Comparison of fatalities due to COVID-19 and other nonexternal causes during the first five pandemic waves : Results from multiple cause of death statistics in Bavaria.

BACKGROUND: Older age is a risk factor for a fatal course of SARS-CoV­2 infection, possibly due to comorbidities whose exact role in this context, however, is not yet well understood. In this paper, the characteristics and comorbidities of persons who had died of COVID-19 in Bavaria by July 2022 are shown and compared with the characteristics of other fatalities during the pandemic. METHODS: Based on data from multiple cause of death statistics, odds ratios for dying from COVID-19 (compared to dying from other nonexternal causes of death) were calculated by using logistic regression models, stratified by age, sex, and pandemic waves. RESULTS: In Bavaria, a total of 24,479 persons (6.5% of all deaths) officially died from COVID-19 between March 2020 and July 2022. In addition to increasing age and male sex, preexisting diseases and comorbidities such as obesity, degenerative diseases of the nervous system, dementia, renal insufficiency, chronic lower respiratory diseases, and diabetes mellitus were significantly associated with COVID-19-related deaths. Dementia was mainly associated with increased COVID-19 mortality during the first and second waves, while obesity was strongly associated during the fourth wave. DISCUSSION: The frequency of specific comorbidities in COVID-19 deaths varied over the course of the pandemic. This suggests that wave-specific results also need to be interpreted against the background of circulating virus variants, changing immunisation levels, and nonpharmaceutical interventions in place at the time.

Unrecognised COVID-19 deaths in central Europe: The importance of cause-of-death certification for the COVID-19 burden assessment.

OBJECTIVE: In Central Europe, the increase in mortality during the COVID-19 pandemic exceeded the number of deaths registered due to coronavirus disease. Excess deaths reported to causes other than COVID-19 may have been due to unrecognised coronavirus disease, the interruptions in care in the overwhelmed health care facilities, or socioeconomic effects of the pandemic and lockdowns. Death certificates provide exhaustive medical information, allowing us to assess the extent of unrecognised COVID-19 deaths. MATERIALS AND METHODS: Data from 187,300 death certificates with a COVID-19 mention from Austria, Bavaria (Germany), Czechia, Lithuania and Poland, 2020-2021, was used. The two step analysis uses Cause of Death Association Indicators (CDAIs) and Contributing CDAIs to identify and measure the statistical strength of associations between COVID-19 and all other medical mentions. RESULTS: 15,700 deaths were reported with COVID-19 only as a contributing condition (comorbidity). In three cases out of four, a typical, statistically significant coronavirus complication or pre-existing condition was registered as the underlying causes of death. In Austria, Bavaria, Czechia and Lithuania the scale of COVID-19 mortality would have been up to 18-27% higher had COVID-19 been coded as the underlying cause of death. Unrecognised coronavirus deaths were equivalent to the entire surplus of excess mortality beyond registered COVID-19 deaths in Austria and the Czech Republic, and its large proportion (25-31%) in Lithuania and Bavaria. CONCLUSIONS: Death certificates with typical coronavirus complications or comorbidities as the underlying causes of death and contributing COVID-19 mentions were plausibly unrecognized coronavirus deaths.

[Avoidable mortality-a new indicator version for prevention reporting]. / Vermeidbare Sterblichkeit ­ Neufassung eines Indikators für die Präventionsberichterstattung.

BACKGROUND: "Avoidable mortality" is used as an indicator in health reporting. The indicator aggregates selected causes of death. In Germany two versions exist, both of which are no longer up to date. A new version is proposed. METHODS: The new version is based on preparatory work on the European level. The feasibility and plausibility of a common OECD Eurostat list are examined using official statistics data from Bavaria from 2016 to 2018. The analysis includes an examination of the variability over time and within the Bavarian administrative districts, as well as possible systematic errors through regional differences in coding behaviour or changes over time. RESULTS: The OECD Eurostat list can be implemented at the regional level with only minor modifications. The age-standardized avoidable mortality in Bavaria in 2018 is almost 23 deaths per 10,000 inhabitants, with preventable deaths by far outweighing treatable deaths. For men, the death rate due to avoidable causes is 30 per 10,000 male inhabitants, which is almost twice as high as that for women (16 per 10,000 female inhabitants). The regional findings on avoidable mortality are consistent with findings on regional health from other studies. DISCUSSION AND CONCLUSION: The results do not indicate a threat to reliability due to random fluctuation or systematic methodological errors. The new version is recommended for application in health reporting.

[Influence of methodological changes on unicausal cause-of-death statistics and potentials of a multicausal data basis]. / Einfluss methodischer Veränderungen auf die unikausale Todesursachenstatistik und Potenziale einer multikausalen Datengrundlage.

BACKGROUND: As a complete survey, cause-of-death statistics are often used for research purposes, but they react sensitively to methodological changes. OBJECTIVES: To show how sensitive the signing of the underlying cause reacts to methodological changes and what potential there is in the use of multicausal analyses. MATERIALS AND METHODS: The methodological examples are based on a sample of the 2016 annual material from Bavaria (age: 65 years or older). It includes n = 24,752 cases of death with information on underlying cause and multiple causes of death. The standardized ratio of multiple to underlying cause (SRMU) value was used to investigate the extent to which dementia and Parkinson's disease are underestimated in the mortality process and which other diseases are noted on the death certificate besides these causes of death. RESULTS: Changes in the set of rules, in the decision tables, and in the confidentiality concept can have an important influence on the signing of the underlying cause. This can lead to changes in the ranking of causes of death or to underestimation or overestimation of certain diseases. Dementia and Parkinson's disease are underestimated as a cause of death in the dying process if only the underlying disease is used for analysis. CONCLUSIONS: Temporal and regional comparisons must always be interpreted against the background of changing methodological guidelines and procedures. Multicausal analyses in this respect offer the chance for the future to mitigate the difficulties of a unicausal approach.