RESEARCH NOTE • Epidemiol. Serv. Saúde 32 (2) 14 July 20232023 • https://doi.org/10.1590/S2237-96222023000200003   copy

Excess deaths among adults in the state of Santa Catarina: an ecological study during the COVID-19 pandemic, Brazil, 2020-2021

Exceso de muertes en adultos en el estado de Santa Catarina: un estúdio ecológico en el período de la pandemia de COVID-19, Brasil, 2020-2021

Rebeca Heyse Holzbach Gabriel Resun Gomes da Silva Jean Carlos Bianchi Danúbia Hillesheim Fabrício Augusto Menegon Ana Luiza de Lima Curi Hallal About the authors

ABSTRACT

Objective:

to estimate excess deaths during the COVID-19 pandemic in the state of Santa Catarina and its macro-regions, Brazil, 2020-2021.

Methods:

this was an ecological study, using data from the Mortality Information System; excess deaths in adults were calculated by the difference between the observed number of deaths and expected number of deaths, taking into account the average of deaths that occurred between 2015 and 2019; the variables “macro-region of residence”, “quarter”, “month”, “sex” and “age group” were analyzed; data were analyzed in a descriptive manner.

Results:

a total of 6,315 excess deaths in 2020 and 17,391 in 2021, mostly in males (57.4%) and those aged 60 years and older (74.0%); macro-regions and periods with the greatest excess deaths were those in which there were most deaths due to COVID-19; the greatest excess deaths occurred in March 2021 (n = 4,207), with a progressive decrease until the end of the year.

Conclusion:

there were excess deaths in the state of Santa Catarina and in all its macro-regions during the COVID-19 pandemic.

Keywords:
COVID-19; Coronavirus; Excess Mortality; Mortality; Descriptive Epidemiology

RESUMEN

Objetivo:

estimar el exceso de muertes en Santa Catarina y macrorregiones durante la pandemia de COVID-19, en los años 2020 y 2021.

Métodos:

estudio ecológico utilizando Sistema de Información de Mortalidad. El exceso de defunciones en adultos se calculó por la diferencia entre defunciones observadas y esperadas, considerando el promedio de defunciones entre 2015 y 2019. Las variables analizadas fueron: macrorregión de residencia, trimestre, mes, sexo y grupo de edad. Los datos se analizaron descriptivamente.

Resultados:

el exceso fue de 6.315 defunciones en 2020 y 17.391 en 2021, mayor en varones (57,4%) y mayores de 60 años (74,0%). Las macrorregiones y periodos con mayor superávit fueron los que registraron más muertes por COVID-19. El mayor exceso de muertes ocurrió en marzo de 2021 (n=4.207), con una disminución progresiva hasta el final del año.

Conclusión:

hubo exceso de muertes en Santa Catarina y en todas macrorregiones durante la pandemia de COVID-19.

Palabras-clave:
COVID-19; Coronavirus; Exceso de Mortalidad; Mortalidad; Epidemiología Descriptiva

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INTRODUCTION

In 2021, Brazil became the epicenter of the COVID-19 pandemic, reaching an average of 4,000 deaths in 24 hours.11 Ministério da Saúde (BR). Secretaria de Vigilância em Saúde. Departamento de Vigilância Epidemiológica. Painel Coronavírus [Internet]. Brasília: Ministério da Saúde; 2022 [citado 2022 Mar 8]. Disponível em: Disponível em: https://covid.saude.gov.br/
https://covid.saude.gov.br/... By the end of June 2022, Brazil recorded 669,530 deaths from COVID-19.22 World Health Organization. WHO coronavirus (COVID-191) dashboard [Internet]. Genebra: World Health Organization; 2022 [cited 2022 Mar 8]. Available from: Available from: https://covid19.who.int/
https://covid19.who.int/... However, the data seem to underestimate the impact of COVID-19 on the country, not only because of significant underreporting, but also for the indirect consequences of the pandemic.33 Hacker KA, Briss PA, Richardson L, Wright J, Petersen R. COVID-19 and chronic disease: the impact now and in the future. Prev Chronic Dis. 2021;18:e62. doi: 10.5888/pcd18.210086
https://doi.org/10.5888/pcd18.210086... ,44 Giovanella L, Bousquat A, Medina MG, Mendonça MHM, Facchini LA, Tasca R, et al. Desafios da atenção básica no enfrentamento da pandemia de COVID-19 no SUS. In: Portela MC, Reis LGC, Lima SML, editores. Covid-19: desafios para a organização e repercussões nos sistemas e serviços de saúde [online]. Rio de Janeiro: Observatório Covid-19 Fiocruz, Editora Fiocruz; 2022. p. 201-16. doi: 10.7476/9786557081587.0013
https://doi.org/10.7476/9786557081587.00...

