Analysis of Excess All-Cause Mortality and COVID-19 Mortality in Peru: Observational Study

Abstract

During the COVID-19 pandemic, an excess of all-cause mortality has been recorded in several countries, including Peru. Most excess deaths were likely attributable to COVID-19. In this study, we compared the excess all-cause mortality and COVID-19 mortality in 25 Peruvian regions to determine whether most of the excess deaths in 2020 were attributable to COVID-19. Excess deaths were calculated as the difference between the number of observed deaths from all causes during the COVID-19 pandemic (in 2020) and the number of expected deaths in 2020 based on a historical from recent years (2017–2019). Death data were retrieved from the Sistema Informatico Nacional de Defunciones (SINADEF) at the Ministry of Health of Peru from January 2017 to December 2020. Population counts were obtained from projections from Peru’s Instituto Nacional de Estadística e Informática (INEI). All-cause excess mortality and COVID-19 mortality were calculated by region per 100,000 population. Spearman’s test and linear and multiple regression models were used to estimate the correlation between excess all-cause mortality and COVID-19 mortality per 100,000 population. Excess all-cause death rates varied widely among regions (range: 115.1 to 519.8 per 100,000 population), and COVID-19 mortality ranged between 83.8 and 464.6 per 100,000 population. There was a correlation between the all-cause excess mortality and COVID-19 mortality (r = 0.90; p = 0.00001; y = 0.8729x + 90.808; R2 = 0.84). Adjusted for confounding factors (mean age in the region, gender balance, and number of intensive care unit (ICU) beds), the all-cause excess mortality rate was correlated with COVID-19 mortality rate (β = 0.921; p = 0.0001). These findings suggest that most of the excess deaths in Peru are related to COVID-19. Therefore, these findings can help decision-makers to understand the high COVID-19 mortality rates in Peru.

Global Excess Mortality during COVID-19 Pandemic: A Systematic Review and Meta-Analysis

“…These measures cut off the main transmission routes of respiratory infectious diseases such as COVID-19 and influenza and lower their prevalence and mortality [ 2 , 3 ]. Notably, despite the reduction of accidental traffic deaths due to strict lockdown policies [ 4 , 5 , 6 , 7 ], these policies may increase the deaths of patients with chronic diseases because they have difficulty receiving timely health care [ 8 , 9 , 10 ]. Additionally, limited medical resources increase the risk of death among patients with chronic diseases [ 11 ].…”

“…Mortality statistics are fundamental to the decision-making of public health [ 14 ]. However, the categorization of death is inconsistent among countries, health systems, and physicians [ 3 , 9 ]. Importantly, COVID-19 deaths may be underestimated in the early stages of the pandemic because many cases and deaths that should have been attributed to COVID-19 were not detected and identified due to inadequate tests and overloaded health systems, caused by a sudden increase in COVID-19 symptom patients in most countries [ 15 ].…”

“…Importantly, COVID-19 deaths may be underestimated in the early stages of the pandemic because many cases and deaths that should have been attributed to COVID-19 were not detected and identified due to inadequate tests and overloaded health systems, caused by a sudden increase in COVID-19 symptom patients in most countries [ 15 ]. Furthermore, influenced by misdiagnosis and pandemic “bias”, indirect deaths during the pandemic are likely to be misclassified as direct deaths of COVID-19, such as deaths caused by resource constraints in health care systems, unnatural causes, or extreme events [ 9 , 14 , 16 ]. Even before the major reshuffling of death causes due to COVID-19, death certificates were known to be notoriously error-prone.…”

Physicians’ Perceptions as Predictors of the Future Use of the National Death Information System in Peru: Cross-sectional Study

“…During the COVID-19 pandemic, SINADEF was used in several studies [ 10 - 12 , 27 ] as an important source of information to document excess mortality from all causes in Peru and was recognized as the most reliable way to measure the severity and the impact of COVID-19 on the population. With the support of SINADEF, an excess mortality of 371.9 per 100,000 inhabitants in 2020 was documented in Peru [ 28 ], and in general, all the researchers agreed in highlighting the importance of strengthening the mortality documentation system in Peru.…”

“…In addition, they coincide in pointing out the importance of the quality of the data provided by SINADEF and the need to strengthen the entire death registration process so that it is useful for containing the health emergency. Recent studies using SINADEF reported that excess mortality from all causes in 2020 was more than 100,000 deaths and that more realistic figures have been obtained owing to coordination initiatives between those responsible for epidemiological surveillance, recording of vital events, and diagnosis [ 13 ]. However, they did not notice that a significant proportion of deaths, especially those that occur in the community, are not reported through SINADEF; therefore, it is important to evaluate the factors that could limit its real use.…”