Artikel
Excess mortality in countries with low-and lower-middle-income: A systematic review and meta-analysis
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Autoren
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Jonathan Mawutor Gmanyami
- School of Public Health, Kwame Nkrumah University of Science and Technology, Ghana; German West-African Centre for Global Health and Pandemic Prevention (G-WAC); Global Health and Infectious Diseases Group, Kumasi Centre for Collaborative Research in Tropical Medicine, Ghana
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Wilm Quentin
- German West-African Centre for Global Health and Pandemic Prevention (G-WAC); Department of Health Care Management, Technische Universität Berlin, Germany
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Oscar Lambert
- School of Public Health, Kwame Nkrumah University of Science and Technology, Ghana; German West-African Centre for Global Health and Pandemic Prevention (G-WAC)
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Andrzej Jarynowski
- Department of Veterinary Medicine, Freie Universität Berlin, Germany
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Vitaly Belik
- Department of Veterinary Medicine, Freie Universität Berlin, Germany
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John Humphrey Amuasi
- School of Public Health, Kwame Nkrumah University of Science and Technology, Ghana; German West-African Centre for Global Health and Pandemic Prevention (G-WAC); Global Health and Infectious Diseases Group, Kumasi Centre for Collaborative Research in Tropical Medicine, Ghana; Bernhard Nocht Institute of Tropical Medicine, Hamburg, Germany
| Veröffentlicht: | 28. November 2023 |
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Gliederung
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Research question: This review sought to answer the following questions:
- 1.
- What is the estimated level of excess mortality during the COVID-19 pandemic in low-and lower-middle-income countries (LLMICs)?
- 2.
- What methods and data are used to estimate excess mortality in LLMICs?
- 3.
- What are the factors influencing excess mortality in LLMICs?
Methods: The protocol was registered in PROSPERO (ID: CRD42022378267). We searched PubMed, Embase, Web of Science, Cochrane Library, Google Scholar, and Scopus for studies conducted in LLMICs on excess mortality. These included studies with at least a one-year non-COVID-19 period as the comparator in estimating excess mortality and with publication dates from 2019 to date. The meta-analysis included studies with extractable data on excess mortality estimates, methods, population size, and observed and expected deaths. We used the Mantel-Haenszel method to estimate the pooled risk ratio of excess mortality with 95% confidence intervals.
Results: The review included 25 studies, of which 7 were included in the meta-analysis. Of 1,405,128,717 individuals, 2,161,846 deaths were expected, and 3,633,661 deaths were reported. The pooled excess mortality was 104.7 deaths per 100,000 population per pandemic period. The risk of excess mortality was 1.68 (95% CI: 1.67, 1.68 p<0.001). Data sources included civil registration systems, obituary notifications, surveys, public cemeteries, funeral counts, burial site imaging, and demographic surveillance systems. Techniques used to estimate expected deaths during the pandemic were mainly statistical forecast modelling and geospatial analysis. Of the 21 studies, only one found higher excess mortality in urban settings.
Discussion: These findings contribute to a better understanding of the effect of the COVID-19 pandemic on excess mortality in LLMICs. Excess mortality in LLMICs during the pandemic was substantial; higher than direct COVID-19 mortality. Even though the availability of reliable data was a problem in many countries, the identified methods may inform future studies to provide more reliable estimates of excess mortality in LLMICs. Further studies are needed to identify the drivers of excess mortality in LLMICs, and methods identified in this review may inform future analyses.
