Sustained excess all-cause mortality post COVID-19 in 21 countries: An ecological investigation

Chryso Th Pallari; Souzana Achilleos; Annalisa Quattrocchi; Mohammad R Rahmanian Haghighi; Minh Tam Phan; Andreas Artemiou; Catherine M Bennett; Joseph Cuthbertson; Claudia Zimmermann; Eva Schernhammer; Catharina Vernemmen; Serge Nganda Mekogo; Jackeline C P Lobato; Laylla Macedo; Maria Athanasiadou; Laust H Mortensen; Julia A Critchley; Lucy P Goldsmith; Gleb Denissov; Nolwenn Le Meur; Levan Kandelaki; Nino Chikhladze; Kostas Athanasakis; Binyamin Binyaminy; Tamar Maor; Enza Caruso; Giuseppe Ambrosio; Cyndy Martial; Marie Chan Sun; Terje P Hagen; Manuel Barron; Mario Chong; Błażej Łyszczarz; Ivan Erzen; José Antonio Cernuda Martínez; Pedro Arcos González; Bo Burstrom; Wenjing Tao; Qian Huang; Antonis Polemitis; Andreas Charalambous; Christiana A Demetriou

doi:10.1093/ije/dyaf075

Sustained excess all-cause mortality post COVID-19 in 21 countries: An ecological investigation

Chryso Th Pallari, Souzana Achilleos, Annalisa Quattrocchi, Mohammad R Rahmanian Haghighi, Minh Tam Phan, Andreas Artemiou, Catherine M Bennett, Joseph Cuthbertson, Claudia Zimmermann, Eva Schernhammer, Catharina Vernemmen, Serge Nganda Mekogo, Jackeline C P Lobato, Laylla Macedo, Maria Athanasiadou, Laust H Mortensen, Julia A Critchley, Lucy P Goldsmith, Gleb Denissov, Nolwenn Le MeurLevan Kandelaki, Nino Chikhladze, Kostas Athanasakis, Binyamin Binyaminy, Tamar Maor, Enza Caruso, Giuseppe Ambrosio, Cyndy Martial, Marie Chan Sun, Terje P Hagen, Manuel Barron, Mario Chong, Błażej Łyszczarz, Ivan Erzen, José Antonio Cernuda Martínez, Pedro Arcos González, Bo Burstrom, Wenjing Tao, Qian Huang, Antonis Polemitis, Andreas Charalambous, Christiana A Demetriou

Producción científica: Contribución a una revista › Artículo de revista › revisión exhaustiva

Resumen

Antecedentes: A pesar de los amplios esfuerzos de vacunación, la mortalidad excesiva continuó significativamente en varios países tras la pandemia de COVID-19. Este estudio tiene como objetivo estimar el exceso de mortalidad durante 2022 en 21 países y regiones, y examinar la relación entre las medidas de control gubernamentales y las tasas de vacunación con el exceso de mortalidad durante 2021–2022 a nivel ecológico. Métodos: Se estimó el exceso de mortalidad para 2022 mediante el análisis de datos semanales de mortalidad desde enero de 2020 hasta diciembre de 2022 en 21 países y regiones participantes del consorcio C-MOR. Esto se logró comparando las tasas de mortalidad estandarizadas por edad por cada 100 000 habitantes observadas con una línea de base derivada de datos históricos (2015–2019). Se investigaron las medidas de control gubernamentales y los esfuerzos de vacunación por su asociación con la mortalidad excesiva semanal durante 2021–2022 mediante modelos multinivel con el país como efecto aleatorio. Resultados: Los 21 países experimentaron exceso de mortalidad en 2022, con rangos desde 8.6 (Perú) hasta 116.2 (Georgia) por cada 100 000 habitantes, señalando que las tasas no fueron directamente comparables entre países. Muchos países presentaron un exceso de mortalidad más alto en 2022 en comparación con años anteriores. Mauricio mostró por primera vez un exceso de mortalidad significativo en 2022. La proporción de muertes por COVID-19 respecto al total de muertes disminuyó en 2022 en la mayoría de países, excepto Australia. Las medidas de control gubernamentales y la vacunación se asociaron con una reducción del exceso de mortalidad en 2021 y 2022, respectivamente. Conclusión: El estudio revela un exceso sostenido de mortalidad a lo largo de 2022. Las muertes en exceso fueron en su mayoría no relacionadas con COVID-19, probablemente debido a una mortalidad desplazada o a impactos más amplios y prolongados de la respuesta a la pandemia. Las políticas de control gubernamental y los esfuerzos de vacunación se asociaron con una menor mortalidad excesiva. Estos hallazgos ofrecen perspectivas críticas sobre la dinámica de la mortalidad durante la pandemia y subrayan la necesidad de mantener la vigilancia y estrategias de salud pública adaptativas.

