All-cause excess mortality in the State of Gujarat, India, during the COVID-19 pandemic (March 2020-April 2021)

Acosta, R. J.; Patnaik, B.; Buckee, C.; Balsari, S.; Mahmud, A.

Official COVID-19 mortality statistics are strongly influenced by the local diagnostic capacity, strength of the healthcare system, and the recording and reporting capacities on causes of death. This can result in significant undercounting of COVID-19 attributable deaths, making it challenging to understand the total mortality burden of the pandemic. Excess mortality, which is defined as the increase in observed death counts compared to a baseline expectation, provides an alternate measure of the mortality shock of the COVID-19 pandemic. Here, we use data from civil death registers for 54 municipalities across the state of Gujarat, India, to estimate the impact of the COVID-19 pandemic on all-cause mortality. Using a model fit to monthly data from January 2019 to February 2020, we estimate excess mortality over the course of the pandemic from March 2020 to April 2021. We estimated 16,000 [95% CI: 14,000, 18,000] excess deaths across these municipalities since March 2020. The sharpest increase in deaths was observed in April 2021, with an estimated 480% [95% CI: 390%, 580%] increase in mortality from expected counts for the same period. Females and the 40 to 60 age groups experienced a greater increase from baseline mortality compared to other demographic groups. Our excess mortality estimate for these 54 municipalities, representing approximately 5% of the state population, exceeds the official COVID-19 death count for the entire state of Gujarat.