Journal Articles International Journal of Epidemiology Year : 2025

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

1 Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
2 Universiteit Antwerpen = University of Antwerp
3 Cyprus University of Technology
4 Deakin University [Melbourne Burwood]
5 The University of Notre Dame [Sydney]
6 MedUni Vienna - Medical University of Vienna = Medizinische Universität Wien
7 Sciensano [Bruxelles]
8 Fluminense Federal University [Niterói]
9 UFRJ - Universidade Federal do Rio de Janeiro [Brasil] = Federal University of Rio de Janeiro [Brazil] = Université fédérale de Rio de Janeiro [Brésil]
10 Health Monitoring Unit, Government of the Republic of Cyprus Ministry of Health, Nicosia, Cyprus
11 ITU - IT University of Copenhagen
12 University of London [London]
13 National Institute for Health Development, Tallinn, Estonia
14 ARENES - Arènes: politique, santé publique, environnement, médias
15 EHESP - École des Hautes Études en Santé Publique
16 RSMS - Recherche sur les services et le management en santé
17 METIS - Département Méthodes quantitatives en santé publique
18 UR - Université de Rennes
19 National Center for Disease Control and Public Health, Head of the Population Registry Division of Department of Medical Statistics, Tbilisi, Georgia
20 TSU - Ivane Javakhishvili Tbilisi State University
21 UNIWA - University of West Attica [Athens]
22 State of Israel Ministry of Health, Israel Center of Disease Control, Ramat Gan, Israel
23 UNIPG - Università degli Studi di Perugia = University of Perugia
24 Demography/Census Unit, Statistics Mauritius, Port Louis, Mauritius
25 University of Mauritius
26 UiO - University of Oslo
27 UPACIFICO - Universidad Del Pacífico – Ecuador
28 Nicolaus Copernicus University [Toruń]
29 Public Health School, National Institute of Public Health, Ljubljana, Slovenia
30 Universidad de Oviedo = University of Oviedo
31 Global Public Health, Karolinska Institute, Stockholm, Stockholm, Sweden.
32 ETSU - East Tennessee State University
33 UNIC - University of Nicosia
34 University of Nicosia Medical School, Nicosia, Cyprus.
Andreas Artemiou
Lucy Goldsmith
Marie Chan Sun
Terje P Hagen

Abstract

Abstract Background 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. Methods 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. Results 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. Conclusion 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.

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hal-05122484 , version 1 (05-11-2025)

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Chryso Th. Pallari, Souzana Achilleos, Annalisa Quattrocchi, Mohammad Reza Rahmanian Haghighi, Minh Tam Phan, et al.. Sustained excess all-cause mortality post COVID-19 in 21 countries: an ecological investigation. International Journal of Epidemiology, 2025, 54 (3), pp.dyaf075. ⟨10.1093/ije/dyaf075⟩. ⟨hal-05122484⟩
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