Idioma original	Inglés
Número de artículo	dyaf075
Publicación	International Journal of Epidemiology
Volumen	54
N.º	3
DOI	https://doi.org/10.1093/ije/dyaf075
Estado	Publicada - jun. 2025

Nota bibliográfica

Publisher Copyright:
© 2025 The Author(s).

Palabras clave

COVID-19
Mortalidad excesiva
Vacunación
Medidas de control gubernamentales
Mortalidad indirecta
Mortalidad por todas las causas

ODS de las Naciones Unidas

Este resultado contribuye a los siguientes Objetivos de Desarrollo Sostenible

Acceder al documento

10.1093/ije/dyaf075Licencia: CC BY-NC

Otros archivos y enlaces

Citar esto

Pallari, C. T., Achilleos, S., Quattrocchi, A., Rahmanian Haghighi, M. R., Phan, M. T., Artemiou, A., Bennett, C. M., Cuthbertson, J., Zimmermann, C., Schernhammer, E., Vernemmen, C., Nganda Mekogo, S., Lobato, J. C. P., Macedo, L., Athanasiadou, M., Mortensen, L. H., Critchley, J. A., Goldsmith, L. P., Denissov, G., ... Demetriou, C. A. (2025). Sustained excess all-cause mortality post COVID-19 in 21 countries: An ecological investigation. International Journal of Epidemiology, 54(3), Artículo dyaf075. https://doi.org/10.1093/ije/dyaf075

@article{8944d0adcc7e4f27bd6777735bc7db99,

title = "Sustained excess all-cause mortality post COVID-19 in 21 countries: An ecological investigation",

abstract = "Despite widespread vaccination efforts, significant excess mortality continued in various countries following the COVID-19 pandemic. This study aims to estimate excess mortality during 2022 in 21 countries and regions, and to examine the relationship of governmental control measures and vaccination rates with excess mortality during 2021–2 at an ecological level.Excess mortality for 2022 was estimated by analysing weekly mortality data from January 2020 to December 2022 across 21 countries and regions participating in the C-MOR consortium. This was achieved by comparing the observed age-standardized mortality rates per 100 000 population to a baseline derived from historical data (2015–19). Governmental control measures and vaccination efforts were investigated for their association with weekly excess mortality during 2021–2 in multilevel models with country as a random effect.All 21 countries experienced excess mortality in 2022, ranging from 8.6 (Peru) to 116.2 (Georgia) per 100 000 population, noting that rates were not directly comparable across countries. Many countries had higher excess mortality in 2022 compared with previous years. Mauritius showed a significant excess mortality for the first time in 2022. The proportion of COVID-19 deaths relative to total deaths decreased in 2022 for most countries, except Australia. Governmental control measures and vaccinations were associated with reduced excess mortality in 2021 and 2022, respectively.The study reveals sustained excess mortality throughout 2022. Excess deaths were mainly non-COVID-19-related, likely due to displaced mortality or to broader long-term impacts of the pandemic response. Governmental control policies and vaccination efforts were associated with lower excess mortality. These findings provide critical insights into pandemic mortality dynamics and emphasize the need for continued vigilance and adaptive public health strategies.",

keywords = "COVID-19, Mortalidad excesiva, Vacunaci{\'o}n, Medidas de control gubernamentales, Mortalidad indirecta, Mortalidad por todas las causas, COVID-19, Excess mortality, Vaccination, Governmental control measures, Indirect mortality, All-cause mortality, indirect mortality, all-cause mortality, excess mortality, governmental control measures, vaccination",

