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Exploring the Gap Between Excess Mortality and COVID-19 Deaths in 67 Countries

Educational Objective
To identify the key insights or developments described in this article

During the SARS-CoV-2 pandemic, a surge in overall deaths has been recorded in many countries, most of them likely attributable to COVID-19. However, COVID-19 confirmed mortality (CCM) is considered an unreliable indicator of COVID-19 deaths because of national health care systems’ different capacities to correctly identify people who actually died of the disease.1,2 Excess mortality (EM) is a more comprehensive and robust indicator because it relies on all-cause mortality instead of specific causes of death.3 We analyzed the gap between the EM and CCM in 67 countries to determine the extent to which official data on COVID-19 deaths might be considered reliable.

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Article Information

Accepted for Publication: May 13, 2021.

Published: July 16, 2021. doi:10.1001/jamanetworkopen.2021.17359

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Sanmarchi F et al. JAMA Network Open.

Corresponding Author: Davide Golinelli, MD, Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum–University of Bologna, Via San Giacomo 12, 40126 Bologna, Italy (davide.golinelli@unibo.it).

Author Contributions: Dr Sanmarchi had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Sanmarchi, Golinelli, Capodici, Gibertoni.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Sanmarchi, Golinelli, Capodici.

Critical revision of the manuscript for important intellectual content: Sanmarchi, Golinelli, Lenzi, Esposito, Reno, Gibertoni.

Statistical analysis: Sanmarchi, Lenzi, Capodici, Gibertoni.

Supervision: Golinelli, Gibertoni.

Conflict of Interest Disclosures: None reported.

References
1.
Bilinski  A , Emanuel  EJ .  COVID-19 and excess all-cause mortality in the US and 18 comparison countries.   JAMA. 2020;324(20):2100-2102. doi:10.1001/jama.2020.20717PubMedGoogle ScholarCrossref
2.
Karanikolos  M , McKee  M ; European Observatory on Health Systems and Policies. How comparable is COVID-19 mortality across countries? Eurohealth. 2020;26(‎2):45-50. Accessed June 12, 2021. https://apps.who.int/iris/handle/10665/336295
3.
Garber  AM .  Learning from excess pandemic deaths.   JAMA. 2021. Published online April 02, 2021. doi:10.1001/jama.2021.5120PubMedGoogle Scholar
4.
Woolf  SH , Chapman  DA , Sabo  RT , Zimmerman  EB .  Excess deaths from COVID-19 and other causes in the US, March 1, 2020, to January 2, 2021.   JAMA. 2021;325(17):1729-1730. doi:10.1001/jama.2021.5199PubMedGoogle ScholarCrossref
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Davies  NG , Kucharski  AJ , Eggo  RM , Gimma  A , Edmunds  WJ ; Centre for the Mathematical Modelling of Infectious Diseases COVID-19 working group.  Effects of non-pharmaceutical interventions on COVID-19 cases, deaths, and demand for hospital services in the UK: a modelling study.   Lancet Public Health. 2020;5(7):e375-e385. doi:10.1016/S2468-2667(20)30133-XPubMedGoogle ScholarCrossref
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Wang  CJ , Ng  CY , Brook  RH .  Response to COVID-19 in Taiwan: big data analytics, new technology, and proactive testing.   JAMA. 2020;323(14):1341-1342. doi:10.1001/jama.2020.3151PubMedGoogle ScholarCrossref
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