Excess mortality in Northeast Iran caused by COVID-19: Neglect of offset community transformations of health

Objective: To make evidence-based decisions based on broad mortality trends for Razavi Khorasan province, Iran. Methods: In order to determine the baseline number of deaths, we used univariate time series analyses for monthly data from the monthly vital statistics reports (From April 2015 to March 2022). For excess mortalities, these baselines were subtracted from reported deaths with a 95% prediction interval. To compare time and causes, a P-score was calculated. Results: From March 2020 to March 2022, there were 61949 registered deaths, and the estimated deaths with a 95% confidence interval (CI) were 43246.16 (35718.28, 50774.05). So, in 2020-2021 and 2021-2022, the death counts were 35.15% and 51.33% higher than projected. A total of 18666 cardiovascular diseases were reported and a total of 15704.46 (12006.95, 19401.96) was estimated. The P-score for this duration was 14.49% and 23.23% higher than expected. Infectious and parasitic diseases plus COVID-19 were 16633 and estimated to be 1044.87 (456.77, 1632.96). A total of 4420 diseases of the respiratory system were reported, and 4564.94 deaths were predicted (2277.43, 6852.43). In the first year of the pandemic, the P-score dropped to -35.28% and in the second year, it jumped sharply to 22.38%. Conclusions: Excess mortality, along with cause-specific mortality, can be helpful for monitoring trends and developing public health policies at the local, national, and international levels.