author = "Pallari, \{Chryso Th\} and Souzana Achilleos and Annalisa Quattrocchi and \{Rahmanian Haghighi\}, \{Mohammad R\} and Phan, \{Minh Tam\} and Andreas Artemiou and Bennett, \{Catherine M\} and Joseph Cuthbertson and Claudia Zimmermann and Eva Schernhammer and Catharina Vernemmen and \{Nganda Mekogo\}, Serge and Lobato, \{Jackeline C P\} and Laylla Macedo and Maria Athanasiadou and Mortensen, \{Laust H\} and Critchley, \{Julia A\} and Goldsmith, \{Lucy P\} and Gleb Denissov and \{Le Meur\}, Nolwenn and Levan Kandelaki and Nino Chikhladze and Kostas Athanasakis and Binyamin Binyaminy and Tamar Maor and Enza Caruso and Giuseppe Ambrosio and Cyndy Martial and \{Chan Sun\}, Marie and Hagen, \{Terje P\} and Manuel Barron and Mario Chong and B{\l}a{\.z}ej {\L}yszczarz and Ivan Erzen and \{Cernuda Mart{\'i}nez\}, \{Jos{\'e} Antonio\} and \{Arcos Gonz{\'a}lez\}, Pedro and Bo Burstrom and Wenjing Tao and Qian Huang and Antonis Polemitis and Andreas Charalambous and Demetriou, \{Christiana A\}",

note = "Publisher Copyright: {\textcopyright} 2025 The Author(s).",

year = "2025",

month = jun,

doi = "10.1093/ije/dyaf075",

language = "English",

volume = "54",

journal = "International Journal of Epidemiology",

issn = "0300-5771",

publisher = "Oxford University Press",

number = "3",

}

Pallari, CT, Achilleos, S, Quattrocchi, A, Rahmanian Haghighi, MR, Phan, MT, Artemiou, A, Bennett, CM, Cuthbertson, J, Zimmermann, C, Schernhammer, E, Vernemmen, C, Nganda Mekogo, S, Lobato, JCP, Macedo, L, Athanasiadou, M, Mortensen, LH, Critchley, JA, Goldsmith, LP, Denissov, G, Le Meur, N, Kandelaki, L, Chikhladze, N, Athanasakis, K, Binyaminy, B, Maor, T, Caruso, E, Ambrosio, G, Martial, C, Chan Sun, M, Hagen, TP, Barron, M , Chong, M, Łyszczarz, B, Erzen, I, Cernuda Martínez, JA, Arcos González, P, Burstrom, B, Tao, W, Huang, Q, Polemitis, A, Charalambous, A & Demetriou, CA 2025, 'Sustained excess all-cause mortality post COVID-19 in 21 countries: An ecological investigation', International Journal of Epidemiology, vol. 54, n.º 3, dyaf075. https://doi.org/10.1093/ije/dyaf075

