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Global Health
April 19, 2022

Global COVID-19 Death Toll May Be Triple the Reported Deaths

JAMA. 2022;327(15):1438. doi:10.1001/jama.2022.4767

More than 3 times as many people may have died around the world due to direct and indirect effects of the COVID-19 pandemic than officially reported, according to an estimate of excess mortality by the Institute for Health Metrics and Evaluation at the University of Washington.

Manish Swarup/AP Images

Whereas global reported COVID-19 deaths for the 18 months ending December 31, 2021, totaled 5.94 million, the authors estimated that 18.2 million people died because of the pandemic. The pandemic accounted for 120.3 extra deaths per 100 000 people during the study period, and 300 extra deaths per 100 000 people in 21 countries, according to the researcher’s modeling.

South Asia, North Africa and the Middle East, and Eastern Europe had the greatest numbers of estimated excess deaths in the report. The countries with the most excess deaths were India, with 4.07 million deaths; the US, with 1.13 million deaths; and Russia, with 1.07 million deaths. These were followed by Mexico, Brazil, Indonesia, and Pakistan, in that order. Among these countries, excess mortality rates were highest in Russia and Mexico.

The authors used 6 statistical models of data collected from 74 countries and territories to estimate excess mortality in 191 countries and territories. Excess mortality was defined as observed mortality minus expected mortality based on historical trends, allowing for mortality increases due to unusual events such as heat waves.

To improve the quality of pandemic mortality information, the authors recommended strengthening death registration systems and additional research to better distinguish direct from indirect deaths.