All-cause excess mortality across 90 municipalities in Gujarat, India, during the COVID-19 pandemic (March 2020-April 2021).
All-cause excess mortality across 90 municipalities in Gujarat, India, during the COVID-19 pandemic (March 2020-April 2021).
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DOI：
10.1371/journal.pgph.0000824
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发表时间：
2022
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官方COVID-19死亡率统计数据受到当地诊断能力、医疗保健和生命登记系统的实力以及死亡认证标准和能力的强烈影响，通常导致COVID-19归因死亡人数严重不足。超额死亡率（定义为观察到的死亡人数与基线预期相比的增加）提供了衡量COVID-19大流行直接和间接死亡率冲击的另一种方法。在这里，我们使用来自印度古吉拉特邦90个（共162个）城市的公民死亡登记数据，以估计COVID-19大流行对全因死亡率的影响。我们使用模型拟合2019年1月至2020年2月的每周数据，估计了2020年3月至2021年4月疫情期间的超额死亡率。在此期间，官方政府数据报告整个古吉拉特邦有10，098人死于COVID-19。我们估计，在此期间，这90个城市的死亡人数增加了21，300 [95% CI：20，700，22，000]，比预期基线增加了44% [95% CI：43%，45%]。在我们的样本中，2021年4月下旬观察到死亡人数的最大增幅，估计死亡人数较预期人数增加678% [95%CI：649%，707%]。与其他年龄组相比，40至65岁年龄组的死亡率增长最快。我们发现男性和女性的死亡率大幅增加。根据2011年人口普查，我们对这90个城市（约占人口至少8%）的超额死亡率估计超过了整个古吉拉特邦的官方COVID-19死亡人数，甚至在2021年5月印度大流行的三角洲浪潮达到顶峰之前。先前的研究得出结论，印度与流行病有关的真实死亡率大大超过官方统计。这项研究直接使用官方死亡登记数据记录的第一点数据，为古吉拉特邦2020年3月至2021年4月的高超额死亡率提供了无可争议的证据。
Official COVID-19 mortality statistics are strongly influenced by local diagnostic capacity, strength of the healthcare and vital registration systems, and death certification criteria and capacity, often resulting in significant undercounting of COVID-19 attributable deaths. Excess mortality, which is defined as the increase in observed death counts compared to a baseline expectation, provides an alternate measure of the mortality shock—both direct and indirect—of the COVID-19 pandemic. Here, we use data from civil death registers from a convenience sample of 90 (of 162) municipalities across the state of Gujarat, India, to estimate the impact of the COVID-19 pandemic on all-cause mortality. Using a model fit to weekly data from January 2019 to February 2020, we estimated excess mortality over the course of the pandemic from March 2020 to April 2021. During this period, the official government data reported 10,098 deaths attributable to COVID-19 for the entire state of Gujarat. We estimated 21,300 [95% CI: 20, 700, 22, 000] excess deaths across these 90 municipalities in this period, representing a 44% [95% CI: 43%, 45%] increase over the expected baseline. The sharpest increase in deaths in our sample was observed in late April 2021, with an estimated 678% [95% CI: 649%, 707%] increase in mortality from expected counts. The 40 to 65 age group experienced the highest increase in mortality relative to the other age groups. We found substantial increases in mortality for males and females. Our excess mortality estimate for these 90 municipalities, representing approximately at least 8% of the population, based on the 2011 census, exceeds the official COVID-19 death count for the entire state of Gujarat, even before the delta wave of the pandemic in India peaked in May 2021. Prior studies have concluded that true pandemic-related mortality in India greatly exceeds official counts. This study, using data directly from the first point of official death registration data recording, provides incontrovertible evidence of the high excess mortality in Gujarat from March 2020 to April 2021.