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            <funder>This work was supported by the University of Nicosia Medical School (internal funding). The funding source did not have any involvement in study design; the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.</funder>
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                <title level="j">International Journal of Epidemiology</title>
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                  <publisher>Oxford University Press (OUP)</publisher>
                  <biblScope unit="volume">52</biblScope>
                  <biblScope unit="issue">3</biblScope>
                  <biblScope unit="pp">664-676</biblScope>
                  <date type="datePub">2023-06-06</date>
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              <idno type="doi">10.1093/ije/dyac170</idno>
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                <term xml:lang="en">Global impact</term>
                <term xml:lang="en">Pandemic</term>
                <term xml:lang="en">Excess mortality</term>
                <term xml:lang="en">All-cause mortality</term>
                <term xml:lang="en">SARS-CoV-2</term>
                <term xml:lang="en">COVID-19</term>
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              <p>Background - To understand the impact of the COVID-19 pandemic on mortality, this study investigates overall, sex- and age-specific excess all-cause mortality in 20 countries, during 2020. Methods - Total, sex- and age-specific weekly all-cause mortality for 2015–2020 was collected from national vital statistics databases. Excess mortality for 2020 was calculated by comparing weekly 2020 observed mortality against expected mortality, estimated from historical data (2015–2019) accounting for seasonality, long- and short-term trends. Crude and age-standardized rates were analysed for total and sex-specific mortality. Results - Austria, Brazil, Cyprus, England and Wales, France, Georgia, Israel, Italy, Northern Ireland, Peru, Scotland, Slovenia, Sweden, and the USA displayed substantial excess age-standardized mortality of varying duration during 2020, while Australia, Denmark, Estonia, Mauritius, Norway, and Ukraine did not. In sex-specific analyses, excess mortality was higher in males than females, except for Slovenia (higher in females) and Cyprus (similar in both sexes). Lastly, for most countries substantial excess mortality was only detectable (Austria, Cyprus, Israel, and Slovenia) or was higher (Brazil, England and Wales, France, Georgia, Italy, Northern Ireland, Sweden, Peru and the USA) in the oldest age group investigated. Peru demonstrated substantial excess mortality even in the &amp;lt;45 age group. Conclusions - This study highlights that excess all-cause mortality during 2020 is context dependent, with specific countries, sex- and age-groups being most affected. As the pandemic continues, tracking excess mortality is important to accurately estimate the true toll of COVID-19, while at the same time investigating the effects of changing contexts, different variants, testing, quarantine, and vaccination strategies.</p>
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