City Research Online

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

Pallari, C. T., Achilleos, S., Quattrocchi, A. , Gabel, J., Critselis, E., Athanasiadou, M., Rahmanian Haghighi, M. R., Papatheodorou, S., Liu, T., Artemiou, A., Rodriguez-Llanes, J. M., Bennett, C. M., Zimmermann, C., Schernhammer, E., Bustos Sierra, N., Ekelson, R., Lobato, J., Macedo, L., Mortensen, L. H., Critchley, J., Goldsmith, L. ORCID: 0000-0002-6934-1925, Denissov, G., Le Meur, N., Kandelaki, L., Athanasakis, K., Binyaminy, B., Maor, T., Stracci, F., Ambrosio, G., Davletov, K., Glushkova, N., Martial, C., Chan Sun, M., Hagen, T. P., Chong, M., Barron, M., Łyszczarz, B., Erzen, I., Arcos Gonzalez, P., Burström, B., Pidmurniak, N., Verstiuk, O., Huang, Q., Polemitis, A., Charalambous, A. & Demetriou, C. A. (2024). 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. BMJ Global Health, 9(4), article number e013018. doi: 10.1136/bmjgh-2023-013018


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.

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.

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.

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.

Publication Type: Article
Additional Information: © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:
Publisher Keywords: COVID-19, Control strategies, Epidemiology, Public Health, Vaccines, Female, Male, Humans, COVID-19, Pandemics, Italy, Greece, Age Factors
Subjects: H Social Sciences > HA Statistics
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Departments: School of Health & Psychological Sciences
School of Health & Psychological Sciences > Healthcare Services Research & Management
SWORD Depositor:
[thumbnail of e013018.full.pdf]
Text - Published Version
Available under License Creative Commons Attribution Non-commercial.

Download (4MB) | Preview


Add to AnyAdd to TwitterAdd to FacebookAdd to LinkedinAdd to PinterestAdd to Email


Downloads per month over past year

View more statistics

Actions (login required)

Admin Login Admin Login