Kazemian Seyedeh Vajiheh, Dadgarmoghaddam Maliheh, Tabesh Hamed, Khajedaluee Amirreza, Khajedaluee Mohammad
Community Medicine Department, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Int J Health Policy Manag. 2025;14:8757. doi: 10.34172/ijhpm.8757. Epub 2025 May 21.
Excess mortality provides a comprehensive measure to assess the true impact of the disease on mortality rates. This study aimed to quantify excess mortality attributable to COVID-19 in northeastern Iran during the pandemic period (2020-2022).
This population-based cross-sectional study utilized population and mortality data extracted from electronic systems linked to Mashhad University of Medical Sciences (MUMS). Data analysis was conducted using R Version 4.3.3. A log-linear model was employed to predict expected deaths during the two-year pandemic period, incorporating predictor variables such as the year of interest, the presence of COVID-19, and the population size for each respective year. Excess deaths were calculated as the difference between the expected and observed mortality. Furthermore, by considering the confirmed deaths directly attributed to COVID-19 and the difference between these and the excess deaths, the number of indirect deaths during the pandemic was determined.
The total count of recorded deaths from all causes exceeded the expected deaths by 31.15% (6750 cases) in the first year and 44.74% (10 078 cases) in the second year. The excess deaths were 1.48 and 1.79 times greater than the official reports of COVID-19 for the first and second years, respectively. It was also found that men experienced increased rates of excess deaths in each of the two years. Moreover, urban residents experienced higher rates of excess death in the same years. Based on cause-specific excess mortality, following infectious diseases, cardiovascular diseases (CVDs) accounted for the largest proportion of excess deaths in both years of the pandemic.
The overall mortality burden during the COVID-19 pandemic exceeded the official reports, highlighting the undercounting of the number of direct effects and emphasizing the significance of indirect effects. These findings underscore the importance of preparedness and organization of healthcare systems prior to a pandemic.
超额死亡率提供了一种全面的衡量方法，用于评估疾病对死亡率的真实影响。本研究旨在量化伊朗东北部在大流行期间（2020 - 2022年）由新冠病毒病（COVID - 19）导致的超额死亡率。
这项基于人群的横断面研究利用了从与马什哈德医科大学（MUMS）相关联的电子系统中提取的人口和死亡率数据。使用R版本4.3.3进行数据分析。采用对数线性模型预测两年大流行期间的预期死亡人数，纳入的预测变量包括感兴趣的年份、是否存在COVID - 19以及各年的人口规模。超额死亡人数通过预期死亡率与观察到的死亡率之间的差值计算得出。此外，通过考虑直接归因于COVID - 19的确诊死亡人数以及这些死亡人数与超额死亡人数之间的差值，确定了大流行期间的间接死亡人数。
所有原因导致的记录死亡总数在第一年比预期死亡人数超出31.15%（6750例），在第二年超出44.74%（10078例）。第一年和第二年的超额死亡人数分别比COVID - 19的官方报告高出1.48倍和1.79倍。还发现男性在这两年中的超额死亡率均有所上升。此外，城市居民在同一年中的超额死亡率更高。基于特定病因的超额死亡率分析，在传染病之后，心血管疾病（CVDs）在大流行的两年中占超额死亡人数的最大比例。
COVID - 19大流行期间的总体死亡负担超过了官方报告，凸显了直接影响数量被低估的情况，并强调了间接影响的重要性。这些发现强调了在大流行之前医疗系统做好准备和组织工作的重要性。
