Excess mortality in Russia and its regions compared to high income countries: An analysis of monthly series of 2020

BACKGROUND: Russia has been portrayed in media as having one of the highest death tolls due to the COVID-19 pandemic in the world. However, the precise scale of excess mortality is still unclear. We provide the first estimates of excess mortality in Russia as a whole and its regions in 2020, placing this in an international context. METHODS: We used monthly death rates for Russia and 83 regions plus the equivalent for 36 comparator countries. Expected mortality was derived in two ways using averages in the same months in preceding years and the same averages adjusted for secular trends. Excess death rates were estimated for the whole year and the last 3 quarters. We also estimated the relationships between excess mortality and reported COVID-19 cases and deaths across countries and Russian regions. RESULTS: Estimating excess deaths rates based on the trend-adjusted average, Russia had the highest excess mortality of any of the 37 countries considered. Using the simple average, Russia had the third highest. Most of the excess deaths were recorded in the 4th quarter of 2020 and the level and trajectory of excess mortality in Russia and most of Eastern European countries differed from that in Western countries. While both the cumulative number of COVID-19 cases and deaths showed positive correlations with excess mortality across countries (r=0.65 and r=0.75, p<0.001), the association across the Russian regions was, surprisingly, negative for cases (r=-0.34, p<0.01) and deaths (r=-0.09, p=0.42). When we replaced reported deaths with final data from death certificates the correlation was positive (r=0.38, p<0.001). CONCLUSION: Russia has one of the largest absolute burden of excess mortality in 2020 but there is a counter-intuitive negative association between excess mortality and cumulative incidence at the regional level. Under-recording of COVID-19 cases seems to be a problem in some regions.