Excess mortality and changes in causes of death in Estonia during the Covid-19 pandemic (years 2020 and 2021)

Abstract

Background: The aim of this study was to describe the changes in the mortality statistics in Estonia during the period of the Covid-19 pandemic (years 2020 and 2021) in terms of excess mortality and the occurrence of causes of death. Methods: The present study is based on retrospective data obtained from the Estonian Causes of Death Registry and the Statistics Estonia database. Data from the period before the pandemic (01.01.2018–31.12.2019) and the two years of the pandemic (2020 and 2021) were compared. In order to compare mortality in different periods, mortality rates were calculated by gender and age group, and incidence rate ratios were used to determine differences between the periods. Excess mortality was expressed as a percentage based on the incidence rate ratio. Mortality patterns were described according to gender and age group using a change point regression model. To analyze the causes of death, the incidence rate ratios by a given period and primary causes of death groups were found. Results: The study results indicated that the mortality rate in 2020 did not significantly differ from the mortality rate in the reference period. Excess mortality occurred in 2021 and was 15%. Excess mortality in 2021 was mainly caused by increased mortality among men aged 35–54 and ≥50 years and women aged ≥50 years. There have been changes in mortality rate trends that do not exactly coincide with the period of the Covid-19 pandemic. In older age groups, the downward trend of mortality has stopped. Several primary causes of death had significantly higher mortality rates during the pandemic years compared to the reference period. Conclusions: Covid-19 pandemic has had both a direct and an indirect impact on the health and mortality of the Estonian population. Given that Covid-19 continues to spread and comprehensive knowledge of its long-term effects is still limited, continued analysis will be necessary to assess the pandemic's impact on the population's health indicators.