Excess Deaths during the COVID-19 Pandemic in Southern Iran: Estimating the Absolute Count and Relative Risk Using Ecological DataAbstract.

Objectives:The coronavirus disease 2019 (COVID-19) pandemic led to increased mortality rates. To assess this impact, this ecological study aimed to estimate the excess death counts in southern Iran. Methods:The study obtained weekly death counts by linking the National Death Registry and Medical Care Monitoring Center repositories. The P-score was initially estimated using a simple method that involved calculating the difference between the observed and expected death counts. The interrupted time series analysis was then used to calculate the mean relative risk (RR) of death during the first year of the pandemic. Results:Our study found that there were 5,571 excess deaths from all causes (P-score=33.29%) during the first year of the COVID-19 pandemic, with 48.03% of these deaths directly related to COVID-19. The pandemic was found to increase the risk of death from all causes (RR=1.26; 95% confidence interval [CI], 1.19-1.33), as well as in specific age groups such as those aged 35-49 (RR=1.21; 95% CI, 1.12-1.32), 50-64 (RR=1.38; 95% CI, 1.28-1.49), and ≥ 65 (RR=1.29; 95% CI, 1.12-1.32) years old. Furthermore, there was an increased risk of death from cardiovascular diseases (RR=1.17; 95% CI, 1.11, 1.22). Conclusions:There was a 26% increase in the death count in southern Iran during the COVID-19 pandemic. More than half of these excess deaths were not directly related to COVID-19, but rather other causes, with cardiovascular diseases being a major contributor.