Changes in stillbirths and child and youth mortality in 2020 and 2021 during the Covid-19 pandemic

Background The COVID-19 pandemic’s impact on mortality, especially among the elderly, has been extensively studied. While COVID-19 rarely causes direct mortality in children and youth, the pandemic’s indirect effects might harm these age groups. Yet, its influence on stillbirths and mortality rates in neonates, infants, children, and youth remains poorly understood. This study examines disruptions in such trends across 95 countries in 2020 and 72 in 2021, providing the inaugural comprehensive analysis of COVID-19’s effect on young mortality and stillbirths. Methods We estimate expected mortality levels in a non-pandemic setting and calculate relative mortality changes (p-scores) by applying generalized linear models to data from civil registers and vital statistics systems (CRSV) and from the Health Management Information System (HMIS). We then use these estimates to analyze, for each age group, the distribution of country-specific mortality changes and the proportion of countries experiencing mortality deficits, no changes, and excess. Results For most countries and territories, stillbirths and mortality at ages under 25 did not differ from expected levels in 2020 and 2021. However, when focusing on the countries that did show changes, more countries experienced mortality deficits than excess. The exception was stillbirths in both years and mortality among neonates and those aged 10-24 in 2021, where more countries had an excess rather than a deficit. Overall, a quarter of the countries examined experienced increases in stillbirths and young adult mortality ([20][1]–[24][2]). Conclusion Despite global disruptions to essential services, stillbirths and youth mortality were as expected in most countries, defying expectations. However, this doesn’t dismiss hypotheses suggesting delayed adverse effects on the youngest that may require more time to be noticeable at the population level. Close and long-term monitoring of health and deaths among children and youth, particularly in low-income and lower-middle-income countries, is required to fully understand the lasting impacts of the COVID-19 pandemic. Key messages ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work was supported by the UN Children's Fund (UNICEF), Bill & Melinda Gates Foundation, and the United States Agency for International Development. The funding sources had no role in this study. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes 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, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All underlying input data from civil registration systems are openly available databases. All the software code for reproducing the analyses are available in OSF, at [1]: #ref-20 [2]: #ref-24