Problems related to resource scarcity, conflicts of interest involving political parties, lack of coordination between the spheres of the executive branch and non-compliance with social isolation measures culminated in what is considered the greatest healthcare and hospital collapse in Brazil’s history.33 Hacker KA, Briss PA, Richardson L, Wright J, Petersen R. COVID-19 and chronic disease: the impact now and in the future. Prev Chronic Dis. 2021;18:e62. doi: 10.5888/pcd18.210086
https://doi.org/10.5888/pcd18.210086... ,55 Castro R. Observatório Covid-19 aponta maior colapso sanitário e hospitalar da história do Brasil [Internet]. Rio de Janeiro: Fundação Oswaldo Cruz; 2021 [atualizado 2021 Mar 17, citado 2022 mar 8]. Disponível em: Disponível em: https://portal.fiocruz.br/noticia/observatorio-covid-19-aponta-maior-colapso-sanitario-e-hospitalar-da-historia-do-brasil
https://portal.fiocruz.br/noticia/observ... ,66 Rodrigues JN, Azevedo DA. Pandemia do Coronavírus e (des)coordenação federativa: evidências de um conflito político-territorial. Espaço e Economia. 2020;18:1-11. doi: 10.4000/ espacoeconomia.12282
https://doi.org/10.4000/ espacoeconomia.... Overloaded health system, delay in receiving care and difficulties in accessing services probably led to greater morbidity and mortality from other diseases, as observed in countries such as the United States and England.33 Hacker KA, Briss PA, Richardson L, Wright J, Petersen R. COVID-19 and chronic disease: the impact now and in the future. Prev Chronic Dis. 2021;18:e62. doi: 10.5888/pcd18.210086
https://doi.org/10.5888/pcd18.210086... ,77 Guimarães NS, Carvalho TML, Machado-Pinto J, Lage R, Bernardes RM, Peres ASS, et al. Aumento de óbitos domiciliares devido a parada cardiorrespiratória em tempos de pandemia de COVID-19. Arq Bras Cardiol. 2021;116(2):266-71. doi: 10.36660/abc.20200547
https://doi.org/10.36660/abc.20200547...

8 Bispo Júnior JP, Santos DB. COVID-19 como sindemia: modelo teórico e fundamentos para a abordagem abrangente em saúde. Cad Saude Publica. 2021;37(10):1-14. doi: 10.1590/0102-311X00119021
https://doi.org/10.1590/0102-311X0011902... -99 Mafham MM, Spata E, Goldacre R, Gair D, Curnow P, Bray M, et al. COVID-19 pandemic and admission rates for and management of acute coronary syndromes in England. Lancet. 2020;396(10248):381-9. doi: 10.1016/S0140-6736(20)31356-8
https://doi.org/10.1016/S0140-6736(20)31...

