COVID-19 causes 13% increase in deaths in Ireland between March and June 2020 - HIQA
The Health Information and Quality Authority (HIQA) has today published a report examining the number of excess deaths that occurred during the current COVID-19 epidemic. This analysis has been provided to the National Public Health Emergency Team (NPHET) to inform the national response to COVID-19.
The report assesses the number of deaths that occurred in Ireland from 11 March 2020 to 16 June 2020, relative to the expected number of deaths, using data from the death notices website RIP.ie. It also examines whether the reported COVID-19 death figures provides an accurate estimate of excess deaths during the epidemic.
HIQA’s Chief Scientist, Dr Conor Teljeur, said: “Based on an analysis of the death notices reported on RIP.ie since 2010, there is clear evidence of excess deaths occurring since the first reported death due to COVID-19 in Ireland. There were about 1,100 to 1,200 more deaths than we would expect based on historical patterns; a 13% increase between 11 March to 16 June. However, the number of excess deaths is substantially less than the reported 1,709 COVID-19-related deaths over the same period.”
HIQA found that the officially-reported COVID-19 deaths likely overestimates the true burden of excess deaths caused by the virus. This could be due to the inclusion within official figures of people who were infected with SARS-CoV-2 (coronavirus) at the time of death whose cause of death may have been predominantly due to other factors.
Dr Conor Teljeur, continued: “Excess deaths peaked by 33% over a six-week period from 25 March 2020 to 5 May 2020. During this period, there was an increase of 1,200 deaths from expected figures, with 1,332 COVID-19-related deaths officially reported.”
“In the last four weeks of the analysis, we have seen a reversal of that trend with fewer deaths than expected. However, it is also possible that the changes to healthcare delivery during the COVID-19 epidemic, such as the suspension of elective activity in public acute hospitals, may have a lasting impact on health outcomes, the effect of which may take years to be seen.”
The Analysis of excess all-cause mortality in Ireland during the COVID-19 epidemic is available on www.hiqa.ie.
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Notes to the Editor:
- Deaths due to COVID-19 have been presented to the public in a variety of ways, often as a case-fatality rate (the number of COVID-19 deaths divided by the number of COVID-19 cases). The case-fatality rate is dependent on accurate coding of cause of death and on the volume of testing to detect cases. Excess mortality eliminates the reliance on identification of cases or cause of death.
- The Central Statistics Office (CSO) is the official source of mortality data in Ireland. While ideally registered as soon as possible after the death, up to three months delay is permitted for a death certificate to be filed. While the data from RIP.ie appears to accurately represent true overall mortality patterns, there are limitations, as the website was not designed for the purpose of monitoring mortality patterns. For example, age and sex are not recorded, and limited data are available on area of residence. HIQA found that monitoring of excess mortality would benefit immensely from more timely availability of official death registration data.
- The data were analysed using a time series approach whereby expected deaths were predicted using historical RIP.ie death notice data. Since 2010, the number of deaths annually has followed an increasing trend due to an increasing and ageing population. Using an average of previous mortality without adjusting for the increasing trend would underestimate expected mortality and therefore overestimate excess mortality.
- Sensitivity analyses were conducted to determine the robustness of the findings. The highest estimated excess mortality from the different models tested was 1,266 deaths. The models incorporated uncertainty and, in all cases, the upper bound for the estimated excess was less than the reported number of COVID-19 deaths.
- The calculation of excess mortality here does not consider cause of death. While it is possible that mortality may have decreased for certain causes of death during the COVID-19 epidemic, it is not possible to examine this using the RIP.ie data. It is also not possible to examine mortality patterns in specific subgroups of the population (for example, those aged 75 years and older).
- Using data from the EuroMOMO collaboration that includes 23 European countries, the excess mortality during the COVID-19 epidemic puts Ireland mid-table, but much closer to the low excess mortality countries than to the countries with high excess mortality.
- COVID-19 may have accelerated time of death in frail and vulnerable individuals over the peak period. The excess mortality observed at the peak is now being followed by a period of decreased mortality as date of death for individuals who would ordinarily have died during this time occurred earlier than expected by a matter of weeks or months.