Covid-19 affected the pattern of mortality from other causes – 02/26/2023 – Marcia Castro

The impact of high mortality from Covid-19 is unquestionable. Worldwide, declines in life expectancy at birth in 2020, 2021 or both years have been observed in the vast majority of countries (one exception is Australia). However, the impact is not limited to deaths from Covid-19, but also indirect effects on other causes of death.

On the one hand, specific comorbidities or conditions increase the risk of dying from Covid-19, such as cancer, cardiovascular and cerebrovascular diseases, diabetes, hypertension, mental and behavioral disorders, obesity, pregnancy, lung diseases and diseases of the renal system. Therefore, deaths from Covid-19 may lead to reduced mortality from these causes in the short term.

On the other hand, some causes may have had an excess of mortality during the pandemic due to the consequences of the long Covid, interruptions in primary care and preventive actions, inadequate care (shortage of equipment, personnel and lack of beds), increased malnutrition, reduced practice of physical exercises, late diagnosis, and potential consequences resulting from job loss and reduced social ties.

In Brazil, the pandemic affected the mortality pattern of several other causes of death. I bring here the results of an analysis carried out in collaboration with the Federal University of Minas Gerais in which we analyzed the mortality rate by groups of causes of death for the period from January 2010 to December 2021.

We observed an increase in mortality rates due to pregnancy, childbirth and the puerperium, diabetes, high blood pressure and kidney diseases. The downward trend in death rates from mental disorders was reversed, and typical fluctuations in death rates from influenza, pneumonia and other respiratory illnesses were not observed. In addition, there was a reduction for groups of causes related to the digestive system, kidney and urinary system, neoplasms and heart and stroke.

These changes were not uniform. For example, the increase in mortality rates from mental and behavioral disorders was more pronounced among men in the Northeast region. In addition, while deaths from cardiovascular disease increased in the US during the pandemic, in Brazil there was a reduction.

These changes make it possible to detail the variation in life expectancy at birth during the pandemic. Between 2019 and 2021, Brazil had a reduction of 3.23 years in life expectancy. This value is the balance between the negative effect of Covid-19 deaths (3.66 years) and the positive effect of all other causes combined (0.43 years).

There were, however, specific cause-of-death groups that had a negative effect on life expectancy (in addition to Covid-19), precisely those whose death rates increased. The largest effect was that of deaths from arterial hypertension (0.08 years).

Population projections from the United Nations indicate that Brazil will return in 2023 to the mortality levels observed before the pandemic. However, uncertainty remains about the magnitude and duration of the consequences of the long Covid and the increase in poverty and hunger.

Actions that promote equity, normalize care and services that were interrupted during the pandemic, and improve mental health care are key to mitigating the indirect consequences of Covid-19 on other causes of death.

Above all, strengthening primary care, surveillance and the use of information to guide policies and programs is a necessary investment to ensure the improvement of the population’s health and the future sustainability of the SUS.

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