Mortality by cause of death in Brazil: effects of the COVID-19 pandemic and contribution to changes in life expectancy at birth

Abstract

We investigate the consequences of the COVID-19 pandemic on other underlying causes of death in Brazil in 2020 and 2021. We estimate monthly age-standardized mortality rates for 2010-2021 and decompose those time series into three additive components: trend, seasonality, and remainder. Given the long-term trend and historical seasonal fluctuations, we assume that any impact from the pandemic will be left on the remainder. We also decompose the contributions of COVID-19 deaths (direct effect) and those from other causes (indirect effects) to the annual change in life expectancy at birth (e0) from 2017 to 2021. Broadly, the remainder mirrors the trajectory of pandemic waves. The impact of the COVID-19 pandemic on other causes of death was not limited to increases but also decreases. The direct effects of the pandemic reduced e0 by 1.89 years between 2019 and 2020 and 1.77 between 2020 and 2021. Indirect effects increased e0 by 0.44 between 2019 and 2020 and had virtually no impact on e0 between 2020 and 2021. Whether trajectories in mortality rates and annual gains in e0 will quickly return to pre-pandemic levels depends on governmental actions to mitigate the consequences of the COVID-19 pandemic.

Large and unequal life expectancy declines during the COVID-19 pandemic in India in 2020

“…Our estimates imply 1.19 million excess deaths in India nationally in 2020, which is about one-third of the excess deaths estimated by the WHO for the rest of the world (11). From a comparative perspective, India's life expectancy decline is similar to or larger than declines seen in the same period in other large LMICs including Brazil (62,63), Russia (35), and Mexico (64). Excess mortality P-scores in India are similar to those observed in Eastern Europe (65), and lower than those observed in LMICs such as Ecuador (4).…”

Socioeconomic, Disease Burden, Physical Functioning, Psychosocial, and Environmental Factors Associated With Mortality Among Older Adults: The Brazilian Longitudinal Study of Ageing (ELSI-Brazil)

“…PAF calculated only for statistically significant predictors of mortality, based on Model five in Table 3. stroke, and pneumonia actually declined (Fernandes et al, 2023). As noted above, the lack of participation of older and much sicker respondents in ELSI, combined with the indirect effect of COVID in reducing mortality risk from some major causes of death among older adults may have contributed to lower number of deaths in our study and a consequent underestimation of death rates at older ages.…”

“…Recent work estimated a .9 year reduction of life expectancy at age 65 between 2019 and 2020 due to the pandemic (Castro et al, 2021). Other work indicates that COVID had not only a direct impact on mortality in Brazil but also had an indirect effect through other causes of death (Fernandes et al, 2023). For example, mortality related to childhood (e.g., pregnancy and childbirth and puerperium) and adulthood (e.g., diabetes and hypertension) increased while death from some conditions with high prevalence among older adults such as malignant neoplasm, heart and stroke, and pneumonia actually declined (Fernandes et al, 2023).…”

“…Other work indicates that COVID had not only a direct impact on mortality in Brazil but also had an indirect effect through other causes of death (Fernandes et al, 2023). For example, mortality related to childhood (e.g., pregnancy and childbirth and puerperium) and adulthood (e.g., diabetes and hypertension) increased while death from some conditions with high prevalence among older adults such as malignant neoplasm, heart and stroke, and pneumonia actually declined (Fernandes et al, 2023). As noted above, the lack of participation of older and much sicker respondents in ELSI, combined with the indirect effect of COVID in reducing mortality risk from some major causes of death among older adults may have contributed to lower number of deaths in our study and a consequent underestimation of death rates at older ages.…”