With regard to the Brazilian scenario, disorganization of services, lack of coordination among federal entities and excessive distances to be traveled when seeking care were other factors that may have contributed to an increase in morbidity and mortality.66 Rodrigues JN, Azevedo DA. Pandemia do Coronavírus e (des)coordenação federativa: evidências de um conflito político-territorial. Espaço e Economia. 2020;18:1-11. doi: 10.4000/ espacoeconomia.12282
https://doi.org/10.4000/ espacoeconomia.... ,1010 Noronha KVMS, Guedes GR, Turra CM, Andrade MV, Botega L, Nogueira D, et al. Pandemia por COVID-19 no Brasil: análise da demanda e da oferta de leitos hospitalares e equipamentos de ventilação assistida segundo diferentes cenários. Cad Saude Publica. 2020;36(6):e00115320. doi: 10.1590/0102-311X00115320
https://doi.org/10.1590/0102-311X0011532... Especially among people with chronic diseases and groups at risk from COVID-19, there was a low demand for health services as a result of more severe measures of social isolation.33 Hacker KA, Briss PA, Richardson L, Wright J, Petersen R. COVID-19 and chronic disease: the impact now and in the future. Prev Chronic Dis. 2021;18:e62. doi: 10.5888/pcd18.210086
https://doi.org/10.5888/pcd18.210086... Furthermore, it is noteworthy that the supply of essential services for other conditions and injuries has been reduced, and even interrupted in several regions,44 Giovanella L, Bousquat A, Medina MG, Mendonça MHM, Facchini LA, Tasca R, et al. Desafios da atenção básica no enfrentamento da pandemia de COVID-19 no SUS. In: Portela MC, Reis LGC, Lima SML, editores. Covid-19: desafios para a organização e repercussões nos sistemas e serviços de saúde [online]. Rio de Janeiro: Observatório Covid-19 Fiocruz, Editora Fiocruz; 2022. p. 201-16. doi: 10.7476/9786557081587.0013
https://doi.org/10.7476/9786557081587.00... impairing the continuity of care and increasing the risk of death from other causes.33 Hacker KA, Briss PA, Richardson L, Wright J, Petersen R. COVID-19 and chronic disease: the impact now and in the future. Prev Chronic Dis. 2021;18:e62. doi: 10.5888/pcd18.210086
https://doi.org/10.5888/pcd18.210086... ,88 Bispo Júnior JP, Santos DB. COVID-19 como sindemia: modelo teórico e fundamentos para a abordagem abrangente em saúde. Cad Saude Publica. 2021;37(10):1-14. doi: 10.1590/0102-311X00119021
https://doi.org/10.1590/0102-311X0011902...

Estimating the effects of the pandemic has therefore become a challenge. Studies that take into account only the notifications of deaths due to COVID-19, and disregard the indirect consequences generated by the disease, underestimate the impact of the pandemic on mortality.1111 Statistical Office of the European Union. Excess Mortality - Statistics. Eurostat - Statistics Explained [Internet]. [Luxemburgo] Statistical Office of the European Union; 2022 jul [cited 2022 July 2]. Available from: Available from: https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Excess_mortality_-_statistics
https://ec.europa.eu/eurostat/statistics... ,1212 Beaney T, Clarke JM, Jain V, Golestaneh AK, Lyons G, Salman D, et al. Excess mortality: the gold standard in measuring the impact of COVID-19 worldwide?.J R Soc Med. 2020;113(9):329-34. doi: 10.1177/0141076820956802
https://doi.org/10.1177/0141076820956802... Thus, the World Health Organization (WHO) recommends the calculation of excess deaths as a powerful tool to estimate the real impact of the pandemic on overall mortality among the population.1111 Statistical Office of the European Union. Excess Mortality - Statistics. Eurostat - Statistics Explained [Internet]. [Luxemburgo] Statistical Office of the European Union; 2022 jul [cited 2022 July 2]. Available from: Available from: https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Excess_mortality_-_statistics
https://ec.europa.eu/eurostat/statistics...

12 Beaney T, Clarke JM, Jain V, Golestaneh AK, Lyons G, Salman D, et al. Excess mortality: the gold standard in measuring the impact of COVID-19 worldwide?.J R Soc Med. 2020;113(9):329-34. doi: 10.1177/0141076820956802
https://doi.org/10.1177/0141076820956802... -1313 World Health Organization. Revealing the Toll of COVID-19: a technical package for rapid mortality surveillance and epidemic response [Internet]. Genebra: World Health Organization ; 2020 [update 2020 May 21, cited 2022 mar 8]. 30 p. Available from: Available from: https://www.who.int/publications/i/item/revealing-the-toll-of-covid-19
https://www.who.int/publications/i/item/...

The objective of this study was to estimate excess deaths in the state of Santa Catarina and its macro-regions during the COVID-19 pandemic between 2020 and 2021.

METHODS

This was an ecological study conducted with the death notifications registered on the Mortality Information System (Sistema de Informações sobre Mortalidade - SIM) between January 1, 2020 and December 31, 2021, with the state of Santa Catarina as a unit of analysis. Data were accessed on January 28, 2022, via the Brazilian National Health System Information Technology Department (Departamento de Informática do Sistema Único de Saúde - DATASUS) website, (https://datasus.saude.gov.br/).

