Beyond Deaths per Capita: Comparative CoViD-19 Mortality Indicators

OBJECTIVES: Following well-established practices in demography, this article discusses several measures based on the number of CoViD-19 deaths to facilitate comparisons over time and across populations. SETTINGS: National populations in 186 UN countries and territories and populations in first-level sub-national administrative entities in Brazil, China, Italy, Mexico, Peru, Spain, and the USA. PARTICIPANTS: None (death statistics only). PRIMARY AND SECONDARY OUTCOME MEASURES: An unstandardized occurrence/exposure rate comparable to the Crude Death Rate; an indirectly age-and-sex standardized rate that can be derived even when the breakdown of CoViD-19 deaths by age and sex required for direct standardization is unavailable; the reduction in life expectancy at birth corresponding to the 2020 number of CoViD-19 deaths. RESULTS: To date, the highest unstandardized rate has been in New York, at its peak exceeding the state 2017 Crude Death Rate. Populations compare differently after standardization: while parts of Italy, Spain and the USA have the highest unstandardized rates, parts of Mexico and Peru have the highest standardized rates. For several populations with the necessary data by age and sex for direct standardization, we show that direct and indirect standardization yield similar results. US life expectancy is estimated to have declined this year by more than a year (-1.26 years), far more than during the worst year of the HIV epidemic, or the worst three years of the opioid crisis, and to reach its lowest level since 2008. Substantially larger reductions, exceeding two years, are estimated for Panama, Peru, and parts of Italy, Spain, the USA, and especially, Mexico. CONCLUSIONS: With lesser demand on data than direct standardization, indirect standardization is a valid alternative to adjust international comparisons for differences in population distribution by sex and age-groups. A number of populations have experienced reductions in 2020 life expectancies that are substantial by recent historical standards.