Assessing COVID-19 pandemic excess deaths in Brazil: years 2020 and 2021

We estimated the impact of the COVID-19 pandemic on mortality in Brazil for 2020 and 2021 years. We used mortality data (2015–2021) from the Health Ministry, the Brazilian government, to fit linear mixed models for forecasting baseline deaths under non-pandemic conditions. An advantage of the linear mixed model is the flexibility to capture year-trend while dealing with the correlations among death counts over time. Following a specified model-building strategy, estimation of all-cause excess deaths at the country level and stratified by sex, age, ethnicity and region of residence, from March 2020 to December 2021. We also considered the estimation of excess deaths due to specific causes. The estimated all-cause excess deaths was 187 842 (95% PI: 164 122; 211 562, P-Score=16.1%) for weeks 10-53, 2020, and 441 048 (95% PI: 411 740; 470 356, P-Score=31.9%) for weeks 1-52, 2021. P-Score values ranged from 1.4% (RS, South) to 38.1% (AM, North) in 2020 and from 21.2% (AL and BA, Northeast) to 66.1% (RO, North) in 2021. Differences among men (18.4%) and women (13.4%) appeared in 2020 only, and the P-Score values were about 30% for both sexes in 2021. Except for youngsters ( < 20 years old), all adult age groups were badly hit, especially those from 40 to 79 years old. In 2020, the Indigenous+East Asian population had the highest P-Score (26.2%), and the Black population suffered the greatest impact (34.7%) in 2021. The pandemic impact had enormous regional heterogeneity and substantial differences according to socio-demographic factors, mainly during the first wave, showing that some population strata benefited from the social distancing measures when they could adhere to them. In the second wave, the burden was very high for all but extremely high for some, highlighting that our society must tackle the health inequalities experienced by groups of different socio-demographic status. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The authors received no specific funding for this work. The first and second authors acknowledge research scholarships (for different projects) from Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior - Brasil (CAPES) - Finance Code 001. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study used ONLY openly available human data that were originally located at: https://opendatasus.saude.gov.br/dataset/sim-1979-2019 and https://opendatasus.saude.gov.br/dataset/sim-2020-2021. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes Data are available from Ministerio da Saude, Governo do Brasil: https://opendatasus.saude.gov.br/dataset/sim-1979-2019 https://opendatasus.saude.gov.br/dataset/sim-2020-2021. However data from 2021 is considered preliminary and might be moved to another url once consolidated. [https://github.com/luziatrinca/COVID-19\_excess\_deaths\_Brazil\_2020_2021][1] [1]: https://github.com/luziatrinca/COVID-19_excess_deaths_Brazil_2020_2021