Abstract
INTRODUCTION: The Coronavirus Disease 2019 (Covid-19) pandemic has been an unprecedented health crisis of recent times. Excess mortality has been said to be a better indicator to measure the true burden of the pandemic. Excess mortality captures the deaths, for all causes, that have increased or been averted, due to the pandemic. The objective of this study was to determine the excess mortality due to the Covid-19 pandemic, by key characteristics, in Malaysia between 1st March 2020 to 31st December 2021.
METHODS: Data is obtained from Jabatan Pendaftaran Negara, and the number of Covid-19 deaths from open-source data. Time series forecasting is used on historical data from March 2015 to March 2020, to determine the expected number of deaths during the pandemic, from March 2020 to December 2021. Prophet and ARIMA forecasting models were used to estimate the expected death, a hypothetical scenario if the pandemic did not happen and is compared with the actual death to determine the difference and excess mortality over the time period. Excess mortality was defined as the number of expected deaths minus the actual number of deaths recorded. Mean Absolute Error (MAE) and weighted Mean Absolute Percentage Error (MAPE) were used to assess the forecast accuracy.
RESULTS: Malaysia recorded an excess mortality of 7,914 deaths from March 2020 to Dec 2021, a 2.4% increase in mortality compared to the expected number of deaths. Between March 2020 and June 2021, Malaysia recorded excess mortality of negative 19,099 deaths. Deaths had increased during the second half of 2021, during the delta wave of the pandemic in Malaysia. The excess mortality appears to be closely related to the number of Covid-19 deaths recorded. Analysis of the disaggregated data shows that most of the negative excess mortality was contributed by the reduction in deaths in health facilities, without an increase in deaths outside health facilities. Excess mortality was mainly contributed by those aged 60 years and above, and males. Those of Malay ethnicity contributed to a positive excess mortality, a total of 11,158 deaths, compared to Chinese ethnicity contributing to negative 4,054 deaths.
DISCUSSION/CONCLUSION: The low excess mortality is attributed to low Covid-19 deaths recorded in Malaysia, as seen in many other countries internationally. The results of this study are consistent with estimates released by World Health Organization (WHO) and The Economist. Excess mortality reported higher among the elderly is consistent with international studies. The excess mortality during the Delta wave could be due to mortality displacement, from the reduction of deaths seen during the early phase, and may be among individuals of high risk status. The reduced excess mortality among the Chinese population could be attributed due to the lower prevalence of NCDs and higher compliance to SOP during the pandemic. The overall low excess mortality in Malaysia indicates that Malaysia has managed the pandemic well, whereby the lockdown measures taken did not affect access to acute healthcare services.
Links
- https://apcph.cphm.my/wp-content/uploads/2022/07/APCPH2022-O-23.pdf
- https://apcph.cphm.my/events/oral-session-4-ballroom-A/
BibTeX (Download)
@proceedings{APCPH2022-O-23,
title = {Excess Mortality: For Deeper Understanding of Covid-19 Pandemic},
author = {Shubash Shander Ganapathy and Muhd Zulfadli Hafiz Ismail and Chan Yee Mang and Tan Lee Ann and Nur Hamizah Nasaruddin and Nazirah Alias and Khaw Wan Fei and Fathullah Iqbal Ab Rahim and Awatef Amer Nordin and Mohd Fadli Kharie and Ahmad Aqram},
url = {https://apcph.cphm.my/wp-content/uploads/2022/07/APCPH2022-O-23.pdf
https://apcph.cphm.my/events/oral-session-4-ballroom-A/},
year = {2022},
date = {2022-08-01},
urldate = {2022-08-02},
issue = {7},
abstract = {INTRODUCTION: The Coronavirus Disease 2019 (Covid-19) pandemic has been an unprecedented health crisis of recent times. Excess mortality has been said to be a better indicator to measure the true burden of the pandemic. Excess mortality captures the deaths, for all causes, that have increased or been averted, due to the pandemic. The objective of this study was to determine the excess mortality due to the Covid-19 pandemic, by key characteristics, in Malaysia between 1st March 2020 to 31st December 2021.
METHODS: Data is obtained from Jabatan Pendaftaran Negara, and the number of Covid-19 deaths from open-source data. Time series forecasting is used on historical data from March 2015 to March 2020, to determine the expected number of deaths during the pandemic, from March 2020 to December 2021. Prophet and ARIMA forecasting models were used to estimate the expected death, a hypothetical scenario if the pandemic did not happen and is compared with the actual death to determine the difference and excess mortality over the time period. Excess mortality was defined as the number of expected deaths minus the actual number of deaths recorded. Mean Absolute Error (MAE) and weighted Mean Absolute Percentage Error (MAPE) were used to assess the forecast accuracy.
RESULTS: Malaysia recorded an excess mortality of 7,914 deaths from March 2020 to Dec 2021, a 2.4% increase in mortality compared to the expected number of deaths. Between March 2020 and June 2021, Malaysia recorded excess mortality of negative 19,099 deaths. Deaths had increased during the second half of 2021, during the delta wave of the pandemic in Malaysia. The excess mortality appears to be closely related to the number of Covid-19 deaths recorded. Analysis of the disaggregated data shows that most of the negative excess mortality was contributed by the reduction in deaths in health facilities, without an increase in deaths outside health facilities. Excess mortality was mainly contributed by those aged 60 years and above, and males. Those of Malay ethnicity contributed to a positive excess mortality, a total of 11,158 deaths, compared to Chinese ethnicity contributing to negative 4,054 deaths.
DISCUSSION/CONCLUSION: The low excess mortality is attributed to low Covid-19 deaths recorded in Malaysia, as seen in many other countries internationally. The results of this study are consistent with estimates released by World Health Organization (WHO) and The Economist. Excess mortality reported higher among the elderly is consistent with international studies. The excess mortality during the Delta wave could be due to mortality displacement, from the reduction of deaths seen during the early phase, and may be among individuals of high risk status. The reduced excess mortality among the Chinese population could be attributed due to the lower prevalence of NCDs and higher compliance to SOP during the pandemic. The overall low excess mortality in Malaysia indicates that Malaysia has managed the pandemic well, whereby the lockdown measures taken did not affect access to acute healthcare services.},
howpublished = {published online at https://apcph.cphm.my},
note = {Type: ORAL PRESENTATION; Organisation: Institut Kesihatan Umum, Institut Kesihatan Negara; Sektor Biostatistik dan Data Repositori, Institut Kesihatan Negara; Institut Penyelidikan Sistem Kesihatan, Institut Kesihatan Negara; Pusat Infomatik Kesihatan, Kementerian Kesihatan Malaysia},
keywords = {},
pubstate = {published},
tppubtype = {proceedings}
}