The following variables were analyzed:

  1. sex (male; female);

  2. Macro-region of residence in the state of Santa Catarina (Great West; Midwest, and Serra; Foz do Rio Itajaí; Vale do Itajaí ; Greater Florianópolis; South; Northeast and North Plateau);

  3. age group (in years: 20 to 29; 30 to 39; 40 to 49; 50 to 59; 60 to 69; 70 to 79; 80 and older);

  4. quarter (1st; 2nd; 3rd; 4th); and

  5. calendar months.

Individuals from 0 to 19 years of age were excluded from the study, since COVID-19 manifests itself differently in children and adolescents,1414 Ludvigsson JF. Systematic review of COVID-19 in children shows milder cases and a better prognosis than adults. Acta Paediatr. 2020;109(6):1088-95. doi: 10.1111/apa.15270
https://doi.org/10.1111/apa.15270... while adults aged 20 years or older and whose death was recorded during the study period were included.

The expected number of deaths was calculated by the simple average of the number of deaths in the years 2015 and 2019, that is, the number of deaths in each of the five years was added (according to the location and period determined) and the result of the addition was divided by 5, according to the methodology proposed by other authors.1212 Beaney T, Clarke JM, Jain V, Golestaneh AK, Lyons G, Salman D, et al. Excess mortality: the gold standard in measuring the impact of COVID-19 worldwide?.J R Soc Med. 2020;113(9):329-34. doi: 10.1177/0141076820956802
https://doi.org/10.1177/0141076820956802... ,1515 National Records of Scotland. Choosing a five year average for the measurement of excess deaths [Internet]. [Edinburgh]:National Records of Scotland; 2022 [cited 2022 Apr 13]. Available from: Available from: https://www.nrscotland.gov.uk/files/statistics/covid19/covid-deaths-methodology-excess-deaths-in-2022.pdf
https://www.nrscotland.gov.uk/files/stat... Excess deaths were estimated by the difference between the observed number of deaths in 2020 and 2021 and expected number of deaths for the same period. The mathematical ratio between the observed number of deaths and expected number of deaths in the period was calculated for each quarter of 2020 and 2021, according to the macro-region.

Data analysis was performed using Microsoft Office Excel 2016. Absolute frequencies (n), averages, standard deviation (SD) and the percentage change of the data was calculated. The percentage change of excess deaths between 2020 and 2021, in each macro-region, was calculated by using the following formula:

Percentage change = (Excess deaths in 2021 - Excess deaths in 2020) x 100÷ Excess deaths in 2020

This study was not submitted for approval of a Research Ethics Committee, given that information from secondary databases, without identification of individuals, and in the public domain was used.

RESULTS

In the five years prior to the COVID-19 pandemic, the average number of deaths in the state of Santa Catarina was 38,522 [(SD) = 1,546.3]. In 2020, there was a 16.3% increase in the number of deaths in relation to this average; and in 2021, a 45.1% increase. In all macro-regions the number of deaths was higher than expected (Table 1).

As for the year 2020, there were 6,315 excess deaths. The South (1,362) and Greater Florianópolis (1,146) macro-regions showed the largest increase, in addition to the highest number of notifications of deaths due to COVID-19. In 2021, there were 17,391 excess deaths, and this number was more significant in the Northeast and North Plateau (3,515), South (2,855) and Midwest and Serra (2,691) macro-regions, as well as there were more deaths due to COVID-19. It could be seen an increase in death ratios in most macro-regions, in almost all quarters; with the exception of the 2nd quarter of 2020 (Tables 1 and 2).

The highest number of excess deaths was observed in the periods when there were more deaths due to COVID-19. In 2020, the highest excess deaths occurred during two peaks, one in July-August and another at the end of the year. The highest values for both excess deaths (4,207) and deaths due to COVID-19 (3,752), occurred in March 2021 (Figure 1a).

Excess deaths were found for all age groups, both in 2020 and 2021; with the exception of the male age group 20-29 in 2020. Excess deaths were higher in males (57.4%), in all other age groups, in both years, when compared to excess deaths in females. For both sexes, it could be seen excess deaths in the population aged 60 years and older (74.0%) (Figure 1b).

