病毒死亡率（作为根本原因或促成原因）与每种非新冠病毒导致的死因的超额死亡率之比。在2020 - 2021年期间，24种非新冠病毒导致的死因中有21种出现了超额死亡率，肺炎的超额死亡率最高（男性为126.5%；95%置信区间为116.6 - 136.9%），其他呼吸系统疾病（男性为45.2%；42.2 - 48.2%），其他肾脏疾病（男性为45.0%，37.8 - 52.0%），糖尿病（女性为38.3%，32.8 - 43.4%）和高血压性心脏病（女性为28.9%，22.8 - 33.9%）。自杀和流感死亡率低于预期。男性新冠病毒（根本原因）与超额死亡率之比为74.2%（69.2 - 79.7%），女性为68.7%（63.5 - 75.0%），在医院死亡（超过90%）中的比例显著高于在家中死亡（低于16%），并且在不同死因之间差异很大。当以多死因衡量时，大流行导致美国几乎所有非新冠病毒导致的死因出现超额死亡率，在几种增加因新冠病毒死亡风险的非传染性疾病中尤其高。由于在家中死亡时新冠病毒死亡率与超额死亡率的比例较低，新冠病毒在家中死亡中的报告似乎不足。
