Excess Mortality Stratified by Age and Sex for Croatia and Croatian Counties During the 2020-2021 COVID-19 Pandemic

Overview

Journal Infect Dis Rep

Publisher MDPI

Specialty Infectious Diseases

Date 2024 Feb 23

PMID 38390950

Authors

Mara Sosic

Zvonimir Boban

Marijan Erceg

Natasa Boban

Affiliations

Soon will be listed here.

Abstract

Excess mortality is often used to estimate the effect of a certain crisis on the population. It is defined as the number of deaths during a crisis exceeding the expected number based on historical trends. Here, we calculated excess mortality due to the COVID-19 pandemic for Croatia in the 2020-2021 period. The excess was calculated on the national and county level for different age and sex categories. In addition to the absolute number, the excess mortality was also expressed as a ratio of excess deaths to the predicted baseline and excess mortality rate. We showed that using both measures is necessary to avoid incorrect conclusions. The estimated excess mortality on the national level was 14,963, corresponding to an excess percentage of 14.3%. With respect to sex, there was a higher excess mortality rate for men compared to women. An exponential relationship was observed between age and the excess mortality rate.These trends wee representative of most counties as well, with large variations in the magnitude of the effect. However, there were also exceptions to the general rule. The reasons for these deviations were discussed in terms of between-county differences in demographic structure, population density and special events that took place during the pandemic.

References

Lopez-Gigosos R, Vegas-Romero M, Mariscal A, Mariscal-Lopez E, Fang J, Gutierrez-Bedmar M . Excess mortality in 22 European countries in 2020 and 2021: relationship with socioeconomic indicators. Perspect Public Health. 2023; :17579139231180800. DOI: 10.1177/17579139231180800. View

Tchicaya A, Lorentz N, Leduc K, de Lanchy G . COVID-19 mortality with regard to healthcare services availability, health risks, and socio-spatial factors at department level in France: A spatial cross-sectional analysis. PLoS One. 2021; 16(9):e0256857. PMC: 8448369. DOI: 10.1371/journal.pone.0256857. View

Parkes B, Stafoggia M, Fecht D, Davies B, Bonander C, De Donato F . Community factors and excess mortality in the COVID-19 pandemic in England, Italy and Sweden. Eur J Public Health. 2023; 33(4):695-703. PMC: 10393497. DOI: 10.1093/eurpub/ckad075. View

Ioannidis J, Zonta F, Levitt M . Variability in excess deaths across countries with different vulnerability during 2020-2023. Proc Natl Acad Sci U S A. 2023; 120(49):e2309557120. PMC: 10710037. DOI: 10.1073/pnas.2309557120. View

Civljak R, Markotic A, Capak K . Earthquake in the time of COVID-19: The story from Croatia (CroVID-20). J Glob Health. 2020; 10(1):010349. PMC: 7211414. DOI: 10.7189/jogh.10.010349. View

Kunz J, Propper C . JUE Insight: Is hospital quality predictive of pandemic deaths? Evidence from US counties. J Urban Econ. 2022; 133:103472. PMC: 9221951. DOI: 10.1016/j.jue.2022.103472. View

Janke A, Mei H, Rothenberg C, Becher R, Lin Z, Venkatesh A . Analysis of Hospital Resource Availability and COVID-19 Mortality Across the United States. J Hosp Med. 2021; 16(4):211-214. PMC: 8025594. DOI: 10.12788/jhm.3539. View

Nielsen J, Norgaard S, Lanzieri G, Vestergaard L, Moelbak K . Sex-differences in COVID-19 associated excess mortality is not exceptional for the COVID-19 pandemic. Sci Rep. 2021; 11(1):20815. PMC: 8531278. DOI: 10.1038/s41598-021-00213-w. View

Boricevic Marsanic V, Dobrovic N, Flander Tadic M, Flander G . 2020 Double crisis in Croatia: earthquakes in the time of COVID-19. Eur Child Adolesc Psychiatry. 2021; 30(8):1309-1313. PMC: 8141410. DOI: 10.1007/s00787-021-01785-8. View

10.

Beaney T, Clarke J, Jain V, Golestaneh A, Lyons G, Salman D . Excess mortality: the gold standard in measuring the impact of COVID-19 worldwide?. J R Soc Med. 2020; 113(9):329-334. PMC: 7488823. DOI: 10.1177/0141076820956802. View

11.

Pascoal R, Rocha H . Population density impact on COVID-19 mortality rate: A multifractal analysis using French data. Physica A. 2022; 593:126979. PMC: 8799374. DOI: 10.1016/j.physa.2022.126979. View

12.

Peckham H, de Gruijter N, Raine C, Radziszewska A, Ciurtin C, Wedderburn L . Male sex identified by global COVID-19 meta-analysis as a risk factor for death and ITU admission. Nat Commun. 2020; 11(1):6317. PMC: 7726563. DOI: 10.1038/s41467-020-19741-6. View

13.

Barbieri M, Wilmoth J, Shkolnikov V, Glei D, Jasilionis D, Jdanov D . Data Resource Profile: The Human Mortality Database (HMD). Int J Epidemiol. 2015; 44(5):1549-56. PMC: 4707194. DOI: 10.1093/ije/dyv105. View

14.

Riou J, Hauser A, Fesser A, Althaus C, Egger M, Konstantinoudis G . Direct and indirect effects of the COVID-19 pandemic on mortality in Switzerland. Nat Commun. 2023; 14(1):90. PMC: 9817462. DOI: 10.1038/s41467-022-35770-9. View

15.

Karlinsky A, Kobak D . Tracking excess mortality across countries during the COVID-19 pandemic with the World Mortality Dataset. Elife. 2021; 10. PMC: 8331176. DOI: 10.7554/eLife.69336. View

16.

Scully E, Haverfield J, Ursin R, Tannenbaum C, Klein S . Considering how biological sex impacts immune responses and COVID-19 outcomes. Nat Rev Immunol. 2020; 20(7):442-447. PMC: 7288618. DOI: 10.1038/s41577-020-0348-8. View

17.

Levin A, Hanage W, Owusu-Boaitey N, Cochran K, Walsh S, Meyerowitz-Katz G . Assessing the age specificity of infection fatality rates for COVID-19: systematic review, meta-analysis, and public policy implications. Eur J Epidemiol. 2020; 35(12):1123-1138. PMC: 7721859. DOI: 10.1007/s10654-020-00698-1. View

18.

Lee W, Park S, Weinberger D, Olson D, Simonsen L, Grenfell B . Direct and indirect mortality impacts of the COVID-19 pandemic in the United States, March 1, 2020 to January 1, 2022. Elife. 2023; 12. PMC: 9946455. DOI: 10.7554/eLife.77562. View

19.

Adlhoch C, Mook P, Lamb F, Ferland L, Melidou A, Amato-Gauci A . Very little influenza in the WHO European Region during the 2020/21 season, weeks 40 2020 to 8 2021. Euro Surveill. 2021; 26(11). PMC: 7976381. DOI: 10.2807/1560-7917.ES.2021.26.11.2100221. View

20.

Desmet K, Wacziarg R . JUE Insight: Understanding spatial variation in COVID-19 across the United States. J Urban Econ. 2021; 127:103332. PMC: 7948676. DOI: 10.1016/j.jue.2021.103332. View