Excess Mortality Calculations to Assess the Impact of the COVID-19 Pandemic: Concepts and Methodological Issues

We describe the main ways of presenting excess mortality: as a mortality rate (incidence rate) or as a percentage increase (relative risk or rate ratio). We discuss what should be regarded as the null value of excess mortality (i.e., when countries or regions can be judged as having fared equally well) and when age and sex standardization, adjustment for other determinants of the spread of a pandemic, or both is necessary. We discuss the level of detail by time and place and person that may be necessary. We note that an excess mortality comparison is essentially a difference-in-differences analysis. We conclude that, although one cannot rule out using excess mortality analyses for causal effect estimates, such analyses will remain most fruitful for generating hypotheses about both the efficiency of measures to curtail the pandemic and factors that cannot be influenced. Nevertheless, a judicious use of arguments and counterarguments can then lead to identifying best practices for various situations. (Am J Public Health. Published online ahead of print March 28, 2024:e1-e6. https://doi.org/10.2105/AJPH.2024.307572).PMID:38547492 | DOI:10.2105/AJPH.2024.307572
Source: American Journal of Public Health - Category: International Medicine & Public Health Authors: Source Type: research