National all-cause mortality during the COVID-19 pandemic: a Danish registry-based study

Abstract

Denmark implemented early widespread social distancing to reduce pressure on the healthcare system from the coronavirus disease 2019 (COVID-19) pandemic, with the aims to reduce mortality. Unintended consequences might be delays in treatment for other diseases and subsequent mortality. We examined national all-cause mortality comparing weeks 1–27 in 2020 and 2015–2019. This registry-based study used Danish national registry data until 5 July 2020. We examined all-cause mortality rates among all deaths recorded from 2015 to 2020 and among chronic conditions (cardiovascular (cardiac & circulatory), chronic pulmonary, chronic kidney disease, cancer, and diabetes), comparing each week in 2020 to weeks in 2015–2019. In 2020, there were 28,363 deaths in weeks 1–27 (30 December 2019–5 July 2020), the mean deaths in 2015–2019 were 28,630 deaths (standard deviation 784). Compared to previous years, the mortality rate in weeks 3–10 of 2020 was low, peaking in week 14 (17.6 per 100,000 persons in week 9, 19.9 per 100,000 in week 14). Comorbidity prevalence among deceased individuals was similar in 2020 and 2015–2019: 71.1% of all deceased had a prior cardiovascular diagnosis, 30.0% of all deceased had a prior cardiac diagnosis. There were 493 deaths with COVID-19 in weeks 11–27, (59.8% male), and 75.1% had a prior cardiovascular diagnosis. Weekly mortality rates for pre-existing chronic conditions peaked in week 14, and then declined. During the COVID-19 pandemic, due to timely lockdown measures, the mortality rate in Denmark has not increased compared to the mortality rates in the same period during 2015–2019. Electronic supplementary material The online version of this article (10.1007/s10654-020-00680-x) contains supplementary material, which is available to authorized users.

All-cause mortality and location of death in patients with established cardiovascular disease before, during, and after the COVID-19 lockdown: a Danish Nationwide Cohort Study

“…This finding is also in keeping with a previous study, in which we found that the overall mortality rate in the general population during weeks 1–27 in 2020 was not higher than the mortality rates in the same period in 2015–2019 in Denmark. 32 However, this is in contrast to the findings from many other countries. 30 , 31 Although we can only speculate on this finding, it is possible that the implementation of timely, and comprehensive, lockdown measures and subsequent low burden of COVID-19 may in part explain the absence of excess mortality in the general population as well as in patients with chronic cardiovascular diseases.…”

COVID-19: facts and failures, a tale of two worlds

“…In contrast with the U.S. situation, the Danish government was among the first European countries to take firm actions against the SARS-CoV-2 spread, declaring one of the earliest national lockdown and borders closure just 2 weeks after the first case was reported in the country [19]. The most immediate observed consequence of this early intervention was the reduction of the prevalence of flu in this country, with a significant drop in the percentage of positive tests when comparing the week in which the preventive measures were issued and the immediately next epidemiological week (20% vs. 7%, respectively), despite the similar number of tests performed in the 2 weeks [7,20]. Furthermore, compared to its neighbor countries, Denmark has shown a more favorable trend regarding the number of new cases of COVID-19 from the beginning of the pandemic, allowing an earlier gradual return to labors such as ordinary hospital care [21,22].…”

“…Furthermore, the authors estimated an annual excess age-standardized death rate of 91.6 per 100,000 p-y (95% CI 89.3-93.9) after comparing age-standardized mortality rates for 2020 vs. 2015-2019. On the other hand, the study of Mills et al assessed the effect of lockdown on allcause mortality in Denmark, finding a similar prevalence of comorbidities among deceased patients compared to previous years and highlighting the lack of an increase in the mortality rates during 2020 compared to the same period during 2015-2019 [7].…”

“…However, this mark has not been the same for all countries, and these differences are being currently analyzed to comprehend, which interventions seemed to be successful and which failed its purpose [5,6]. In this commentary, we will discuss the scenarios of two different countries: Denmark and the United States, by analyzing the results from two studies recently published in the European Journal of Epidemiology [7,8], highlighting the different approaches taken to manage the pandemic by the two governments, and subsequently, the results so far.…”

Sheltering in place and the likelihood of non-natural death

“…Although clinical anecdote (7) supports the intuition of increased mortality during sheltering-in-place, the scholarly literature reports mixed results (8)(9)(10). These divergent results likely arise, at least in part, because the observed populations varied in the fraction at risk of what the Centers for Disease Control (CDC) term "natural" death or that plausibly averted had sheltering in place not disrupted medical care (11).…”