TY - JOUR

T1 - Sustained excess all-cause mortality post COVID-19 in 21 countries

T2 - An ecological investigation

AU - Pallari, Chryso Th

AU - Achilleos, Souzana

AU - Quattrocchi, Annalisa

AU - Rahmanian Haghighi, Mohammad R

AU - Phan, Minh Tam

AU - Artemiou, Andreas

AU - Bennett, Catherine M

AU - Cuthbertson, Joseph

AU - Zimmermann, Claudia

AU - Schernhammer, Eva

AU - Vernemmen, Catharina

AU - Nganda Mekogo, Serge

AU - Lobato, Jackeline C P

AU - Macedo, Laylla

AU - Athanasiadou, Maria

AU - Mortensen, Laust H

AU - Critchley, Julia A

AU - Goldsmith, Lucy P

AU - Denissov, Gleb

AU - Le Meur, Nolwenn

AU - Kandelaki, Levan

AU - Chikhladze, Nino

AU - Athanasakis, Kostas

AU - Binyaminy, Binyamin

AU - Maor, Tamar

AU - Caruso, Enza

AU - Ambrosio, Giuseppe

AU - Martial, Cyndy

AU - Chan Sun, Marie

AU - Hagen, Terje P

AU - Barron, Manuel

AU - Chong, Mario

AU - Łyszczarz, Błażej

AU - Erzen, Ivan

AU - Cernuda Martínez, José Antonio

AU - Arcos González, Pedro

AU - Burstrom, Bo

AU - Tao, Wenjing

AU - Huang, Qian

AU - Polemitis, Antonis

AU - Charalambous, Andreas

AU - Demetriou, Christiana A

PY - 2025/6

Y1 - 2025/6

N2 - Despite widespread vaccination efforts, significant excess mortality continued in various countries following the COVID-19 pandemic. This study aims to estimate excess mortality during 2022 in 21 countries and regions, and to examine the relationship of governmental control measures and vaccination rates with excess mortality during 2021–2 at an ecological level.Excess mortality for 2022 was estimated by analysing weekly mortality data from January 2020 to December 2022 across 21 countries and regions participating in the C-MOR consortium. This was achieved by comparing the observed age-standardized mortality rates per 100 000 population to a baseline derived from historical data (2015–19). Governmental control measures and vaccination efforts were investigated for their association with weekly excess mortality during 2021–2 in multilevel models with country as a random effect.All 21 countries experienced excess mortality in 2022, ranging from 8.6 (Peru) to 116.2 (Georgia) per 100 000 population, noting that rates were not directly comparable across countries. Many countries had higher excess mortality in 2022 compared with previous years. Mauritius showed a significant excess mortality for the first time in 2022. The proportion of COVID-19 deaths relative to total deaths decreased in 2022 for most countries, except Australia. Governmental control measures and vaccinations were associated with reduced excess mortality in 2021 and 2022, respectively.The study reveals sustained excess mortality throughout 2022. Excess deaths were mainly non-COVID-19-related, likely due to displaced mortality or to broader long-term impacts of the pandemic response. Governmental control policies and vaccination efforts were associated with lower excess mortality. These findings provide critical insights into pandemic mortality dynamics and emphasize the need for continued vigilance and adaptive public health strategies.

AB - Despite widespread vaccination efforts, significant excess mortality continued in various countries following the COVID-19 pandemic. This study aims to estimate excess mortality during 2022 in 21 countries and regions, and to examine the relationship of governmental control measures and vaccination rates with excess mortality during 2021–2 at an ecological level.Excess mortality for 2022 was estimated by analysing weekly mortality data from January 2020 to December 2022 across 21 countries and regions participating in the C-MOR consortium. This was achieved by comparing the observed age-standardized mortality rates per 100 000 population to a baseline derived from historical data (2015–19). Governmental control measures and vaccination efforts were investigated for their association with weekly excess mortality during 2021–2 in multilevel models with country as a random effect.All 21 countries experienced excess mortality in 2022, ranging from 8.6 (Peru) to 116.2 (Georgia) per 100 000 population, noting that rates were not directly comparable across countries. Many countries had higher excess mortality in 2022 compared with previous years. Mauritius showed a significant excess mortality for the first time in 2022. The proportion of COVID-19 deaths relative to total deaths decreased in 2022 for most countries, except Australia. Governmental control measures and vaccinations were associated with reduced excess mortality in 2021 and 2022, respectively.The study reveals sustained excess mortality throughout 2022. Excess deaths were mainly non-COVID-19-related, likely due to displaced mortality or to broader long-term impacts of the pandemic response. Governmental control policies and vaccination efforts were associated with lower excess mortality. These findings provide critical insights into pandemic mortality dynamics and emphasize the need for continued vigilance and adaptive public health strategies.

KW - COVID-19

KW - Mortalidad excesiva

KW - Vacunación

KW - Medidas de control gubernamentales

KW - Mortalidad indirecta

KW - Mortalidad por todas las causas

KW - COVID-19

KW - Excess mortality

KW - Vaccination

KW - Governmental control measures

KW - Indirect mortality

KW - All-cause mortality

KW - indirect mortality

KW - all-cause mortality

KW - excess mortality

KW - governmental control measures

KW - vaccination

UR - https://www.scopus.com/pages/publications/105008154639

UR - https://www.mendeley.com/catalogue/f2e6298b-d1ad-3b71-b58b-9b77fa885454/

U2 - 10.1093/ije/dyaf075

DO - 10.1093/ije/dyaf075

M3 - Article in a journal

SN - 0300-5771

VL - 54

JO - International Journal of Epidemiology

JF - International Journal of Epidemiology

IS - 3

M1 - dyaf075

ER -

Sustained excess all-cause mortality post COVID-19 in 21 countries: An ecological investigation

Resumen

Nota bibliográfica

Palabras clave

ODS de las Naciones Unidas

Acceder al documento

Otros archivos y enlaces

Huella

Citar esto