Excess deaths reveal the true spatial, temporal and demographic impact of COVID-19 on mortality in Ecuador

Abstract

Accepted Background In early 2020, Ecuador reported one of the highest surges of per capita deaths across the globe. Methods We collected a comprehensive dataset containing individual death records between 2015 and 2020, from the Ecuadorian National Institute of Statistics and Census and the Ecuadorian Ministry of Government. We computed the number of excess deaths across time, geographical locations and demographic groups using Poisson regression methods. Results Between 1 January and 23 September 2020, the number of excess deaths in Ecuador was 36 402 [95% confidence interval (CI): 35 762–36 827) or 208 per 100 000 people, which is 171% of the expected deaths in that period in a typical year. Only 20% of the excess deaths are attributable to confirmed COVID-19 deaths. Strikingly, in provinces that were most affected by COVID-19 such as Guayas and Santa Elena, the all-cause deaths are more than double the expected number of deaths that would have occurred in a normal year. The extent of excess deaths in men is higher than in women, and the number of excess deaths increases with age. Indigenous populations had the highest level of excess deaths among all ethnic groups. Conclusions Overall, the exceptionally high level of excess deaths in Ecuador highlights the enormous burden and heterogeneous impact of COVID-19 on mortality, especially in older age groups and Indigenous populations in Ecuador, which was not fully revealed by COVID-19 death counts. Together with the limited testing in Ecuador, our results suggest that the majority of the excess deaths were likely to be undocumented COVID-19 deaths.

Police-reported suicides during the first 16 months of the COVID-19 pandemic in Ecuador: A time-series analysis of trends and risk factors until June 2021

“…The drop in the proportion of suicides in indigenous and other minorities is surprising, as these groups historically accounted for a disproportionate number of suicides relative to their population size 25 and these groups had higher overall mortality during the pandemic. 21 Ethnic disparities in the impact of the pandemic on suicide rates have been reported in studies from the United States. 24 Our finding of a decrease in the proportion of suicides by indigenous people is consistent with the decreases observed in the suicide rates of Native Hawaiian people in the US.…”

“…This is surprising, as historically the Coast has had considerably lower suicide rates than the Highland and Amazon regions. 20 As for the impact of the pandemic across Ecuador's regions, evidence shows the Coast was the worst affected area, with the highest excess mortality of all regions 21 ; patients with diagnosed or suspected COVID-19 from the Coast also had higher levels of anxiety and depression than in other regions. 22 It could be hypothesised that the impact of the COVID-19 pandemic on the inhabitants of coastal areas may have influenced the increase in the proportion of suicides.…”

Excess all-cause mortality and COVID-19 reported fatality in Iran (April 2013–September 2021): age and sex disaggregated time series analysis

“…Investigations of mortality statistics worldwide have demonstrated increased mortality rates during the COVID-19 pandemic compared to previous years [ 18 , 19 ]. While the COVID-19 pandemic has an undeniable impact on excess mortality, it should be highlighted that the rise in mortality linked to COVID-19 is not the only explanation for the increased total mortality [ 20 – 22 ].…”

Assessing COVID-19 pandemic excess deaths in Brazil: years 2020 and 2021

“…Accounting for the total impact of pandemics on mortality is relevant for a better understanding of its consequences while acknowledging deficiencies and hardships population groups are subjected to. This may be captured by estimating the excess deaths attributable to the pandemic, the difference between the observed and the predicted expectation or baseline deaths, over the same period, had the pandemic not happened [1][2][3][4][5][6]. Excess death measures are preferable to COVID-19 deaths because they account for direct and indirect effects of the pandemic and circumvent the issues related to limited testing and death-cause misreporting countries were subject to [7,8].…”