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Table 1
- Overall deaths and COVID-19 deaths reported by macro-region of residence and year, state of Santa Catarina, Brazil, 2015-2021
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Table 2
- The ratio between the observed number of deaths and expected number of deaths by quarter, excess deaths and percentage change according to macro-region, state of Santa Catarina, Brazil, 2020-2021

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Figure 1
- Evolution of COVID-19 deaths and excess deaths in the period (a) and distribution of excess deaths according to sex and age group (b), state of Santa Catarina, Brazil, 2020-2021

DISCUSSION

In 2020 and 2021, there were excess deaths in the state of Santa Catarina, higher in males and for the variable age, in individuals aged 60 years and older. It could be seen excess deaths and an increasing death ratio for most macro-regions of the state and periods, with the exception of the 2nd quarter of 2020 and December 2021. The largest excess deaths occurred in the same periods and locations where there was a higher number of deaths due to COVID-19.

In a context of low testing and lack of standardization in data notification, a technical note pointed out rates of underreporting of deaths in Santa Catarina during the COVID-19 pandemic near 278%.1616 Nogueira AL, Nogueira CL, Zibetti AW, Roqueiro N, Bruna-Romero O, Carciofi BAM. Estimativa da Subnotificação de Casos da COVID-19 no Estado de Santa Catarina [Internet]. Joinville: Universidade Federal de Santa Catarina; 2020 [atualizado 2020 Jul 23; citado 2023 out 23]. Disponível em: Disponível em: https://covid19sc.github.io/subnotificacao_covid19.html
https://covid19sc.github.io/subnotificac... The excess deaths found in this study was 27.4% higher than the number of cumulative deaths due to COVID-19 and reported by the state. A possible explanation for this lies in the fact that excess deaths are not an indicator affected by the classification of causes of death, therefore they have not been affected by the high underreporting.1111 Statistical Office of the European Union. Excess Mortality - Statistics. Eurostat - Statistics Explained [Internet]. [Luxemburgo] Statistical Office of the European Union; 2022 jul [cited 2022 July 2]. Available from: Available from: https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Excess_mortality_-_statistics
https://ec.europa.eu/eurostat/statistics... ,1212 Beaney T, Clarke JM, Jain V, Golestaneh AK, Lyons G, Salman D, et al. Excess mortality: the gold standard in measuring the impact of COVID-19 worldwide?.J R Soc Med. 2020;113(9):329-34. doi: 10.1177/0141076820956802
https://doi.org/10.1177/0141076820956802... In addition, excess deaths encompass not only deaths due to COVID-19, but may also be a reflection of indirect mortality, resulting, among other factors, from health system overload that led to an increase in deaths from other conditions.33 Hacker KA, Briss PA, Richardson L, Wright J, Petersen R. COVID-19 and chronic disease: the impact now and in the future. Prev Chronic Dis. 2021;18:e62. doi: 10.5888/pcd18.210086
https://doi.org/10.5888/pcd18.210086...

Studies show the association between higher COVID-19 morbidity and mortality and regions and locations with high population density, where there are usually higher transmission rates and lower social isolation.1717 Wong DWS, Li Y. Spreading of COVID-19: density matters. PLoS One. 2020;15(12):e0242398. doi: 10.1371/journal.pone.0242398
https://doi.org/10.1371/journal.pone.024...

18 Chen K, Li Z. The spread rate of SARS-CoV-2 is strongly associated with population density. J Travel Med. 2021;27(8):taaa186. doi: 10.1093/jtm/taaa186
https://doi.org/10.1093/jtm/taaa186... -1919 Ilardi A, Chieffi S, Iavarone A, Ilardi CR. SARS-CoV-2 in Italy: population density correlates with morbidity and mortality. Jpn J Infect Dis. 2020;74(1):61-4. doi: 10.7883/yoken.JJID.2020.200
https://doi.org/10.7883/yoken.JJID.2020.... In this study, the macro-regions with the highest demographic density were those with the highest excess deaths and most deaths due to COVID-19, in line with what is described in the literature.1717 Wong DWS, Li Y. Spreading of COVID-19: density matters. PLoS One. 2020;15(12):e0242398. doi: 10.1371/journal.pone.0242398
https://doi.org/10.1371/journal.pone.024...

18 Chen K, Li Z. The spread rate of SARS-CoV-2 is strongly associated with population density. J Travel Med. 2021;27(8):taaa186. doi: 10.1093/jtm/taaa186
https://doi.org/10.1093/jtm/taaa186...

