Attributed causes of excess mortality during the COVID-19 pandemic in a south Indian city

Joseph A. Lewnard (), Chandra Mohan B, Gagandeep Kang and Ramanan Laxminarayan
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Joseph A. Lewnard: University of California, Berkeley
Chandra Mohan B: Indian Administrative Service
Gagandeep Kang: Christian Medical College
Ramanan Laxminarayan: One Health Trust

Nature Communications, 2023, vol. 14, issue 1, 1-14

Abstract: Abstract Globally, excess deaths during 2020–21 outnumbered documented COVID-19 deaths by 9.5 million, primarily driven by deaths in low- and middle-income countries (LMICs) with limited vital surveillance. Here we unravel the contributions of probable COVID-19 deaths from other changes in mortality related to pandemic control measures using medically-certified death registrations from Madurai, India—an urban center with well-functioning vital surveillance. Between March, 2020 and July, 2021, all-cause deaths in Madurai exceeded expected levels by 30% (95% confidence interval: 27–33%). Although driven by deaths attributed to cardiovascular or cerebrovascular conditions, diabetes, senility, and other uncategorized causes, increases in these attributions were restricted to medically-unsupervised deaths, and aligned with surges in confirmed or attributed COVID-19 mortality, likely reflecting mortality among unconfirmed COVID-19 cases. Implementation of lockdown measures was associated with a 7% (0–13%) reduction in all-cause mortality, driven by reductions in deaths attributed to injuries, infectious diseases and maternal conditions, and cirrhosis and other liver conditions, respectively, but offset by a doubling in cancer deaths. Our findings help to account for gaps between documented COVID-19 mortality and excess all-cause mortality during the pandemic in an LMIC setting.

Date: 2023
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DOI: 10.1038/s41467-023-39322-7

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