ABSTRACT
Objective
To investigate excess mortality during the COVID-19 pandemic and its spatial distribution in Pernambuco, Brazil.
Methods
This was an ecological, descriptive and analytical study of deaths, by municipality, recorded on the Mortality Information System, in 2020 and 2021. Excess mortality was measured by comparing observed and expected deaths, the latter estimated by calculating standardized mortality ratio (SMR). SMR and respective confidence intervals (95%CI) were calculated. Spatial analysis was performed by calculating the Global and Local Moran Index.
Results
Excess mortality was 20.6% and 27.5%, respectively, in 2020 and 2021, with positive spatial correlation (p-value < 0.05). More populous municipalities (2020: SMR = 1.26; 95%CI 1.24;1.27 and 2021: SMR = 1.34; 95%CI 1.32;1.34), more developed municipalities (2020: SMR = 1.43; 95%CI 1.41;1.44 and 2021: SMR = 1.51;95%CI 1.50;1.53) and municipalities in the Sertão region (2020:SMR = 1.31;95%CI 1.30;1.33 and 2021: SMR = 1.44; 95%CI 1.42;1.46) showed greater excess deaths.
Conclusion
Excess mortality coincided with peak periods of COVID-19 transmission.
Keywords
Excess Mortality; COVID-19; Spatial Analysis; Proportional Mortality Ratio; Ecological Studies
Study contributions
Main results
There was excess mortality in Pernambuco in 2020 and 2021, which coincided with the peak of the COVID-19 epidemic curve. Municipalities with higher population density, developed municipalities and municipalities in the Sertão region had higher excess deaths.
Implications for services
The results highlighted the effects of the pandemic on mortality in the state. Strengthening mortality surveillance can assist health management in formulating strategies and public policies for the Brazilian National Health System.
Perspectives
Adoption of this type of analysis could contribute to identification of inequalities in the mortality burden between different population groups, and could be used for analysis of future health challenges.
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