Journal Article Ppublish
PubMed: 40768708 DOI: 10.2105/AJPH.2025.308136
Excess Mortality and Containment Performance During the COVID-19 Pandemic: Evidence From 34 Countries.
Am J Public Health 115(9):1518-1528
Authors: Chieh Cheng, Hsiao-Yu Wu, Shu-Chen Kuo, Brandon Fan, Ya-Ting Hsu, Yi-Kai Chen, Byron Fan, Yung-An Jang, Chih-Fan Hung, Wei-Ming Jiang, Hung-Yi Chiou, Wei J Chen, Hsiao-Hui Tsou
Affiliations
- Chieh Cheng, Hsiao-Yu Wu, Ya-Ting Hsu, Yi-Kai Chen, Yung-An Jang, Chih-Fan Hung, and Wei-Ming Jiang were with the Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli County, Taiwan, at the time of this study. Shu-Chen Kuo is with the National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan. Brandon Fan is with the Richard Montgomery High School, Rockville, MD. Byron Fan is with the Department of Applied Mathematics, Brown University, Providence, RI. Hung-Yi Chiou and Hsiao-Hui Tsou are with the Institute of Population Health Sciences, National Health Research Institutes, Zhunan. Wei J. Chen is with the Center for Neuropsychiatric Research, National Health Research Institutes, Zhunan.
Abstract
Objectives. To expand COVID-19 containment indicators to evaluate the relationship between excess mortality and government response. Methods. We developed a longitudinal study analyzing excess mortality, COVID-19 containment, and structural conditions in 34 countries between 2020 and 2022. Results. The average excess mortality ratios of the 34 countries were 1.09, 1.14, and 1.11 in 2020, 2021, and 2022, respectively. Thirteen countries experienced continuous annual rises, while only 2 had consistent annual declines. Top-performing countries significantly reduced excess deaths by 5.7% (b = -0.06; 95% CI [confidence interval] = -0.10, -0.01; P = .02) in 2020 and 12.9% (b = -0.13; 95% CI = -0.17, -0.08; P < .001) in 2021, compared to bottom performers. Middle-performing countries saw reductions of 6.7% (b = -0.07; 95% CI = -0.11, -0.02; P = .01) and 10.6% (b = -0.11; 95% CI = -0.15, -0.06; P < .001). These findings suggest that better containment is associated with fewer excess deaths, even after accounting for preexisting structural differences. Conclusions. The COVID-19 containment indicators' precision emphasizes the association between better containment and lower excess mortality during early and postvaccine development periods. Public Health Implications. Our findings urge governments to utilize new metrics that balance flexibility and strictness for pandemic strategies, informing future policy interventions. (Am J Public Health. 2025;115(9):1518-1528. https://doi.org/10.2105/AJPH.2025.308136).
MeSH
Mortality, Public Health, Covid-19, Pandemics