Excess deaths reveal the true spatial, temporal and demographic impact of COVID-19 on mortality in Ecuador

Journal Article · 12 August 2021 · International Journal of Epidemiology

DOI: https://doi.org/10.1093/ije/dyab163 · OSTI ID:1813081

Cuéllar, Leticia ^[1]; Torres, Irene ^[2]; Romero-Severson, Ethan ^[3]; Mahesh, Riya ^[4]; Ortega, Nathaniel ^[5]; Pungitore, Sarah ^[6]; Hengartner, Nicolas ^[3]; Ke, Ruian  ^[3]

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1. A-1 Information Systems and Modeling, Analytics, Intelligence and Technology Division, Los Alamos National Laboratory, Los Alamos, NM, USA
2. Fundación Octaedro, Quito, Ecuador
3. T-6 Theoretical Biology and Biophysics, Theoretical Division, Los Alamos National Laboratory, Los Alamos, NM, USA
4. T-6 Theoretical Biology and Biophysics, Theoretical Division, Los Alamos National Laboratory, Los Alamos, NM, USA, Department of Biology, University of Texas, Austin, TX, USA
5. T-6 Theoretical Biology and Biophysics, Theoretical Division, Los Alamos National Laboratory, Los Alamos, NM, USA, Department of Ecology, Evolution and Marine Biology, University of California Santa Barbara, Santa Barbara, CA, USA
6. T-6 Theoretical Biology and Biophysics, Theoretical Division, Los Alamos National Laboratory, Los Alamos, NM, USA, Program in Applied Mathematics, University of Arizona, Tucson, AZ, USA

Accepted Background In early 2020, Ecuador reported one of the highest surges of per capita deaths across the globe. Methods We collected a comprehensive dataset containing individual death records between 2015 and 2020, from the Ecuadorian National Institute of Statistics and Census and the Ecuadorian Ministry of Government. We computed the number of excess deaths across time, geographical locations and demographic groups using Poisson regression methods. Results Between 1 January and 23 September 2020, the number of excess deaths in Ecuador was 36 402 [95% confidence interval (CI): 35 762–36 827] or 208 per 100 000 people, which is 171% of the expected deaths in that period in a typical year. Only 20% of the excess deaths are attributable to confirmed COVID-19 deaths. Strikingly, in provinces that were most affected by COVID-19 such as Guayas and Santa Elena, the all-cause deaths are more than double the expected number of deaths that would have occurred in a normal year. The extent of excess deaths in men is higher than in women, and the number of excess deaths increases with age. Indigenous populations had the highest level of excess deaths among all ethnic groups. Conclusions Overall, the exceptionally high level of excess deaths in Ecuador highlights the enormous burden and heterogeneous impact of COVID-19 on mortality, especially in older age groups and Indigenous populations in Ecuador, which was not fully revealed by COVID-19 death counts. Together with the limited testing in Ecuador, our results suggest that the majority of the excess deaths were likely to be undocumented COVID-19 deaths.

• Research Organization: Los Alamos National Laboratory (LANL), Los Alamos, NM (United States)
• Sponsoring Organization: LDRD; USDOE
• Grant/Contract Number: 89233218CNA000001
• OSTI ID: 1813081
• Report Number(s): LA-UR--21-21361
• Journal Information: International Journal of Epidemiology, Journal Name: International Journal of Epidemiology Journal Issue: 1 Vol. 51; ISSN 0300-5771
• Publisher: Oxford University PressCopyright Statement
• Country of Publication: United Kingdom
• Language: English