Excess mortality during COVID-19 and prediction of mortality in Bangladesh: an analysis based on death records in urban graveyards.

Background: The COVID-19 pandemic significantly impacted global mortality, underscoring the need for reliable data to guide public health policy. In low- and middle-income countries, graveyard-based death records can offer valuable insights into COVID-19-related mortality, yet they remain limited. Additionally, data on mortality beyond the pandemic remains scarce as we approach the 2030 Sustainable Development Goals. We addressed this gap by using graveyard-based data to assess excess mortality during the pandemic (2020-23) and predict mortality trends through 2030.

Methods: We analysed 70 585 deaths from six graveyards in Dhaka, Bangladesh, from January 2001 to December 2023. The data was divided into pre-COVID-19 (2001-19), peak-COVID-19 (2020-21), and end-of-COVID-19 (2022-23) phases. We assessed the excess mortality using the P-score and Bayesian approach. We estimated excess mortality with a log-linear Bayesian model and predicted death trends for 2024-30, reporting incidence rate ratio (IRR) with 95% credible intervals (CrI).

Results: Overall, excess mortality was 69% greater in 2020 and 31% in 2023 compared to the 2018-19 average. The IRR for deaths during peak-COVID-19 was 1.66 times higher than pre-COVID-19 (95% CrI = 1.35-2.04). Neonates had significantly higher IRRs during both the peak (IRR = 1.45; 95% CrI = 1.02-2.05) and end-of-COVID-19 (IRR = 1.67; 95% CrI = 1.02-2.71). Individuals aged >40 years showed a significantly higher IRR during peak-COVID-19 (IRR = 1.79; 95% CrI = 1.46-2.18). Predictions using data between 2001-23 indicate rising mortality, with the number of adult deaths increasing from 3318 in 2023 to 5089 (95% CrI = 3871-6267) by 2030.

Conclusions: We revealed a significant rise in mortality during the pandemic, with elevated death rates persisting at the end of the pandemic. Predictions indicate continued mortality increases through 2030, underscoring the pandemic's long-term health impacts. While further research is needed, these findings highlight the value of graveyard-based death registration data for tracking mortality trends and informing public health strategies.