All-Cause Excess Mortality During the COVID-19 Pandemic in a Rural Area of North India.

Introduction COVID-19 pandemic significantly impacted global mortality; however, many deaths were underreported. Excess mortality explains both direct and indirect impacts of the COVID-19 pandemic and therefore provides true and better estimates of pandemic deaths. Objectives The objective of this study was to estimate excess all-cause mortality during the COVID-19 pandemic in a rural area of North India. Methods The study was carried out in the field practice area of the Rural Health Training Centre (RHTC) of a tertiary care hospital in North India. This area covers fifteen villages where home-based comprehensive health care is provided. Age, gender, and month-wise mortality data of these villages (for the years 2015-2023) were extracted from the records. Two models, historical five-year average and negative binomial regression, were used to estimate all-cause excess mortality for the COVID-19 period (January 2020-May 2023) compared with pre-pandemic years (2015-2019). Excess mortality was estimated as the difference between the number of all-cause deaths and baseline expected deaths for each model. Percentage excess mortality (ratio of excess deaths to expected deaths) was calculated. Results Monthly all-cause excess mortality was observed to be higher (exceeding 95% CI upper bounds) during the months of April, May, and August 2021 than expected mortality. May 2021 had the highest excess mortality, consisting of 47 and 43 deaths (223.8%, 167.4%) using historical average and negative binomial regression analysis, respectively. However, it was lower than expected in 2020, 2022, and 2023. Males and adults aged 40-59 years had higher excess mortality. Overall excess mortality was 19 (1.8%), with the year 2021 reporting high excess mortality of 72 (24%). Conclusions Findings indicate significant excess all-cause mortality during the COVID-19 pandemic. The study witnessed high excess mortality across age groups, particularly among 40- to 59-year-old adults and males.