19 Ilardi A, Chieffi S, Iavarone A, Ilardi CR. SARS-CoV-2 in Italy: population density correlates with morbidity and mortality. Jpn J Infect Dis. 2020;74(1):61-4. doi: 10.7883/yoken.JJID.2020.200
https://doi.org/10.7883/yoken.JJID.2020.... -2020 Serviço Brasileiro de Apoio às Micro e Pequenas Empresas. Santa Catarina em números [Internet]. Florianópolis: Serviço Brasileiro de Apoio às Micro e Pequenas Empresas. 2013 [citado 2022 Mar 8]. Disponível em: Disponível em: https://www.sebrae.com.br/sites/PortalSebrae/ufs/sc/quem_somos/santa-catarina-em-numeros,2fedd49dc3246410VgnVCM2000003c74010aRCRD
https://www.sebrae.com.br/sites/PortalSe... Great West and Midwest and Serra, although they are locations of low population density, showed high excess deaths, especially in 2021, and possible explanations for this finding would be the intense flow of people and unfavorable sanitary conditions in meat industries in the region, which are favorable to the spread of the virus.2020 Serviço Brasileiro de Apoio às Micro e Pequenas Empresas. Santa Catarina em números [Internet]. Florianópolis: Serviço Brasileiro de Apoio às Micro e Pequenas Empresas. 2013 [citado 2022 Mar 8]. Disponível em: Disponível em: https://www.sebrae.com.br/sites/PortalSebrae/ufs/sc/quem_somos/santa-catarina-em-numeros,2fedd49dc3246410VgnVCM2000003c74010aRCRD
https://www.sebrae.com.br/sites/PortalSe...

21 Moura PH, Luz RA, Gai MJP, Klokner S, Torrico G, KnapiK J, et al. Perfil epidemiológico da covid-19 em Santa Catarina. RIES. 2020;9(19):163-80. doi: 10.33362/ries.v9i1.2316
https://doi.org/10.33362/ries.v9i1.2316...

22 Merêncio I, Monteiro GM, Vieira CAO. Aglomerados ativos de COVID-19 em Santa Catarina, Brasil, e tendência de mobilidade dos locais de trabalho. Cad Saude Publica. 2021;37(6):1-13. doi: 10.1590/0102-311X00301620
https://doi.org/10.1590/0102-311X0030162...

23 Governo do Estado (SC). Secretaria do Estado de Saúde de Santa Catarina. Coronavírus [Internet]. 2020 [atualizado 2022 Mar 8; citado 2022 Mar 8]. Disponível em: Disponível em: http://www.coronavirus.sc.gov.br/
http://www.coronavirus.sc.gov.br/... -2424 Ripplinger F, Dalmora TWR, Scherma RA. Geografia da covid-19 em Santa Catarina: notas sobre o trabalho na criação e na indústria de abates de animais. Revista Pegada. 2020;21(2):463-92. doi: 10.33026/peg.v21i2.7816
https://doi.org/10.33026/peg.v21i2.7816...

The first death due to COVID-19 in the state of Santa Catarina occurred in March 2020, when the social isolation rate reached 72.8% - probably attributed to the implementation of social distancing measures.2323 Governo do Estado (SC). Secretaria do Estado de Saúde de Santa Catarina. Coronavírus [Internet]. 2020 [atualizado 2022 Mar 8; citado 2022 Mar 8]. Disponível em: Disponível em: http://www.coronavirus.sc.gov.br/
http://www.coronavirus.sc.gov.br/... ,2525 Inloco. Mapa brasileiro da COVID-19 [Internet]. [s.l.]: Inloco; 2020 [atualizado 2022 Mar 8; citado 2022 Mar 8]. Disponível em: Disponível em: https://mapabrasileirodacovid.inloco.com.br/pt/
https://mapabrasileirodacovid.inloco.com... ,2626 Hughes HMFBR, Carneiro RAVD, Hillesheim D, Hallal ALC. Evolução da COVID-19 em Santa Catarina: decretos estaduais e indicadores epidemiológicos até agosto de 2020. Epidemiol Serv Saude. 2021;30(4):e2021521. doi: 10.1590/S1679-49742021000400025
https://doi.org/10.1590/S1679-4974202100... However, a study indicated inconsistency with the reality of the pandemic at the time of publication of state decrees, especially in the 2nd half, with early flexibility and partial restrictions. At the end of the year, there was also government and media encouragement of tourism, increasing the risk of spreading the virus.2727 Caponi S. Covid-19 em Santa Catarina: um triste experimento populacional. Hist Cienc Saude Manguinhos. 2021;28(2):593-8. doi: 10.1590/S0104-59702021005000004
https://doi.org/10.1590/S0104-5970202100... This scenario seems to explain the evolution of excess deaths in the state in 2020, with higher surplus in the 2nd half of the year.2727 Caponi S. Covid-19 em Santa Catarina: um triste experimento populacional. Hist Cienc Saude Manguinhos. 2021;28(2):593-8. doi: 10.1590/S0104-59702021005000004
https://doi.org/10.1590/S0104-5970202100...

