All-cause excess mortality in 2020: The example of Bursa city in Turkey

Abstract

Background: This study aimed to estimate excess all-cause mortality rates in Bursa Province in 2020. Methods: In this study, a retrospective descriptive analysis of the mortality rates in Bursa, Turkey's fourth biggest city, between 2015-2020 was conducted. The data were taken from Bursa Metropolitan Municipality death records. Daily mortality data were classified as age, gender, the date and cause of death (communicable or non-communicable disease). An Excel mortality calculator was used to analyze the data and calculate the excess mortality. Excess mortality was calculated with a 5-year death average. The excess mortality-expected death ratio (P-score) was calculated as a percentage difference between the average number of deaths in 2015-2019 and the number of deaths in the same period (week or month) of 2020. The Chi-square test was used for statistical analysis. Results: In 2020 in Bursa, crude excess mortality was calculated as 5390 (95% CI: 4525-6256) compared to the previous five years' average, and the P-score was 35%. Excess mortality decreased in the 0-14 age group in both genders and increased mainly in the 65+ age group. In 2020, 85.3% of the excess mortality was due to communicable diseases, and 4596 (95% CI: 4562-4631) people reported to die due to communicable diseases. Thus, deaths because of communicable diseases increased approximately 76 times in 2020 compared to the previous five years' average. Conclusion: Compared to the previous five years' average, the annual number of deaths in Bursa increased by approximately one-third in 2020, and most of the excess deaths were due to communicable diseases. For the use of revealing the actual burden of the COVID-19 pandemic on all-cause mortality, it is crucial to assess the extreme all-cause mortality.