Magnitude and determinants of excess total, age-specific and sex-specific all-cause mortality in 24 countries worldwide during 2020 and 2021: results on the impact of the COVID-19 pandemic from the C-MOR project.

INTRODUCTION: To examine the impact of the COVID-19 pandemic on mortality, we estimated excess all-cause mortality in 24 countries for 2020 and 2021, overall and stratified by sex and age. METHODS: Total, age-specific and sex-specific weekly all-cause mortality was collected for 2015-2021 and excess mortality for 2020 and 2021 was calculated by comparing weekly 2020 and 2021 age-standardised mortality rates against expected mortality, estimated based on historical data (2015-2019), accounting for seasonality, and long-term and short-term trends. Age-specific weekly excess mortality was similarly calculated using crude mortality rates. The association of country and pandemic-related variables with excess mortality was investigated using simple and multilevel regression models. RESULTS: Excess cumulative mortality for both 2020 and 2021 was found in Austria, Brazil, Belgium, Cyprus, England and Wales, Estonia, France, Georgia, Greece, Israel, Italy, Kazakhstan, Mauritius, Northern Ireland, Norway, Peru, Poland, Slovenia, Spain, Sweden, Ukraine, and the USA. Australia and Denmark experienced excess mortality only in 2021. Mauritius demonstrated a statistically significant decrease in all-cause mortality during both years. Weekly incidence of COVID-19 was significantly positively associated with excess mortality for both years, but the positive association was attenuated in 2021 as percentage of the population fully vaccinated increased. Stringency index of control measures was positively and negatively associated with excess mortality in 2020 and 2021, respectively. CONCLUSION: This study provides evidence of substantial excess mortality in most countries investigated during the first 2 years of the pandemic and suggests that COVID-19 incidence, stringency of control measures and vaccination rates interacted in determining the magnitude of excess mortality.

Epidemiology of Offences against Health in the Republic of Kazakhstan: 2015-2019.

The epidemiology of offences against health is a subject of debate in developed nations but it is poorly studied in former socialist economies, to which the countries of Central Asia belong. This study investigated the epidemiology of medical errors and associated compensation payments, pre-trial settlements and court hearings in the Republic of Kazakhstan over a period of five years (2015-2019). We performed the analysis of nationwide data on offences against health and associated mortality. There was a decrease in the rate of offences against health from 4,024 per 100,000 population in 2015 to 2,533 per 100,000 population in 2019. Likewise, the mortality rate from offences against health has gradually declined. Over the study period there were significant variations in the numbers of adverse events, compensation payments, patient victims and health care providers involved. Understanding the scope of unsafe care in Kazakhstan and solutions to be adopted is critical for delivering safe and effective medical care to the country's citizens. Decisions made on the safety of medical services should be evidence-based. It is necessary to construct a State program focused on monitoring of medical errors and their consequences in order to protect patients and strengthen legal protection of health care workers.