In the state of Santa Catarina, the stratification of excess deaths by sex and age showed excess deaths in males and growth with increasing age. It is commonly known that the risk of dying from COVID-19 is higher in males, associated with hormonal, immunological factors and their lower tendency to self-care.2828 Bwire GM. Coronavirus: why men are more vulnerable to covid-19 than women?. SN Comp Clin Med. 2020;2(7):874-6. doi: 10.1007/s42399-020-00341-w
https://doi.org/10.1007/s42399-020-00341... The risk of death is also higher in older adults, given that, in addition to the natural consequences of aging, there is a high prevalence of comorbidities in this age group, making it more susceptible to both COVID-19 and lack of healthcare services during the pandemic.2929 Perrotta F, Corbi G, Mazzeo G, Boccia M, Aronne L, D’Agnano V, et al. COVID-19 and the elderly: insights into pathogenesis and clinical decision-making. Aging Clin Exp Res. 2020;32(8):1599-608. doi: 10.1007/s40520-020-01631-y
https://doi.org/10.1007/s40520-020-01631...

As a limitation, it is noteworthy that the way to estimate the excess deaths is not among the most robust ones, although it is pointed out as a standard and effective approach.1515 National Records of Scotland. Choosing a five year average for the measurement of excess deaths [Internet]. [Edinburgh]:National Records of Scotland; 2022 [cited 2022 Apr 13]. Available from: Available from: https://www.nrscotland.gov.uk/files/statistics/covid19/covid-deaths-methodology-excess-deaths-in-2022.pdf
https://www.nrscotland.gov.uk/files/stat... Secondary databases are also directly influenced by the quality of filling out, and their heterogeneous coverage in the territory. As a potentiality, the analyzed indicator has been pointed out as one of the most important in the COVID-19 pandemic scenario, because, in addition to capturing the direct and indirect impact of mortality due to the pandemic, it is independent of testing strategies or the final classification of causes of death.1111 Statistical Office of the European Union. Excess Mortality - Statistics. Eurostat - Statistics Explained [Internet]. [Luxemburgo] Statistical Office of the European Union; 2022 jul [cited 2022 July 2]. Available from: Available from: https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Excess_mortality_-_statistics
https://ec.europa.eu/eurostat/statistics...

12 Beaney T, Clarke JM, Jain V, Golestaneh AK, Lyons G, Salman D, et al. Excess mortality: the gold standard in measuring the impact of COVID-19 worldwide?.J R Soc Med. 2020;113(9):329-34. doi: 10.1177/0141076820956802
https://doi.org/10.1177/0141076820956802... -1313 World Health Organization. Revealing the Toll of COVID-19: a technical package for rapid mortality surveillance and epidemic response [Internet]. Genebra: World Health Organization ; 2020 [update 2020 May 21, cited 2022 mar 8]. 30 p. Available from: Available from: https://www.who.int/publications/i/item/revealing-the-toll-of-covid-19
https://www.who.int/publications/i/item/...

It can be concluded that there were excess deaths in Santa Catarina and in all its macro-regions during the years 2020 and 2021, in most of the periods analyzed, higher in males and in those aged 60 years and older.

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  • ASSOCIATE ACADEMIC WORK

    Article derived from an undergraduate dissertation entitled Excess mortality in Santa Catarina and macro-regions during the COVID-19 pandemic, submitted by Rebeca Heyse Holzbach to the Medical School of the Universidade Federal de Santa Catarina, in 2022.
  • 5

Publication Dates

  • Publication in this collection
    14 July 2023
  • Date of issue
    2023

History

  • Received
    01 June 2022
  • Accepted
    07 Feb 2023
  • Corrected
    15 May 2024
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This is an open-access article distributed under the terms of the Creative Commons Attribution License
Secretaria de Vigilância em Saúde e Ambiente - Ministério da Saúde do Brasil Brasília - Distrito Federal - Brazil
E-mail: ress.svs@gmail.com
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