Excess mortality associated with the COVID-19 pandemic in Latvia: a population-level analysis of all-cause and noncommunicable disease deaths in 2020

Inese Gobiņa; Andris Avotiņš; Una Kojalo; Ieva Strēle; Santa Pildava; Anita Villeruša; Ģirts Briģis

doi:10.1186/s12889-022-13491-4

Excess mortality associated with the COVID-19 pandemic in Latvia: a population-level analysis of all-cause and noncommunicable disease deaths in 2020

BMC Public Health. 2022 Jun 3;22(1):1109. doi: 10.1186/s12889-022-13491-4.

Authors

Inese Gobiņa¹, Andris Avotiņš², Una Kojalo³, Ieva Strēle³, Santa Pildava⁴, Anita Villeruša³, Ģirts Briģis⁵

Affiliations

¹ Institute of Public Health, Riga Stradiņš University, Anninmuizas Boulevard 26a, Riga, LV-1067, Latvia. inese.gobina@rsu.lv.
² Faculty of Biology and Faculty of Geography and Earth Sciences, University of Latvia, Jelgavas street 1, Riga, LV-1004, Latvia.
³ Institute of Public Health, Riga Stradiņš University, Anninmuizas Boulevard 26a, Riga, LV-1067, Latvia.
⁴ Centre for Disease Prevention and Control, Duntes 22, k-5, Riga, LV-1005, Latvia.
⁵ Department of Public Health and Epidemiology, Riga Stradiņš University, Kronvalda Boulevard 9, Riga, LV-1010, Latvia.

Abstract

Background: Age-standardised noncommunicable disease (NCD) mortality and the proportion of the elderly population in Latvia are high, while public health and health care systems are underresourced. The emerging COVID-19 pandemic raised concerns about its detrimental impact on all-cause and noncommunicable disease mortality in Latvia. We estimated the timing and number of excess all-cause and cause-specific deaths in 2020 in Latvia due to COVID-19 and selected noncommunicable diseases.

Methods: A time series analysis of all-cause and cause-specific weekly mortality from COVID-19, circulatory diseases, malignant neoplasms, diabetes mellitus, and chronic lower respiratory diseases from the National Causes of Death Database from 2015 to 2020 was used by applying generalised additive modelling (GAM) and joinpoint regression analysis.

Results: Between weeks 14 and 52 (from 1 April to 29 December) of 2020, a total of 3111 excess deaths (95% PI 1339 - 4832) were estimated in Latvia, resulting in 163.77 excess deaths per 100 000. Since September 30, with the outbreak of the second COVID-19 wave, 55% of all excess deaths have occurred. Altogether, COVID-19-related deaths accounted for only 28% of the estimated all-cause excess deaths. A significant increase in excess mortality was estimated for circulatory diseases (68.91 excess deaths per 100 000). Ischemic heart disease and cerebrovascular disease were listed as the underlying cause in almost 60% of COVID-19-contributing deaths.

Conclusions: All-cause mortality and mortality from circulatory diseases significantly increased in Latvia during the first pandemic year. All-cause excess mortality substantially exceeded reported COVID-19-related deaths, implying COVID-19-related mortality during was significantly underestimated. Increasing mortality from circulatory diseases suggests a negative cumulative effect of COVID-19 exposure and reduced access to healthcare services for NCD patients.

Keywords: COVID-19; Excess deaths; Mortality; Noncommunicable diseases.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
COVID-19*
Cardiovascular Diseases* / epidemiology
Cause of Death
Diabetes Mellitus* / epidemiology
Humans
Latvia / epidemiology
Mortality
Noncommunicable Diseases* / epidemiology
Pandemics